Understanding the Role of Biofilms and Superantigens in Chronic Rhinosinusitis

Abstract

Purpose of Review

This review explores recent discoveries in our understanding of how biofilms and superantigens contribute to the pathogenesis of chronic rhinosinusitis (CRS). It also examines clinical implications and novel treatment approaches for biofilm-associated CRS.

Recent Findings

While the role of biofilms in CRS has been studied for 14 years, research interest has now turned toward elucidating new methods of biofilm detection, microbial diversity, and novel treatment approaches. Recent studies on biofilm superantigens aim to clarify the immunological mechanisms of upper airway inflammation, particularly the type-2 response seen in nasal polyposis.

Summary

Biofilms are a topic of research interest for their role in the pathogenesis of chronic rhinosinusitis, particularly when they elute superantigens. New studies on this topic focus on the molecular and cellular mechanisms at play.

https://ift.tt/2vdzzwD

Aeroallergens in North-Central Nigeria

Publication date: Available online 25 July 2018

Source: Allergologia et Immunopathologia

Author(s): Dimphna N. Ezikanyi, Gloria Sakwari, Catherine V. Nnamani

Abstract

Introduction and Objectives

Aeroallergens are airborne organic substances which are responsible for allergenic diseases in hypersensitive individuals. People are exposed to their allergens either directly or after their entrance into the interiors. The spatio-temporal pattern of aeroallergens and their relationship with weather variability in Abuja and Nassarawa, North-Central Nigeria was studied.

Materials and Methods

Aerosamples were trapped with modified Tauber-like pollen traps. Samples were collected monthly and centrifuged at 2500 rpm for 5 min and subjected to acetolysis. Meteorological data were collected from the Nigerian Meteorological Agency.

Results and Conclusion

Aeroallergens concentration were unequivocally regulated by weather variables in both locations, indicating the possible use of aeroallergens especially pollen and spores as bio-indicators of weather variations and change. Aeroallergens encountered were fungal spores, pollen, diatom frustules, fern spores, algal cyst/cells in decreasing order of dominance. Among pollen group, Poaceae, Amarathaceae/Chenopodiaceae and Hymenocardia acida dominated. Spores of Smut species, Puccinia, Curvularia and Nigrospora were major contributors among aeromycoflora. Fungal spores morphotype dominated during the rainier months and were major contributors of the aeroallergen spectrum with those belonging to Deuteromycete preponderant. Aeroallergens which were previously identified as triggers of conjunctivitis, asthma, allergic sinusitis and bronchopulmonary allergic diseases were frequently present in both locations. Pollen prevailed more during the harmattan, influenced by northeast trade wind. Pollen component differed and was based on autochthonous source plants, indicating difference in sub-vegetational types.

https://ift.tt/2v8leRO

Motile Ciliary Disorders in Chronic Airway Inflammatory Diseases: Critical Target for Interventions

Abstract

Purpose of Review

Impaired mucociliary clearance has been implicated in chronic upper and lower airway inflammatory diseases (i.e., allergic and non-allergic rhinitis, chronic rhinosinusitis with or without nasal polyps and asthma). How motile ciliary disorders (impaired ciliogenesis, ciliary beating and ultrastructural defects) are implicated in chronic airway inflammatory diseases is not fully understood. Elaboration of the role of motile ciliary disorders may serve as therapeutic targets for improving mucociliary clearance, thereby complementing contemporary disease management.

Recent Findings

We have summarized the manifestations of motile ciliary disorders and addressed the underlying associations with chronic airway inflammatory diseases. A panel of established and novel diagnostic tests and therapeutic interventions are outlined. Physicians should be vigilant in screening for motile ciliary disorders, particularly in patients with co-existing upper and lower airway inflammatory diseases.

Summary

Proper assessment and treatment of motile ciliary disorders may have added value to the management and prevention of chronic airway inflammatory diseases.

https://ift.tt/2v4Jape

Femoral neuropathy following a psoas hitch vesicopexy

A 68-year-old man classified as III on the American Society of Anaesthesiologists (ASA) physical status classification system, with a high-grade papillary urothelial cell carcinoma of the left distal ureter, underwent open retroperitoneal distal ureterectomy followed by a ureteroneocystostomy with a vesico-psoas hitch. Postoperatively, the patient complained of left proximal lower limb weakness, severe pain and hypaesthesia of the ventral left thigh suggestive of femoral neuropathy. After excluding common causes for postsurgical pain, a surgical re-exploration was eventually performed during which the sutures used in the vesicopexy were removed, resulting in almost complete resolution of the symptoms. Electromyographic analysis 4 weeks after discharge confirmed the diagnosis of femoral neuropathy, most likely caused by the sutures used in the vesicopexy. This is a rare complication with major consequences for postoperative recovery.

https://ift.tt/2vdy0yL

Avoiding diagnostic delay for mucopolysaccharidosis IIIB: do not overlook common clues such as wheezing and otitis media

Mucopolysaccharidosis IIIB (MPS IIIB) is an autosomal recessive lysosomal storage disorder. In comparison to Hurler syndrome (MPS I) and Hunter syndrome (MPS II), characteristic facial and physical features tend to be milder and progression of neurological symptoms may initially be slower. Obvious neurological and behavioural symptoms may not appear until age 2–6 years, but once they begin, progression is relentless, leading to death by the early 20s. Although there is currently no known cure for MPS IIIB, enzyme replacement clinical trials are showing hope for delay in the progression of symptoms. Early diagnosis is therefore necessary before neurological symptoms have progressed. In our case, MPS IIIB was diagnosed at an early age because recurrent wheezing and otitis media in conjunction with hepatomegaly were recognised as more than trivial findings. A thorough examination and a definitive proactive decision to perform a liver biopsy resulted in early diagnosis of a rare disease.

https://ift.tt/2LnXeoQ

Frey syndrome following herpes zoster in an otherwise healthy girl

A 12-year-old girl presented with red spots appearing on the left side of her face. The girl was usually healthy and fully vaccinated, including varicella vaccination.

Six years prior to her presentation, she had suffered an episode of blister rash on the left side of her face, including lesions in the ear canal and buccal mucous membrane. A diagnosis of herpes zoster was made, and she was treated with acyclovir with complete skin recovery. A hearing examination demonstrated mild-to-moderate left neurosensory hearing loss.

Since then, she is having short episodes of redness on her face without pain or sweating at the exact distribution of the zoster blisters 6 years ago. The appearance of spots is related to sour foods, such as sour flavoured candies, yoghourt and green apples. The diagnosis of postherpetic Frey syndrome was made, and observational approach was adopted due to the benign character of symptoms.

https://ift.tt/2v0CBEa

Hepatitis C virus infection: 'beyond the liver

There are rare reports of association between hepatitis C virus (HCV) infection and dermatomyositis although cause and effect remains to be proven. We present a clinical case with a probable cause and effect association between these two entities. A 71-year-old woman developed an erythematous exanthem with pruritic and scaly lesions located at the torso and upper limbs associated with heliotrope and Gottron's papules. At the same time, she notice a significant loss of muscular strength. Skin and muscular biopsies made the diagnosis of dermatomyositis and the patient started with prednisolone (60 mg/day) with poor symptoms control. Paraneoplastic syndrome, HIV, hepatitis B virus and syphilis infections were excluded. HCV serology was positive, with a viral load of 58 159 IU/mL (genotype 1a). Therefore, the patient underwent a 12-week treatment with grazoprevir 100 mg and elbasvir 50 mg achieving a sustained virological response with regression of skin lesions and complete recovery of muscular strength (photodocumented before/after treatment). Additionally it was possible to reduce prednisolone dosage to 5 mg/day.

https://ift.tt/2LogO4q

Stroke-induced resolution of primary blepharospasm: evidence for the lenticular nucleus as a control candidate

Primary blepharospasm is an adult-onset focal dystonia characterised by involuntary contractions of the orbicularis oculi, leading to bilateral spasmodic closure of the eyelids. While spasms of this muscle constitute the hallmark of disease, other motor manifestations include increased spontaneous blinking and apraxia of eyelid opening. Originally misdiagnosed as a psychiatric condition, blepharospasm is now well established as being of neurological origin although questions remain as to its pathophysiological mechanisms.

We report a 66-year-old woman who had a 14-year history of primary blepharospasm which completely resolved following a left medial cerebral artery thromboembolic infarct of the lenticular nucleus. This report provides supporting evidence of the lenticular nucleus as a key structure mediating the disease which can lead to functional blindness.

https://ift.tt/2v7R94T

Levels and gas-particle partitioning of hexabromocyclododecanes in the urban air of Dalian, China

Abstract

The concentrations of α-, β-, and γ-hexabromocyclododecane diastereomers (HBCDs) in gas phase and particulate phase of Dalian urban air, China, were monitored from September 2016 to August 2017 with high-volume active sampler. The total concentration of ∑HBCDs (gas phase + particulate phase) ranged from 15.47 to 43.57 pg m⁻³, with an average of 27.07 pg m⁻³, and 73.39–96.76% of the total HBCDs were found in the particulate phase. No matter in gas phase or in particulate phase, α-HBCD was the predominant component in all, and there was a good negative correlation between the relative contribution of α-HBCD to ∑HBCDs and that of γ-HBCD to ∑HBCDs. The average ratios of the air concentration of α-HBCD to γ-HBCD were comparable with those found in decorative polystyrene, which indicated that HBCDs in outdoor air of Dalian probably came from indoor air and ventilation air from inside of buildings coupled with the already present contamination in background air. There were clear seasonal differences in the HBCD concentrations. Spearman's rank correlation analysis between the concentrations of HBCDs with meteorological parameters was conducted. The exposure risk of HBCDs was evaluated, which illustrated that the estimated exposure of HBCDs via the outdoor air in Dalian was well below the reference doses (200 ng kg⁻¹ bw day⁻¹) derived by the US National Research Council.

https://ift.tt/2LOYtcZ

Motile Ciliary Disorders in Chronic Airway Inflammatory Diseases: Critical Target for Interventions

Abstract

Purpose of Review

Impaired mucociliary clearance has been implicated in chronic upper and lower airway inflammatory diseases (i.e., allergic and non-allergic rhinitis, chronic rhinosinusitis with or without nasal polyps and asthma). How motile ciliary disorders (impaired ciliogenesis, ciliary beating and ultrastructural defects) are implicated in chronic airway inflammatory diseases is not fully understood. Elaboration of the role of motile ciliary disorders may serve as therapeutic targets for improving mucociliary clearance, thereby complementing contemporary disease management.

Recent Findings

We have summarized the manifestations of motile ciliary disorders and addressed the underlying associations with chronic airway inflammatory diseases. A panel of established and novel diagnostic tests and therapeutic interventions are outlined. Physicians should be vigilant in screening for motile ciliary disorders, particularly in patients with co-existing upper and lower airway inflammatory diseases.

Summary

Proper assessment and treatment of motile ciliary disorders may have added value to the management and prevention of chronic airway inflammatory diseases.

https://ift.tt/2v4Jape

100% survival after transplantation of 34 Wiskott Aldrich Syndrome patients over 20 years

Publication date: Available online 25 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): R. Elfeky, J.M. Furtado-Silva, R. Chiesa, K. Rao, P. Amrolia, G. Lucchini, K. Gilmour, S. Adams, S. Bibi, A. Worth, A.J. Thrasher, W. Qasim, P. Veys

https://ift.tt/2A8Q8zf

Building Bridges for Asthma Care: Reducing School Absence for Inner City Children with Health Disparities

Publication date: Available online 25 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Stanley J. Szefler, Michelle M. Cloutier, Miguel Villarreal, Jessica P. Hollenbach, Melanie Gleason, Christy Haas-Howard, Carol Vinick, Agustin Calatroni, Lisa Cicutto, Marty White, Shann Williams, Meghan McGinn, Christine Langton, Donna Shocks, Herman Mitchell, David A. Stempel

Abstract

Background

Children with asthma are at increased risk for experiencing health and educational disparities because of increased school absence. School nurses are well-positioned to support asthma management and improve school attendance.

Objective

To implement and assess the effect of the Building Bridges for Asthma Care Program on improving school attendance and measures of asthma control.

Methods

Children with asthma, ages 5 through 14 years, in the Denver Public School System (n=240) and the Hartford Public School System (n=223) were enrolled in the Building Bridges Program during the 2013-2014 and the 2014-2015 school years and followed until the end of the second school year. The primary outcome was school absence with secondary outcomes including asthma control measured by the Childhood Asthma Control Test (cACT) or the Asthma Control Test (ACT), and rescue inhaler use.

Results

Participants experienced a 22% absolute decrease in school absenteeism; the number of children with an ACT/cACT score below the control threshold of 20 decreased from 42.7% to 28.8% and bronchodilator use >2 times per week declined from 35.8% to 22.9% (all changes were significant, p<.01).

Conclusions

Children enrolled in the Building Bridges for Asthma Care Program experienced reduced school absence and improved asthma control.

https://ift.tt/2Oe5J3w

A Revisit to High Jugular Bulb: A Newer Clinical Grading

Abstract

A revisit to high riding jugular bulb with a newer classification. Observational study. Patients in the age group between 15 to 60 years, who underwent various Tympanomastoid and otosclerotic surgeries from April 2015 to 2018, have been included in the study. An analysis was made on high riding jugular bulb which encountered and different anatomical variations were noticed. A total of 531 patients underwent various tympanomastoid surgeries and 48 patients underwent otosclerotic surgeries. Out of which 8% of the cases (n = 49) were noticed to have high riding jugular bulb. In those 49 cases, 81% (n = 37) have Grade I, 11% (n = 5) have Grade II, 6% (n = 3) have grade III, 6% of the case (n = 3) have Grade IV and 2% (n = 1) has Grade V high riding Jugular bulb. Among these the prevalence of Grade I jugular bulb is high followed by Grade II. With the observation of our clinical study the authors have made a revisit to high riding jugular bulb and proposed a new clinical grading for high jugular bulb called BPH, that is Basava Prasad's grading clinical on High jugular bulb (Channa Basava Hubli and K. C. Prasad) as: Grade I high riding jugular bulb up to the level of inferior tympanic annulus. Grade II extending from the level of tympanic annulus up to the inferior margin of the round window niche. Grade III Completely obliterating the round window niche. Grade IV Lies between superior margin of round window niche and stapes. Grade V Abuting the Stapes Arch.

https://ift.tt/2LTcXs0

Varied Presentation of Venous Ectasia Head and Neck: Case Series and Review of Literature

Abstract

Jugular venous ectasia in head and neck region is a rare entity. They may present as asymptomatic neck masses and should be considered in the differential diagnosis of cystic neck masses. Management is individualised based on the patient and includes conservative or surgical management. We hereby report three cases of venous ectasia (2—external jugular and 1—facial vein) managed at our institute.

https://ift.tt/2uPD2C4

Inhibition of ER stress-related IRE1α/CREB/NLRP1 pathway promotes the apoptosis of human chronic myelogenous leukemia cell

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Zheng Xu, Huirui Wang, Suhua Wei, Zhencheng Wang, Guanghou Ji

Abstract

Endoplasmic reticulum (ER) stress is induced in chronic myelogenous leukemia (CML) cells. As an important sensor of ER stress, inositol-requiring protein-1α (IRE1α) promotes the survival of acute myeloid leukemia. NLRP1 inflammasome activation promotes metastatic melanoma growth and that IRE1α can increase NLRP1 inflammasome gene expression. This study aimed to investigate the role and molecular mechanism of IRE1α in CML cell growth. We found that overexpression of IRE1α or NLRP1 significantly promoted the proliferation and decreased the apoptosis of CML cells, whereas downregulation of these two genes showed the opposite effects. 4-phenylbutyric acid (4-PBA), an ER stress inhibitor, reduced the expression of IRE1α and NLRP1. IRE1α elevated NLRP1 expression via cAMP responsive element binding protein (CREB) phosphorylation. NLRP1 inflammasome was activated in CML cells and its activation partly reversed ER stress inhibitor-induced cell apoptosis. Furthermore, inhibition of IRE1α/NLRP1 pathway sensitized CML cells to imatinib-mediated apoptosis. Additionally, IRE1α expression was elevated and NLRP1 inflammasome was activated in primary cells from CML patients. Downregulation of IRE1α or NLRP1 suppressed the proliferation and elevated the apoptosis of primary CML cells. Collectively, this study demonstrated that the IRE1α/CREB/NLRP1 pathway contributes to the progression of CML and the development of imatinib resistance. Hence, targeting ER stress-related IRE1α expression or NLRP1 inflammasome activation may block CML development.

https://ift.tt/2LrduFP

Shaping the humoral immune response: Actin regulators modulate antigen presentation and influence B-T interactions

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Marianne Burbage, Selina Jessica Keppler

Abstract

B cells are an integral part of the adaptive immune system. During an immune response, the actin cytoskeleton plays a central role in regulating B cell antigen uptake, polarization and presentation as well as B cell migration and interaction with T cells. Genetic defects affecting actin regulators can result in reduced B cell activation, limited antibody production and hence cause disease. In this review, we discuss molecular mechanisms of actin regulation and their involvement in antigen polarisation and presentation, as well as their role in influencing interactions between B and T cells. Improved understanding of these mechanisms is necessary for the development of new therapeutic options modulating humoral immune responses.

https://ift.tt/2v9qyVk

Adaptive coding in the human brain: Distinct object features are encoded by overlapping voxels in frontoparietal cortex

Publication date: Available online 25 July 2018

Source: Cortex

Author(s): Jade Jackson, Alexandra Woolgar

Abstract

Our ability to flexibly switch between different tasks is a key component of cognitive control. Non-human primate (NHP) studies (e.g. Freedman, Riesenhuber, Poggio, & Miller, 2001) have shown that prefrontal neurons are re-used across tasks, re-configuring their responses to code currently relevant information. In a similar vein, in the human brain, the "multiple demand" (MD) system is suggested to exert control by adjusting its responses, selectively processing information in line with our current goals (Duncan, 2010). However, whether the same or different resources (underlying neural populations) in the human brain are recruited to solve different tasks remains elusive. In the present study, we aimed to bridge the gap between the NHP and human literatures by examining human functional imaging data at an intermediate level of resolution: quantifying the extent to which single voxels contributed to multiple neural codes. Participants alternated between two tasks requiring the selection of feature information from two distinct sets of objects. We examined whether neural codes for the relevant stimulus features in the two different tasks depended on the same or different voxels. In line with the electrophysiological literature, MD voxels were more likely to contribute to multiple neural codes than we predicted based on permutation tests. Comparatively, in the visual system the neural codes depended on distinct sets of voxels. Our data emphasise the flexibility of the MD regions to re-configure their responses and adaptively code relevant information across different tasks.

https://ift.tt/2NLEf4f

Spatial working memory in Progressive Supranuclear Palsy

Publication date: Available online 25 July 2018

Source: Cortex

Author(s): Daniel T. Smith, Neil Archibald

Abstract

The neural and cognitive mechanisms of spatial working memory are tightly coupled with the systems that control eye-movements but the precise nature of this coupling is not well understood. In particular, there are very few neuropsychological studies that explicitly examine how deficits of oculomotor control affect visuospatial working memory. Here, we examined the link between spatial working memory and the oculomotor system in a sample of patients with PSP, a degenerative neurological disease characterised by defective vertical eye-movements but relatively preserved horizontal eye-movements. Consistent with the idea that the oculomotor system plays a critical role in spatial working memory performance, people with PSP had significantly shorter spatial spans when stimuli were presented along the vertical axis compared to the horizontal axis. This effect was not observed in age matched controls. We hypothesise that PSP disrupts a colliculo-parietal feedback loop that contributes to the maintenance of activation in a parietal priority map during the delay period. This result is the first direct neuropsychological evidence for an association between oculomotor function and spatial working memory and is broadly consistent with idea that rehearsal in visuospatial working memory is mediated by an 'oculomotor loop', as proposed by Baddeley (1986). We conclude that optimal spatial working memory performance depends on an intact oculomotor system.

https://ift.tt/2uRc0Kp

A Revisit to High Jugular Bulb: A Newer Clinical Grading

Abstract

A revisit to high riding jugular bulb with a newer classification. Observational study. Patients in the age group between 15 to 60 years, who underwent various Tympanomastoid and otosclerotic surgeries from April 2015 to 2018, have been included in the study. An analysis was made on high riding jugular bulb which encountered and different anatomical variations were noticed. A total of 531 patients underwent various tympanomastoid surgeries and 48 patients underwent otosclerotic surgeries. Out of which 8% of the cases (n = 49) were noticed to have high riding jugular bulb. In those 49 cases, 81% (n = 37) have Grade I, 11% (n = 5) have Grade II, 6% (n = 3) have grade III, 6% of the case (n = 3) have Grade IV and 2% (n = 1) has Grade V high riding Jugular bulb. Among these the prevalence of Grade I jugular bulb is high followed by Grade II. With the observation of our clinical study the authors have made a revisit to high riding jugular bulb and proposed a new clinical grading for high jugular bulb called BPH, that is Basava Prasad's grading clinical on High jugular bulb (Channa Basava Hubli and K. C. Prasad) as: Grade I high riding jugular bulb up to the level of inferior tympanic annulus. Grade II extending from the level of tympanic annulus up to the inferior margin of the round window niche. Grade III Completely obliterating the round window niche. Grade IV Lies between superior margin of round window niche and stapes. Grade V Abuting the Stapes Arch.

https://ift.tt/2LTcXs0

Varied Presentation of Venous Ectasia Head and Neck: Case Series and Review of Literature

Abstract

Jugular venous ectasia in head and neck region is a rare entity. They may present as asymptomatic neck masses and should be considered in the differential diagnosis of cystic neck masses. Management is individualised based on the patient and includes conservative or surgical management. We hereby report three cases of venous ectasia (2—external jugular and 1—facial vein) managed at our institute.

https://ift.tt/2uPD2C4

Thyroid Cancer Treatment Choice: A Pilot Study of a Tool to Facilitate Conversations with Patients with Papillary Microcarcinomas Considering Treatment Options

Thyroid, Ahead of Print.


https://ift.tt/2mOXHlr

Simultaneous multi-parametric mapping of total sodium concentration, T1, T2 and ADC at 7 T using a multi-contrast unbalanced SSFP

Publication date: Available online 25 July 2018

Source: Magnetic Resonance Imaging

Author(s): Lisa Leroi, Arthur Coste, Ludovic de Rochefort, Mathieu D. Santin, Romain Valabregue, Franck Mauconduit, Eric Giacomini, Michel Luong, Edouard Chazel, Julien Valette, Denis Le Bihan, Cyril Poupon, Fawzi Boumezbeur, Cécile Rabrait-Lerman, Alexandre Vignaud

Abstract

Purpose

Quantifying multiple NMR properties of sodium could be of benefit to assess changes in cellular viability in biological tissues. A proof of concept of Quantitative Imaging using Configuration States (QuICS) based on a SSFP sequence with multiple contrasts was implemented to extract simultaneously 3D maps of applied flip angle (FA), total sodium concentration, T₁, T₂, and Apparent Diffusion Coefficient (ADC).

Methods

A 3D Cartesian Gradient Recalled Echo (GRE) sequence was used to acquire 11 non-balanced SSFP contrasts at a 6 × 6 × 6 mm³ isotropic resolution with carefully-chosen gradient spoiling area, RF amplitude and phase cycling, with TR/TE = 20/3.2 ms and 25 averages, leading to a total acquisition time of 1 h 18 min. A least-squares fit between the measured and the analytical complex signals was performed to extract quantitative maps from a mono-exponential model. Multiple sodium phantoms with different compositions were studied to validate the ability of the method to measure sodium NMR properties in various conditions.

Results

Flip angle maps were retrieved. Relaxation times, ADC and sodium concentrations were estimated with controlled precision below 15%, and were in accordance with measurements from established methods and literature.

Conclusion

The results illustrate the ability to retrieve sodium NMR properties maps, which is a first step toward the estimation of FA, T₁, T₂, concentration and ADC of ²³Na for clinical research. With further optimization of the acquired QuICS contrasts, scan time could be reduced to be suitable with in vivo applications.

https://ift.tt/2LPP8l2

Erratum: Different transseptal puncture for different procedures: Optimization of left atrial catheterization guided by transesophageal echocardiography

Annals of Cardiac Anaesthesia 2018 21(3):346-346



https://ift.tt/2A6J71O

A curious case of raised gradient across mitral bioprosthetic valve

Monish S Raut, Vijay Mohan Hanjoora, Murtaza A Chishti, Akhil Govil, Rakesh Pandey, Aman Jyoti, Ravi Kumar Mahavar, Shweta Suri Kandpal, Dileep Kumar Singh Rathor

Annals of Cardiac Anaesthesia 2018 21(3):321-322

High Doppler valve gradient is generally suggestive of valve thrombosis. However, it should be corroborated with the finding of restricted leaflet movement to confirm the diagnosis. In the present case, abnormally high gradient was not associated with limited leaflet movements or any valve thrombus.

https://ift.tt/2mHjVW9

Neurogenic stress cardiomyopathy: What do we need to know

Ramachandran Gopinath, Syama Sundar Ayya

Annals of Cardiac Anaesthesia 2018 21(3):228-234

The interaction between the heart and brain is complex and integral to the maintenance of normal cardiovascular function. Even in the absence of coronary disease, acute neuronal injury can induce a variety of cardiac changes. Recent neuroimaging data revealed a network including the insular cortex, anterior cingulate gyrus, and amygdala playing a crucial role in the regulation of central autonomic nervous system. Damage in these areas has been associated with arrhythmia, myocardial injury, higher plasma levels of brain natriuretic peptide, catecholamines, and glucose. Some patients after brain injury may die due to occult cardiac damage and functional impairment in the acute phase. Heart failure adversely influences acute stroke mortality. Troponin and NT-proBNP are elevated in acute brain injury patients, in response to the activated renin–angiotensin–aldosterone system and other neurohumoral changes, as a protective mechanism for sympathoinhibitory activity. Such patients have been shown to be associated with higher short- and long-term mortality. While thrombolysis, neuroprotection, and other measures, alone or in combination, may limit the cerebral damage, attention should also be directed toward the myocardial protection. Early administration of cardioprotective medication aimed at reducing increased sympathetic tone may have a role in myocardial protection in stroke patients. For a full understanding of the brain–heart control, the consequences of disruption of this control, the true incidence of cardiac effects of stroke, and the evidence-based treatment options further research are needed.

https://ift.tt/2AbeGYl

Refractory hypokalemia while weaning off bypass

Rashmi Soori, Aanchal Dixit, Prabhat Tewari

Annals of Cardiac Anaesthesia 2018 21(3):311-312

Hypokalemia is defined as serum potassium level less than 3.5 mEq/L. When the serum level of potassium is less than 3 mEq/L, intravenous potassium supplementation is warranted. A 23 yr old adult female with complaints of dyspnoea (NYHA II) since 6 yrs, dyspnoea (NYHA III) and paroxysmal nocturnal dyspnoea on and off since 2 months, diagnosed with severe mitral stenosis, was posted for mitral valve replacement. After the release of ACC, ECG revealed sine wave pattern, Transesophageal echocardiographic examination revealed global hypokinesia and ABG showed potassium of 2.3 mEq/L. Hypokalemia in cardiac patients can occur due to the effect of poor oral intake, increased renal loss by the secondary hyperaldosteronism in congestive heart failure, loss due to use of digoxin and diuretics like thiazide diuretics, loop diuretics etc. Hypokalemia should be avoided while weaning off cardiopulmonary support as it can lead to atrial and ventricular arrhythmias. Potassium ion is very important for the normal contractility of the heart. Hypokalemia if refractory to intravenous potassium supplementation, concomitant magnesium deficiency should be suspected and treated.

https://ift.tt/2OfqfRo

Sedation effects by dexmedetomidine versus propofol in decreasing duration of mechanical ventilation after open heart surgery

Ahmed Said Elgebaly, Mohab Sabry

Annals of Cardiac Anaesthesia 2018 21(3):235-242

Objective: The objective of this study was to compare the suitability (efficacy and safety) of dexmedetomidine versus propofol for patients admitted to the intensive care unit (ICU) after the cardiovascular surgery for the postoperative sedation before weaning from mechanical ventilation. Background: Sedation is prescribed in patients admitted to the ICU after cardiovascular surgery to reduce the patient discomfort, ventilator asynchrony, to make mechanical ventilation tolerable, prevent accidental device removal, and to reduce metabolic demands during respiratory and hemodynamic instability. Careful drug selection for sedation by the ICU team, postcardiovascular surgery should be done so that patients can be easily weaned from mechanical ventilation after sedation is stopped to achieve a shorter duration of mechanical ventilation and decreased the length of stay in ICU. Methods: A total of 50 patients admitted to the ICU after cardiovascular surgery, aged from 18 to 55 years and requiring mechanical ventilation on arrival to the ICU were enrolled in a prospective and comparative study. They were randomly divided into two groups as follows: Group D patients (n = 25) received dexmedetomidine in a maintenance infusion dose of 0.8 μg/kg/h and Group P patients (n = 25) received propofol in a maintenance infusion dose of 1.5 mg/kg/h. The patients were assessed for 12 h postoperatively, and dosing of the study drug was adjusted based on sedation assessment performed with the Richmond Agitation-Sedation Scale (RASS). The patients were required to be within the RASS target range of −2 to +1 at the time of study drug initiation. At every 4 h, the following information was recorded from each patient such as heart rate (HR), mean arterial pressure (MAP), arterial blood gases (ABG), tidal volume (TV), exhaled TV, maximum inspiratory pressure, respiratory rate and the rapid shallow breathing index, duration of mechanical ventilation, midazolam and fentanyl dose requirements, and financial costs. Results: The study results showed no statistically significant difference between both groups with regard to age and body mass index. Group P patients were more associated with lower MAP and HR than Group D patients. There was no statistically significant difference between groups with regard to ABG findings, oxygenation, ventilation, and respiratory parameters. There was significant difference between both the groups in midazolam and fentanyl dose requirement and financial costs with a value of P < 0.05. Conclusion: Dexmedetomidine is safer and equally effective agent for the sedation of mechanically ventilated patients admitted to the ICU after cardiovascular surgery compared to the patients receiving propofol, with good hemodynamic stability, and equally rapid extubation time.

https://ift.tt/2AamCZV

Transesophageal echocardiography guidance for expedited pulmonary artery catheter insertion and accurate estimation of cardiac output

Monish S Raut, Vijay Mohan Hanjoora, Murtaza A Chisti

Annals of Cardiac Anaesthesia 2018 21(3):339-340



https://ift.tt/2LB4e0Y

Quest for the holy grail: Assessment of echo-derived dynamic parameters as predictors of fluid responsiveness in patients with acute aneurysmal subarachnoid hemorrhage

Ajay Prasad Hrishi, Manikandan Sethuraman, Girish Menon

Annals of Cardiac Anaesthesia 2018 21(3):243-248

Background: Acute aneurysmal subarachnoid hemorrhage (aSAH) is a potentially devastating event often presenting with a plethora of hemodynamic fluctuations requiring meticulous fluid management. The aim of this study was to assess the utility of newer dynamic predictors of fluid responsiveness such as Delta down (DD), superior vena cava collapsibility index (SVCCI), and aortic velocity time integral variability (VTIAoV) in patients with SAH undergoing neurosurgery. Materials and Methods: Fifteen individuals with SAH undergoing surgery for intracranial aneurysmal clipping were enrolled in this prospective study. Postinduction, vitals, anesthetic parameters, and the study variables were recorded as the baseline. Following this, patients received a fluid bolus of 10 ml/kg of colloid over 20 min, and measurements were repeated postfluid loading. Continuous variables were expressed as mean ± standard deviation and compared using Student's t-test, with a P < 0.05 considered statistically significant. The predictive ability of variables for fluid responsiveness was determined using Pearson's coefficient analysis (r). Results: There were 12 volume responders and 3 nonresponders (NR). DD >5 mm Hg was efficient in differentiating the responders from NR (P < 0.05) with a sensitivity and specificity of 90% and 85%, respectively, with a good predictive ability to identify fluid responders and NR; r = 0.716. SVCCI of >38% was 100% sensitive and 95% specific in detecting the volume status and in differentiating the responders from NR (P < 0.05) and is an excellent predictor of fluid responsive status; r = 0.906. VTIAoV >20% too proved to be a good predictor of fluid responsiveness, with a sensitivity and specificity of 100% and 90%, respectively, with a predictive power; r = 0.732. Conclusion: Our study showed that 80% of patients presenting with aSAH for intracranial aneurysm clipping were fluid responders with normal hemodynamic parameters such as heart rate and blood pressure. Among the variables, SVCCI >38% appears to be an excellent predictor followed by VTIAoV >20% and DD >5 mmHg in assessing the fluid status in this population.

https://ift.tt/2uZFp4q

Concomitant diaphragmatic hernia repair with coronary artery bypass grafting surgery

Gokulakrishnan Mohan, Srinivas Kalyanaraman, Sivakumar Ramakrishnan, Sanjay Theodore

Annals of Cardiac Anaesthesia 2018 21(3):304-306

Congenital Bochdalek diaphragmatic hernia (DH) is often diagnosed incidentally in adulthood. It is recommended that all cases of DH be repaired immediately at diagnosis since acute presentation after the complications have already developed has higher morbidity and mortality. A 47-year-old male presented with Grade III angina and dyspnea. A routine chest radiograph revealed bowel shadows in the right thorax, and subsequent computerized tomography (CT) scan confirmed the same. Coronary angiogram revealed coronary artery disease which needed surgery. Off-pump coronary artery bypass grafting followed by DH repair under one-lung ventilation.

https://ift.tt/2LprQWS

Barriers for the referral to outpatient cardiac rehabilitation: A predictive model including actual and perceived risk factors and perceived control

Ali Soroush, Behzad Heydarpour, Saeid Komasi, Mozhgan Saeidi, Parvin Ezzati

Annals of Cardiac Anaesthesia 2018 21(3):249-254

Objective: To assess the roles of demographic factors, actual and perceived risk factors, and perceived control in the referral to cardiac rehabilitation (CR) after coronary artery bypass graft (CABG). Methods: In this cross-sectional study, data related to 312 CABG patients in a hospital of the Western part of Iran, gathered through demographics and actual risk factors' checklist, open single item of perceived heart risk factors, life stressful events scale, and perceived control questionnaire. Data analyzed by binary logistic regression. Results: The results showed that only 8.3% of CABG patients refer to CR. The facilitators of this referral included official employment (P < 0.05), coronary history (P = 0.016), and hyperlipidemia (P = 0.030) but more distance to the CR center (P = 0.042) and perceived physiological risk factor (P = 0.025) are concerned as the barriers for the referral to CR. Conclusion: Providing appropriate awareness about the benefits of CR for patients with regard to their job status, coronary history, and perception about the illness risk factors can be effective in referral to CR. In addition, the presence of CR centers in towns and facilitated achievement to these centers can play a significant role in patients' participation.

https://ift.tt/2LA9BNN

Abnormal mitral valve apparatus in a case of hypertrophic obstructive cardiomyopathy: Intraoperative transesophageal echocardiography

Neelam Aggarwal, Jasbir Singh Khanuja, Sameer Saurabh Arora, Rahul Maria

Annals of Cardiac Anaesthesia 2018 21(3):315-318

Hypertrophic obstructive cardiomyopathy is a relatively common disorder that signifies asymmetric hypertrophy of interventricular septum causing obstruction of the left ventricular outflow tract (LVOT). However, more recent studies have shown that during ventricular systole, flow against an abnormal mitral valve apparatus results in drag forces on the part of the leaflets. The mitral leaflet is pushed into the LVOT to obstruct it. We present a case where intraoperative transesophageal echocardiography played a crucial role in defining the etiology of LVOT obstruction that subsequently helped in deciding the surgical plan.

https://ift.tt/2JVqUEp

Prospective, randomized clinical trial comparing use of intraoperative transesophageal echocardiography to standard care during radical cystectomy

Richa Dhawan, Sajid Shahul, Joseph Devin Roberts, Norm D Smith, Gary D Steinberg, Mark A Chaney

Annals of Cardiac Anaesthesia 2018 21(3):255-261

Purpose: Our prospective, randomized clinical study aims to evaluate the utility of intraoperative transesophageal echocardiography (TEE) in patients undergoing radical cystectomy. Materials and Methods: Eighty patients were randomized to a standard of care group or the intervention group that received continuous intraoperative TEE. Data are presented as means ± standard deviations, median (25th percentile, 75th percentile), or numbers and percentages. Characteristics were compared between groups using independent sample t-tests, Wilcoxon–Mann–Whitney tests or Chi-square tests, as appropriate. All tests were two-sided and P < 0.05 was considered to indicate statistical significance. Results: Both groups had similar preoperative demographic characteristics. There was a significant difference between central line insertion with all insertions in the control group (15%, 6 vs. 0%, 0; P < 0.003). Of all the perioperative complications, 80% occurred in the control group versus 20% in the TEE group, with 21% of controls experiencing a cardiac or pulmonary complication compared to 5% in the TEE group (8 vs. 2, P < 0.04). The control group patients were more likely to have adverse cardiac complications than the TEE group (15%, 6 vs. 3%, 1; P < 0.040). Postoperative cardiac arrhythmia was observed only in the control group (13%, 5 vs. 0%, 0; P <.007). Prolonged intubation was only observed in the control group (10%, 4 vs. 0%, 0; P < 0.017). Conclusion: TEE can be a useful monitoring tool in patients undergoing radical cystectomy, limiting the use of central line insertion and potentially translating into earlier extubation and decreased postoperative cardiac morbidities.

https://ift.tt/2mIPOxP

Inhaled levosimendan versus intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement

Tanveer Singh Kundra, PS Nagaraja, KS Bharathi, Parminder Kaur, N Manjunatha

Annals of Cardiac Anaesthesia 2018 21(3):328-332

Context: Inhaled levosimendan may act as selective pulmonary vasodilator and avoid systemic side effects of intravenous levosimendan, which include decrease in systemic vascular resistance (SVR) and systemic hypotension, but with same beneficial effect on pulmonary artery pressure (PAP) and right ventricular (RV) function. Aim: The aim of this study was to compare the effect of inhaled levosimendan with intravenous levosimendan in patients with pulmonary hypertension undergoing mitral valve replacement. Settings and Design: The present prospective randomized comparative study was conducted in a tertiary care hospital. Subjects and Methods: Fifty patients were randomized into two groups (n = 25). Group A: Levosimendan infusion was started immediately after coming-off of cardiopulmonary bypass and continued for 24 h at 0.1 mcg/kg/min. Group B: Total dose of levosimendan which would be given through intravenous route over 24 h was calculated and then divided into four equal parts and administered through inhalational route 6th hourly over 24 h. Hemodynamic profile (pulse rate, mean arterial pressure, pulmonary artery systolic pressure [PASP], SVR) and RV function were assessed immediately after shifting, at 1, 8, 24, and 36 h after shifting to recovery. Statistical Analysis Used: Intragroup analysis was done using paired student t-test, and unpaired student t-test was used for analysis between two groups. Results: PASP and RV-fractional area change (RV-FAC) were comparable in the two groups at different time intervals. There was a significant reduction in PASP and significant improvement in RV-FAC with both intravenous and inhalational levosimendan. SVR was significantly decreased with intravenous levosimendan, but no significant decrease in SVR was observed with inhalational levosimendan. Conclusions: Inhaled levosimendan is a selective pulmonary vasodilator. It causes decrease in PAP and improvement in RV function, without having a significant effect on SVR.

https://ift.tt/2OiASDa

A Low-dose human fibrinogen is not effective in decreasing postoperative bleeding and transfusion requirements during cardiac surgery in case of concomitant clinical bleeding and low FIBTEM values: A retrospective matched study

Iuliana-Marinela Lupu, Zineb Rebaine, Laurence Lhotel, Christine Watremez, Stéphane Eeckhoudt, Michel Van Dyck, Mona Momeni

Annals of Cardiac Anaesthesia 2018 21(3):262-269

Background: Studies evaluating the hemostatic effects of fibrinogen administration in cardiac surgery are not conclusive. Aims: We investigated whether the use of a low-dose human fibrinogen in case of clinical bleeding after protamine administration and concomitant low FIBTEM values is effective in reducing postoperative bleeding. Secondary end-point was to investigate the consumption of allogeneic blood products. Setting and Design: This was a retrospective matched study conducted at university hospital. Materials and Methods: Among 2257 patients undergoing surgery with cardiopulmonary (CPB) bypass, 73 patients received a median dose of 1 g human fibrinogen (ROTEM-Fibri group). This group was matched with 73 patients who had not received human fibrinogen (control group) among 390 patients having undergone surgery at the moment FIBTEM analysis was unavailable. Statistical Analysis: Matching was performed for the type and the presence of redo surgery. McNemar and Wilcoxon paired tests were used to respectively compare the categorical and quantitative variables. Results: The CPB bypass time was significantly higher in the ROTEM-Fibri group (P = 0.006). This group showed significantly higher bleeding in the first 12 and 24 h postoperatively (P < 0.001) and required significantly more transfusion of blood products (P < 0.001) and surgical revision (P = 0.007) when compared with the control group. There was no significant difference in the number of thromboembolic complications. Conclusions: These results show that the administration of 1 g of fibrinogen based on low-FIBTEM values and clinical bleeding after protamine administration does not stop bleeding and the need for transfusion of allogeneic blood products.

https://ift.tt/2Aamslh

Sustained ventricular arrhythmias in an asymptomatic child posted for laparoscopic rectopexy: An anesthetist's dilemma?

Kavya R Upadhya, Chandrika Y Ramavakoda, Madhavi Ravindra, Anuradha Ganigara

Annals of Cardiac Anaesthesia 2018 21(3):343-344



https://ift.tt/2mHjrPP

Use of autologous umbilical cord blood transfusion in neonates undergoing surgical correction of congenital cardiac defects: A pilot study

Kunal Sarin, Sandeep Chauhan, Akshay Kumar Bisoi, Anjali Hazarika, Neena Malhotra, Pratik Manek

Annals of Cardiac Anaesthesia 2018 21(3):270-274

Background: Blood transfusion requirement during neonatal open heart surgeries is universal. Homologous blood transfusion (HBT) in pediatric cardiac surgery is used most commonly for priming of cardiopulmonary bypass (CPB) system and for postoperative transfusion. To avoid the risks associated with HBT in neonates undergoing cardiac surgery, use of autologous umbilical cord blood (AUCB) transfusion has been described. We present our experience with the use of AUCB for neonatal cardiac surgery. Designs and Methods: Consecutive neonates scheduled to undergo cardiac surgery for various cardiac diseases who had a prenatal diagnosis made on the basis of a fetal echocardiography were included in this prospective observational study. After a vaginal delivery or a cesarean section, UCB was collected from the placenta in a 150-mL bag containing 5 mL of citrate–phosphate–dextrose–adenine-1 solution. The collected bag with 70–75 mL cord blood was stored at 2°C–6°C and tested for blood grouping and infections after proper labeling. The neonate's autologous cord blood was used for postcardiac surgery blood transfusion to replace postoperative blood loss. Results: AUCB has been used so far at our institute in 10 neonates undergoing cardiac surgery. The donor exposure in age and type of cardiac surgery-matched controls showed that the neonates not receiving autologous cord blood had a donor exposure to 5 donors (2 packed red blood cells [PRBCs], including 1 for CPB prime and 1 for postoperative loss, 1 fresh frozen plasma, 1 cryoprecipitate, and 1 platelet concentrate) compared to 1 donor for the AUCB neonate (1 PRBC for the CPB prime). Postoperative blood loss was similar in both the groups of matched controls and study group. Values of hemoglobin, total leukocyte count, platelet counts, and blood gas parameters were also similar. Conclusions: Use of AUCB for replacement of postoperative blood loss after neonatal cardiac surgery is feasible and reduces donor exposure to the neonate. Its use, however, requires a prenatal diagnosis of a cardiac defect by fetal echo and adequate logistic and psychological support from involved clinicians and the blood bank.

https://ift.tt/2AbtWEI

Regional analgesia in cardiothoracic surgery: A changing paradigm toward opioid-free anesthesia?

Murali Chakravarthy

Annals of Cardiac Anaesthesia 2018 21(3):225-227



https://ift.tt/2OfqcFc

In Response to “Use of autologous umbilical cord blood transfusion in neonates undergoing surgical correction of congenital cardiac defects: A pilot study”

Praveen Kumar Neema

Annals of Cardiac Anaesthesia 2018 21(3):275-276



https://ift.tt/2AbUyp2

The unexpected diagnosis of phaeochromocytoma in the anaesthetic room

Louise Kenny, Victoria Rizzo, Jason Trevis, Elena Assimakopoulou, Dierdre Timon

Annals of Cardiac Anaesthesia 2018 21(3):307-310

A 77-year-old man was admitted for aortic valve replacement and combined coronary bypass grafting. Grossly, labile arterial pressures were demonstrated on anesthetic induction prompting cancellation and Intensive Care Unit transfer. Urine analysis identified high normetadrenaline/creatinine ratio, plasma metanephrine, and plasma normetanephrine. A left adrenal lesion on computed tomography scan collectively indicated pheochromocytoma. Laparoscopic adrenalectomy was prioritized at multidisciplinary team before cardiac surgery. Vague symptoms of pheochromocytoma pose a diagnostic problem, being often attributed to common/co-existing pathology. The blood pressure instability on anesthetic required precise control, multidisciplinary input, and awareness of possible diagnosis as a routine intervention for hypotension may have been fatal in view of underlying cardiac pathology.

https://ift.tt/2mKnvz4

Transcatheter aortic valve implantation: General anesthesia using transesophageal echocardiography does not decrease the incidence of paravalvular leaks compared to sedation alone

Cédrick Zaouter, Sara Smaili, Lionel Leroux, Guillaume Bonnet, Sébastien Leuillet, Alexandre Ouattara

Annals of Cardiac Anaesthesia 2018 21(3):277-284

Background: Transcatheter aortic valve implantation (TAVI) is a valid option for patients with severe aortic stenosis judged to be at high surgical risk. For this procedure, there is no agreement on the appropriate type of anesthesia. Sedation offers several advantages, but general anesthesia (GA) leads to less paravalvular leaks (PVLs) probably because of the transesophageal echocardiography (TEE) guidance. The objective was to compare the incidence of PVL among patients receiving conscious sedation (TAVI-S) and patients receiving GA (TAVI-GA). We made the hypothesis that a referral center does not necessitate TAVI-GA to reduce the incidence of moderate-to-severe PVL. Aim: The primary outcome was the incidence of moderate-to-severe PVL at 30 days after the implantation. Design and Setting: This study design was a retrospective observational trial in a university hospital. Methods: The TAVI-S group underwent the procedure under conscious sedation. In the TAVI-GA group, an endotracheal tube and a TEE probe were inserted. After the valve deployment, PVL was assessed by hemodynamic and fluoroscopic measurements in the TAVI-S group. TEE was also used in the TAVI-GA group to evaluate the presence of PVL. When PVL was moderate or severe according to the Valve Academic Research Consortium criteria. Results: TAVI-S and TAVI-GA were accomplished in 168 (67.5%) and 81 (32.5%) patients, respectively. Our results show no difference between the two groups regarding the incidence and grade of PVL. Conclusion: Performing TAVI under GA with TEE guidance is not associated with a lower incidence of moderate and severe PVL.

https://ift.tt/2A79C7o

Echocardiographic evaluation of aorta to right atrial fistula secondary to ruptured sinus of valsalva aneurysm

Ashley V Fritz, Kathryn S Boles, Archer Kilbourne Martin

Annals of Cardiac Anaesthesia 2018 21(3):313-314

We present the case of a 37 year old male who presented with new onset dyspnea, tachycardia, palpitations, and chest tightness. His initial work up demonstrated a dilated pulmonary artery with reflux of contrast dye in to the IVC. Transthoracic echocardiogram identified a "windsock" appearance indicating Sinus of Valsalva aneurysm (SVA) and severe aortic regurgitation. As a result, the patient was taken for emergent surgery where the windsock tissue was surgically repaired with bovine pericardial patch. This case illuminates the uncommon occurrence of SVA and the ability to recognize these findings on multiple imaging modalities including transthoracic, transesophageal two and three dimensional echocardiography as well as direct surgical field visualization.

https://ift.tt/2mHj9sd

Vallecular cyst in the pediatric population: Evaluation and management

Publication date: Available online 25 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Youjin Li, Alexandria L. Irace, Natasha D. Dombrowski, Antonio R. Perez-Atayde, Caroline D. Robson, Reza Rahbar

Abstract

Objective

To review the presentation of pediatric vallecular cysts and outline an approach for evaluation and management.

Methods

Medical records of patients diagnosed with vallecular cyst between 2005 and 2017 were reviewed. Data on demographics, clinical characteristics, diagnostic methods, surgical procedures, and outcomes were collected and analyzed. A comprehensive literature search for pediatric cases of vallecular cyst was conducted for comparative analysis.

Results

Twenty patients underwent surgery for congenital vallecular cysts during the study period. Age at diagnosis ranged from birth to 8 years (median age = 1.1 years). The most common preoperative symptom was inspiratory stridor (45%) followed by feeding difficulties (40%). Eight patients (40%) initially presented with laryngomalacia and 7 (35%) with feeding difficulties. Imaging was obtained in 16 patients and consisted of plain films, ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI). Marsupialization of the cyst was performed in all 20 patients. Three patients (15%) presented with recurrence.

Conclusion

Vallecular cysts can cause feeding difficulties due to upper airway obstruction and pressure at the laryngeal inlet. Diagnostic work-up for vallecular cysts should include a detailed medical history, complete head and neck examination including endoscopic examination, and appropriate imaging, as each of these components complements the histopathologic findings. Our findings indicate that performing marsupialization is associated with low rate of recurrence or complication.

https://ift.tt/2K0EjL8

Interdisciplinary aerodigestive care model improves risk, cost, and efficiency

Publication date: Available online 25 July 2018

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): R. Paul Boesch, Karthik Balakrishnan, Rayna M. Grothe, Sherilyn W. Driscoll, Erin E. Knoebel, Sue L. Visscher, Shelagh A. Cofer

Abstract

Objective

This study sought to evaluate the impact of an interdisciplinary care model for pediatric aerodigestive patients in terms of efficiency, risk exposure, and cost.

Methods

Patients meeting a standard clinical inclusion definition were studied before and after implementation of the aerodigestive program.

Results

Aerodigestive patients seen in the interdisciplinary clinic structure achieved a reduction in time to diagnosis (6 vs 150 days) with fewer required specialist consultations (5 vs 11) as compared to those seen in the same institution prior. Post-implementation patients also experienced a significant reduction in risk, with fewer radiation exposures (2 vs 4) and fewer anesthetic episodes (1 vs 2). Total cost associated with the diagnostic evaluation was significantly reduced from a median of $10,374 to $6,055.

Conclusion

This is the first study to utilize a pre-post cohort to evaluate the reduction in diagnostic time, risk exposure, and cost attributable to the reorganization of existing resources into an interdisciplinary care model. This suggests that such a model yields improvements in care quality and value for aerodigestive patients, and likely for other pediatric patients with chronic complex conditions.

https://ift.tt/2LFaXab

Post-treatment sequelae and management of primary laryngeal NK/T-cell lymphoma: A case report

Publication date: Available online 25 July 2018

Source: American Journal of Otolaryngology

Author(s): Joseph B. Meleca, Andrea Hanick, Eric Lamarre, Paul C. Bryson

Abstract

Outcome objectives

1.

Describe the presentation and treatment options of laryngeal NK/T-Cell lymphoma

2.

Discuss post-chemoradiotherapy sequelae and airway management

Methods

Case Report, April 2016.

Results

A 27-year-old female presented with a three-week history of flu-like symptoms including sore throat, myalgia and insidious nasal congestion. Her hospital course was complicated by pancytopenia, extensive GI bleed of unknown origin and fever. Radiographic studies revealed multifocal centrilobular ground-glass lung nodules, splenomegaly, frontal and paranasal sinus opacification and mucosal thickening and inflammatory process of false and true vocal cords with concentric multi-level narrowing. Extensive rheumatologic, hematologic and infectious workup failed to demonstrate an etiology. Flexible laryngoscopic and bronchoscopic examinations with biopsies exhibited a diffuse supraglottic and glottic exophytic, "heaped-up" infiltration; limited vocal cord motion; and airway narrowing to 3 mm. Pathology yielded NK/T-Cell lymphoma with PET/CT confirming nasopharyngeal and laryngeal involvement sparing the brain and other distant structures. During treatment, the patient's airway became increasingly compromised requiring tracheostomy. Flexible laryngoscopic examination after four rounds of SMILE (dexamethasone, methotrexate, ifosfamide, l-asparaginase, and etoposide) chemotherapy and subsequent radiotherapy with 50 Gy in 25 fractions revealed complete glottic stenosis with alteration of the laryngeal anatomy and a pin-hole aperture seen posteriorly through the tracheostomy. Two dilation procedures performed one month apart, improved her airway considerably which allowed for successful decannulation. She continues to be disease-free post treatment but has persistent supraglottic and glottic scar and has developed tracheal stenosis at her tracheostomal site.

Conclusions

NK/T-Cell lymphoma of the larynx has been rarely described. Herein, we describe the sequalae of treatment and the requisite airway management.

https://ift.tt/2Oiseoc

Necrotizing epiglottitis treated with early surgical debridement: A case report

Publication date: Available online 25 July 2018

Source: American Journal of Otolaryngology

Author(s): Clare Richardson, Prashanth Thalanayar Muthukrishnan, Chelsea Hamill, Vidya Krishnan, Freedom Johnson

Abstract

Objective

Necrotizing supraglottitis is a rare but potentially morbid infection most often seen in immunocompromised patients. All reported cases have utilized intravenous antibiotic therapy as the mainstay of treatment and many have had associated morbidities.

Methods

We describe a case of a 50-year-old previously healthy female who presented with necrotizing epiglottis and was treated with immediate surgical debridement followed by directed antibiotic therapy.

Results

Our patient rapidly recovered with no further invasive interventions. On follow up she had no further complications or functional deficits.

Conclusions

Although uncommon, providers should be aware of the potential benefits of early debridement when treating patients with similar pathology. Early surgical intervention should be considered to avoid local tissue loss, airway interventions, and long-term sequelae.

https://ift.tt/2LOmPU8

Improvement of sinonasal mucociliary function by endoscopic sinus surgery in patients with chronic rhinosinusitis

Publication date: Available online 25 July 2018

Source: American Journal of Otolaryngology

Author(s): Mohsen Naraghi, Neda Baghbanian, Melorina Moharari, Amene Saghazadeh

Abstract

Objectives

Mucociliary clearance is an important defense mechanism for upper and lower airway. Chronic rhinosinusitis has been frequently associated with mucociliary dysfunction. Endoscopic sinus surgery (ESS) is recommended for treatment-resistant sinusitis in order to improve mucociliary function. The present study investigated the effect of ESS on the saccharin time (mucociliary clearance time) in relation to symptom profile assessed by the Sino-nasal Outcome Test (SNOT)-22, and disease severity based on the Lund-Kennedy endoscopic scores and Lund-Mackay computed tomographic (CT) scores.

Method

The present cohort study included 22 patients with chronic rhinosinusitis who were considered a candidate for ESS due to lack of response to medical treatment. Saccharin test was used before and 3 months after ESS to evaluate changes in mucociliary function. The CT scan was used for preoperative assessment of sinonasal anatomy. In addition, diagnostic nasal endoscopy was performed before and 3 months after ESS. The CT scan and nasal endoscopy findings were respectively analyzed based on the Lund-Mackay and the Lund-Kennedy staging systems recommended for chronic rhinosinusitis. Symptom severity was assessed from before to 3 months after ESS using SNOT-22.

Results

The present study showed decreased saccharin time in patients with chronic rhinosinusitis three months after ESS. The mean pre-operative and post-operative saccharin time were 23.4 and 16.9 min, respectively. There was also a trend toward significance for the effect of changes in the SNOT-22 scores on changes in saccharin time. By contrast, no effects of age, gender, pre-operative Lund-Mackay CT scores, and changes in Lund-Kennedy endoscopy scores were observed on post-ESS saccharin time.

Conclusion

The study confirms that ESS in patients with treatment-resistant chronic rhinosinusitis confers improvement in performance on the saccharin test of mucociliary function.

https://ift.tt/2OiO62P

Substernal goiter: Treatment and challenges. Twenty-two years of experience in diagnosis and management of substernal goiters

Publication date: Available online 25 July 2018

Source: Auris Nasus Larynx

Author(s): Maria Doulaptsi, Alexandros Karatzanis, Emmanuel Prokopakis, Stylianos Velegrakis, Alexia Loutsidi, Athina Trachalaki, George Velegrakis

Abstract

Objective

Descending goiter has been a focus of controversy in thyroid surgery until nowadays. This study aims to investigate the diagnosis and treatment options of thyroid goiters extending into the mediastinum and the thoracic cavity.

Methods and materials

A retrospective study was conducted assessing all cases of substernal goiter managed in a tertiary care referral center within 22 years. Demographics, clinical, operative, anatomical, and pathological data of the patients were recorded and analyzed.

Results

Among 3.028 total thyroidectomies, 212 procedures for substernal goiters were studied. All cases underwent total thyroidectomy. The surgical approach was cervical in all but two cases. A very low rate of complications and zero mortality were noted. Incidence of malignancy on permanent histology was 16%.

Conclusion

Descending goiter constitutes a major indication for thyroid surgery. The overwhelming majority of descending goiters may be managed surgically through a neck incision. In experienced hands good results with low morbidity should be expected. Such cases should be considered as challenging, however, and therefore management in a referral center may be necessary in order to ensure optimal results.

https://ift.tt/2AbusTd

The density and distribution of acral melanocytic nevi and acral melanomas on the plantar foot

https://ift.tt/2v91Swa

Preservation of Sebaceous Glands and PPARγ Expression in Central Centrifugal Cicatricial Alopecia

https://ift.tt/2LkDVwJ

Melanoma risk after in vitro fertilization: A review of the literature

The role of female sex hormones in the pathogenesis of malignant melanoma (MM) remains controversial. While melanocytes appear to be hormonally responsive, the effect of estrogen on MM cells is less clear. Available clinical data does not consistently demonstrate that increased endogenous hormones from pregnancy, or increased exogenous hormones from oral contraceptive pills and hormone replacement, impact MM prevalence and outcome.

https://ift.tt/2v91M7M

Practical Needle Driver Cleaning Technique When Using Fast Absorbing Plain Gut Sutures for Facial Defect Repair

https://ift.tt/2LkEwyt

Substernal goiter: Treatment and challenges. Twenty-two years of experience in diagnosis and management of substernal goiters

Descending goiter has been a focus of controversy in thyroid surgery until nowadays. This study aims to investigate the diagnosis and treatment options of thyroid goiters extending into the mediastinum and the thoracic cavity.

https://ift.tt/2Lr9XqM

Melanoma risk after in vitro fertilization: A review of the literature

Publication date: Available online 25 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Juliana Berk-Krauss, Amy Kalowitz Bieber, Maressa C. Criscito, Jane M. Grant-Kels, Marcia S. Driscoll, Martin Keltz, Miriam Keltz Pomeranz, Kathryn J. Martires, Tracey N. Liebman, Jennifer A. Stein

Abstract

Background

The role of female sex hormones in the pathogenesis of malignant melanoma (MM) remains controversial. While melanocytes appear to be hormonally responsive, the effect of estrogen on MM cells is less clear. Available clinical data does not consistently demonstrate that increased endogenous hormones from pregnancy, or increased exogenous hormones from oral contraceptive pills and hormone replacement, impact MM prevalence and outcome.

Objective

We sought to examine potential associations between in vitro fertilization (IVF) and melanoma.

Methods

A literature review was conducted. Primary outcomes were reported as associations between IVF and melanoma risk, as compared to the general population. Secondary outcomes included associations stratified by type of IVF regimen and subgroup, such as parous versus nulliparous patients.

Results

Eleven studies met our inclusion criteria. Five studies found no increased risk of MM among IVF users as compared to the general population. Two studies found an increase in MM in clomiphene users. Four studies found an increase in MM among patients who were gravid or parous either before or after IVF.

Conclusions

The reviewed studies do not reveal consistent patterns of association between IVF and MM among all infertile women. However, the data indicates that there may be an increased risk of MM in ever-parous patients treated with IVF. High-quality studies, which include a large number of MM cases and control for well-established MM risk factors, are needed to adequately assess the relationship between IVF and MM, particularly among ever-parous women.

https://ift.tt/2Aaq6Ma

Practical Needle Driver Cleaning Technique When Using Fast Absorbing Plain Gut Sutures for Facial Defect Repair

Publication date: Available online 25 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Romi Bloom, Daihung Do

https://ift.tt/2mIlRxG

The density and distribution of acral melanocytic nevi and acral melanomas on the plantar foot

Publication date: Available online 25 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Shirin Ghanavatian, Collin M. Costello, Matthew R. Buras, Helen JL. Cumsky, Mark R. Pittelkow, David L. Swanson, Aaron R. Mangold

https://ift.tt/2A6Pxhw

Preservation of Sebaceous Glands and PPARγ Expression in Central Centrifugal Cicatricial Alopecia

Publication date: Available online 25 July 2018

Source: Journal of the American Academy of Dermatology

Author(s): Yemisi Dina, Walaa Borhan, Gulsun Erdag, Ginette A. Okoye, Rajni Sharma, Powell Perng, Crystal Aguh

https://ift.tt/2OiaMQA

Reply

Publication date: Available online 25 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Silvia Bulfone-Paus, Rajia Bahri, Mohamed H. Shamji, Adnan Custovic, Paul J. Turner

https://ift.tt/2v7aUtl

Mast cell activation test versus basophil activation test and related competing issues

Publication date: Available online 25 July 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Salvaore Chirumbolo, Geir Bjørklund, Antonio Vella

https://ift.tt/2LlTBQe

Bromate removal from aqueous solution with novel flower-like Mg-Al-layered double hydroxides

Abstract

A series of flower-like Mg-Al-layered double hydroxides (FHMA) with four Mg/Al ratios were successfully prepared via a simple method which put the mixed solution of magnesium and aluminum in the mixed solution of water and ethylene glycol (EG). After calcination under 600 °C, the calcination products (CFHMA) were used to adsorb bromate anionic from aqueous solution. The FHMA, CFHMA, and reconstructed CFHMA were characterized by FT-IR, XRD spectra, TG/DTA, N₂ adsorption-desorption isotherm, and SEM. It was found that FHMA had the flower-like morphology when Mg/Al ratio was 2 and 3. Moreover, FHMA lost the layered structures during calcination under 600 °C, but the disappeared structures were reconstructed after adsorption of bromate anionic, which was attributed to the "reformation effect" of FHMA with bromate as an interlayer anion. A series of adsorption studies were performed and the mechanism and reactivity of CFHMA were discussed including the effect of different kind of equilibration conditions, such as initial bromate anionic concentration, adsorbent dosage, contact time, initial solution pH, and co-existing anions. The results of adsorption displayed that the most suitable calcination temperature of FHMA is 600 °C, and the best ratio of Mg/Al is 2:1 to remove bromate anionic pollutant from water. The equilibrium adsorption data of CFHMA revealed a good compliance with the Langmuir model and the experimental data of CFHMA fitted well to the pseudo-second-order kinetic model. The calcination product of FHMA was a decent adsorbent of bromate anionic pollutant.

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Association Between Mediterranean Anti-inflammatory Dietary Profile and Severity of Psoriasis

This cohort study uses a self-completed questionnaire by respondents in the French NutriNet-Santé study to evaluate the association between a Mediterranean anti-inflammatory dietary profile and the severity of psoriasis.

https://ift.tt/2AjJfvl

RCM and En Face Histopathologic Correlation of the Dermoscopic “Circle Within a Circle” in LM

This case report describes a process by which the dermoscopic "circle within a circle" feature can be correlated with findings of reflectance confocal microscopic (RCM) and en face histopathologic findings from a lentigo maligna lesion.

https://ift.tt/2mJ3x7R

Violaceous Patches in the Axilla

A man in his 40s presented with dark red, circular lesions in his right axilla without pain, blisters, or other symptoms; after resolution with a topical cream, similar lesions appeared in his left axilla and inguinal folds 5 months later. What is your diagnosis?

https://ift.tt/2AbsUZw

Increasing Minority Representation in the Dermatology Department

This Viewpoint reviews Johns Hopkins' successful experience in increasing the number of faculty physicians in dermatology from groups underrepresented in medicine and suggests steps that other institutions can take to replicate this success.

https://ift.tt/2OcMYxo

Facial-Aging App Availability in Waiting Rooms as a Potential Opportunity for Skin Cancer Prevention

This survey study explores whether a single exposure of adult patients in a waiting room to an app that approximates facial UV damage may lead to altered UV protection behavior.

https://ift.tt/2A7cEZx

Performance of Dermatology Physician Assistants—Reply

In Reply We thank Marghoob et al for the opportunity to address their concerns regarding our study. Number needed to biopsy (NNB) (or excise) is a well-established measure consistent with prior publications, including studies by Marghoob and colleagues. While NNB can vary with disease prevalence, patients in both cohorts in our study had similar rates of keratinocyte carcinomas and invasive melanomas. Patients were also similarly distributed by age and sex, and our NNB findings remained consistent when patients with a melanoma history were excluded.

https://ift.tt/2mJAyQY

Performance of Dermatology Physician Assistants

To the Editor In a recent issue of JAMA Dermatology, Anderson et al aimed to compare skin cancer diagnostic accuracy of physician assistants (PAs) with that of dermatologists (MDs) and used the number needed to biopsy as the main outcome measure.

https://ift.tt/2AjITF1

Characteristics and Skin Cancer Risk Behaviors of US Adult Sunless Tanners

This secondary analysis of a cross-sectional study using data from the 2015 National Health Interview Survey assesses the demographic characteristics and skin cancer risk behaviors of US adults who are sunless tanners.

https://ift.tt/2Ohv8tl

Incidence of Endemic Human Cutaneous Leishmaniasis in the United States

This observational study reviews cases of endemic human leishmaniasis occurring in the United States, mostly in Texas, over a 10-year period.

https://ift.tt/2AjI9zJ

Refractory hypoglycemia in a pediatric patient with desmoplastic small round cell tumor

Journal Name: Journal of Pediatric Endocrinology and Metabolism
Issue: Ahead of print


https://ift.tt/2NG8j1d

Cysteine cathepsins B, X and K expression in peri-arteriolar glioblastoma stem cell niches

Abstract

Glioblastoma (GBM) is the most lethal brain tumor also due to malignant and therapy-resistant GBM stem cells (GSCs) that are localized in protecting hypoxic GSC niches. Some members of the cysteine cathepsin family of proteases have been found to be upregulated in GBM. Cathepsin K gene expression is highly elevated in GBM tissue versus normal brain and it has been suggested to regulate GSC migration out of the niches. Here, we investigated the cellular distribution of cathepsins B, X and K in GBM tissue and whether these cathepsins are co-localized in GSC niches. Therefore, we determined expression of these cathepsins in serial paraffin sections of 14 human GBM samples and serial cryostat sections of two samples using immunohistochemistry and metabolic mapping of cathepsin activity using selective fluorogenic substrates. We detected cathepsins B, X and K in peri-arteriolar GSC niches in 9 out of 16 GBM samples, which were defined by co-expression of the GSC marker CD133, the niche marker stromal-derived factor-1α (SDF-1α) and smooth muscle actin as a marker for arterioles. The expression of cathepsin B and X was detected in stromal cells and cancer cells throughout the GBM sections, whereas cathepsin K expression was more restricted to arteriole-rich regions in the GBM sections. Metabolic mapping showed that cathepsin B, but not cathepsin K is active in GSC niches. On the basis of these findings, it is concluded that cathepsins B, X and K have distinct functions in GBM and that cathepsin K is the most likely GSC niche-related cathepsin of the three cathepsins investigated.

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Multiples Myelom

https://ift.tt/2LxpJQl

Moderne Diagnostik des multiplen Myeloms

Zusammenfassung

Hintergrund

Kaum eine Erkrankung in der Hämatologie entwickelt sich so dynamisch wie das multiple Myelom (MM) in den letzten Jahren. Dies betrifft sowohl therapeutische wie auch diagnostische Möglichkeiten.

Ziel

In diesem Übersichtsartikel werden die gegenwärtige Standarddiagnostik des MM dargestellt und ein Ausblick auf zukünftige Diagnostika aufgezeigt.

Ergebnisse und Schlussfolgerung

In absehbarer Zeit wird die Überprüfung einer persistierenden minimalen Resterkrankung nach Therapie sowie der Einsatz funktioneller Bildgebung Einzug in die Standarddiagnostik des MM halten. Die ersten positiven Studienergebnisse für zielgerichtete Therapien für genetisch determinierte Myelomsubgruppen – Venetoclax für t(11;14)-positive Patienten – legen zudem die Notwendigkeit einer Ausweitung der genetischen Diagnostik für MM-Patienten nahe.

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Vorbereitung zur Facharztprüfung HNO

https://ift.tt/2LkuEEN

Comparative physiological behaviors of Ulva lactuca and Gracilariopsis lemaneiformis in responses to elevated atmospheric CO 2 and temperature

Abstract

Physiological metabolisms of seaweeds usually suffered climate changes in the field. Gracilariopsis lemaneiformis and Ulva lactuca, collected from Nan'ao Island, Shantou, China, were cultured under ambient and elevated CO₂ supply (390 and 800 μl L⁻¹), with low and high temperatures (15 °C and 25 °C) for 2 weeks, aiming to compare the difference of the main physiological metabolism between two seaweed species in response to the elevated CO₂ and high temperature. At 15 °C, the pH reduction in the culture medium caused by elevated CO₂ was larger in G. lemaneiformis than in U. lactuca. At 25 °C, elevated CO₂ significantly increased photosynthetic rates (P_n or P_g) and maintained constant respiratory rates (R_d) in G. lemaneiformis. However, for 25 °C-grown U. lactuca, the increment of CO₂ did not enhance the P_n (P_g) rates but rapidly decreased the R_d rates itself. With the higher R_d/P_g ratios in G. lemaneiformis than U. lactuca, the warming thereby promoted more allocation of photosynthetic products to respiratory consumption in G. lemaneiformis. Both P_g and R_d rates exhibited lower temperature acclimation in two seaweeds. In addition, elevated CO₂ markedly increased the relative growth rate (RGR) and phycobiliprotein (PB) contents at 25 °C, but exhibited no enhancement of chlorophyll a (Chl a), carotenoids (Car), soluble carbohydrate (SC), and soluble protein (SP) contents in G. lemaneiformis, with the reduction of SC when temperature increased only. We suggested that climate changes were probably a more benefit to U. lactuca than to G. lemaneiformis, inherently justifying the metabolism during G. lemaneiformis maricultivation.

https://ift.tt/2JUw6bp

Pollution assessment of heavy metal accumulation in the farmland soils of Beijing’s suburbs

Abstract

In this study, we used GIS to assess heavy metal concentrations and their spatial variations in Beijing's suburban farmlands. The Beijing soil heavy metal background values (background values), the primary standard of the Chinese Environmental Quality Standard of Soil (primary standard), and the Environmental Quality Standard of Green Food Production Site (green standard) were used as the standards for assessing soil heavy metals. Results showed that the average Hg value was higher than that of the primary standard. The Ni and Pb values were lower than the corresponding background values. From the percentage area, the concentration is 100% area with As, more than 93% area with Cr, Cu, Pb and Zn, and 67% area with Cd and Hg, meeting the primary standard; over 97% area met the green standard. The calculated Nemerow index showed that less than 3% of the samples were slightly polluted, indicating good environmental quality. But the accumulated pollution of Cd and Hg was relatively high in some areas which was mainly affected by the high density of the industry. The farmland soils in Beijing suburbs were found to be suitable for farming, but a small percentage of the soils exceeded the green standard; Cd and Hg levels require special attention.

https://ift.tt/2Lm5GoA

Spinal Cord Stimulation Combined with Anterior Cingulotomy to Manage Refractory Phantom Limb Pain

Background: Phantom limb pain (PLP) is an intractable and debilitating disease without satisfactory treatment options presently available. Central reorganization, peripheral changes, and psychiatric factors contribute to its development; thus, a neuropsychiatry-orientated combined therapy could be promising. Objectives: We used a combined strategy with the aims of demonstrating its therapeutic outcomes on PLP. Methods: The patient initially received spinal cord stimulation (SCS) implantation and then anterior cingulotomy (ACING) 2 years later. We administered the Hamilton Depression Scale-24, Hamilton Anxiety Scale, Pain Rating Index, Numerical Pain Rating Scale, and the Short Form (36) Health Survey to assess its outcomes at 5 time points, namely the time before performing SCS implantation, 1 year and 2 years after SCS implantation, and 1 year and 2 years after SCS combined with ACING. Results: Excellent pain relief and significant improvement in depression symptoms were observed in this patient with PLP who underwent SCS combined with ACING. Conclusions: This report suggests that SCS combined with ACING is efficacious for PLP. However, further studies are warranted.
Stereotact Funct Neurosurg 2018;96:1–5

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A Case of Symptomatic Granular Cell Tumor of the Pituitary Treated with Stereotactic Radiosurgery

Background: Granular cell tumors (GCT) of the pituitary are rare. Surgery is considered the primary management option. However, complete resection is often difficult, and surgery is associated with high rates of postoperative complications. Aims: To report a unique case of pituitary GCT treated with stereotactic radiosurgery (SRS). Case Description: We report a case of a 40-year-old female with endocrine dysfunction who underwent stereotactic biopsy and then SRS for the management of a suprasellar granular cell tumor. Over the ensuing 10 years, tumor regression was observed. Thirteen years after SRS, the patient remained asymptomatic; however, follow-up MRI demonstrated tumor progression. Fifteen years after SRS, the patient required endoscopic endonasal surgery after developing a new optic neuropathy. Her images demonstrated further tumor growth beyond the targeted area. Conclusion: SRS resulted in long-term tumor control without additional endocrine dysfunction, but the onset of new optic neuropathy associated with delayed tumor growth prompted surgical decompression.
Stereotact Funct Neurosurg 2018;96:1–7

https://ift.tt/2mN3AQ5

Silastic “Spring” Spacers for Use Following Endoscopic Sinus Surgery

Abstract

The prevention of middle turbinate lateralization, and middle meatal synechiae formation, is the key to maintain a patent ostiomeatal complex following endoscopic sino-nasal surgery (ESS). Different techniques have been described to prevent this undesirable outcome, however, most of them are invasive, expensive, uncomfortable and/or obstructive. We present our technique to modified silastic sheets to circumvent these problems and improve ventilation and drainage of sinuses after surgery. The aim of this paper is to present how this silastic sheeting can be easily customized to the shape of the ethmoid cavity after ESS, allowing for ventilation of the aerated sinonasal cavities and at the same time preventing problematic synechiae/scar formation. A practical and easy technique to customize silastic stents following ESS is presented. Silastic sheets could be easily customized of the ethmoid cavity after ESS providing an excellent alternative to reduce middle turbinate lateralization and synechiae formation.

https://ift.tt/2v4vuuB

Inositol-C2-PAF acts as a biological response modifier and antagonizes cancer-relevant processes in mammary carcinoma cells

Abstract

Purpose

Previous studies have identified alkyl-phospholipids as promising compounds for cancer therapy by targeting constituents of the cell membrane and different signaling pathways. We previously showed that the alkylphospholipid Inositol-C2-PAF inhibits the proliferation and migration of immortalized keratinocytes and the squamous carcinoma-derived cell line SCC-25. Here, we investigated the effect of this compound on growth and motility as well as its mode of action in mammary carcinoma-derived cell lines.

Methods

Using BrdU incorporation and haptotactic cell migration assays, we assessed the effects of Inositol-C2-PAF on MCF-7 and MBA-MB-231 cell proliferation and migration. The phosphorylation status of signaling molecules was investigated by Western blotting as well as indirect immunofluorescence analysis and capillary isoelectric focusing.

Results

We found that Inositol-C2-PAF inhibited the growth as well as the migration in MCF-7 and MBA-MB-231 cells. Furthermore, we found that this compound inhibited phosphorylation of the protein kinase Akt at serine residue 473, but had no impact on phosphorylation at threonine 308. Phosphorylation of other kinases, such as Erk1/2, FAK and Src, which are targeted by Inositol-C2-PAF in other cells, remained unaffected by the compound in the mammary carcinoma-derived cell lines tested. In MCF-7 cells, we found that IGF-1-induced growth, as well as phosphorylation of Akt^S473, mTOR and the tumor suppressor pRB, was inhibited in the presence of Inositol-C2-PAF. Moreover, we found that in these cells IGF-1 had no impact on migration and did not seem to be linked to full Akt activity. Therefore, MCF-7 cell migration appears to be inhibited by Ino-C2-PAF in an Akt-independent manner.

Conclusion

The antagonistic effects of Inositol-C2-PAF on cell migration and proliferation are indicative for its potential for breast cancer therapy, alone or in combination with other cytostatic drugs.

https://ift.tt/2AafCwb

Correction to: The versatile role of exosomes in cancer progression: diagnostic and therapeutic implications

In the title of above mentioned article the word 'versatile' had been replaced by 'multifaceted'.

https://ift.tt/2OgSy23

Interplay between NRF1, E2F4 and MYC transcription factors regulating common target genes contributes to cancer development and progression

Abstract

Background

Nuclear respiratory factor 1 (NRF1), historically perceived as a protein regulating genes controlling mitochondrial biogenesis, is now widely recognized as a multifunctional protein and as a key player in the transcriptional modulation of genes implicated in various cellular functions. Here, we present emerging data supporting novel roles of NRF1 in cancer development and progression through its interplay with the transcription factors E2F4 and MYC. To identify common human NRF1, E2F4 and MYC target genes, we analyzed the Encyclopedia of DNA Elements (ENCODE) NRF1 ChIP-Seq data. By doing so, we identified 9253 common target genes with NRF1, E2F4 and MYC binding motifs. NRF1 binding motifs were found to be present in genes operating in signaling pathways governing all hallmarks of malignant transformation and progression, including proliferation, invasion, self-renewal and apoptosis.

Conclusions

In addition to controlling mitochondrial biogenesis NRF1, in conjunction with E2F4 and MYC, may play a critical role in the acquisition of human cancer characteristics. Additionally, NRF1 may orchestrate both MYC and E2F4 to regulate common target genes linked to multiple networks in the development and progression of cancer. A comprehensive understanding of this dynamic interplay will set the stage, not only for the design of novel treatment strategies, but also for the discovery of pan-cellular transcription factor regulatory strategies to predict cancer risk, therapy response and patient prognosis.

https://ift.tt/2A59zsK

Randomized controlled trial of a self-administered five-day antiseptic bundle versus usual disinfectant soap showers for preoperative eradication of Staphylococcus aureus colonization.

Related Articles

Randomized controlled trial of a self-administered five-day antiseptic bundle versus usual disinfectant soap showers for preoperative eradication of Staphylococcus aureus colonization.

Infect Control Hosp Epidemiol. 2018 Jul 24;:1-9

Authors: Kline SE, Neaton JD, Lynfield R, Ferrieri P, Kulasingam S, Dittes K, Glennen A, Jawahir S, Kaizer A, Menk J, Johnson JR

Abstract
OBJECTIVE: To determine the efficacy in eradicating Staphylococcus aureus (SA) carriage of a 5-day preoperative decolonization bundle compared to 2 disinfectant soap showers, with both regimens self-administered at home.
DESIGN: Open label, single-center, randomized clinical trial.
SETTING: Ambulatory orthopedic, urologic, neurologic, colorectal, cardiovascular, and general surgery clinics at a tertiary-care referral center in the United States.ParticipantsPatients at the University of Minnesota Medical Center planning to have elective surgery and not on antibiotics.
METHODS: Consenting participants were screened for SA colonization using nasal, throat, axillary, and perianal swab cultures. Carriers of SA were randomized, stratified by methicillin resistance status, to a decolonization bundle group (5 days of nasal mupirocin, chlorhexidine gluconate [CHG] bathing, and CHG mouthwash) or control group (2 preoperative showers with antiseptic soap). Colonization status was reassessed preoperatively. The primary endpoint was absence of SA at all 4 screened body sites.
RESULTS: Of 427 participants screened between August 31, 2011, and August 9, 2016, 127 participants (29.7%) were SA carriers. Of these, 121 were randomized and 110 were eligible for efficacy analysis (57 decolonization bundle group, 53 control group). Overall, 90% of evaluable participants had methicillin-susceptible SA strains. Eradication of SA at all body sites was achieved for 41 of 57 participants (71.9%) in the decolonization bundle group and for 13 of 53 participants (24.5%) in the control group, a difference of 47.4% (95% confidence interval [CI], 29.1%-65.7%; P<.0001).
CONCLUSION: An outpatient preoperative antiseptic decolonization bundle aimed at 4 body sites was significantly more effective in eradicating SA than the usual disinfectant showers (ie, the control).Trial RegistrationClinicalTrials.gov identifier: NCT02182115.

PMID: 30037355 [PubMed - as supplied by publisher]

https://ift.tt/2uLKxtC

Silastic “Spring” Spacers for Use Following Endoscopic Sinus Surgery

Abstract

The prevention of middle turbinate lateralization, and middle meatal synechiae formation, is the key to maintain a patent ostiomeatal complex following endoscopic sino-nasal surgery (ESS). Different techniques have been described to prevent this undesirable outcome, however, most of them are invasive, expensive, uncomfortable and/or obstructive. We present our technique to modified silastic sheets to circumvent these problems and improve ventilation and drainage of sinuses after surgery. The aim of this paper is to present how this silastic sheeting can be easily customized to the shape of the ethmoid cavity after ESS, allowing for ventilation of the aerated sinonasal cavities and at the same time preventing problematic synechiae/scar formation. A practical and easy technique to customize silastic stents following ESS is presented. Silastic sheets could be easily customized of the ethmoid cavity after ESS providing an excellent alternative to reduce middle turbinate lateralization and synechiae formation.

https://ift.tt/2v4vuuB

Ocriplasmin in the Treatment of Vitreomacular Traction in a Patient with Central Retinal Vein Occlusion: A Case Report

Aim: To investigate the efficacy of intravitreal injection of ocriplasmin (JETREA®) in the treatment of vitreomacular traction (VMT). Materials and Methods: An 81-year-old man with VMT associated with central retinal vein occlusion in his left eye, was treated with a single intravitreal injection of ocriplasmin (25 μg). Best corrected visual acuity (BCVA), ocular fundus, and optical coherence tomography were examined before and after treatment. Results: Complete release of VMT produced a reduction of central macular thickness, ranging from 459 to 141 μm. BCVA remained stable. Discussion and Conclusions: The use of ocriplasmin was effective in the treatment of VMT. Ocriplasmin represents a valid alternative to conventional pars plana vitrectomy.
Case Rep Ophthalmol 2018;9:357–364

https://ift.tt/2NKvszz

Heterotopic Gastrointestinal Cyst of the Oral Cavity Radiology–Pathology Correlation

Abstract

Heterotopic gastrointestinal cyst of the oral cavity is a rare congenital lesion that may arise from ectopic undifferentiated endodermal cells. Imaging, particularly MRI, is useful for surgical planning. On MRI, the cysts typically demonstrate high signal on T2-weighted sequences and variable signal on T1-weighted sequences, which can resemble other conditions, such as dermoids. On histology, the appearance of these lesions can be variable, and may include stratified squamous, simple and ciliated columnar, as well as foveolar and intestinal-type epithelia, often surrounding by smooth muscle. Complete surgical excision is the treatment of choice.

https://ift.tt/2JXVD3o

Clear Cell Odontogenic Carcinoma: Occurrence of EWSR1-CREB1 as Alternative Fusion Gene to EWSR1-ATF1

Abstract

Clear cell odontogenic carcinoma (CCOC) is a rare, low-grade malignant epithelial neoplasm, occurring in the jawbones, mainly affecting the mandible of elderly patients. In addition to hyalinizing clear cell carcinoma of the salivary gland, it is one of the epithelial neoplasms known to harbor an EWSR1-ATF1 fusion. Therefore, a link between these tumors seems plausible. We describe six cases of CCOC showing EWSR1 rearrangements, with two cases being positive for the ATF1 partner gene using FISH analysis. In one case, an EWSR1-CREB1 fusion was identified using RT-PCR, which we report for the first time in this tumor type. The other three cases investigated by FISH were negative for ATF1, CREB1 and CREB3L2. In conclusion, our data show that EWSR1-CREB1 is an alternative fusion gene to EWSR1-ATF1 in CCOC.

https://ift.tt/2mKh7rf

Is orbital floor a reliable and useful surgical landmark in endoscopic endonasal surgery?: a systematic review

The orbital floor is considered as an important intraoperative reference point in endoscopic sinonasal surgery. The aim of this review is to evaluate its reliability and usefulness as a surgical landmark in en...

https://ift.tt/2Lp0xMA

Evaluation of stacked resonators to enhance the performance of a surface receive-only array for prostate MRI at 3 Tesla

Publication date: Available online 25 July 2018

Source: Magnetic Resonance Imaging

Author(s): Jorge Chacon-Caldera, Alexander Fischer, Matthias Malzacher, Yannik Vetter, Mathias Davids, Martina Flöser, Christopher Stumpf, Lothar R. Schad

Abstract

Prostate MRI is an important tool to diagnose and characterize cancer. High local sensitivity and good parallel imaging performance are of paramount importance for diagnostic quality and efficiency. The purpose of this work was to evaluate stacked resonators as part of a surface receiver array for prostate MRI at 3 Tesla. A base array of 6-channels consisting of a flexible anterior and a rigid posterior part were built each with three loop coils. A pair of stacked resonators was added concentrically to the center loops (anterior and posterior) of the base array. The evaluated stacked resonators were butterflies, composites and dipoles which yielded a total of three 8-channel arrays. The arrays were compared using noise correlations and single-channel signal-to-noise ratio maps in a phantom. Combined signal-to-noise ratio maps and parallel imaging performances were measured and compared in vivo in 6 healthy volunteers. The results were compared to the base and a commercial array. The SNR values in the prostate yielded by all the arrays were not statistically different using fully sampled k-space. However, significant differences were found in the parallel imaging performance of the arrays. More specifically, up to 88% geometric factor reduction was found compared to the commercial array and up to 83% reduction compared to the base array using butterfly coils. Thus, signal-to-noise ratio improvements were observed with stacked resonators when using parallel imaging. The use of stacked elements, in particular butterfly coils, can improve the performance of a base array consisting solely of single loops when using parallel imaging. We expect prostate MRI at 3 Tesla to benefit from using combinations of single loops and stacked resonators.

https://ift.tt/2v3h0uN

Heterotopic Gastrointestinal Cyst of the Oral Cavity Radiology–Pathology Correlation

Abstract

Heterotopic gastrointestinal cyst of the oral cavity is a rare congenital lesion that may arise from ectopic undifferentiated endodermal cells. Imaging, particularly MRI, is useful for surgical planning. On MRI, the cysts typically demonstrate high signal on T2-weighted sequences and variable signal on T1-weighted sequences, which can resemble other conditions, such as dermoids. On histology, the appearance of these lesions can be variable, and may include stratified squamous, simple and ciliated columnar, as well as foveolar and intestinal-type epithelia, often surrounding by smooth muscle. Complete surgical excision is the treatment of choice.

https://ift.tt/2JXVD3o

Clear Cell Odontogenic Carcinoma: Occurrence of EWSR1-CREB1 as Alternative Fusion Gene to EWSR1-ATF1

Abstract

Clear cell odontogenic carcinoma (CCOC) is a rare, low-grade malignant epithelial neoplasm, occurring in the jawbones, mainly affecting the mandible of elderly patients. In addition to hyalinizing clear cell carcinoma of the salivary gland, it is one of the epithelial neoplasms known to harbor an EWSR1-ATF1 fusion. Therefore, a link between these tumors seems plausible. We describe six cases of CCOC showing EWSR1 rearrangements, with two cases being positive for the ATF1 partner gene using FISH analysis. In one case, an EWSR1-CREB1 fusion was identified using RT-PCR, which we report for the first time in this tumor type. The other three cases investigated by FISH were negative for ATF1, CREB1 and CREB3L2. In conclusion, our data show that EWSR1-CREB1 is an alternative fusion gene to EWSR1-ATF1 in CCOC.

https://ift.tt/2mKh7rf

Mukoide Pseudozysten – wann wie therapieren?

Zusammenfassung

Die Therapie der mukoiden Pseudozysten muss eine hohe Neigung zu Lokalrezidiven berücksichtigen. Aktuell stehen sowohl etablierte konservative als auch effektive operative Therapieverfahren zur Verfügung. Die Entscheidung über die geeignete Behandlungsmethode wird in Abhängigkeit von Lokalbefund und Beschwerden unter Berücksichtigung möglicher Nebenwirkungen getroffen. In dieser Übersicht werden Vor- und Nachteile der nichtinvasiven therapeutischen Optionen diskutiert. Zudem werden bewährte chirurgische Verfahren vorgestellt. Im Anschluss wird ein Therapiealgorithmus vorgeschlagen. Bei rezidivierenden und symptomatischen Läsionen mit Schmerzen oder Deformierung der Nagelplatte kann eine operative Therapie durch Exzision und Verschluss mittels kleiner Lappenplastik erwogen werden.

https://ift.tt/2NIk1s4