Esthetic and functional result of crooked nose treatment; internal microperforating osteotomy and subtotal septal reconstruction

Abstract

Crooked nose is mostly characterized by a deviation of both the bone and the cartilaginous parts of the nose. In order to obtain proper functional and improved esthetic results, both of these parts have to be corrected. The objective of this study is to evaluate the esthetical and the functional outcomes following correction procedures of the bone pyramid through internal microperforating technique and the cartilaginous part through subtotal septal reconstruction. The medical records of 158 patients who have undergone through primary septorhinoplasty for crooked nose treatment during the period of 21 June 2016 and 31 July 2017 have been reviewed. Functional results have been evaluated using the Nasal Obstruction Symptom Evaluation (NOSE) scores and the esthetical results through Rhinoplasty Outcome Evaluation (ROE) scores. The observation times have been arranged preoperatively as 6 months–1 year (group 1) and 1–2 years (group 2). Septorhinoplasty procedure has been performed on 158 patients with crooked noses. Out of this number, 104 of the patients (65.8%) were women and 54 were men (34.2%). The average age of the patients was 31.59 (9.3%), all of who have undergone this procedure. There was a significant improvement (P < 0.001) in the NOSE and the ROE scores of group 1 and group 2, which was statistically significant. There was no difference between group 1 and group 2. In crooked nose treatment, correction of the deviated bone pyramid using internal microperforating osteotomy and correction of the severely deviated septum using subtotal septal reconstruction yield improved functional and esthetic results.

Level of Evidence: Level V, therapeutic study.

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Coffee May Reduce Rosacea Risk

Caffeinated coffee was associated with a significant reduction in risk of rosacea but other sources of caffeine, such as soda and tea, did not appear protective.
Medscape Medical News

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Innate immune priming of insulin secretion

Elise Dalmas

https://ift.tt/2S11XfI

Oxeiptosis: a discreet way to respond to radicals

Pietro Scaturro | Andreas Pichlmair

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Surgical technique and chylothorax following coronary artery bypass grafting

Achilleas Lazopoulos, Dimitrios Paliouras, Nikolaos Barbetakis

Annals of Cardiac Anaesthesia 2018 21(4):468-468



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Predictors of acute kidney injury in patients undergoing adult cardiac surgery

Sreja Gangadharan, KR Sundaram, Senthilvelan Vasudevan, B Ananthakrishnan, Rakhi Balachandran, Abraham Cherian, Praveen Kerala Varma, Luis Bakero Gracia, K Murukan, Ashish Madaiker, Rajesh Jose, Rakesh Seetharaman, Kirun Gopal, Sujatha Menon, M Thushara, Reshmi Liza Jose, G Deepak, Sudheer Babu Vanga, Aveek Jayant

Annals of Cardiac Anaesthesia 2018 21(4):448-454

Background: Acute kidney injury (AKI) after cardiac surgery (CS) is not uncommon and has serious effects on mortality and morbidity. A majority of patients suffer mild forms of AKI. There is a paucity of Indian data regarding this important complication after CS. Aims and Objectives: The primary objective was to study the incidence of AKI associated with CS in an Indian study population. Secondary objectives were to describe the risk factors associated with AKI-CS in our population and to generate outcome data in patients who suffer this complication. Methods: Serial patients (n = 400) presenting for adult CS (emergency/elective) at a tertiary referral care hospital in South India from August 2016 to November 2017 were included as the study individuals. The incidence of AKI-CS AKI network (AKIN criteria), risk factors associated with this condition and the outcomes following AKI-CS are described. Results: Out of 400, 37 (9.25%) patients developed AKI after CS. AKI associated with CS was associated with a mortality of 13.5% (no AKI group mortality 2.8%, P = 0.001 [P < 0.05]). When AKI was severe enough to need renal replacement therapy, the mortality increased to 75%. Patients with AKI had a mean hospital stay 16.92 ± 12.75 days which was comparatively longer than patients without AKI (14 ± 7.98 days). Recent acute coronary syndrome, postoperative atrial fibrillation, and systemic hypertension significantly predicted the onset of AKI-CS in our population. Conclusions: The overall incidence of AKI-CS was 9.25%. The incidence of AKI-CS requiring dialysis (Stage 3 AKIN) AKI-CS was lower (2%). However, mortality risks were disproportionately high in patients with AKIN Stage 3 AKI-CS (75%). There is a need for quality improvement in the care of patients with AKI-CS in its most severe forms since mortality risks posed by the development of Stage 3 AKIN AKI is higher than reported in other index populations from high resource settings.

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Facilitating noncardiac surgery for the patient with left ventricular assist device: A guide for the anesthesiologist

Kai-Yin Hwang, Nian-Chih Hwang

Annals of Cardiac Anaesthesia 2018 21(4):351-362

The introduction of left ventricular assist device (LVAD) has improved survival rates for patients with end-stage heart failure. Two categories of VADs exist: one generates pulsatile flow and the other produces nonpulsatile continuous flow. Survival is better for patients with continuous-flow LVADs. With improved survival, more of such patients now present for noncardiac surgery (NCS). This review, written for the general anesthesiologists, addresses the perioperative considerations when the patient undergoes NCS. For best outcomes, a multidisciplinary approach is essential in perioperative management of the patient.

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Unrecognized hyperlucent lesion on lateral film of chest X-Ray

Ankita Singh, Navneet Kumar Srivastva, Prabhat Tewari, Gauranga Majumdar

Annals of Cardiac Anaesthesia 2018 21(4):440-441

We report an interesting case of bulla right lung, incidently found during CABG surgery.

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The efficacy of different modes of analgesia in postoperative pain management and early mobilization in postoperative cardiac surgical patients: A systematic review

Brenda Nachiyunde, Louisa Lam

Annals of Cardiac Anaesthesia 2018 21(4):363-370

Cardiac surgery induces severe postoperative pain and impairment of pulmonary function, increases the length of stay (LOS) in hospital, and increases mortality and morbidity; therefore, evaluation of the evidence is needed to assess the comparative benefits of different techniques of pain management, to guide clinical practice, and to identify areas of further research. A systematic search of the Cochrane Central Register of Controlled Trials, DARE database, Joanna Briggs Institute, Google scholar, PUBMED, MEDLINE, EMBASE, Academic OneFile, SCOPUS, and Academic search premier was conducted retrieving 1875 articles. This was for pain management postcardiac surgery in intensive care. Four hundred and seventy-one article titles and 266 abstracts screened, 52 full text articles retrieved for critical appraisal, and ten studies were included including 511 patients. Postoperative pain (patient reported), complications, and LOS in intensive care and the hospital were evaluated. Anesthetic infiltrations and intercostal or parasternal blocks are recommended the immediate postoperative period (4–6 h), and patient-controlled analgesia (PCA) and local subcutaneous anesthetic infusions are recommended immediate postoperative and 24–72 h postcardiac surgery. However, the use of mixed techniques, that is, PCA with opioids and local anesthetic subcutaneous infusions might be the way to go in pain management postcardiac surgery to avoid oversedation and severe nausea and vomiting from the narcotics. Adequate studies in the use of ketamine for pain management postcardiac surgery need to be done and it should be used cautiously.

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Missing swan ganz catheter

Monish S Raut, Arun Maheshwari

Annals of Cardiac Anaesthesia 2018 21(4):462-463



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Tissue oximetry during cardiac surgery and in the cardiac intensive care unit: A prospective observational trial

Benjamin J Heller, Pranav Deshpande, Joshua A Heller, Patrick McCormick, Hung-Mo Lin, Ruiqi Huang, Gregory Fischer, Menachem M Weiner

Annals of Cardiac Anaesthesia 2018 21(4):371-375

Background: Cerebral oximetry using near-infrared spectroscopy (NIRS) has well-documented benefits during cardiac surgery. The authors tested the hypothesis that NIRS technology can be used at other sites as a tissue oximeter during cardiac surgery and in the Intensive Care Unit (ICU). Aims: To establish feasibility of monitoring tissue oximetry during and after cardiac surgery, to examine the correlations between tissue oximetry values and cerebral oximetry values, and to examine correlations between oximetry values and mean arterial pressure (MAP) in order to test whether cerebral oximetry can be used as an index organ. Settings and Designs: A large, single-center tertiary care university hospital prospective observational trial of 31 patients undergoing cardiac surgery with cardiopulmonary bypass was conducted. Materials and Methods: Oximetry stickers were applied to both sides of the forehead, the nonarterial line forearm, and the skin above one paraspinal muscle. Data were collected from before anesthesia induction until extubation or for at least 24 h in patients who remained intubated. Statistical Analysis: Categorical variables were evaluated with Chi-square or Fisher's exact tests, while Wilcoxon rank-sum tests or student's t-tests were used for continuous variables. Results: The correlation between cerebral oximetry values and back oximetry values ranged from r = 0.37 to 0.40. The correlation between cerebral oximetry values and forearm oximetry values ranged from r = 0.11 to 0.13. None of the sites correlated with MAP. Conclusions: Tissue oximetry at the paraspinal muscle correlates with cerebral oximetry values while at the arm does not. Further research is needed to evaluate the role of tissue oximetry on outcomes such as acute renal failure, prolonged need for mechanical ventilation, stroke, vascular ischemic complications, prolonged ICU and hospital length of stay, and mortality in cardiac surgery.

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The value of institutional protocols and focused cardiac ultrasound during a case of ultramassive transfusion

Muhammad Salman Tahir Janjua, Shvetank Agarwal, Manuel R Castresana

Annals of Cardiac Anaesthesia 2018 21(4):433-436

A 53-year-old female was admitted to the emergency department with an exsanguinating bleed from the rectum which was of unclear origin. In what could be considered an ultramassive transfusion, 60 units packed red blood cells, 23 units fresh frozen plasma, 20 units platelets, 6 units cryoprecipitate, 30 L of crystalloids, 2 L of colloids, and 4 g of tranexamic acid were transfused over the course of 7 h. An arterio-enteric fistula was diagnosed and treated by an interventional radiologist. The patient recovered rapidly thereafter without any major neurologic, pulmonary, cardiac, or hematologic complications.

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Preoperative predictors of poor laryngoscope views in pediatric population undergoing cardiac catheterization

Madan Mohan Maddali, Haifa Mohammed Ali Al-Zaabi, Is'haq Said Salim Al-Aamri, Nishant Ram Arora, Sathiya Murthi Panchatcharam

Annals of Cardiac Anaesthesia 2018 21(4):376-381

Background: The primary objective of this study was to identify pre-anesthetic airway assessment parameters that would predict Cormack and Lehane grade III and IV laryngoscopy views in pediatric patients undergoing cardiac catheterization procedures. The secondary end points were to identify factors that would contribute to difficult laryngoscope views in this subset of patients. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Materials and Methods: 199 children below 5 years of age undergoing elective cardiac catheterization were included. Pre-anesthetic airway assessment was done by modified Mallampati grading, lower lip to chin distance [LCD], tragus to mouth angle [TMA], thyromental distance [TMD], neck circumference [NC], and the ratio of height to thyromental distance [RHTMD]. Demographic data including American Society of Anesthesiologists physical status [ASA PS] were recorded for each child. Receiver Operating Characteristic curves were plotted and Areas Under the Curve were measured to identify the best cut off values for each of the airway evaluation method that would predict poor laryngoscopy views as well as assess their accuracy in doing so. Results: LCD, TMD and low body mass index were found to have good sensitivity, specificity and accuracy in predicting Grade III and IV laryngoscope views. ASA PS grade III and above patients had a significantly higher incidence of poor laryngoscope visualization. Conclusions: LCD, TMA, TMD, NC, RHTMD and BMI could all be used combinedly as screening tools during pre-anesthetic airway evaluation for predicting difficult laryngoscope views in children. Among these, LCD, TMD along with low body mass index might have better accuracy.

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Abdominal compartment syndrome after surgical repair of Type A aortic dissection

Fotini Ampatzidou, Athanasios Madesis, George Kechagioglou, George Drossos

Annals of Cardiac Anaesthesia 2018 21(4):444-445

Abdominal compartment syndrome is associated with severe dysfunction of intra-abdominal and intrathoracic organs. Medical therapy, with the goal of reducing intra-abdominal pressure, leads to improvement in organ perfusion.

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Usefulness of ultrasound-guided measurement of minimal transverse diameter of subglottic airway in determining the endotracheal tube size in children with congenital heart disease: A prospective observational study

Rahul Pillai, Suresh Kumaran, L Jeyaseelan, Sajan P George, Raj Sahajanandan

Annals of Cardiac Anaesthesia 2018 21(4):382-387

Introduction: The search for an accurate and predictable method to estimate the endotracheal tube (ETT) size in pediatric population had led to derivation of many formulae. Of this, age-based formulae are the most commonly used. Studies have shown that minimal transverse diameter of subglottic airway (MTDSA) measurements using a high-frequency probe improves the success rate of predicting the airway diameter to about 90%. We did a prospective observational study using MTDSA as the criteria to select the size of ETT in children with congenital heart disease. Methods: In this prospective observational study, 51 children aged from 1 day to 5 years, scheduled for cardiac surgery, were enrolled for this study. The ETT size was guided solely based on the MTDSA. Leak test was used to determine the best-fit ETT size. Results: Data from 49 patients were analyzed. Agreement between the ETT determined by MTDSA and that predicted by Cole's age-based formulas with the best-fit ETT size was analyzed using a Bland–Altman plot. Conclusion: Age-based formula showed poor correlation (27.5%) compared to MTDSA (87.8%) in predicting the best-fit ETT. We observed that pediatric patients with congenital heart disease need a larger sized ETT as compared to what was predicted by age-based formula. Using ultrasound MTDSA measurements to guide selection of ETT size is a safe and accurate method in pediatric cardiac population.

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Is routine preoperative chest X-ray: An underutilized tool in asymptomatic patients!

Swati Jindal, Satinder Gombar, Kompal Jain

Annals of Cardiac Anaesthesia 2018 21(4):460-461



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Dreams content and emotional load in cardiac rehabilitation patients and their relation to anxiety and depression

Saeid Komasi, Ali Soroush, Habibolah Khazaie, Ali Zakiei, Mozhgan Saeidi

Annals of Cardiac Anaesthesia 2018 21(4):388-392

Background: The assessment of a dream and its mechanisms and functions may help us to percept cognitions, emotions, and complex behaviors of patients. Hence, the present study aimed to assess (i) the rate of perceived dream and its emotional load and content and (ii) the relationship between functions of dream with anxiety and depression. Methods: In this cross-sectional study, 167 cardiac patients who had undergone rehabilitation in the western part of Iran were assessed during May–October 2016. Research instrument included Beck depression inventory, Beck anxiety inventory, Schredl's dream emotions manual, and content analysis of dreams manual. The findings were analyzed through Pearson's correlative coefficient and multiple regression analysis. Results: The mean age of participants (66.5% men) was 59.1 ± 9 years. The results indicated that the emotional content of patients' dreams included happiness (49.1%), distress (43.1%), sad (13.8%), fear (13.2%), and anger (3%). Although women report more sad dreams than men (P = 0.026), there was no difference between them in terms of other components of dreams, anxiety, and depression. Regression models showed that anxiety and depression were significantly able to predict perceived dream rates (P = 0.030) and emotionally negative dreams (P = 0.019). Conclusion: The increased rates of depression, especially anxiety, are related to increasing perceived dreams with negative and harmful emotional load. Regarding severity and negative content of dreams are reflexes of stressful emotional daily experiences, the management of experienced psychological symptoms such as depression and anxiety is concerned as an undeniable necessity.

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Anesthesia considerations in neonate with tetralogy of fallot posted for laparotomy

Sushama Raghunath Tandale, Kalpana V Kelkar, Amey A Ghude, Priyanka V Kambale

Annals of Cardiac Anaesthesia 2018 21(4):465-466



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Is elevated blood glucose a marker of occult tissue hypoperfusion in off-pump coronary artery bypass grafting?

Soumi Das, Kakali Ghosh, Avijit Hazra, Chaitali Sen, Anupam Goswami

Annals of Cardiac Anaesthesia 2018 21(4):393-401

Context: Hyperglycemia has been found to occur during myocardial infarction and cardiac surgery even in nondiabetic patients. These being essentially stressful processes associated with hypoperfusion, we decided to find a possible relationship between the occurrence of global tissue hypoperfusion (GTH) and elevated blood glucose level in adult nondiabetic patients undergoing elective off-pump coronary artery bypass grafting (CABG). Aims: This study aims to observe for the occurrence of global tissue hypoperfusion and its effect on blood glucose level and whether raised blood glucose level can be used as a marker for GTH. Design: Prospective, observational study. Settings: Cardiothoracic operation theater and intensive care unit of a tertiary care teaching hospital. Materials and Methods: The occurrence of global tissue hypoperfusion were detected with the help of combined markers of mixed venous oxygen saturation and arterial lactate level at various perioperative study points together with arterial blood glucose level. Blood glucose level compared between the patients with and without GTH. Statistical Analysis Used: Numerical variables were compared between groups by Student's t-test and categorical variables by Fisher's exact test. Two-tailed P ≤ 0.05 was considered for statistically significant. Results: The incidence of GTH was 67%. Blood glucose level was raised in patients with GTH at some study time points but with poor sensitivity and specificity values. Conclusions: Global tissue hypoperfusion is a common occurrence in even nondiabetic patients undergoing elective off-pump CABG. A relationship exists between rise in blood glucose level and global tissue hypoperfusion in such patients, although it cannot be viewed as marker of the same.

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Statistical literacy for healthcare professionals: Why is it important?

Rakesh Aggarwal

Annals of Cardiac Anaesthesia 2018 21(4):349-350



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Predictors and outcome of early extubation in infants postcardiac surgery: A single-center observational study

Shahzad Alam, Akunuri Shalini, Rajesh G Hegde, Rufaida Mazahir, Akanksha Jain

Annals of Cardiac Anaesthesia 2018 21(4):402-406

Objective: The objective of the current study was to evaluate the timing of first extubation and compare the outcome of patient extubated early with others; we also evaluated the predictors of early extubation in our cohort. Materials and Methods: This prospective cohort study included children <1 year of age undergoing surgery for congenital heart disease. Timing of first extubation was noted, and patients were dichotomized in the group taking 6 h after completion of surgery as cutoff for early extubation. The outcome of the patients extubated early was compared with those who required prolonged ventilation. Variables were compared between the groups, and predictors of early extubation were evaluated using multivariate logistic regression analysis. Results: One hundred and ninety-four (33.8%) patients were extubated early including 2 extubation in operating room and 406 (70.7%) were extubated within 24 h. Four (0.7%) patients died without extubation. No significant difference in mortality and reintubation was observed between groups. Patient extubated early had a significant lower incidence of sepsis (P = 0.003) and duration of Intensive Care Unit (ICU) stay (P = 0.000). Age <6 months, risk adjustment for congenital heart surgery category ≥3, cardiopulmonary bypass time ≥80 min, aortic cross-clamp time ≥ 60 min, and vasoactive-inotropic score >10 were independently associated with prolonged ventilation. Conclusion: Early extubation in infants postcardiac surgery lowers pediatric ICU stay and sepsis without increasing the risk of mortality or reintubation. Age more than 6 months, less complex of procedure, shorter surgery time, and lower inotropic requirement are independent predictors of early extubation.

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Right atrial myxoma: Unusual location; uncommon association

Om Prakash Sanjeev, Soumya Sankar Nath, Deepak Malviya, Subhas Singh Rajput

Annals of Cardiac Anaesthesia 2018 21(4):437-439

We are presenting a case of the right atrial myxoma found in a case of rheumatic heart disease. During transthoracic echocardiography for the evaluation of a suspected rheumatic valvular heart disease, a diagnosis of severe mitral stenosis with severe mitral regurgitation with the right atrial thrombus was made. On transesophageal echocardiography, a pedunculated mass in the right atrium was confirmed. In the course of surgery, it was found that there is a tumor originating from the right atrial appendage (RAA) which was confused with clot on echocardiography. Rheumatic heart disease and myxomas have different etiopathogenesis, and this coexistence has not been reported. Further, right atrial myxoma arising out of RAA is also being reported for the first time.

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Predictors and outcome of early extubation in infants postcardiac surgery: A single-center observational study

Bhupesh Kumar, Ganesh Kumar Munirathinam

Annals of Cardiac Anaesthesia 2018 21(4):407-408



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Aortic regurgitation after chemoport catheter insertion: Diagnostic dilemma

Vijay Mohan Hanjoora, Gaurav Gupta, Monish S Raut

Annals of Cardiac Anaesthesia 2018 21(4):442-443

Catheter insertion in central vein can potentially cause accidental arterial injury. However it is very unusual to see such catheter in aorta causing aortic regurgitation. Pressure monitoring and Ultrasound guidance can reliably prevent accidental arterial puncture.

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Mesenchymale Stammzellen: Tumorfördernde oder -hemmende Eigenschaften – Ein aktueller Überblick

Laryngo-Rhino-Otol 2018; 97: 678-687
DOI: 10.1055/a-0650-4673

Eine multimodale Tumortherapie richtet sich nicht nur gegen die Tumorzellen, sondern beeinflusst auch das tumorumgebende Stroma. Das Tumorstroma beherbergt verschiedene nicht-maligne Zellen, unter anderem Fibroblasten, Immunzellen, aber auch mesenchymalen Stammzellen (MSC). MSC haben die Fähigkeit der Migration in Richtung Tumorgewebe. Welche Einflüsse MSC auf Tumorzellen ausüben wird in der gängigen Literatur kontrovers diskutiert. Die meisten Publikationen berichten von tumorfördernden Eigenschaften der MSC, welche über vier Hauptmechanismen ermöglicht werden: Die Sekretion löslicher Mediatoren verbunden mit Zell-Zell-Kontakten, die Transdifferenzierung der MSC in tumorassoziierte Fibroblasten, die Verbesserung der Neoangiogenese und zuletzt die Einleitung einer Immunsuppression durch MSC. In dieser Übersicht wird über den aktuellen Stand der Literatur referiert.
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Ambulante Cochlea-Implantation: was führt zur stationären Aufnahme?

Laryngo-Rhino-Otol 2018; 97: 664-665
DOI: 10.1055/a-0651-3971

Patel TA et al. Clinical Indicators of Admission for Pediatric Cochlear Implant Procedures. Ann Otol Rhinol Laryngol 2018; 127: 470–474 Eine ambulante Cochlea-Implantation bei Kindern gilt als sicher. Allerdings wird eine Minderheit über Nacht stationär aufgenommen. In Studien wird nahezu ausschließlich über postoperative Komplikationen und Behandlungsergebnisse und kaum über prognostische Indikatoren des Outcomes berichtet. Daher suchten amerikanische HNO-Ärzte nach Parametern, die mit der stationären Aufnahme korrelieren und prüften die Auswirkungen auf das klinische Ergebnis.
[...]

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Larynxpapillomatose

Laryngo-Rhino-Otol 2018; 97: 670-671
DOI: 10.1055/a-0652-6483

Humane Papillomviren verursachen den gutartigen Epitheltumor, der bei Kehlkopfbefall zu Heiserkeit und Atemnot führt. Die Larynxpapillomatose ist nicht heilbar, gegenwärtig ist die phonochirurgische Behandlung das Mittel der Wahl.
[...]

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Komplikationen nach Septumplastik analysiert

Laryngo-Rhino-Otol 2018; 97: 665-666
DOI: 10.1055/a-0651-3994

Dąbrowska-Bień J et al. Complications in septoplasty based on a large group of 5639 patients. Eur Arch Otorhinolaryngol 2018; 275: 1789–1794 In der Literatur fehlen Angaben zu Komplikationen nach alleiniger Septumplastik sowie der Kombination von Septumplastik mit Nasenmuschelreduktion in großen Populationen. Eine Arbeitsgruppe aus Warschau versuchte Komplikationen bei der Septumplastik zu bestimmen und die Inzidenz in Abhängigkeit von der Operationstechnik zu analysieren.
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Diagnostik und operative Therapie der Otosklerose

Laryngo-Rhino-Otol 2018; 97: 717-734
DOI: 10.1055/a-0652-6494

Für die – oft in Diagnostik und Therapie anspruchsvolle – Otosklerose kann bei richtiger Diagnosestellung eine operative oder apparative Hörrehabilitation mit sehr hohen Erfolgschancen in Aussicht gestellt werden. Der erste Teil des Fortbildungsbeitrags umfasste Grundlagen, Diagnostik und Differenzialdiagnostik, im zweiten Teil soll auf therapeutische Aspekte und Nachsorge eingegangen werden.
[...]

Georg Thieme Verlag KG Stuttgart · New York

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Mundhöhlenkarzinom: Optionen zum Erhalt der Unterkieferspeicheldrüse

Laryngo-Rhino-Otol 2018; 97: 666-668
DOI: 10.1055/a-0651-4005

Cakir Cetin A et al. Submandibular gland invasion and feasibility of gland-sparing neck dissection in oral cavity carcinoma. J Laryngol Otol 2018; 132: 446–451 Ärzte der medizinischen Fakultät der Universität in Izmir untersuchten Inzidenz und relevante Faktoren die mit der Beteiligung Unterkieferspeicheldrüse am Mundhöhlenkarzinom assoziiert sind. Insbesondere deswegen, um herauszufinden, ob in einem frühen Stadium des Plattenepithelkarzinoms der Mundhöhle die Möglichkeit besteht, die Unterkieferspeicheldrüse zu erhalten.
[...]

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Anmerkungen zur Minimal-invasiven Otoplastik (MIO)

Laryngo-Rhino-Otol 2018; 97: 672-677
DOI: 10.1055/a-0671-4010

Die minimal-invasive Otoplastik (MIO) ist nach unseren inzwischen sehr umfangreichen Erfahrungen eine zuverlässige Technik zur Korrektur abstehender Ohren. Sie bringt bei richtiger Indikation ästhetisch ansprechende natürliche und dauerhafte Ergebnisse. Die Grenzen der minimalinvasiven Technik müssen allerdings erkannt und berücksichtigt werden. Neue Instrumente erleichtern den Eingriff und verringern Komplikationsraten. V. a. Keloide und große hypertrophe Narben infolge ausgedehnter Hautinzisionen und -resektionen auf der Ohrmuschelrückseite sind mit der MIO fast ausgeschlossen.Wir stellen unser über zwei Jahrzehnte gewachsenes operatives Konzept vor.
[...]

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Expertise Plastische Chirurgie

Laryngo-Rhino-Otol 2018; 97: 669-669
DOI: 10.1055/a-0674-8368

© Georg Thieme Verlag KG Stuttgart · New York

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Rechtliche Aspekte der Digitalisierung in der Medizin

Laryngo-Rhino-Otol 2018; 97: 713-716
DOI: 10.1055/a-0652-6505

© Georg Thieme Verlag KG Stuttgart · New York

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2018; 97: 735-736
DOI: 10.1055/a-0652-6516

© Georg Thieme Verlag KG Stuttgart · New York

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Fehlbildungschirurgie von Nase und Lippe

Laryngo-Rhino-Otol 2018; 97: 737-739
DOI: 10.1055/a-0652-6560

© Georg Thieme Verlag KG Stuttgart · New York

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Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2018; 97: 660-661
DOI: 10.1055/a-0652-6450

© Georg Thieme Verlag KG Stuttgart · New York

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Postmortem Analysis of Vitreous Humor For Detection of Antemortem Disorders in Glucose Metabolism. An Old Method Revisited

Exp Clin Endocrinol Diabetes
DOI: 10.1055/a-0752-0028

It has been estimated that 15% up to one third of cases of deaths due to diabetic ketoacidosis occur in individuals with so far unknown diabetes. Moreover, cardiac arrhythmias that occur during nocturnal hypoglycaemia include bradycardia and ectopics that may provoke lethal arrhythmias. As postmortem capillary glucose concentrations have no diagnostic value, the postmortem forensic proof of hyperglycaemia or hypoglycaemia remains a challenge. The established but rarely applied method of postmortem determination of glucose and lactate in vitreous humor with or without calculation of the sum formula of Traub could provide reliable exclusion or proof of severe antemortem disorders in glucose metabolism. To date, diagnostic puncture of vitreous humor is more established for the postmortem detection of diabetic ketoacidosis than for the exclusion or proof of lethal hypoglycaemia. Vitreous humor is protected from postmortem degradation and contamination due to its isolated localization. The autolytic process in vitreous humor is considerably delayed compared to blood or liquor. In vitreous humor also the triggering agent of hypoglycaemia (insulin, insulin analogues) is easier to be detected than in blood since insulins are very unstable in postmortem blood. Furthermore, parameters of long term glycaemic control such as 1,5-anhydroglucitol, HbA1c and fructosamine can be determined in vitreous humor. However, limitations and interference factors of this method should be carefully considered. So far, clinical diabetology has taken no broad notice of this useful forensic procedure.
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© Georg Thieme Verlag KG Stuttgart · New York

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

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71st World Health Assembly, Geneva, Switzerland 2018

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In Response

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Protecting the Beans: Perioperative Acute Kidney injury

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In Response

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“Randomization at the Expense of Relevance.” L. J. Cronbach and Intravenous Acetaminophen as an Opioid-Sparing Adjuvant

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American Society for Enhanced Recovery and Perioperative Quality Initiative Joint Consensus Statement on Postoperative Gastrointestinal Dysfunction Within an Enhanced Recovery Pathway for Elective Colorectal Surgery: Erratum

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Preoperative Intravenous Iron to Enhance a Blood Management Program: Is It All in “Vein”?

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Perioperative Two-Dimensional Transesophageal Echocardiography: A Practical Handbook, 2nd ed

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Multimodal General Anesthesia: A Principled Approach to Producing the Drug-Induced, Reversible Coma of Anesthesia

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In Response

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Why Cost-Effectiveness?

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Nitrous Oxide Supply Systems

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Intraoperative Oliguria: Physiological or Beginning Acute Kidney Injury?

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Balancing Act: Multimodal General Anesthesia

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Surveying the Literature: Synopsis of Recent Key Publications

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Anesthesia: The Gift of Oblivion and the Mystery of Consciousness

No abstract available

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Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival: A Planned Subanalysis of the ENIGMA-II Trial

BACKGROUND: Globally, >300 million patients have surgery annually, and ≤20% experience adverse postoperative events. We studied the impact of both cardiac and noncardiac adverse events on 1-year disability-free survival after noncardiac surgery. METHODS: We used the study cohort from the Evaluation of Nitrous oxide in Gas Mixture of Anesthesia (ENIGMA-II) trial, an international randomized trial of 6992 noncardiac surgical patients. All were ≥45 years of age and had moderate to high cardiac risk. The primary outcome was mortality within 1 postoperative year. We defined 4 separate types of postoperative adverse events. Major adverse cardiac events (MACEs) included myocardial infarction (MI), cardiac arrest, and myocardial revascularization with or without troponin elevation. MI was defined using the third Universal Definition and was blindly adjudicated. A second cohort consisted of patients with isolated troponin increases who did not meet the definition for MI. We also considered a cohort of patients who experienced major adverse postoperative events (MAPEs), including unplanned admission to intensive care, prolonged mechanical ventilation, wound infection, pulmonary embolism, and stroke. From this cohort, we identified a group without troponin elevation and another with troponin elevation that was not judged to be an MI. Multivariable Cox proportional hazard models for death at 1 year and assessments of proportionality of hazard functions were performed and expressed as an adjusted hazard ratio (aHR) and 95% confidence intervals (CIs). RESULTS: MACEs were observed in 469 patients, and another 754 patients had isolated troponin increases. MAPEs were observed in 631 patients. Compared with control patients, patients with a MACE were at increased risk of mortality (aHR, 3.36 [95% CI, 2.55–4.46]), similar to patients who suffered a MAPE without troponin elevation (n = 501) (aHR, 2.98 [95% CI, 2.26–3.92]). Patients who suffered a MAPE with troponin elevation but without MI had the highest risk of death (n = 116) (aHR, 4.29 [95% CI, 2.89–6.36]). These 4 types of adverse events similarly affected 1-year disability-free survival. CONCLUSIONS: MACEs and MAPEs occur at similar frequencies and affect survival to a similar degree. All 3 types of postoperative troponin elevation in this analysis were associated, to varying degrees, with increased risk of death and disability.

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In Response

No abstract available

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Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery: A Retrospective Cohort Study

BACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure. METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables. RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99–1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03–1.12) per 5-mm Hg decrease (P = .001). CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined.

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In Response

No abstract available

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Safety of Drilling 3-Dimensional-Printed Temporal Bones.

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Safety of Drilling 3-Dimensional-Printed Temporal Bones.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):797-801

Authors: Freiser ME, Ghodadra A, Hart L, Griffith C, Jabbour N

Abstract
Importance: Three-dimensional (3-D) printing of temporal bones is becoming more prevalent. However, there has been no measure of the safety of drilling these models to date. It is unknown whether the heat and sheer from the drill may create harmful volatile organic compounds (VOCs).
Objective: To determine the level of exposure to airborne contaminants when conducting high-speed drilling on 3-D-printed models and to explore whether there is a need for exposure control measures.
Design, Setting, and Participants: In this occupational safety assessment carried out in a temporal bone laboratory, 3 individual 3-D-printed temporal bones were made using 3 different materials commonly cited in the literature: polylactic acid (PLA), photoreactive acrylic resin (PAR), and acrylonitrile butadiene styrene (ABS). Each model was drilled for 40 minutes while the surgeon wore a sampling badge. Sampling was conducted for airborne concentrations of VOCs and total particulate (TP). Monitoring for VOCs was conducted using Assay Technology 521-25 organic vapor badge worn at the surgeon's neckline. Monitoring for TP was conducted using a polyvinyl chloride filter housed inside a cassette and coupled with an SKC AirChek 52 personal air-sampling pump. Samples were collected and analyzed in accordance with NIOSH Method 500.
Main Outcomes and Measures: Presence of VOCs and TP count exposures at Occupational Safety and Health Administration (OSHA) actionable levels.
Results: Results of the VOC sample were less than detection limits except for isopropyl alcohol at 0.24 ppm for PAR. The TP samples were less than the detection limit of 1.4 mg/m3. The results are below all applicable OSHA Action Levels and Permissible Exposure Limits for all contaminants sampled for.
Conclusions and Relevance: Drilling 3-D-printed models made from PLA, ABS, and PAR was safe by OSHA standards. Continued monitoring and safety testing are needed as 3-D-printed technologies are introduced to our specialty.

PMID: 30335883 [PubMed - in process]

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Evaluation of Social Media Presence of Otolaryngology Residency Programs in the United States.

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Evaluation of Social Media Presence of Otolaryngology Residency Programs in the United States.

JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):802-806

Authors: Xie DX, Dedmon MM, O'Connell BP, Yawn RJ, Haynes DS

Abstract
Importance: Over two-thirds of the adult population in the United States use Facebook. Despite the high interest in and use of social media by the general public, the presence and accessibility of health care organizations on social media has not yet been fully evaluated.
Objective: To determine the use and popularity of social media among otolaryngology residency programs in the United States.
Design, Setting, and Participants: A cross-sectional study of the presence of accredited otolaryngology residency programs in the United States in an internet data repository was conducted. Programs were stratified by Doximity Residency Navigator reputation rankings (dividing programs into quartiles) and US News & World Report (comparing programs affiliated with hospitals ranked in the top 50 vs programs affiliated with unranked hospitals). Social media sites and activity for each program were assessed using internet searches. The study was conducted in April 2017.
Results: Among 101 otolaryngology residency programs, 30 were found to have social media sites (29.7%). Facebook and Twitter were the most commonly used services, with 25 (24.8%) and 14 (13.9%) accounts, respectively. Based on Doximity Residency Navigator rankings, programs in the first quartile were more likely to have Facebook profiles than programs in the fourth quartile (42.3% vs 12.0%; absolute difference, 30%; 95% CI, 2.9% to 52.6%). First- and second-quartile programs showed increased Facebook activity. There was greater Twitter presence in first- vs fourth-quartile programs (19.2% vs 8.0%; absolute difference, 11.2%; 95% CI, -11.6% to 33.0%). Higher-quartile programs were more active on Twitter and exhibited increased numbers of likes and followers. Analysis of US News & World Report rankings revealed that ranked programs had higher rates of presence, activity, and popularity on both Facebook and Twitter. However, these were smaller differences than seen when comparing Doximity Residency Navigator rankings. Correlation between the 2 ranking systems was indicated (Spearman ρ = 0.59; 95% CI, 0.34 to 0.76).
Conclusions and Relevance: This study suggests that otolaryngology residency programs with higher Doximity Residency Navigator reputation rankings have a stronger presence on social media. Smaller trends were observed for programs in the top 50 US News & World Report rankings. Overall, social media use among otolaryngology programs seems relatively low, and this may present an opportunity to increase communication with the public via these technologies.

PMID: 30335882 [PubMed - in process]

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JAMA Otolaryngol Head Neck Surg. 2018 Sep 01;144(9):848-849

Authors: Merati M, Manzoor NF, Ahadizadeh EN, Mowry SE, Semaan M, Buethe DJ, Honda K

PMID: 30335881 [PubMed - in process]

https://ift.tt/2PHs6yD

Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences: A Randomized Crossover Trial.

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Effect of a Change in Papillary Thyroid Cancer Terminology on Anxiety Levels and Treatment Preferences: A Randomized Crossover Trial.

JAMA Otolaryngol Head Neck Surg. 2018 Oct 01;144(10):867-874

Authors: Nickel B, Barratt A, McGeechan K, Brito JP, Moynihan R, Howard K, McCaffery K

Abstract
Importance: Given evidence of overdiagnosis and overtreatment of small papillary thyroid cancers (PTCs), strategies are needed to promote the consideration of less invasive treatment options for patients with low-risk PTC.
Objective: To determine the association of treatment preferences and anxiety levels for PTC with the terminology used to describe the condition.
Design, Setting, and Participants: This randomized crossover study involved a community sample of 550 Australian men and women 18 years or older without a history of thyroid cancer. Between March 16, 2016, and July 26, 2016, participants accessed an online study that presented 3 hypothetical but clinically realistic scenarios, each of which described PTC as papillary thyroid cancer, papillary lesion, or abnormal cells. Participants were exposed to all 3 scenarios with the different terminologies, and participants were randomized by the order (first, second, or third) in which they viewed the terminologies. Data analysis was conducted from September 1, 2016, to May 15, 2017.
Main Outcomes and Measures: Treatment choice (total thyroidectomy, hemithyroidectomy, or active surveillance), diagnosis anxiety, and treatment choice anxiety.
Results: Of the 550 participants who completed the online study and were included in the analysis, 279 (50.7%) were female and the mean (SD) age was 49.9 (15.2) years. A higher proportion of participants (108 [19.6%]) chose total thyroidectomy when papillary thyroid cancer was used to describe the condition compared with the percentage of participants who chose total thyroidectomy when papillary lesion (58 [10.5%]) or abnormal cells (60 [10.9%]) terminology was used. At first exposure, the papillary thyroid cancer terminology led 60 of 186 participants (32.3%) to choose surgery compared with 46 of 191 participants (24.1%) who chose surgery after being exposed to papillary lesion terminology first (risk ratio [RR], 0.73; 95% CI, 0.53-1.02) and 47 of 173 participants (27.2%) after being exposed to abnormal cells (RR, 0.82; 95% CI, 0.60-1.14) terminology first. After the first exposure, participants who viewed papillary thyroid cancer terminology reported significantly higher levels of anxiety (mean, 7.8 of 11 points) compared with those who viewed the papillary lesion (mean, 7.0 of 11 points; mean difference, -0.8; 95% CI, -1.3 to -0.3) or abnormal cells (mean, 7.3 of 11 points; mean difference, -0.5; 95% CI, -1.0 to 0.01). Overall, interest in active surveillance was high and higher levels of anxiety were reported by those who chose surgery, regardless of which terminology was viewed first (mean difference, 1.5; 95% CI, 1.0-1.9).
Conclusions and Relevance: Changing the terminology of small PTCs may be one strategy to reduce patients' anxiety levels and help them consider less invasive management options. To curtail overdiagnosis and overtreatment in PTC, other strategies may include providing balanced information about the risks and advantages of alternative treatments.
Trial Registration: anzctr.org.au Identifier: ACTRN12616000271404.

PMID: 30335875 [PubMed - in process]

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JAMA Otolaryngol Head Neck Surg. 2018 Oct 01;144(10):950-951

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Medical Practice Entrepreneurship.

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JAMA Otolaryngol Head Neck Surg. 2018 Oct 01;144(10):949-950

Authors: Meyers A

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The Evolving Nomenclature of Thyroid Cancer: What's in a Name?

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JAMA Otolaryngol Head Neck Surg. 2018 Oct 01;144(10):874-875

Authors: Shuman AG

PMID: 30335872 [PubMed - in process]

https://ift.tt/2S0PvwF

A 12-day-old Male With a “Skin Tag” on the Chin: Answer

No abstract available

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ALK Gene Fusions in Epithelioid Fibrous Histiocytoma: A Study of 14 Cases, With New Histopathological Findings

Abstract: Previous studies showed that ALK is often positive in epithelioid fibrous histiocytoma (EFH). Two cases of EFH with ALK gene fusions have been recorded. Our objective was to study a series of EFH to present histopathological variations of EFH, identify novel ALK gene fusions, and determine whether there is a correlation between histopathological features and particular gene. We investigated 14 cases of EFH, all ALK immunopositive. The cases were assessed histopathologically as well as for ALK and TFE-3 rearrangements using FISH and ALK gene fusions using next-generation sequencing. The analysis of the sequencing results was performed using the Archer Analysis software (v5; ArcherDX Inc). The study group consisted of 8 female and 6 male patients, ranging in age from 18 to 79 years (mean 42 years; median 37.5 years). All presented with a solitary lesion. Microscopically, most lesions were polypoid and composed of epithelioid cells with ample cytoplasm. In addition, a variable number of bi-, tri-, or multinucleated, spindled, multilobated, cells with eccentric nuclei, cells with nuclear pseudoinclusions, mucinous, and grooved cells were admixed. In 5 cases, the predominant epithelioid cell component consisted of rather small cells, whereas spindled cells dominated in 3 cases. Of these, 2 lesions were composed rather of pale eosinophilic to clear cells, occasioning a resemblance to PEComa or leiomyoma. Immunohistochemically, all cases expressed ALK and 11 were positive for TFE-3. The break apart test for ALK was positive in 11 cases, whereas specimens from the remaining 3 cases were not analyzable. ALK genes fusions were found in all but 3 cases and included SQSTM1-ALK (3), VCL-ALK (3), TMP3-ALK (2), PRKAR2A-ALK (1), MLPH-ALK (1), and EML4-ALK (1). No correlation between histological features and type of ALK fusion was found. TFE-3 break apart test was negative. It is concluded that ALK-immunopositive EFH shows ALK gene fusions that involve various protein-coding genes, implicated in a variety of biological processes. Rare variants of EFH rather consist of spindled "non-epithelioid" cells.

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A New, Firm, Solitary Nodule in a Patient With HIV/AIDS: Challenge

No abstract available

https://ift.tt/2Pd0owS

A Comparison of the Histopathologic Growth Patterns Between Non–Merkel Cell Small Round Blue Cell Tumors and Merkel Cell Carcinoma

Background: Merkel cell carcinoma (MCC) is a rare neuroendocrine cutaneous malignancy that shares cytologic, histopathologic, and immunohistochemical features with other small round blue cell (SRBC) tumors. Although the trabecular pattern is anecdotally associated with MCC, objective data are lacking. Methods: This was a retrospective institutional review board–approved observational study conducted on microscopic images of 79 MCCs and 74 other SRBC tumors (desmoplastic small round cell tumor, primitive neuroectodermal tumor, neuroblastoma, embryonal rhabdomyosarcoma, alveolar rhabdomyosarcoma, synovial sarcoma, carcinoid, metastatic small cell lung cancer, non-Hodgkin small cell lymphoma, retinoblastoma, medulloblastoma, nephroblastoma, small cell osteosarcoma, and round cell liposarcoma). An expert dermatopathologist evaluated blinded and randomized microscopic specimens and recorded histologic patterns (diffuse, infiltrative, large anastomosing nests, small islands, any trabecular, focal trabecular, mixed trabecular, and predominately trabecular). Results: Trabecular features were identified in over 72% of MCCs but only rarely in non-MCC SRBC tumors. The presence of any amount of a trabecular pattern favored a diagnosis of MCC over SRBC tumors with a sensitivity of 72.2% and a specificity of 87.8%. If "any" and "focal" trabecular patterns were discounted, specificity rose to 93.2%. Conclusion: The presence of a trabecular pattern helps to differentiate MCC from other SRBC tumors, and specificity approaches that achieved with immunostaining.

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Malignant Melanoma With Massive Crust Mimicking a Cutaneous Horn: An Unexpected Finding

No abstract available

https://ift.tt/2P8MCev

Granulomatous Rosacea Versus Lupus Miliaris Disseminatus Faciei—2 Faces of Facial Granulomatous Disorder: A Clinicohistological and Molecular Study

Abstract: Granulomatous rosacea (GR) and lupus miliaris disseminatus faciei (LMDF) are 2 forms of facial granulomatous diseases. Although they show some morphological overlap, they have distinct clinical presentation. This study was performed to demonstrate the clinical and histological features of GR and LMDF and to establish their relationship to tuberculous etiology by molecular technique. All the cases of GR (n = 20) and LMDF (n = 10) diagnosed on skin biopsy over the past 6 years were reviewed along with their clinical detail. Polymerase chain reaction (PCR) was performed using primers specific for Mycobacterium tuberculosis. The mean age of patients with GR was 45 years 10 months (range 18–75 years) as compared to 33 years 5 months (range 18–57 years) in patients with LMDF. The GR cases comprised 13 men and 7 women patients, whereas all 10 LMDF cases were seen in men. GR cases had papular lesion over an erythematous base on face, whereas LMDF cases had papular/nodular/nodulocystic lesions on the face and neck. Histologically, GR cases showed small granulomas without necrosis in a background of variable lymphoid infiltrate and dilated capillaries, whereas LMDF showed large granulomas with caseous necrosis and minimal inflammation. Five cases (25%) of GR showed degenerating Demodex folliculorum mites. No case of GR or LMDF showed positivity for mycobacterial polymerase chain reaction. Despite some similarities, GR and LMDF show distinct clinical and histological features. Thus, LMDF is a distinct clinicopathological entity separate from the GR, with different etiopathogenesis. However, none of the conditions are related to a tuberculous etiology.

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Pustular Eruption After Cocaine Use: Answer

No abstract available

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Childhood Phimosis Secondary to Lichen Sclerosus: Is There a Spatial Pattern of Histopathological Changes?

Introduction: The accurate histopathological diagnosis of the phimotic prepuce is indispensable because early diagnosis, treatment, and close follow-up are crucial in genital dermatosis such as lichen sclerosus (LS). This study analyzes the histopathological spectrum of childhood phimosis with special emphasis on LS. We also highlight a peculiar pattern of histopathological evolution in LS, prepuce. Material and methods: The histopathology slides of all the pediatric preputial circumcision specimens performed for the indication of pathological phimosis (n = 43) during the study period (2012–2017) were analyzed. Eight histopathological features viz. hyperkeratosis, hypergranulosis, epidermal atrophy, acanthosis, dermoepidermal cleft, upper dermal edema and homogenization, mid dermal lymphocytic band, and interface dermatitis were studied in each case, separately in inner preputial surface, tip, and outer preputial surface. On the basis of evolution of the disease and histopathological features, the lesions of LS were classified into early, established, and advanced. Result: LS was found in 32 cases, whereas 11 cases showed nonspecific inflammation and fibrosis. The upper dermal homogenization (n = 29), dermoepidermal cleft (n = 28), and mid dermal band (n = 27) were the commonest histopathological changes. The established and advanced changes were confined to the inner preputial surface (n = 31), and the outer preputial skin surface was unaffected in all the cases. A peculiar histopathological evolution pattern was seen with established or advanced lesions, early lesion, and normal histology on the inner preputial surface, mucocutaneous junction, and outer preputial skin, respectively. Conclusions: LS is a common cause of childhood phimosis. It shows a peculiar histopathological evolution that mandates the thorough analysis of inner mucosal surface.

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Cutaneous Atypical Neurofibroma: A Case Report and Review of Literature

No abstract available

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Subconjunctival Herniation of Fat Does Not Demonstrate Loss of RB Gene Expression

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Progressive, Painful Erosions of the Face, Neck, and Lips: Challenge

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Case Report of Myeloid Sarcoma Masquerading as In-Transit Metastasis at a Previous Melanoma Site: Avoiding a Diagnostic Pitfall

Abstract: Myeloid sarcoma is a rare extramedullary hematologic malignancy. Accurate and timely diagnosis may be challenging because myeloid sarcoma is known to mimic solid tumors, including hepatobiliary, nasopharyngeal, and breast carcinomas. We report a case of myeloid sarcoma that developed in the primary tumor lymphatic drainage field of a previously treated intermediate-thickness cutaneous melanoma, clinically and radiographically mimicking an in-transit metastasis, in a patient with myelodysplastic syndrome. The diagnosis of myeloid sarcoma was achieved after surgical excision of the mass and pathological examination that included extensive immunohistochemical studies. Awareness of such an unusual clinical presentation can help reduce diagnostic delay and ensure that adequate tissue is obtained for pathological examination and ancillary studies that are critical for accurate diagnosis and appropriate patient management.

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Pigmented Lesions of the Nail Unit

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Dual-Positive CD4/CD8 Primary Cutaneous Peripheral T-Cell Lymphoma Previously Classified as Mycosis Fungoides a Tumor D'Emblée

Abstract: Cutaneous peripheral T-cell lymphoma, not otherwise specified represents a "waste basket" of all cases that cannot be put into another of the categories of mature cutaneous T-cell lymphoma. Previously, the sudden multifocal development of cutaneous CD4+ tumors without preceding a patch or plaque stage was classified as d'emblée form of mycosis fungoides (MF). Currently, the term "MF" reserved only for the classic Alibert–Bazin type characterized by the evolution of patches, plaques, and tumors or for variants showing a similar clinical course. The authors describe a 75-year-old white woman who presented with a solitary skin tumor in the right supraclavicular region, with no lymph node or systemic involvement. Local external beam radiation treatment resulted in a complete response. The patient relapsed after 5 months with new tumors in the left neck and left upper chest. Biopsy of the lesions showed a dermal infiltrate of atypical small- to medium-sized T-lymphocytes, and immunohistochemical staining showed coexpression of CD4/CD8 in a subset of these cells, which was confirmed with flow cytometry of the tumor. Although the patient had no preceding patch or plaque stage, the authors herein report this extremely rare case of CD4/CD8 dual-positive peripheral T-cell lymphoma, not otherwise specified presented as MF d'emblée and discuss the seldom similar cases published previously.

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A New, Firm, Solitary Nodule in a Patient With HIV/AIDS: Answer

No abstract available

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Bowen Disease With Sebaceous Differentiation: A Case Report and Immunohistochemical Analysis of Adipophilin and Cytokeratin 1

Abstract: Bowen disease with sebaceous differentiation has been rarely documented to date. Here, we present a case of Bowen disease with sebaceous differentiation. A 67-year-old man presented with a 6.0 × 3.5 cm erythematous plaque adjacent to a 7.0 × 3.0 cm erythematous plaque on his left abdomen. Dermoscopy revealed yellow structureless areas and dotted vessels on a pink homogenous background in addition to surface scales. Histopathological examination of the upper erythematous plaque showed parakeratosis and acanthosis with proliferation of atypical keratinocytes in the epidermis. Some of the atypical cells had large and hyperchromatic nuclei. Histopathological examination of the lower erythematous plaque showed tumor nests extending from the epidermis. Tumor nests with hyperchromatic and atypical cells had vacuolated cells. The diagnosis of Bowen disease with sebaceous differentiation was made. Immunohistochemistry revealed a positive reaction for cytokeratin 1 (CK1) in tumor cells of Bowen disease and a negative reaction for CK1 in tumor cells with the sebaceous differentiation, whereas immunohistochemistry revealed no apparent adipophilin-positive granules in tumor nests of Bowen disease compared with the prominent staining of adipophilin in tumor nests with sebaceous differentiation. We show Bowen disease with sebaceous differentiation taking advantage of immunohistochemistry of adipophilin and CK1. Those findings of Bowen disease with sebaceous differentiation may deepen our understandings and insights into the pathogenesis of sebaceous carcinoma and Bowen disease.

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Book Review of “Alopecia” by Mariya Miteva

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Verrucous Plaque With Unusually Large Candida Blastoconidia: A Unique Clinicopathological Presentation of Systemic Mucocutaneous Candidiasis

Abstract: Mucocutaneous candidiasis is a common infection affecting both immunocompetent and immunosuppressed individuals. Diversity in the clinical and histopathological presentation of mucocutaneous candidiasis is well known. However, the occurrence of cutaneous verrucous lesions and giant yeast-like structures has been rarely reported. In this article, we describe a case of disseminated mucocutaneous candidiasis in an immunosuppressed patient who presented as a verrucous plaque on the scrotum with giant Candida blastoconidia. This peculiar presentation expands the clinicopathological spectrum of mucocutaneous candidiasis and highlights the wide range of clinical manifestations and great morphologic variability of this common fungal infection.

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