Head and Neck Diseases by Alexandros G.Sfakianakis: 08/29/18

The synchronous colorectal malignancy is well described in the literature but combination of pancreatic incidentaloma with sigmoid cancer has not been well described and the association has not been described ...

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An unusual cause of a breast mass in a 13-year-old girl: a case report

Adolescents rarely present with breast lumps, and such lumps are usually due to benign causes. Foreign bodies in the breast are an uncommon finding and could be detected incidentally during imaging or be sympt...

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A case of cutaneous lymphoid hyperplasia after hyaluronic acid filler injection and fat grafting

Australasian Journal of Dermatology, EarlyView.

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A case of cutaneous lymphoid hyperplasia after hyaluronic acid filler injection and fat grafting

Australasian Journal of Dermatology, EarlyView.

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Assessment of NETest Clinical Utility in a U.S. Registry‐Based Study

AbstractBackground.The clinical relevance of molecular biomarkers in oncology management has been recognized in breast and lung cancers. We evaluated a blood‐based multigene assay for management of neuroendocrine tumors (NETs) in a real‐world study (U.S. registry NCT02270567). Diagnostic accuracy and relationship to clinical disease status in two cohorts (treated and watch‐and‐wait) were evaluated.Materials and Methods.Patients with NETs (n = 100) were followed for 6–12 months. Patients' primary tumors were gastroenteropancreatic (68%), lung 20%, and of unknown origin (12%). Characteristics included well‐differentiated, low‐grade tumors (97%), stage IV disease (96%); treatment with surgery (70%); and drug treatment (56%). NETest was measured at each visit and disease status determined by RECIST. Scores categorized as low (NETest 14%–40%) or high (≥80%) defined disease as stable or progressive. Multivariate analyses determined the strength of the association with progression‐free survival (PFS).Results.NETest diagnostic accuracy was 96% and concordant (95%) with image‐demonstrable disease. Scores were reproducible (97%) and concordant with clinical status (98%). The NETest was the only feature linked to PFS (odds ratio, 6.1; p < .0001). High NETest correlated with progressive disease (81%; median PFS, 6 months), and low NETest correlated with stable disease (87%; median PFS, not reached). In the watch‐and‐wait cohort, low NETest was concordant with stable disease in 100% of patients, and high NETest was associated with management changes in 83% of patients. In the treated cohort, all low NETest patients (100%) remained stable. A high NETest was linked to intervention and treatment stabilization (100%). Use of NETest was associated with reduced imaging (biannual to annual) in 36%–38% of patients.Conclusion.Blood NETest is an accurate diagnostic and can be of use in monitoring disease status and facilitating management change in both watch‐and‐wait and treatment cohorts.Implications for Practice.A circulating multigene molecular biomarker to guide neuroendocrine tumor (NET) management has been developed because current biomarkers have limited clinical utility. NETest is diagnostic (96%) and in real time defines the disease status (>95%) as stable or progressive. It is >90% effective in guiding treatment decisions in conjunction with diagnostic imaging. Monitoring was effective in watch‐and‐wait or treatment groups. Low levels supported no management change and reduced the need for imaging. High levels indicated the need for management intervention. Real‐time liquid biopsy assessment of NETs has clinical utility and can contribute additional value to patient management strategies and outcomes.

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Erlotinib as Neoadjuvant Therapy in Stage IIIA (N2) EGFR Mutation‐Positive Non‐Small Cell Lung Cancer: A Prospective, Single‐Arm, Phase II Study

AbstractLessons Learned. The findings of this prospective, single‐arm, phase II study showed that neoadjuvant erlotinib was well tolerated and might improve the radical resection rate in patients with stage IIIA‐N2 epidermal growth factor receptor mutation‐positive non‐small cell lung cancer (NSCLC).Erlotinib shows promise as a neoadjuvant therapy option in this patient population.Next‐generation sequencing may be useful for predicting outcomes with preoperative tyrosine kinase inhibitors (TKIs) in patients with NSCLC.Large‐scale randomized controlled trials investigating the role of TKIs in perioperative therapy, combining neoadjuvant and adjuvant treatments to enhance personalized therapy for patients in this precision medicine era, are warranted.Background.Information on epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) as neoadjuvant therapy in non‐small cell lung cancer (NSCLC) is scarce. We evaluated whether neoadjuvant erlotinib improves operability and survival in patients with stage IIIA‐N2 EGFR mutation‐positive NSCLC.Methods.We conducted a prospective, single‐arm, phase II study. Patients received erlotinib 150 mg per day for 56 days in the neoadjuvant period. The primary endpoint was the radical resection rate.Results.Nineteen patients were included in the final analysis. After erlotinib treatment, 14 patients underwent surgery. The radical resection rate was 68.4% (13/19) with a 21.1% (4/19) rate of pathological downstaging. The objective response rate was 42.1%; 89.5% (17/19) of patients achieved disease control, with a 10.3‐month median disease‐free survival among patients who underwent surgery. Among all 19 patients who received neoadjuvant therapy, median progression‐free survival (PFS) and overall survival were 11.2 and 51.6 months, respectively. Adverse events (AEs) occurred in 36.8% (7/19) of patients, with the most common AE being rash (26.3%); 15.8% experienced grade 3/4 AEs. Quality of life (QoL) improvements were observed after treatment with erlotinib for almost all QoL assessments. Effects of TP53 mutation on prognosis were evaluated in eight patients with adequate tissue samples. Next‐generation sequencing revealed that most patients had a TP53 gene mutation (7/8) in addition to an EGFR mutation. No TP53 mutation, or very low abundance, was associated with longer PFS (36 and 38 months, respectively), whereas high abundance was associated with short PFS (8 months).Conclusion.Neoadjuvant erlotinib was well tolerated and may improve the radical resection rate in this patient population. Next‐generation sequencing may predict outcomes with preoperative TKIs.

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Antitumor Effect of Nivolumab on Subsequent Chemotherapy for Platinum‐Resistant Ovarian Cancer

AbstractPlatinum‐resistant recurrent ovarian cancer is generally refractory to chemotherapy. Programmed cell death‐1 (PD‐1) signaling is a new target for antitumor therapy. The anti‐PD‐1 antibody nivolumab had a 10% durable complete response rate in our phase II clinical trial. However, how nivolumab affects sensitivity to subsequent chemotherapy remains unclear. We encountered several cases of unexpected antitumor response among patients who underwent palliative chemotherapy in the follow‐up study of our phase II nivolumab trial (UMIN000005714). Several agents had an unexpected antitumor response in patients who were resistant or refractory to standard chemotherapeutic agents. In one patient, both pegylated liposomal doxorubicin (PLD) and nedaplatin (CDGP) resulted in partial response. In another patient, PLD and CDGP resulted in partial response and stable disease, respectively. These two patients remained alive on the cutoff date. These two cases raise the possibility that nivolumab might improve sensitivity to adequate chemotherapy for ovarian cancer.

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The Current and Evolving Landscape of First‐Line Treatments for Advanced Renal Cell Carcinoma

AbstractAgents targeting the vascular endothelial growth factor (VEGF) and its receptors (VEGFRs), as well as the mammalian target of rapamycin (mTOR) and immune checkpoint receptor programmed death 1 (PD‐1) signaling pathway have improved clinical outcomes for patients with advanced renal cell carcinoma (RCC). The VEGFR tyrosine kinase inhibitors (TKIs) pazopanib and sunitinib are FDA‐approved first‐line treatment options for advanced RCC; however, other treatment options in this setting are available, including the recently approved combination of nivolumab (anti‐PD‐1) and ipilimumab (anti‐cytotoxic T‐lymphocyte‐associated protein‐4 [CTLA‐4]) for patients with intermediate or poor risk. Unfortunately, treatment guideline recommendations provide little guidance to aid first‐line treatment choice. In addition, several ongoing randomized phase III trials of investigational first‐line regimens may complicate the RCC treatment paradigm if these agents gain approval. This article reviews clinical trial and real‐world evidence for currently approved and investigational first‐line treatment regimens for advanced RCC and provides clinical evidence to aid first‐line treatment selection.Implications for Practice.Vascular endothelial growth factor receptor tyrosine kinase inhibitors are approved by the U.S. Food and Drug Administration as first‐line treatment options for advanced renal cell carcinoma; however, the treatment paradigm is rapidly evolving. The combination of nivolumab plus ipilimumab was recently approved for intermediate‐ and poor‐risk patients, and other combination strategies and novel first‐line agents will likely be introduced soon.

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Study of Variation and Latency of Wave V of Brain Stem Evoked Response Audiometry in North Central India

Abstract

The brainstem evoked response audiometry (BERA) is an objective electrophysiological method for assessing the auditory pathway from the auditory nerve to the brain stem. To access the hearing pathway by BERA and compare differences in latency of wave five associated with age, gender and side of ear (left and right) in our set up. Total 257 patients were selected, there were 125 males and 132 females. All patients with auditory and vestibular complaint were assessed and underwent otoscopic examination, Pure Tone Audiometry (free field audiometry in children), Impedence and BERA. The analysis revealed that there has been progressive rise in latency (mean) of wave V with age, with a significant rise in latency in elderly individuals above 60. The analysis also revealed that that latency (mean) was higher in males than females in corresponding age group, also latency was higher in right ear in females but no such statistically significant relation could be established in males. There is still a need to have standardized set of absolute latency and interwave latency peak difference. Also in such cases of inclusion and exclusion needs to be mentioned.

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Aural Polyp is not Always Due to Chronic Otitis Media (COM): Preoperative Computed Tomographic Scan is Good Pointer for Sinister Lesions

Abstract

Twenty five patients of aural polyp who underwent canal wall down mastoidectomy were analysed retrospectively. Histopathological examination revealed cholesteatoma in 22 (88%) patients. However, histopathological diagnosis in 3 of these patients was unusual and rare benign tumors of the middle ear cleft-meningioma, neurilemmoma and capillary hemangioma. Review of the preoperative High Resolution Computed Tomography (HRCT) temporal bone revealed an unusual picture in all of the three cases. Features noted were: widening of the jugular foramen (meningioma), destruction of the anterior wall of mesotympanum (neurilemmoma), enhancing soft tissue density lesion (capillary hemangioma). Further, there was only partial loss of pneumatisation of the mastoid air cells in all of the 3 cases. It was observed that though HRCT temporal bone is a commonly advised investigation in patients of chronic otitis media (COM) with aural polyp, meticulous interpretation may reveal unusual features pointing towards sinister diagnosis. Conclusion: Aural polyp with preservation of pneumatisation of mastoid air cells points towards diagnosis other than COM.

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Evaluation of Lateral Temporal Bone Resection in Locally Advanced Tumours of the Parotid Gland

Abstract

This study evaluated the effects of lateral temporal bone resection (LTBR) on local tumour control in patients with locally advanced parotid gland tumours. The medical records of seven patients treated with radical parotidectomy combined with LTBR for locally advanced primary parotid tumour at the Otolaryngology Department of Dokuz Eylul University between January 1995 and December 2016 were retrospectively evaluated. Demographic variables, tumour characteristics, treatment properties, postoperative complications, follow-up durations and local, regional and distant recurrences were analysed. Before referral to our clinic, four patients had de novo primary parotid tumours, and three patients had a recurrence of primary parotid tumours. The histopathologic diagnoses were squamous cell carcinoma in two patients, and adenosquamous carcinoma, malignant myoepithelial carcinoma, adenocarcinoma, adenoid cystic carcinoma and spindle cell sarcoma in the other patients. During the follow-up period, one patient died due to postoperative pulmonary embolism in the first month, and four patients died due to distant metastasis without local or regional recurrences. LTBR combined with radical parotidectomy in locally advanced primary malignant parotid gland tumours is a feasible surgical technique for local tumour control. However, the most common cause of death in these cases is distant metastases, despite appropriate resection.

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Study of Variation and Latency of Wave V of Brain Stem Evoked Response Audiometry in North Central India

Abstract

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Aural Polyp is not Always Due to Chronic Otitis Media (COM): Preoperative Computed Tomographic Scan is Good Pointer for Sinister Lesions

Abstract

https://ift.tt/2NrAdOK

Evaluation of Lateral Temporal Bone Resection in Locally Advanced Tumours of the Parotid Gland

Abstract

https://ift.tt/2ws5hHM

Dietary Intervention with Oatmeal in Patients with uncontrolled Type 2 Diabetes Mellitus – A Crossover Study

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0677-6068

Background In a pilot study, we evaluated the efficacy of two days of oatmeal on insulin resistance and glucose metabolism and found a marked decrease of insulin requirements. The most important shortcoming of that study was that the interventions were not isocaloric (diabetes adapted diet: 1500 kcal/d vs. oatmeal 1100 kcal/d). To address these drawbacks we designed the OatMeal And Insulin Resistance (OMA-IR) study. Methods The study was a randomized, open label crossover dietary intervention study with consecutive inclusion of 15 patients with uncontrolled type 2 diabetes. The intervention comprised two days of oatmeal on days 3 and 4 of a 5 days hospital stay. During the control period, patients received a diabetes mellitus adapted diet only. The primary endpoint was the daily insulin requirement and glycemic control. Results Upon oatmeal treatment, the required insulin dose could be significantly reduced on the third and fourth day as compared to the second day of inpatient stay (82.0±30.3 and 69.9±29.9IU versus 112±36.2IU;P<0.001). During control treatment, insulin requirement did not change. There were no significant differences in the changes of mean blood glucose or fasting glucose between both treatments. HbA1c was lower four weeks after the oatmeal intervention. Conclusion In this crossover study, two days of oatmeal intervention allowed a highly significant reduction of required daily insulin doses while maintaining adequate metabolic control as compared to a diabetes adapted diet only. The beneficial effects of the intervention might last for several weeks as shown by the lower HbA1c four weeks after the intervention.
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Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Quality of Life, Glycemic Control, Safety and Tolerability Associated with Liraglutide or Insulin Initiation in Patients with Type 2 Diabetes in Germany: Results from the Prospective, Non-interventional LIBERTY Study

12-2017-0475-dia_10-1055-a-0636-3961-1.j

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0636-3961

Purpose To assess quality of life, glycemic control, and safety/tolerability associated with liraglutide versus insulin initiation in patients with type 2 diabetes in Germany. Methods Liraglutide/insulin-naïve adults with type 2 diabetes and inadequate glycemic control despite using oral antidiabetic medication were assigned to liraglutide (≤1.8 mg daily; n=878) or any insulin (n=382) according to the treating physician's decision and followed for 52 weeks. The primary objective was to evaluate Audit of Diabetes-Dependent Quality of Life (ADDQoL) scores. Results At baseline, the liraglutide group was younger and had shorter type 2 diabetes duration, lower glycated hemoglobin (HbA1c), higher body mass index, and a lower prevalence of certain diabetes-related complications than the insulin group (all p<0.05). ADDQoL average weighted impact scores improved numerically in both groups from baseline to 52 weeks (mean difference [95% confidence interval], liraglutide vs. insulin: 0.159 [−0.023;0.340]; not significant). Changes in general wellbeing and five ADDQoL domains significantly favored liraglutide (remaining 14 domains, not significant). HbA1c reductions were greater with insulin than liraglutide (−2.0% vs. −1.2%; p<0.01); however, mean HbA1c after 52 weeks was 7.2% in both groups. Compared with insulin, liraglutide significantly decreased body mass index (−1.54 kg/m2 vs. +0.27 kg/m2; p<0.001), systolic blood pressure (−5.03 mmHg vs. −1.03 mmHg; p<0.01) and non-severe hypoglycemia (0.85% vs. 4.55% at 52 weeks; p<0.01). Adverse drug reactions were reported for<3% of patients in both groups. Conclusions Liraglutide improved certain ADDQoL components and reduced body mass index, systolic blood pressure, and non-severe hypoglycemia versus insulin. Both treatments improved glycemic control.
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Article in Thieme eJournals:
Table of contents | Abstract | Full text

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The Prognostic Importance of Impaired Fasting Glycemia in Chronic Coronary Heart Disease Patients

05-2018-0180-dia_10-1055-a-0684-9601-1.j

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0684-9601

Objectives Impaired glucose metabolism represents one the most important cardiovascular risk factors, with steeply raising prevalence in overall population. We aimed to compare mortality risk of impaired fasting glycaemia (IFG) and overt diabetes mellitus (DM) in patients with coronary heart disease (CHD). Study design prospective cohort study Methods A total of 1685 patients, 6–24 months after myocardial infarction and/or coronary revascularization at baseline, were followed in a prospective cohort study. Overt DM was defined as fasting glucose ≥ 7 mmol/L and/or use of antidiabetic treatment, while IFG as fasting glucose 5.6–6.99 mmol/L, but no antidiabetic medication. The main outcomes were total and cardiovascular mortality during 5 years of follow-up. Results During follow-up of 1826 days, 172 patients (10.2%) deceased, and of them 122 (7.2%) from a cardiovascular cause. Both exposures, overt DM (n=623, 37.0% of the whole sample) and IFG (n=436, 25.9%) were associated with an independent increase of 5-year total mortality, compared to normoglycemic subjects [fully adjusted hazard risk ratio (HRR) 1.63 (95%CI: 1.01–2.61)]; p=0.043 and 2.25 (95%CI: 1.45–3.50); p<0.0001, respectively]. In contrast, comparing both glucose disorders one with each other, no significant differences were found for total mortality [HRR 0.82 (0.53–1.28); p=0.33]. Taking 5-years cardiovascular mortality as outcome, similar pattern was observed [HRR 1.96 (95%CI: 1.06–3.63) and 3.84 (95%CI: 2.19–6.73) for overt DM and IFG, respectively, with HRR 0.63 (95%CI: 0.37–1.07) for comparison of both disorders]. Conclusions Impaired fasting glycaemia adversely increases mortality of CHD patients in the same extent as overt DM.
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Article in Thieme eJournals:
Table of contents | Abstract | Full text

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Characteristic features of neck skin aging in Chinese women

Journal of Cosmetic Dermatology, EarlyView.

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Characteristic features of neck skin aging in Chinese women

Journal of Cosmetic Dermatology, EarlyView.

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Determining the likelihood that fatigue was present in a road accident: A theoretical review and suggested accident taxonomy

Estimates in developed countries of the extent to which fatigue contributes to road accidents range from as low as 5% to as high as 50% of all accidents. Compared with other causes of road accidents (e.g. speeding, drink-driving), the variability in these estimates is exceptionally high and may be indicative of the difficulty in determining the likelihood of fatigue as a cause of road accidents.This review compares differences in the way road accidents are classified as fatigue-related (or not) by expert panels and road safety regulators, highlighting conflicting conceptual approaches, lack of consistency, and the poor psychometric qualities of classification rules used across jurisdictions.

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Surgical margins in head and neck cancer: Intra- and postoperative considerations

To provide a perspective on the significance of recent reports for optimizing cancer free surgical margins that have challenged standard practices.

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FDA Warns of Serious Genital Infection With SGLT2 Inhibitors

The agency has received reports of 12 cases of necrotizing fasciitis of the perineum in patients taking sodium-glucose cotransporter-2 (SGLT2) inhibitors, including five women.
News Alerts

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Efficacy responses with tildrakizumab in moderate-to-severe chronic plaque psoriasis patients with previous exposure to apremilast: Results of a pooled analysis of reSURFACE 1 and reSURFACE 2

Background: Tildrakizumab (TIL) is a high-affinity anti–IL-23p19 monoclonal antibody for the treatment of chronic plaque psoriasis. We assessed a subgroup of chronic plaque psoriasis patients who reported previous treatment with apremilast (APT), a phosphodiesterase 4 inhibitor, to evaluate its potential influence on efficacy in two large, phase 3 clinical studies of tildrakizumab.

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Modified purse string closure for excisional biopsy of pigmented lesions on extremities

Proper selection of biopsy technique is imperative, especially when approaching a suspicious pigmented lesion on the extremity. When possible, a complete excisional biopsy with narrow margins is preferred to prevent partial sampling and inadequate evaluation of a lesion. A vertically oriented fusiform excisional biopsy is often selected for biopsy as it preserves lymphatics and prevents circumferential scarring. In this communication, we highlight possible pitfalls of selecting a fusiform ellipse for potential melanomas and provide a patient centered step-by-step guide to the use of narrow excisional biopsy with modified purse string closure.

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Impact of palmoplantar psoriasis on clinical and patient-reported outcomes: Results from the Corrona Psoriasis Registry

Objective: Palmoplantar psoriasis (PPP) is associated with a profound negative impact on patients' quality of life and is difficult to treat. The objective of this study was to assess the impact of PPP on clinical and patient reported outcomes (PROs) among patients enrolled in the Corrona Psoriasis (Pso) Registry.

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Cutaneous complications associated with intraosseous access placement: A retrospective cohort study

Purpose: Intraosseous (IO) access can provide a lifesaving means of vascular access in emergency settings. Insertion sites include the tibia, humerus, and sternum. IO access allows the administration of large volumes of fluids, vasopressors, blood products and other medications at flow rates of up to 125 mL/min using a 15 or 18 gauge needle. An additional benefit of IO access is the rare incidence of complications, with many recent studies revealing rates of <1%. The most common cited complications include compartment syndrome, osteomyelitis, traumatic bone fracture, and epiphyseal plate damage.

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Laterality of skin cancer in the Utah population

Background: Previous retrospective studies have reported increased frequency of both malignant melanoma (MM, using population-based SEER data) and nonmelanoma skin cancer (NMSC) on the left side of the body. Population-based studies for basal and squamous cell carcinoma (BCC and SCC) have been very difficult as a database similar to SEER does not exist for NMSC, resulting in inferences from smaller retrospective cohorts to assess laterality. As Utah has one of the highest incidences of both MM and NMSC, we explored this question for both skin cancer types using a large database of all biopsies read by the University of Utah Dermatopathology Lab over the past decade.

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Fibroadenoma of ectopic breast tissue masquerading as an axillary lipoma

Fibroadenoma of the breast is the most common benign breast condition found in up to 33% of women aged 35-50. Clinically, these are firm, mobile growths within the breast measuring 1-2 cm. The differential diagnosis include cysts, tubular adenoma and phyllodes tumors. The American College of Obstetricians and Gynecologists (ACOG) notes that fibroadenoma of the breast is associated with an elevated risk factor of 1.76 for future breast cancer. The clinician can differentiate between these growths using mammography and ultrasound.

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Differential facial esthetic treatment considerations for African-American, Asian, and Hispanic skin color populations

Background: By 2050, more than half the U.S. population will be African American, Asian, or Hispanic. The unique anatomic needs, esthetic goals, and cultural considerations for these growing patient populations should be evaluated to optimize treatment expectations and outcomes. A study was performed to gain insights into areas of esthetic concern, prioritization of treatment areas, and barriers to receiving injectables among these populations.

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Man with a perianal ulcer, what to think?

Perianal ulcers imply a vast differential diagnosis, including in the first place squamous cell carcinoma, follow by others such as Bowen's disease, Paget disease, acuminated condyloma, metastatic gastrointestinal carcinoma, Crohn's disease, and others. We present the case of a 51-year-old man that came to the emergency room with a 5-year-evolution perianal ulcer. He referred that it started as a perianal abscess that did not improve over the time and came progressively bigger. It was always asymptomatic and did not give him any problem until 2 weeks before the consultation when it started to hurt and had some episodes of diarrhea, what motivated the consultation.

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Influence of mycosis fungoides immunophenotype on prognosis, a retrospective cohort study of 160 patients

Background: Mycosis fungoides (MF) typically has a CD4+CD8− T-cell phenotype. Rare cases of CD4-CD8+, CD4-CD8− or CD4+CD8+ immunophenotypes have been described. Little is known about the impact of MF immunophenotypes on disease behavior.

https://ift.tt/2N3Cpio

Health care delivery model effects on access to dermatologic care

Introduction: In contrast to direct access (DA) health care models, gatekeeper (GK) models require a referral for specialist evaluation. Upon dermatologist evaluation, a skin biopsy may be necessary. Under the gatekeeper model, preauthorization is required to perform this procedure. This entails that the patient visit his primary care provider (PCP) to obtain authorization and a following appointment for dermatologic biopsy. This introduces a waiting time to diagnosis and treatment. This is of concern in patients with melanoma, where staging correlates with survival.

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Erythema nodosum–like eruption in the setting of sorafenib therapy

Background: Sorafenib, a small molecule inhibitor of RAF kinase and VEGFR-2/PDGFR-beta, is approved for use in several cancers. Numerous cutaneous adverse events from sorafenib therapy have been reported. To the best of our knowledge, we report the first case of erythema nodosum (EN)–like eruption concurrent with sorafenib therapy.

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Effectiveness of a nature-based sensitive skin regimen (NBSSR) compared with a synthetic dermatologist-recommended control regimen (CR) in subjects with clinically diagnosed sensitive skin

Background: Sensitive skin is associated with complaints of discomfort and may result from epidermal barrier impairment. An NBSSR is formulated to be safe and effective for sensitive skin.

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Definition and classification of chronic prurigo: First expert consensus

Pruriginous conditions may have numerous different causes and manifest with a wide range of clinical presentations, ranging from papules to large plaques. Owing to these characteristics, a plethora of terms have been associated with prurigo without clear criteria, leading to confusion among clinicians, researchers and patients. To address this issue, specialists of the Task Force Pruritus of the European Academy of Dermatology and Venereology gathered with the aim of reaching a clear definition and classification for chronic prurigo.

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Comparison of the real-world costs associated with different treatment patterns in adults initiating apremilast or biologics for the treatment of psoriasis

Background: Apremilast, an oral, nonbiologic medication, was approved by the U.S. FDA in 2014 for the treatment of adult patients with active psoriatic arthritis and patients with moderate to severe plaque psoriasis. Treatment patterns in patients with psoriasis initiating apremilast or biologics are well described in the literature. However, cost differences associated with different treatment patterns have not been described in biologic-naive patients initiating apremilast compared with biologics for treatment of psoriasis.

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Combined treatment of striae using calcium hydroxylapatite, ascorbic acid delivered by microneedling, and microfocused ultrasound

Background and objective: Striae (i.e., stretch marks) are associated with the loss of collagen and reduced fibrillin and elastin in the skin. Currently available treatments are less than optimal. The objective of this retrospective study was to evaluate improvements in straie appearance after combined treatment with microneedling, topical ascorbic acid, calcium hydroxylapatite (CaHA; Merz North America), and microfocused ultrasound with visualization (MFU-V; Ulthera).

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Melanoma follow-up and mortality: A large-scale study of Medicare patients

Background: Cutaneous melanoma is one of the fastest growing skin cancers in the United States, yet is highly curable when detected early. Despite the growing impact of melanoma in the United States, current research on assessing how well patients follow-up and how follow-up and socioeconomic factors affect mortality in patients with melanoma has been limited.

https://ift.tt/2NwCvwf

Long-term incidence and geographic trends of follicular lymphoma in Canada: A population-based study

Rationale: Follicular lymphoma is the most common indolent lymphoma and the second most common non-Hodgkin lymphoma. Follicular lymphoma accounts for 10%-20% of all lymphomas in the Western world. Primary cutaneous follicular B-cell lymphoma arises in the skin, while the systemic extranodal follicular lymphoma often involves the skin. Epidemiology and geographic trends of follicular lymphoma have not been investigated in Canada. Our study's objective is to analyze incidence and geographic characteristics of follicular lymphoma in Canada.

https://ift.tt/2wrGnYO

Itching for answers: Prevalence and severity of pruritus in psoriasis

Introduction: Psoriasis is a very common skin pathology worldwide. Pruritus is the most frequently reported bothersome complaint or symptom for psoriasis patients. Despite the morbidity associated with pruritus in psoriasis there are few studies evaluating the prevalence of itch in psoriasis in the current context of biologic agents. The aims of this study were to ascertain the severity, characteristics and aggravators of itch in psoriasis.

https://ift.tt/2NyEfFg

Improving stratum corneum cell cohesion and skin appearance through an advanced ultramild lamellar cleanser comprising dual lipids with triglycerides and glyceryl monooleate

Background: The introduction of moisturizing liquid cleanser is one of the most significant changes to affect the personal cleansing market in recent years. A key factor contributing to the popularity of these products is that the advanced lipid-containing cleaner can be designed to deliver significant skin care benefits over the ordinary personal cleansing products.

https://ift.tt/2wqq9PD

Hypertrophic lichen planus–like eruption secondary to pembrolizumab for metastatic melanoma

A 52-year-old man presented with a new skin eruption primarily affecting the chest, upper extremities, palms, and soles. He previously received pembrolizumab for 3 months for metastatic melanoma, the last infusion of which coincided with the onset of rash. Physical examination revealed scaly, annular erythematous to violaceous plaques predominantly located on the forearms, hands, and feet, with lesser involvement on the chest. Small white papules were present on the buccal mucosa. A punch biopsy was obtained from the left arm.

https://ift.tt/2NwN4iA

Outcome Tracking in Facial Palsy

Outcome tracking in facial palsy is multimodal, consisting of patient-reported outcome measures, clinician-graded scoring systems, objective assessment tools, and novel tools for layperson and spontaneity assessment. Patient-reported outcome measures are critical to understanding burden of disease in facial palsy and effects of interventions from the patient perspective. Clinician-graded scoring systems are inherently subjective and no 1 single system satisfies all needs. Objective assessment tools quantify facial movements but can be laborious. Recent advances in facial recognition technology have enabled automated facial measurements. Novel assessment tools analyze attributes such as spontaneous smile, emotional expressivity, disfigurement, and attractiveness as determined by laypersons.

https://ift.tt/2Pjrvm3

Ramucirumab + Pembrolizumab in Patients With Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma

Condition: Head and Neck Squamous Cell Carcinoma
Interventions: Drug: Ramucirumab; Drug: Pembrolizumab; Other: EORTC QLQ-30; Other: FACT H&N; Procedure: Peripheral blood
Sponsors: Washington University School of Medicine; Eli Lilly and Company
Not yet recruiting

https://ift.tt/2NuYeVd

Predictive Biomarkers for Response to Nivolumab in Head and Neck Squamous Cell Carcinoma

Conditions: HNSCC; DNA Damage; DNA Double Strand Break
Interventions: Other: Biomarker Research; Drug: Nivolumab
Sponsor: Attikon Hospital
Recruiting

https://ift.tt/2MFjPxJ

Biofeedback Rehabilitation to Improve Speaking and Eating in Public

Condition: Oral Cavity Squamous Cell Carcinoma
Intervention: Device: Electropalatography Biofeedback Training
Sponsors: Douglas Chepeha; University Health Network, Toronto
Not yet recruiting

https://ift.tt/2MGvfS9

Ramucirumab + Pembrolizumab in Patients With Recurrent/Metastatic Head and Neck Squamous Cell Carcinoma

Biofeedback Rehabilitation to Improve Speaking and Eating in Public

A Safety and Tolerability Study of INCAGN02390 in Select Advanced Malignancies

Conditions: Cervical Cancer; Gastric Cancer (Including Stomach and Gastroesophageal Junction); Esophageal Cancer; Hepatocellular Carcinoma; Melanoma (Uveal Melanoma Excluded); Merkel Cell Carcinoma; Mesothelioma; Microsatellite Instability (MSI)-High/ Deficient Mismatch Repair (dMMR) Tumors; Non-small Cell Lung Cancer (NSCLC); Ovarian Cancer; Squamous Cell Carcinoma of the Head and Neck; Small Cell Lung Cancer; Renal Cell Carcinoma (RCC); Triple-negative Breast Cancer; Urothelial Carcinoma
Intervention: Drug: INCAGN02390
Sponsor: Incyte Corporation
Not yet recruiting

https://ift.tt/2MAwPVs

Randomized Controlled Trial of a E-intervention to Help Patients Newly Diagnosed With Cancer Cope Better: Pilot Study

Condition: Head and Neck Cancer
Interventions: Device: PTSD Coach; Behavioral: Game application
Sponsors: Jewish General Hospital; Canadian Institutes of Health Research (CIHR)
Not yet recruiting

https://ift.tt/2NvziNk

A Safety and Tolerability Study of INCAGN02390 in Select Advanced Malignancies

Afatinib and Nivolumab as Treatment for Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck

Conditions: Recurrent Squamous Cell Carcinoma of the Head or Neck; Platinum- and Cetuximab-Refractory Squamous Cell Carcinoma of the Head or Neck; Metastatic Squamous Cell Carcinoma of the Head or Neck; Squamous Cell Carcinoma
Interventions: Drug: Nivolumab; Drug: Afatinib
Sponsors: Vanderbilt-Ingram Cancer Center; National Comprehensive Cancer Network; Boehringer Ingelheim
Not yet recruiting

https://ift.tt/2NvXn6D

Randomized Controlled Trial of a E-intervention to Help Patients Newly Diagnosed With Cancer Cope Better: Pilot Study

Predictive Biomarkers for Response to Nivolumab in Head and Neck Squamous Cell Carcinoma

Conditions: HNSCC; DNA Damage; DNA Double Strand Break
Interventions: Other: Biomarker Research; Drug: Nivolumab
Sponsor: Attikon Hospital
Recruiting

https://ift.tt/2MFjPxJ

Afatinib and Nivolumab as Treatment for Recurrent/Metastatic Squamous Cell Carcinoma of the Head and Neck

Issue Information

Experimental Dermatology, Volume 27, Issue 9, Page 939-940, September 2018.

https://ift.tt/2om6H24

Altered expression of matrix remodelling associated 7 (MXRA7) in psoriatic epidermis: Evidence for a protective role in the psoriasis imiquimod mouse model

Experimental Dermatology, Volume 27, Issue 9, Page 1038-1042, September 2018.

https://ift.tt/2wEeNHd

Clinical Snippets

Experimental Dermatology, Volume 27, Issue 9, Page i-i, September 2018.

https://ift.tt/2ojRaQf

Defining and validating a Body Skin Discomfort Index (BSDI)

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

https://ift.tt/2N79EBL

Drug reaction with eosinophilia and systemic symptoms (DRESS) and multiple organ dysfunction syndrome (MODS): one more reason for a new effective treatment against leishmaniasis

International Journal of Dermatology, EarlyView.

https://ift.tt/2NvsyPk

Acacia seyal and Terminalia brownii associated airborne contact dermatitis (Dukhan dermatitis)

International Journal of Dermatology, EarlyView.

https://ift.tt/2MYFyjx

A novel approach to the classification of epidermodysplasia verruciformis

International Journal of Dermatology, EarlyView.

https://ift.tt/2LBQgYG

Molecular subgroups and B7-H4 expression levels predict responses to dendritic cell vaccines in glioblastoma: an exploratory randomized phase II clinical trial

Abstract

Dendritic cell (DC)-based vaccination is a promising approach for active-specific immunotherapy, but is currently of limited efficacy. The safety and effectiveness of a DC vaccine (DCV) loaded with glioblastoma stem cell-like (GSC) antigens was assessed in glioblastoma multiforme (GBM) patients. In this double-blind, placebo-controlled phase II clinical trial, 43 GBM patients were randomized after surgery at a 1:1 ratio to receive either DCV (n = 22) or normal saline placebo (n = 21). Overall survival (OS) and progression-free survival (PFS) were analysed. Participants were stratified into different molecular subgroups based on the mutation (MT) status of isocitrate dehydrogenase (IDH1/2) and telomerase reverse transcriptase (TERT). Plasma cytokine levels, tumor-infiltrating lymphocyte numbers and immune co-inhibitory molecules PD-L1 and B7-H4 were also assessed. Multivariate Cox regression analysis revealed that DCV treatment significantly prolonged OS (p = 0.02) after adjusting for IDH1 and TERT promoter MT and B7-H4 expression, primary vs recurrent GBM. Among IDH1^{wild type (WT)} TERT^MT patients, DCV treatment significantly prolonged OS (p < 0.01) and PFS (p = 0.03) and increased plasma levels of cytokines CCL22 and IFN-γ compared with placebo. Patients with low B7-H4 expression showed significantly prolonged OS (p = 0.02) after DCV treatment. Therefore, IDH1^WTTERT^MT and low B7-H4 expression identified subgroups of GBM patients more responsive to GSC DCV-based specific active-immunotherapy.

https://ift.tt/2okVNcI

Effects of β2-adrenergic agonists on periostin-induced adhesion, superoxide anion generation, and degranulation of human eosinophils

Publication date: Available online 29 August 2018

Source: Allergology International

Author(s): Toru Noguchi, Kazuyuki Nakagome, Takehito Kobayashi, Yutaka Ueda, Tomoyuki Soma, Hidetomo Nakamoto, Makoto Nagata

https://ift.tt/2NrPXBb

Advanced head and neck surgical techniques: A survey of US otolaryngology resident perspectives

Publication date: Available online 28 August 2018

Source: Auris Nasus Larynx

Author(s): Karolina A. Plonowska, Patrick K. Ha, William R. Ryan

Abstract

Objectives

To assess the perspectives of OHNS residents with regards to their training in the following advanced head and neck surgery techniques: transoral robotic surgery (TORS), transoral laser microsurgery (TLM), sialendoscopy, and surgeon-performed ultrasound (SP-US) for possible curricula development.

Methods

Cross-sectional survey. A 20-item questionnaire was electronically distributed to OHNS residency programs assessing volume of cases, training barriers, satisfaction, additional training preferences, and pertinence to future practice.

Results

One hundred thirty-one residents completed the questionnaire. Trainee satisfaction with advanced techniques did not vary significantly with level of training (PGY) or intent to pursue fellowship. Residents who participated in more TLM, sialendoscopy, and SP-US cases were significantly more likely to be satisfied with their training (all p < 0.05). The most frequently reported limitation to training was low home institution procedure volume. Seventy-eight of 123 respondents (63.4%) indicated insufficient opportunity to participate in TORS, with most residents reporting that TORS was preferentially performed by attendings (59/78, 75.6%). Forty-five of 126 (35.7%) reported having adequate access to skills training in TORS, compared to 43.6%, 48.4%, and 54.8% for sialendoscopy, TLM, and SP-US, respectively. A vast majority expressed interest in home institution-sponsored training courses in SP-US (120/127, 94.5%) and sialendoscopy (105/129, 81.4%). Many anticipated using SP-US (63.3%) and sialendoscopy (49.6%) in their future practices.

Conclusion

Greater resident participation in advanced head and neck surgical procedures is associated with higher trainee satisfaction. There is a possible need for additional home institution-sponsored training courses, especially in sialendoscopy and SP-US.

Level of evidence: N/A.

https://ift.tt/2Ntjf2s

Cancer of the mandibular gingiva metastasizing to the small intestine

Publication date: Available online 28 August 2018

Source: Auris Nasus Larynx

Author(s): Takeshi Okamura, Takeshi Beppu, Takao Tokumaru, Masato Yamada, Tomonori Sugiyama, Nobuaki Koide, Miyuki Tani, Masayuki Kaneko, Atsumori Hamahata, Yu Nishimura, Takashi Fukuda

Abstract

Head and neck cancer metastasizing to the small intestine is very rare. Here we report a case of cancer of the mandibular gingiva metastasizing to the small intestine. The patient was an 82-year-old man who had squamous cell carcinoma of the mandibular gingiva staged as T2N2bM0. Two months after surgery, he presented with lower abdominal pain accompanied by signs of peritoneal irritation. Urgent abdominal surgery was performed, during which a crater-shaped perforation was noted on the wall of the ileum. Microscopic findings at this site confirmed a diagnosis of metastatic squamous cell carcinoma in the small intestine from the mandibular gingiva. To our knowledge, this is the first case report of oral cancer metastasizing to the small intestine. If gastrointestinal symptoms appear in a patient with advanced oral cancer, a differential diagnosis of metastasis to the gastrointestinal tract should be kept in mind.

https://ift.tt/2woXJFx

Optical coherence tomography for observation of the olfactory epithelium in mice

Publication date: Available online 28 August 2018

Source: Auris Nasus Larynx

Author(s): Toshio Ueda, Tatsunori Sakamoto, Masayoshi Kobayashi, Fumihiko Kuwata, Masaaki Ishikawa, Koichi Omori, Takayuki Nakagawa

Abstract

Objective

Optical coherence tomography (OCT) is an imaging tool that exploits the coherence of infrared light and is clinically utilized in the field of ophthalmology and dermatology. This study aimed to examine the feasibility of using OCT for diagnosing degeneration and regeneration of the olfactory epithelium in mice.

Methods

The olfactory and respiratory epithelia in excised nasal septa of adult mice were observed using OCT. Subsequently, histological assessments were performed with hematoxylin and eosin (H–E) staining. The thicknesses of the olfactory or respiratory epithelia were measured in both OCT images and H–E-stained paraffin sections. The ability of OCT to distinguish olfactory epithelia from respiratory epithelia in normal mice was compared with that of H–E staining. The feasibility of using OCT assessments for detecting changes in the thickness of olfactory epithelia was tested in a mouse model of the degeneration and regeneration of olfactory epithelia.

Results

OCT allowed visualization of the gross morphology of the olfactory and respiratory epithelium in normal mice, although it was limited in terms of visualizing cellular components. OCT-based measurements of epithelial thickness helped to distinguish olfactory epithelia from respiratory epithelia. Similar to H–E staining, OCT also clarified changes in the olfactory epithelium thickness after methimazole application.

Conclusions

These findings indicate the utility of OCT for assessment of olfactory epithelial thickness and its potential for clinical evaluation of human olfactory epithelia.

https://ift.tt/2NvgWMe

Program Director and Resident Perspectives on New Parent Leave in Dermatology Residency

This study investigates how new parent leave policies are perceived by dermatology program directors and residents.

https://ift.tt/2BXRQVd

A Child With Multiple Hypopigmented Macules on the Abdomen

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

https://ift.tt/2N23l2e

Analysis of the Effect of Gentian Violet on Apoptosis and Proliferation in Cutaneous T-Cell Lymphoma in an In Vitro Study

This preclinical in vitro study identifies novel small molecules that induce extrinsic apoptosis and serve as an alternative treatment for cutaneous T-cell lymphoma.

https://ift.tt/2BYVo9L

Risk Factors for Dupilumab-Associated Conjunctivitis in Patients With Atopic Dermatitis

This case series evaluates 12 patients with atopic dermatitis who experienced conjunctivitis secondary to injectable dupilumab treatment to investigate severity and common risk factors for secondary conjunctivitis.

https://ift.tt/2MYcybL

Disease in a Nutshell Sarcoidosis

Publication date: Available online 28 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Vivian Wang, Fonda Jiang, Anita Kallepalli, Tyler Basen, Joseph Yusin, Guha Krishnaswamy

https://ift.tt/2wxeIWz

Improving allergy office scheduling increases patient follow up and reduces asthma readmission after pediatric asthma hospitalization

Publication date: Available online 28 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Melanie A. Ruffner, Sarah E. Henrickson, Marianne Chilutti, Robert Grundmeier, Jonathan M. Spergel, Terri F. Brown-Whitehorn

Abstract

Background

Pediatric asthma is a major contributor to emergency room utilization and hospital readmission rates.

Objective

To develop an allergy department-based intervention to improve follow-up appointment scheduling processes for pediatric asthma patients following discharge for asthma exacerbation.

Methods

This quality improvement (QI) study was conducted in the allergy clinic of an urban, tertiary children's hospital. Children receiving subspecialty allergy care for asthma were included into the intervention group during the intervention period. The QI intervention consisted of three attempts by telephone to reach the family to schedule the follow-up appointment. If this was unsuccessful or if the appointment was not kept then a reminder letter was sent to the family. The primary outcome of interest in this study was the percent of post-discharge follow-up appointments scheduled within 30 days of discharge. Secondary outcomes measured were the percent of allergy appointments attended within 30 days of discharge and the 30-day hospital readmission rate.

Results

Demographics did not differ significantly between the intervention and baseline pre-intervention year. The initial baseline scheduled allergy follow-up visit rate was 48.8±13.3% of patients discharged per month. This increased to an overall rate of 75.7±20.1% patients scheduling allergy follow-up within 30-days of discharge during the intervention year. We additionally observed a significant increase in attended allergy visits 30 days post-discharge from 35.5±15.6% in Year 1 to 53.9±25.5% during the intervention year and a significant decrease in the 30-day readmission rate on the allergy service.

Conclusion

This data suggests that minor changes in allergy practice organization can significantly affect post-hospitalization follow-up rates and decrease asthma readmission rates.

https://ift.tt/2wE4TW3

Giants in Allergy-Immunology Dr. Henry N. Claman

Publication date: Available online 28 August 2018

Source: Annals of Allergy, Asthma & Immunology

Author(s): Stephen C. Dreskin

https://ift.tt/2wmUezk

Tragedy of transition: hypertensive crisis in a young adult secondary to unilateral ureteropelvic junction obstruction following pyeloplasty as an adolescent

A 25-year-old man with a history of left ureteropelvic junction (UPJ) obstruction that was corrected surgically at the age of 16 presented with a chief complaint of syncope. He was found to have severe hypertension with evidence of end organ damage on laboratory evaluation. His blood pressure was controlled with intravenous and oral antihypertensives with improvement in end organ dysfunction. Workup for secondary causes of hypertension implicated failed left-sided pyeloplasty with resultant hydronephrosis as the aetiology. The patient was transitioned to an oral antihypertensive regimen and discharged with urological surgery follow-up. Blood pressure control was maintained with oral antihypertensives and a low-salt diet; however, evidence of chronic kidney disease persisted. This case highlights the importance of close follow-up and adequate transition of care in patients with UPJ obstruction who transitioned to adulthood.

https://ift.tt/2NuRaYL

History conflict and non-formulary medicine: a threat for anaesthesiologist in low and middle-income countries

The practice of complementary and non-formulary medicine has gained tremendous popularity due to their claimed beneficial effects in cardiac, respiratory and chronic diseases, as also other disorders. The most threatening aspect related to these practices pertains to the non-disclosure of its use by patients at the time of their preoperative assessment in elective or emergency setting. We report a case of profound, long-lasting unexplained hypotension during and after anaesthesia in a patient presented for emergency vocal cord surgery (cordectomy). He was taking complementary medicine for last 2 years. Serum cortisol level was sent postoperatively in intensive care unit that was found extremely low.

https://ift.tt/2MXd8Xc

Acute horseshoe abscess of the hand after corticosteroid injection to treat trigger thumb

Local corticosteroid injections are frequently used in the management of trigger finger. We present a case of a 56-year-old woman who developed an acute horseshoe abscess of the hand after injection of corticosteroid and local anaesthetic into the left thumb. This was managed successfully with intravenous antibiotics, operative intervention and early mobilisation. This case highlights the possible complications that can occur with such a minimally invasive procedure. The pathophysiology behind this condition is explained by communication between the radial and ulnar bursae. Knowledge of the anatomy of the hand and its variants is therefore essential to assist in diagnosis. Prompt clinical diagnosis and surgical management is required to avoid disastrous complications.

https://ift.tt/2NznTw8

Acute spontaneous intracranial epidural haematoma and disseminated intravascular coagulation in a paediatric sickle cell patient

An African American teenage boy during an acute sickle cell crisis spontaneously developed acute bifrontal epidural haematomas (EDHs) in addition to disseminated intravascular coagulation (DIC). The successfully evacuated EDH reaccumulated postoperatively. After multiple transfusions, the patient underwent repeat surgery. Subsequent maximal medical therapy was unable to significantly improve the patient's neurological status, and due to family wishes, care was withdrawn. EDH are the most common emergent neurosurgical complication of sickle cell disease (SCD). Twenty-two such cases have been previously reported. We present one further complicated by DIC leading to reaccumulation of the patient's EDH. An understanding of the mechanisms of EDH formation in SCD and their associated radiological findings could help clinicians identify when a patient is at high risk of EDH formation and thus offer the potential for early intervention prior to the development of an emergency.

https://ift.tt/2MXd35Q

Optical coherence tomography of iris mammillations

Description

A 10-year-old girl presented with blurred vision of 2 months. Uncorrected visual acuity was 20/20 in both eyes (OU). Refraction revealed 0.75 diopters of astigmatism OU. Visual blur was related to a moderate convergence insufficiency. The superior 90% of the left iris was darkly pigmented and velvety in consistency with regularly spaced protuberances (mammillations) (figure 1).

Figure 1

Slit lamp photograph of the right normal iris (A) and left dark velvety iris with mammillations (B). The inferior sector of the left iris is normal. Anterior segment optical coherence tomography (OCT) of the normal right iris demonstrates smooth surface with random crypts (C). OCT of the left eye shows numerous micronodules on the iris surface with flattening of the entire iris (D).

We present a novel anterior optical coherence tomography (OCT) report of iris mammillations.1 2...

https://ift.tt/2LADidC

SIADH and water intoxication related to ecstasy

Recreational drug use is a significant societal issue and remains a clinical challenge in emergency and critical care departments. We report on a 19-year-old woman admitted to hospital semiconscious and with severe hyponatraemia. Urinalysis was positive for methamphetamine and supported a diagnosis of hyponatraemia related to ecstasy use together with a syndrome of inappropriate antidiuretic hormone secretion (SIADH). The woman was transferred to an intensive care unit, where a hypertonic saline infusion was started. Three hours postadmission she developed polyuria. Follow-up urinalysis at this point was consistent with water intoxication. This case is a reminder that hyponatraemia is a potentially fatal complication after the ingestion of 3,4-methylenedioxymethamphetamine, illustrates the sequential nature of an SIADH and water intoxication and highlights the importance of considering the sequence of onset of hyponatraemia, as the patient may be admitted at any stage.

https://ift.tt/2woD3NY

Hypothermia as a forgotten sign of prolonged severe hypoglycaemia

Hypothermia is often a sign of serious illness. Commonly reported aetiologies include but are not limited to sepsis, exposure to cold and endocrine disorders. Hypoglycaemia, a common occurrence, is rarely associated with hypothermia. We present a case of prolonged, severe hypothermia due to hypoglycaemia. A 58-year-old man with diabetes who presented with chest pain and was diagnosed with Non-ST elevation myocardial infarction. He was given nothing per mouth in preparation for a left heart catheterisation but received his reported insulin glargine dosage at bedtime. A few hours later, he was noted to have diaphoresis and hypoglycaemia, and his temperature steadily started dropping which was unresponsive to local warming. Once his hypoglycaemia was successfully treated with dextrose infusion, his temperature improved. An extensive workup revealed no infective or endocrine disorder.

https://ift.tt/2LHoA4M

Bronchobiliary fistula caused by diaphragmatic invasion of a hepatic tumour

A 71-year-old man presented with a productive cough consisting of yellow fluid. He had previously been treated for pneumonia without resolution in his symptoms. Sputum was tested for bilirubin using a urine dipstick given its similar appearance to bile, which was positive. Hepatobiliary scintigraphy scan revealed uptake of radiotracer in the right lower lobe of the lung. Endoscopic retrogade cholangiopancreatography confirmed diagnosis of a bronchobiliary fistula. The patient had a stent placed in the common bile duct promoting anterograde bile flow with complete resolution of symptoms.

https://ift.tt/2wmc2uA

When your immune system falls out with your heart: an important lesson on antisynthetase myocarditis

A 57-year-old special Olympics athlete presented with subacute onset dyspnoea. Baseline investigations revealed troponin T rise and an abnormal ECG, which prompted coronary angiography. This was unremarkable, as was his transthoracic echocardiography (TTE). He re-presented 7 months later with progressive dyspnoea associated with significant weight loss, peripheral oedema and intermittent fevers. Examination revealed bilateral fine end-inspiratory crackles, peripheral oedema and fever. Investigations revealed elevated troponin T and raised inflammatory markers. ECG remained unchanged, whereas TTE revealed mild global impairment of left ventricular function. Chest radiography was suggestive of extensive interstitial lung disease, which was confirmed by high resolution CT. Presence of interstitial lung disease and myocarditis raised the suspicion of a systemic inflammatory condition. Subsequently, an autoimmune screen was positive for anti-Jo-1 antibody associated with antisynthetase syndrome. He was treated with high-dose steroids and rituximab with dramatic symptomatic improvement and immediate fall in troponin T level.

https://ift.tt/2NtgwpH

Extrapulmonary tuberculosis: atypical presentation in otorhinolaryngology

Tuberculosis (TB) continues to be a major health burden globally more so in low/middle-income countries like India. There is an increase in the prevalence of extrapulmonary TB (EPTB) because of HIV epidemics and increased usage of immunomodulating drugs. EPTB constitutes 15%–20% of all patients with TB and >50% of HIV-TB coinfected patients. We present three such atypical presentations of EPTB in head and neck region. EPTB can mimic any disease, hence knowledge of the unusual presentations helps in making early diagnosis and thereby reduces the morbidity and mortality involved with the disease.

https://ift.tt/2MY5snD

Flashes of light and floaters: an unusual presentation of urothelial carcinoma

Description

A 59-year-old Caucasian woman with multiple sclerosis presented with blurred vision in the right eye, floaters and flashes of light for 2 weeks. She had right-sided optic neuritis which was treated 8 years prior. There was a 20 pack-year smoking history. Examination was remarkable for right-sided temporal field loss and a palpable breast lump. Ophthalmological examination revealed right exudative retinal detachment, with ultrasonography demonstrating a choroidal mass with medium to high internal reflectivity. MRI was significant for a 14 mm intraocular metastasis (figure 1). On further questioning, the patient described haematuria. Urine cytology demonstrated large cells with high nuclear to cytoplasmic ratio, irregular nuclear borders and necrosis, all suggesting high-grade malignancy. Abdominal imaging revealed an ill-defined heterogeneously hypoenhancing infiltrative lesion of the right kidney within the mid and superior portions measuring 7.5x6.6x8.5 cm (figure 2). Biopsy of both the renal and breast masses confirmed urothelial...

https://ift.tt/2NvJCEU

Spontaneous bacterial empyema: an elusive diagnosis in a patient with cirrhosis

Hepatic hydrothorax refers to the presence of a pleural effusion (usually >500 mL) in a patient with cirrhosis in whom other causes of pleural effusion, such as cardiopulmonary causes, pleural disease or malignancy have been excluded. It is seen in 5%–10% of patients with end-stage liver disease. A subset of these patients can develop infection of the hepatic hydrothorax, called spontaneous bacterial empyema. They may present with fever, chills and dyspnoea. We present the case of an 83-year-old man with a history of cirrhosis who developed a large right-sided pleural effusion, confirmed to be empyema by pleural fluid analysis. We aim to highlight the occurrence of spontaneous bacterial empyema. While less common that spontaneous bacterial peritonitis as a complication of cirrhosis, it is equally serious with potential for adverse outcomes.

https://ift.tt/2wp5ZFt

Unusual discovery of a vestibular schwannoma following eradication therapy for Mycobacterium abscessus

A young man with cystic fibrosis in his early 30s presented to accident and emergency with acute onset unilateral lower motor neuron facial palsy, hearing loss and impaired balance following Mycobacterium abscessus eradication induction therapy. The hearing loss and impaired balance developed over a 3-day period prior to the onset of facial palsy. Further investigation with a CT scan and MRI scan led to a diagnosis of vestibular schwannoma. The facial palsy resolved with steroid treatment; however, the hearing loss is irreversible, which has had a profound impact on his life and career. This case is intriguing as the cause and association of events are unclear. A working diagnosis of incidental Bell's palsy and unilateral hearing loss caused by the vestibular schwannoma was applied. However, the onset of these symptoms in relation to M. abscessus eradication induction therapy promotes discussion.

https://ift.tt/2LwCW7T

Use of cinacalcet in lithium-induced hyperparathyroidism

The case of a 61-year-old female patient with a long-standing history of bipolar affective disorder treated medically with lithium therapy for the past two decades. In late 2012, the patient was diagnosed with hyperparathyroidism secondary to lithium therapy. The patient underwent parathyroidectomy in August 2013. During surgery, only two glands were conclusively located and removed. This resulted in a reduction in the patient's plasma total calcium levels and parathyroid hormone. The psychiatric management of the bipolar affective disorder was reviewed, and lithium discontinued as a result of the findings. Over the following year, a variety of different mood stabilisers were trialled, however none were found to successfully maintain the patient's mental health. In August 2014, the patient was admitted with a severe depressive relapse of her bipolar affective disorder. Her admission tests showed hypercalcaemia, which may also have contributed to her mood symptoms and mental state deterioration. The patient was reviewed by the endocrinology team and subsequently commenced on cinacalcet treatment (30 mg twice a day). Over the following months, the patient's plasma total calcium levels returned to within normal range. The patient's depressive symptomatology gradually improved with a combination of physical and pharmacological treatments.

https://ift.tt/2woD1FQ

Breast cancer and organising pneumonia: the importance of correlating the pathological findings with the clinical and radiological picture

This case describes a female patient with a history of breast cancer who presented with a persistent cough and weight loss after a 17-year disease-free period. Radiologically there were new bilateral intrapulmonary nodules and areas of consolidation with a broad differential diagnosis. Brushings gained via bronchoscopy were suggestive of malignancy, but subsequent video-assisted thoracoscopic surgery wedge resection demonstrated organising pneumonia (OP) with no evidence of malignancy. Diagnostic uncertainty remained after this, and after a period of observation, there was evidence of disease progression. Further tissue was obtained for cytological and histological assessment which provided conclusive evidence of metastatic breast cancer. In this case, OP was secondary to proximal bronchial obstruction due to metastatic infiltration, of which there are no reported similar cases in the current literature. We discuss the importance of differentiating secondary OP from cryptogenic OP.

https://ift.tt/2NuCGIi

Paediatric duodenal injury complicated by common bile duct rupture due to blunt trauma: a multispecialist approach

We report a case of late presenting duodenal perforation with common bile duct rupture secondary to blunt handlebar trauma in an 11-year-old boy. The patient presented with upper abdominal wall ecchymosis, pain and vomiting. He was discharged after 24 hours with resolving symptoms. However, the boy presented 2 days later febrile with signs of peritonitis. CT indicated duodenal perforation, which was confirmed during laparotomy where common bile duct rupture was also demonstrated. Primary repair of the duodenum was undertaken. Here, decompression was achieved with a nasogastric tube proximal to the injury and T-tube duodenostomy distally. Common bile duct repair was achieved over a biliary stent. This case represents a rare subset of duodenal injury for which there is a paucity of evidence for optimal surgical management, particularly in the paediatric setting. This operative plan will guide surgeons and junior doctors in managing complicated cases like this in future.

https://ift.tt/2MXzEz7

Retzius space haematoma as a rare cause of concealed retroperitoneal postpartum haemorrhage following spontaneous vaginal delivery

A 34-year-old woman presented to hospital in shock 8 hours after a spontaneous home vaginal delivery. She is a known carrier of haemophilia A. Examination revealed a tender but firm, central and contracted uterus. There was a small second-degree perineal tear which was not actively bleeding and no other trauma or bleeding visualised in the vault or cervix. Bedside ultrasound showed a large 1 L blood clot anterior to the empty uterus. Exploratory laparotomy was performed which revealed a haematoma in the Retzius space with extension beneath the anterior serosa of the bladder, through the left broad ligament and into the retroperitoneal space. Bleeding from the Santorini plexus was controlled with haemostatic sutures, reinforced with FLOSEAL and intra-abdominal packing. A CT angiogram and relook laparotomy the following day confirmed haemostasis and facilitated removal of intra-abdominal packs. This case demonstrates a very rare cause of postpartum retroperitoneal haemorrhage.

https://ift.tt/2NvJB3O

Primary Epstein-Barr virus infection in immunocompetent patients with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome as neurological manifestations

Neurological manifestations of a primary Epstein-Barr virus (EBV) infection are rare. We describe a case with acute transverse myelitis and another case with a combination of polyradiculitis and anterior horn syndrome as manifestations of a primary EBV infection.

The first case is a 50-year-old immunocompetent male diagnosed with acute transverse myelitis, 2 weeks after he was clinically diagnosed with infectious mononucleosis. The second case is an 18-year-old immunocompetent male diagnosed with a combination of polyradiculitis and anterior horn syndrome while he had infectious mononucleosis. The first patient was treated with methylprednisolone. After 1 year, he was able to stop performing clean intermittent self-catheterisation. The second patient completely recovered within 6 weeks without treatment.

Primary EBV infection should be considered in immunocompetent patients presenting with acute transverse myelitis and a combination of polyradiculitis and anterior horn syndrome. Antiviral treatment and steroids are controversial, and the prognosis of neurological sequelae is largely unknown.

https://ift.tt/2MYo7zB

Severe capillary leak syndrome with cardiac arrest triggered by influenza virus infection

Systemic capillary leak syndrome (SCLS), also known as Clarkson syndrome, is a rare disease with potential fatal outcome. The clinical picture involves leakage of fluid and protein from the bloodstream into peripheral tissues, resulting in hypoalbuminaemia, elevated haematocrit, oedema and hypotension. The spectrum of the symptoms ranges from discrete swelling/oedema of extremities to fulminant cardiogenic shock. We present a case with a 52-year-old man diagnosed with SCLS after being resuscitated from cardiac arrest, which was complicated by compartment syndrome. The severe episode of capillary leak was potentially triggered by influenza virus infection. With the benefit of hindsight, he presented with symptoms of SCLS 2 years prior the major acute episode. Here we describe this case and review some aspects of the literature on SCLS, with particular focus on the pathogenesis, treatment/prophylaxis and long-term physical and psychological complications.

https://ift.tt/2NxlQbE

An interesting case of vanishing shoulder

Description

A 37-year-old woman with progressive difficulty in using her left arm and with discomfort in the left shoulder was evaluated. Her complaints were of insidious onset and progressed over a period of 3 months. She had a soft shoulder and passive movements in the left shoulder were increased in all ranges, with internal and external rotation of 180° each (figure 1A,B). Active abduction was up to 90°. Radiographs of the shoulder demonstrated the absence of humeral head and a small sliver of bone, reminiscent of the greater tubercle (figure 1C). She was evaluated for neuropathic arthropathy, infection, neoplastic, metabolic and endocrine causes of osteolysis using appropriate blood tests and imaging techniques. Her blood parameters were normal. MRI confirmed absence of the proximal humerus and resorption and expansion of the glenoid cavity (figure 2A,C). A syrinx extending from the C2–D9 spinal region (figure 2C,D) was incidentally...

https://ift.tt/2wmCqVo

Challenges faced by young otolaryngologists-head & neck surgeons around the world

Publication date: Available online 28 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): I. Fournier, N. Fakhry, T. Kennel, N. Tessier, A. Bahgat, J.R. Lechien, T. Ayad

Abstract

Objectives

To document work-related stressors and to identify coping strategies employed by young board-certified otolaryngologists-head & neck surgeons (OTL-HNS) around the world. The second objective is to evaluate demographic and professional characteristics associated with a higher level of work-related stress.

Methods

A survey was sent to all OTL-HNS under 45 years old from the 2017 IFOS meeting. This survey was conducted by the YO-IFOS group (Young Otolaryngologists of the International Federation of Otolaryngological Societies). Data were collected for a period of 1 month. Demographic characteristics and information concerning challenges encountered by OTL-HNS during the early years of their career were collected.

Results

Among the 2787 attendees, 928 responded to the survey (response rate = 33.3%). The three most frequent challenges faced by OTL-HNS in the early years of their career were related to administrative workload (45%), high patient quota (42%) and desire to achieve adequate work-life balance (42%). Practices used by OTL-HNS to cope with stress were physical activity (37%), recreational activities (35%) and self-organization (32%). Higher levels of stress were frequently found in participants who possessed five to ten years of experience (P = 0.007) and who were employed by an academic institution (P = 0.020). On the other hand, lower levels of stress were often encountered in participants who had 5 years or less of experience (P = 0.002).

Conclusion

This study provides insight on characteristics that are associated with various levels of stress. Moreover, it demonstrates the work-related stressors and the resilience techniques employed by OTL-HNS in early years of their career. Stress will always be present during the surgeon's career. Therefore, knowing how to recognize it and how to deal with it is key. More resources should be made available for OTL-HNS needing aid. Because surgeons must be in control of their stress if they want to provide high quality health care.

https://ift.tt/2POO3MT

Urgent endoscopic orbital decompression for vision deterioration in dysthyroid optic neuropathy

Publication date: Available online 28 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): L.J. Sowerby, C. Rajakumar, L. Allen, B.W. Rotenberg

Abstract

Aims

To report visual acuity outcomes and potential complications in patients undergoing endoscopic transnasal orbital decompression in the setting of acutely deteriorating sight secondary to dysthyroid optic neuropathy (DON) unresponsive to corticosteroid therapy. No previous reports describe vision outcomes in this specific patient population undergoing urgent endoscopic decompression.

Material and methods

Retrospective case review at a tertiary-care academic hospital. Four patients with DON were identified that underwent urgent endoscopic orbital decompression for acutely deteriorating vision. Three patients underwent a later decompression of the other orbit, yielding seven decompressions in total for acutely deteriorating vision. Operative technique entailed inferior and medial wall decompressions. The posterior limit of medial wall decompression was within the sphenoid, just anterior to the annulus of Zinn to fully decompress the optic nerve. Primary outcome was visual acuity.

Results

In all seven decompressions, visual acuity improved substantially. In 5/7 eyes, preoperative vision was severely impaired at 20/150 or worse. Two eyes had mild and moderate impairment at 20/50 and 20/100. Post-operatively, the moderately and severely impaired eyes improved to 20/60 or better. No complications were encountered.

Conclusion

Transnasal endoscopic orbital decompression is a safe, effective treatment for acutely worsening visual loss from DON. All cases demonstrated significant objective improvement in visual acuity. Given the need for later contralateral decompression in 3 patients, consideration should be given to performing bilateral orbital decompressions at the time of surgery.

https://ift.tt/2LD3rZ7

Welcome to YO-IFOS (Young Otolaryngologists of the International Federation of Oto-rhino-laryngological Societies)!

Publication date: Available online 28 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): N. Fakhry, N. Teissier

https://ift.tt/2N2EpHG

The development of new clinical instruments in laryngopharyngeal reflux disease: The international project of young otolaryngologists of the International Federation of Oto-rhino-laryngological Societies

Publication date: Available online 28 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): J.R. Lechien, A. Schindler, A.L. Hamdan, F. Bobin, M.R. Barillari, B. Harmegnies, D. Dequanter, A. Rodriguez, E. Bartaire, T. Ayad, P. Karkos, L. Crevier-Buchman, C. Finck, S. Saussez

Abstract

Introduction

To analyze the epidemiological characteristics of placebo controlled randomized trials (RCTs) that evaluated the effectiveness of medical treatments over placebo in laryngopharyngeal reflux (LPR).

Material and methods

PubMed, Cochrane database, and Scopus were assessed for subject headings using the PRISMA recommendations. Placebo RCTs published between 1990 and 2018 describing clinical evolution throughout LPR treatment were extracted and analyzed for evidence-based level, number of patients, inclusion and exclusion criteria, gender, age, symptoms and signs used as therapeutic outcomes, and treatment schemes.

Results

The database search identified 15 placebo RCTs with a total of 763 patients. The mean age of patients was 48.59 years and 52.68% of patients were female. Among the 15 placebo RCTs, 9 have demonstrated a partial or total superiority of a medical treatment over placebo. Most of authors based the LPR diagnosis on symptoms and signs without additional examination. Our analysis reveals an important heterogeneity between studies with regard to the diagnosis criteria, treatment schemes and signs and symptoms used as therapeutic outcomes. Many commonly reported signs and symptoms related to LPR were not used as therapeutic outcomes. Half of the authors did not prescribe diet and behavioral changes along the treatment.

Conclusion

The controversy in the RCTs about the superiority of medical treatment over placebo in LPR disease is probably due to discrepancies in the diagnosis method, exclusion criteria, therapeutic schemes and the lack of comprehensive tools for the assessment of signs and symptoms. In this context, the LPR Study Group of Young-Otolaryngologists of the International Federations of Oto-Rhino-Laryngological Societies developed two new instruments to precisely assess signs and symptoms throughout the treatment. These two instruments could be used in future trials comparing medical treatment over placebo in LPR disease.

https://ift.tt/2LFvaZg

The use of standardized order sets to improve adherence to evidence-based postoperative management in major head and neck surgery

Publication date: Available online 28 August 2018

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): S. Ansari, K. Fung, S.D. MacNeil, A.C. Nichols, J. Yoo, L.J. Sowerby

Abstract

Background

Standardized order sets (SOSs) are clinical tools derived from clinical care pathways that have shown improved patient-recovery and economic benefits. The primary objective was to examine the effect of SOSs on adherence to evidence-based postoperative guidelines for laryngectomy patients.

Methods

A retrospective chart review comparing handwritten and SOS-based postoperative physician orders was conducted for consecutive laryngectomies performed (n = 70) within a 3-year time period. Orders were analyzed for errors and deviations from evidence-based guidelines. Secondary outcome included complications such as thromboembolic disease, return to operating room, fistula formation, salivary bypass tube, length of hospital stay and death.

Results

Approximately 81% of cases utilizing handwritten orders had at least one error (n = 36) compared to 38% in the group that used an SOS (n = 34) (P < 0.0001). Subgroup analyses demonstrated that errors in mechanical deep vein thrombosis prophylaxis (P < 0.0001) and antibiotic prophylaxis (P = 0.0173) orders were significantly reduced in the SOS group compared to the handwritten group. No significant differences were observed between the two groups for measured postoperative complications (P > 0.05) and length of hospital stay (18.6 days in both SOS and handwritten orders groups).

Conclusions

SOSs are associated with reduced errors in postoperative orders. They are important tools to improve adherence to standardized guidelines for surgeries requiring complex postoperative management. Clinical care pathways and Enhanced Recovery After Surgery protocols can use SOSs to ensure appropriate orders are being made.

https://ift.tt/2PQ8g51

Advances Series, Advances and Highlights In Primary Immunodeficiencies 2017

Publication date: Available online 29 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Javier Chinen, Morton J. Cowan

Abstract

This manuscript reviews selected topics in primary immunodeficiency diseases (PIDD) published in 2017. These include:

1. The role of follicular T cells in the differentiation of B cells and development of optimal antibody responses.

2. Impaired NFkB1 signaling in the pathogenesis of common variable immunodeficiency (CVID) revealing an association between impaired B cell maturation and development of inflammatory conditions.

3. Autoimmune and inflammatory manifestations in PIDDs in T and B cell deficiencies, as well as in neutrophil disorders.

4. Newly described gene defects causing PIDD including: exostosin-like 3 (EXTL3), TNF-α–induced protein 3 (TNFAIP3, A20), ARPC1B (actin-related protein 2/3 complex-subunit 1B), v-Rel avian reticuloendotheliosis viral oncogene homolog A (RELA), hypoxia upregulated 1 (HYOU1), BTB Domain And CNC Homolog 2 (BACH2), CD70 and CD55.

5. The use of rapamycin and a PI3K inhibitor, leniolisib, to reduce autoimmunity and regulate B cell function in the activated phosphoinositide 3-kinase δ syndrome (APDS).

6. Improved outcomes in hematopoietic stem cell transplantation (HSCT) for severe combined immunodeficiency (SCID) in the last decade with an overall two-year survival of 90%, in part due to early diagnosis by the implementation of universal newborn screening.

7. The demonstration of efficacy of lentiviral vector mediated gene therapy for ADA-SCID.

8. The promise of gene editing for PIDD using CRISPR/Cas9 and Zinc Finger Nuclease technology for SCID and chronic granulomatous disease (CGD).

9. The efficacy of thymus transplantation in Europe, although associated with an unexpected high incidence of autoimmunity.

Thus, remarkable progress in the understanding and management of PIDDs reflects the current interest in this area and continues to improve the care of immunodeficient patients.

https://ift.tt/2wx71yr

Airways exudation of plasma macromolecules: in innate defense, epithelial regeneration, and asthma

Publication date: Available online 29 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Carl Persson;

Abstract

This review discusses in vivo airway aspects of plasma exudation in relation to current views on epithelial permeability and epithelial regeneration in health and disease. Microvascular-epithelial exudation of bulk plasma proteins characteristically occurs in asthma being especially pronounced in severe and exacerbating asthma. Healthy human and guinea-pig airways challenged by non-injurious histamine-leukotriene-type autacoids also respond by prompt mucosal exudation of non-sieved plasma macromolecules. Contrary to current beliefs, epithelial permeability in the opposite direction (=absorption of inhaled molecules) has not been increased in asthma and allergic rhinitis or in acutely exuding healthy airways. A slightly increased subepithelial hydrostatic pressure produces such unidirectional outward perviousness to macromolecules. Lack of increased absorption permeability in asthma may further be reconciled with occurrence of epithelial shedding leaving small patches of denuded basement membrane. Counteracting escalating barrier breaks, plasma exudation promptly covers the denuded patches. Here it creates, and sustains, a biologically active barrier involving a neutrophil-rich, fibrin-fibronectin net. Further, in the plasma-derived milieu all epithelial cell types bordering the denuded patch dedifferentiate and migrate from all sides to cover the denuded basement membrane. However, the speedy epithelial regeneration may come at a cost. Guinea-pig in vivo-studies demonstrate that patches of epithelial denudation-regeneration are exudation hot spots evoking asthma-like features including recruitment/activation of granulocytes, proliferation of fibrocyte/smooth muscle cells, and basement membrane thickening. In conclusion, non-sieved plasma macromolecules can operate on the intact airway mucosa as potent components of first line innate immunity responses. Exuded plasma also takes center stage in epithelial regeneration. When exaggerated, epithelial regeneration may contribute to inception and development of asthma.

https://ift.tt/2wqCOC3

Breastfeeding and Delivery Mode Modify the Association between Maternal Atopy and Childhood Allergic Outcomes

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Alexandra Rene Sitarik, Nena Sabri Kasmikha, Haejin Kim, Ganesa Wegienka, Suzanne Havstad, Dennis Ownby, Edward Zoratti, Christine Cole Johnson

https://ift.tt/2wwVIGH

Hypomorphic CARD11 mutations associated with diverse immunologic phenotypes with or without atopic disease

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Batsukh Dorjbal, Jeffrey R. Stinson, Chi A. Ma, Michael A. Weinreich, Bahar Miraghazadeh, Julia M. Hartberger, Stefanie Frey-Jakobs, Stephan Weidinger, Lena Moebus, Andre Franke, Alejandro A. Schäffer, Alla Bulashevska, Sebastian Fuchs, Stephan Ehl, Sandhya Limaye, Peter D. Arkwright, Tracy A. Briggs, Claire Langley, Claire Bethune, Andrew F. Whyte

Abstract

Background

CARD11 encodes a scaffold protein in lymphocytes that links antigen receptor engagement with downstream signaling to NF-κB, JNK, and mTORC1. Germline CARD11 mutations cause several distinct primary immune disorders in humans, including SCID (biallelic null mutations), B cell Expansion with NF-κB and T cell Anergy (BENTA; heterozygous, gain-of-function mutations), and severe atopic disease (loss-of-function, heterozygous, dominant interfering mutations), which has focused attention on CARD11 mutations discovered by whole exome sequencing.

Objectives

To determine the molecular actions of an extended allelic series of CARD11, and to characterize the expanding range of clinical phenotypes associated with heterozygous CARD11 loss-of-function alleles.

Methods

Cell transfections and primary T cell assays were utilized to evaluate signaling and function of CARD11 variants.

Results

Here we report on an expanded cohort of patients harboring novel heterozygous CARD11 mutations that extend beyond atopy to include other immunologic phenotypes not previously associated with CARD11 mutations. In addition to (and sometimes excluding) severe atopy, heterozygous missense and indel mutations in CARD11 presented with immunologic phenotypes similar to those observed in STAT3-LOF, DOCK8 deficiency, common variable immune deficiency (CVID), neutropenia, and immune dysregulation, polyendocrinopathy, enteropathy, X-linked (IPEX)-like syndrome. Pathogenic variants exhibited dominant negative activity, and were largely confined to the CARD or coiled-coil domains of the CARD11 protein.

Conclusion

These results illuminate a broader phenotypic spectrum associated with CARD11 mutations in humans, and underscore the need for functional studies to demonstrate that rare gene variants encountered in expected and unexpected phenotypes must nonetheless be validated for pathogenic activity.

https://ift.tt/2omqLkY

Flow Cytometry: Surface Markers and Beyond

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Ottavia M. Delmonte, Thomas A. Fleisher

Abstract

Flow cytometry is a routinely available laboratory method to study cells in suspension from a variety of human sources. The application of this technology as a clinical laboratory method has evolved from the identification of cell surface proteins to characterizing intracellular proteins and providing multiple different techniques to assess specific features of adaptive and innate immune function. This expanded menu of flow cytometry testing approaches has increased the utility of this platform in characterizing and diagnosing disorders of immune function.

https://ift.tt/2Nt9aT7

Practice Pattern Changes and Improvements in Hematopoietic Cell Transplantation for Primary Immunodeficiencies

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Rebecca Marsh, Kyle M. Hebert, Daniel Keesler, Jaap J. Boelens, Christopher Dvorak, Michael J. Eckrich, Neena Kapoor, Suhag Parikh, Mary Eapen

https://ift.tt/2oiovLt

Risk factors for H. influenzae and pneumococcal respiratory tract colonization in CVID

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Federica Pulvirenti, Romina Camilli, Maria Giufrè, Cinzia Milito, Fernanda Pimentel de Araujo, Fabiola Mancini, Rita Cardines, Alessandra Ciervo, Annalisa Pantosti, Marina Cerquetti, Isabella Quinti

https://ift.tt/2wwejmk

Predicting steroid responsiveness in asthmatic children: are we there yet?

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): Peter D. Sly, Patrick G. Holt

https://ift.tt/2ohaLRc

Allergen content in German cockroach extracts and sensitization profiles to a new expanded set of cockroach allergens determine in vitro extract potency for IgE reactivity

Publication date: Available online 28 August 2018

Source: Journal of Allergy and Clinical Immunology

Author(s): J. Glesner, S. Filep, L.D. Vailes, S. Wünschmann, M.D. Chapman, G. Birrueta, A. Frazier, K.Y. Jeong, C. Schal, L. Bacharier, A. Beigelman, P. Busse, V. Schulten, A. Sette, A. Pomés

Abstract

Background

Cockroach allergens are an important cause of IgE-mediated sensitization in inner-city asthmatics. However, cockroach extracts used for diagnosis and immunotherapy are not standardized.

Objective

To determine the allergen content of non-standardized German cockroach extracts and the levels of sensitization to an expanded set of cockroach allergens as determinants of in vitro extract potency for IgE reactivity.

Methods

Twelve German cockroach extracts were compared for allergen content and for potency of IgE reactivity. Bla g 1, Bla g 2 and Bla g 5 were measured by immunoassays. IgE antibody levels to eight purified recombinant allergens from groups 1, 2, 4, 5, 6, 7, 9 and 11 were measured by ImmunoCAP. IgE antibody binding inhibition assays were performed to assess extract in vitro potencies (IC30) relative to an arbitrarily selected reference extract in five cockroach allergic subjects.

Results

Allergen levels were highly variable. Three new major allergens (groups 6, 9 and 11), were identified among highly cockroach-sensitized subjects (CAP-class ≥ 3). Sensitization profiles were unique per subject, without immunodominant allergens. The sum of IgE to eight allergen components showed a good correlation with cockroach-specific IgE (r = 0.88; p < 0.001). In vitro potencies varied among different extracts per subject, and among subjects for each extract.

Conclusions

The in vitro potency of German cockroach extracts for IgE reactivity depends on allergen content and allergen-specific IgE titers of the cockroach-allergic subject. These factors are relevant for selection of potent extracts to be used for immunotherapy and for the design and interpretation of data from immunotherapy trials.

Clinical Implications

Allergen content, variable in non-standardized German cockroach extracts, and IgE sensitization profiles to a new expanded set of cockroach allergens determine in vitro extract potency for IgE reactivity.

https://ift.tt/2NuIce0

Molecular patterns in the isotype-specific antibody responses to the major cedar aeroallergen Jun a 1

Publication date: September 2018

Source: Molecular Immunology, Volume 101

Author(s): Randall M. Goldblum, Rumali S. Madagoda-Desilva, Yueqing Zhang, Julius van Bavel, Terumi Midoro-Horiuti

Abstract

Most studies of the immune responses in allergic rhinitis have focused on IgE antibodies to mixtures of allergenic proteins. Based on our previous studies of the major mountain cedar allergen Jun a 1, we sought to describe a broader assessment of the humoral immune responses to a single, dominant allergen, in three groups of allergic subjects, all of whom had similarly exposures to the whole cedar pollen. The major outcomes of this study was that, with the onset of allergic rhinitis symptoms, and after treatment with immunotherapy, serum IgE and IgG (but not IgA) antibodies to Jun a 1 increased. Interestingly, both IgE and IgG4 antibodies to the Jun a 1 allergen were strongly focused on its conformation epitopes. These IgG antibodies to conformationalstructures may be a useful marker of the therapeutic response to immunotherapy.

https://ift.tt/2wpyaV3

Activation of NF-κB induced by TRIMCyp showing a discrepancy between owl monkey and northern pig-tailed macaque

Publication date: Available online 28 August 2018

Source: Molecular Immunology

Author(s): Jia-Wu Zhu, Dan Mu, Feng-Liang Liu, Meng-Ting Luo, Rong-Hua Luo, Yong-Tang Zheng

Abstract

TRIMCyp generated by retrotransposition of a cyclophilin A inserting into TRIM5 locus, has been identified in owl monkey and most of Old World monkeys (OWM). Owl monkey TRIMCyp (omTRIMCyp) inhibits HIV-1 infection by direct interaction with viral capsid and indirect innate immune induction, whereas most of TRIMCyps from OWM cannot inhibit HIV-1, and the impact of which on immunoregulation is largely unknown. Here we reported that omTRIMCyp induces NF-κB, AP-1 and IFN-β activation in a dose-dependent manner, while TRIMCyp from northern pig-tailed macaque (npmTRIMCyp) does not activate NF-κB and moderately enhances AP-1 and IFN-β activities. The Cyclophilin A (CypA) domain plays an important role in omTRIMCyp-mediated NF-κB activation, and RBCC domains have a synergetic effect. We further indicated the mechanism by which npmTRIMCyp unable to activate NF-κB is that npmTRIMCyp hardly phosphorylates IκBα, different from omTRIMCyp which dramatically induces IκBα phosphorylation. Ubiquitination activity of omTRIMCyp was greater than npmTRIMCyp, although both could be ubiquitylated. Given that npmTRIMCyp neither interacts with viral capsid resulting in susceptibility to HIV-1 infection, nor activates NF-κB that is indispensable to HIV-1 provirus transcription, we proposed a model that npmTRIMCyp may play an important role in HIV-1 infected northern pig-tailed macaque with latency.

https://ift.tt/2PieEAz

Comparison of targeted next generation sequencing (NGS) versus isolated BRAF V600E analysis in patients with metastatic melanoma

Abstract

Molecular testing on advanced metastatic melanoma is critical for guiding targeted therapy. Traditionally, this analysis has relied on isolated BRAF V600E analysis; however, more recently targeted next generation sequencing (NGS) is being utilized. The clinical utility of BRAF V600E allele-specific PCR and targeted NGS were compared for metastatic melanoma samples sent to UHCMC pathology during a two and half year span. In two thirds of cases, negative for BRAF V600E, additional mutations were detected that may stratify patients for potential or approved targeted therapies. Targeted-NGS testing is feasible and cost-affordable and provides additional potentially actionable information for patients with BRAF V600E/K negative metastatic melanoma. Based on this analysis, we have adopted to screen patients with advanced melanoma with allele-specific V600E/K PCR and reflex negative cases for targeted NGS to maximize patient benefit.

https://ift.tt/2N16sqX

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Τετάρτη 29 Αυγούστου 2018

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