Head and Neck Diseases by Alexandros G.Sfakianakis: 11/09/18

Παρασκευή 9 Νοεμβρίου 2018

Efficacy of two plant extracts against acne vulgaris: Initial results of microbiological tests and cell culture studies

Summary

Background

Acne vulgaris is a common skin disease characterized by increased sebum production, inflammation, and colonization of Propionibacterium acnes (P. acnes) on pilosebaceous follicles.

Aims

To determine the efficacy of two different plant extracts against P. acnes and to analyze the gene expression levels of IL‐1α, SRD5A1, and TNFα in HaCaT cells treated with these plant extracts.

Methods

Anti‐acne extract 1 (AE1) consisted of Juglans regia (walnut husk), Myrtus communis (myrtle leaves), Matricaria chamomilla (chamomilla flowers), Urtica dioica (stinging nettle leaves), and Rosa damascena (rose flowers). Anti‐acne extract 2 (AE2) contained Brassica oleracea var. botrytis (broccoli) and B. oleracea var. italica (cauliflower). The antimicrobial activities of the extracts were tested on two different P. acnes strains: the reference strain of P. acnes (ATCC 51277) and the clinical isolate from a patient. The minimum inhibitory concentration (MIC) of the extracts was determined using the broth dilution method. Human keratinocyte cells were used for in vitro tests. Gene expression analyses were performed with RT‐qPCR.

Results

The MIC values of the extracts were below 1/2048 µg/mL. In the gene expression analysis, AE1 increased the expression level of TNFα (1.1719, P < 0.0001), suppressed the expression level of IL‐1α, SRD5A1 (0.0588, P = 0.0231; 0.3081, P = 0.0351), respectively. AE2 suppressed gene expression level of IL‐1α, SRD5A1, TNFα (0.3815, P = 0.0254; 0.3418, P = 0.0271; 0.1997, P = 0.0623).

Conclusions

Both herbal extracts demonstrated strong antibacterial and anti‐inflammatory activity in this preliminary trial. In conclusion, the topical application of these botanical extracts can be good candidates for local acne treatment.

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Efficacy of two plant extracts against acne vulgaris: Initial results of microbiological tests and cell culture studies

Summary

Background

Acne vulgaris is a common skin disease characterized by increased sebum production, inflammation, and colonization of Propionibacterium acnes (P. acnes) on pilosebaceous follicles.

Aims

To determine the efficacy of two different plant extracts against P. acnes and to analyze the gene expression levels of IL‐1α, SRD5A1, and TNFα in HaCaT cells treated with these plant extracts.

Methods

Results

Conclusions

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Bacterial self-defense antibiotics release from organic-inorganic hybrid multilayer films for long-term anti-adhesion and biofilm inhibition properties.

Bacterial self-defense antibiotics release from organic-inorganic hybrid multilayer films for long-term anti-adhesion and biofilm inhibition properties.

Nanoscale. 2017 Dec 14;9(48):19245-19254

Authors: Xu Q, Li X, Jin Y, Sun L, Ding X, Liang L, Wang L, Nan K, Ji J, Chen H, Wang B

Abstract
Implant-associated bacterial infections pose serious medical and financial issues due to the colonization and proliferation of pathogens on the surface of the implant. The as-prepared traditional antibacterial surfaces can neither resist bacterial adhesion nor inhibit the development of biofilm over the long term. Herein, novel (montmorillonite/poly-l-lysine-gentamicin sulfate)8 ((MMT/PLL-GS)8) organic-inorganic hybrid multilayer films were developed to combine enzymatic degradation PLL for on-demand self-defense antibiotics release. Small molecule GS was loaded into the multilayer films during self-assembly and the multilayer films showed pH-dependent and linear growth behavior. The chymotrypsin- (CMS) and bacterial infections-responsive film degradation led to the peeling of the films and GS release. Enzyme-responsive GS release exhibited CMS concentration dependence as measured by the size of the inhibition zone and SEM images. Notably, the obtained antibacterial films showed highly efficient bactericidal activity which killed more than 99.9% of S. aureus in 12 h. Even after 3 d of incubation in S. aureus, E. coli or S. epidermidis solutions, the multilayer films exhibited inhibition zones of more than 1.5 mm in size. Both in vitro and in vivo antibacterial tests indicated good cell compatibility, and anti-inflammatory, and long-term bacterial anti-adhesion and biofilm inhibition properties.

PMID: 29188848 [PubMed - indexed for MEDLINE]

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First‐in‐Human Phase I Study of MBC‐11, a Novel Bone‐Targeted Cytarabine‐Etidronate Conjugate in Patients with Cancer‐Induced Bone Disease

AbstractLessons Learned. Results are consistent with MBC‐11 targeting and treating cancer‐induced bone lesions by concentrating cytarabine and etidronate at the site of disease.MBC‐11 was well tolerated, with an maximum tolerated dose of 5 mg/kg per day and myelosuppression as the principal toxicity.Treatment significantly reduced cancer cell activity in over half of bone lesions detected at baseline.MBC‐11 pharmacokinetic and pharmacodynamic parameters are consistent with the novel drug design goals, and encouraging results warrant further clinical development.Background.MBC‐11 is a first‐in‐class conjugate of the bone‐targeting bisphosphonate etidronate covalently linked to the antimetabolite cytarabine (araC). This first‐in‐human phase I dose escalation study assessed safety, tolerability, maximum tolerated dose (MTD), plasma pharmacokinetics, bone turnover, tumor biomarkers, and bone lesion activity by fluorodeoxyglucose positron emission tomography/computed tomography (18F‐FDG‐PET/CT) imaging.Methods.Fifteen patients with advanced solid cancers and cancer‐induced bone disease (CIBD) were treated with 0.5–10 mg/kg per day of MBC‐11 administered daily for 5 days of every 4 weeks for up to four cycles.Results.Grade 1–2 myelosuppression, involving all lineages, was the principal toxicity. Two of three patients treated with 10 mg/kg experienced dose‐limiting grade 4 neutropenia and thrombocytopenia (adverse event [AE] duration ≤5 days); the MTD was 5 mg/kg. Four of five patients with pretreatment elevations of the bone resorption marker TRAP5b (tartrate resistant acid phosphatase‐5b) had persistent decrements. Six of 13 patients who reported baseline pain noted a reduction after MBC‐11. 18F‐FDG‐PET/CT imaging demonstrated partial metabolic responses in three patients and stable metabolic responses in three other patients. SUVmax (standard unit of emission normalized to total uptake) was reduced by at least 25% in 110 (52%) of 211 bone lesions. Significant activity was noted across all doses, and myelosuppression increased with dose.Conclusion.At MBC‐11 doses that were well tolerated, substantial reductions in metabolic activity of bone‐associated cancer cells provide a foundation for further disease‐directed efficacy studies.

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Eribulin Mesylate as Third or Subsequent Line Chemotherapy for Elderly Patients with Locally Recurrent or Metastatic Breast Cancer: A Multicentric Observational Study of GIOGer (Italian Group of Geriatric Oncology)‐ERIBE

AbstractBackground.Metastatic breast cancer (MBC) is highly prevalent in middle‐aged or elderly patients. Eribulin is a nontaxane microtubule inhibitor, approved for the treatment of pretreated MBC. This multicentric study (sponsored by GIOGer, Italian Group for Geriatric Oncology) was designed to assess the efficacy and tolerability of eribulin, according to parameters usually used in geriatric oncology.Subjects, Materials, and Methods.An observational study was conducted on 50 consecutive elderly patients with MBC. The primary endpoint was to evaluate the change in items score of comprehensive geriatric assessment (CGA) and health‐related quality of life (HRQL). Italian versions of the CGA and HRQL questionnaires were administered at baseline, before the third and fifth cycles, and then every three cycles until treatment discontinuation. Secondary endpoints were efficacy and safety.Results.Overall, both EQ‐5D scores and EQ‐5D‐3 L visual analogic scale did not significantly change from baseline; the percentage of subjects without problems doing usual activities tended to decrease during treatment (p for linear trend .018), and the percentage of patients with minor problems performing usual activities tended to increase (p for linear trend.012). Among CGA items, Instrumental Activities of Daily Living tended to decrease during treatment and Geriatric Depression Scale tended to increase. After 12 months follow‐up, 24 patients (out of 47) showed clinical benefits; median progression‐free survival was 4.49 months (2.10–10.33) and median OS was 7.31 months (3.70–14.03). The treatment was associated with mild toxicity.Conclusion.Eribulin treatment preserved quality of life and geriatric parameters included in the CGA, except for instrumental functioning and geriatric depression, in elderly patients with MBC.Implications for Practice.A collaboration between oncologist and geriatric specialists is essential in the management of patients with metastatic breast cancer, who are frequently elderly or frail. The assessment of geriatric parameters in the decision‐making process can contribute to direct toward the most appropriate therapeutic plan and preserve the quality of life of patients. Eribulin does not seem to affect quality of life or worsen the overall geriatric status; therefore, it can be considered a suitable option for elderly patients with metastatic breast cancer.

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Immune Checkpoint Inhibitors and the Risk of Allograft Rejection: A Comprehensive Analysis on an Emerging Issue

AbstractBackground.It is well known that the state of immune tolerance induced by broad immunosuppression to prevent allograft rejection leads to an increased risk of the development of cancer. One of the most promising new areas of cancer treatment has been the development of immune checkpoint inhibitors that target the cytotoxic T‐lymphocyte‐associated antigen 4 and programmed cell death protein 1/programmed death‐ligand 1 (PD‐L1) pathways. As a logical consequence, growing interest in these agents translated into their implementation in patients with transplant‐related malignancies. Because of overlapping and perhaps mutually exclusive mechanisms of action of transplant immunosuppression and cancer immunomodulation, it is critical to examine these interactions.Materials and Methods.We carried out a systematic search for review articles and case reports published between July 2014 and November 2017 using three engines: Usearch, PubMed, and Up‐to‐date.Results.Overall, there were 20 cases with 12 allograft rejections. The rejection rate associated with nivolumab was 73% (8/11) and with pembrolizumab it was 100% (2/2). The use of ipilimumab did not lead to rejection in any instance (0/4, 0%). Of the two patients treated with the sequential use of ipilimumab/nivolumab, one lost his allograft, yielding a rejection rate of 50%. The sequential use of ipilimumab/pembrolizumab led to a rejection rate of 100% (1/1, 100%).Conclusion.The use of agents that act on the PD‐L1 pathway are contraindicated in the face of solid organ allografts because of unacceptably high rates of irreversible allograft rejection. It appears that the use of ipilimumab may be tolerated as the mechanism is different from that of the PD‐L1 agents.Implications for Practice.Transplant rejection is a complex process that puts stress on patients and their families and can lead to tragic results. Significant advancements in the field of immunosuppression have led to the engenderment of agents devised to extend the survival of transplant recipients. The advent of immunomodulators in cancer therapy has been paradigm‐shifting; however, because of their mechanism of action, their use must be carefully considered in patients with allografts and concomitant cancer. It appears that ipilimumab can be administered safely in these patients but that agents acting on the programmed death‐ligand 1 pathway are contraindicated because of high rates of irreversible rejection.

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SMAD4 Mutation in Small Cell Transformation of Epidermal Growth Factor Receptor Mutated Lung Adenocarcinoma

AbstractThe large screening of exons 18 to 21 of the epidermal growth factor receptor (EGFR) gene may lead to the discovery of rare, atypical molecular alterations for which the sensitivity to tyrosine kinase inhibitors (TKIs) remains uncertain. We are reporting a rare exon 18 EGFR mutation (p.E709_710 > D) that confers sensitivity to second‐generation EGFR TKI (afatinib), lasting for 1 year. Tumor progression biopsy showed small cell lung cancer transformation, associated with a SMAD4 mutation.Key Points. A rare exon 18 epidermal growth factor receptor mutation with sensitivity to afatinib is reported.Small cell transformation was observed at tumor progression.Acquisition of a SMAD4 mutation was observed at tumor progression.

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“As Long as You Ask”: A Qualitative Study of Biobanking Consent—Oncology Patients’ and Health Care Professionals’ Attitudes, Motivations, and Experiences—the B‐PPAE Study

AbstractIntroduction.Consent to biobanking remains controversial, with little empirical data to guide policy and practice. This study aimed to explore the attitudes, motivations, and concerns of both oncology patients and health care professionals (HCPs) regarding biobanking.Materials and Methods.Qualitative interviews were conducted with oncology patients and HCPs purposively selected from five Australian hospitals. Patients were invited to give biobanking consent as part of a clinical trial and/or for future research were eligible. HCPs were eligible if involved in consenting patients to biobanking or to donate specimens to clinical trials.Results.Twenty‐two patients participated, with head and neck (36%) and prostate (18%) the most common cancer diagnoses; all had consented to biobanking. Twenty‐two HCPs participated, from across eight cancer streams and five disciplines. Themes identified were (a) biobanking is a "no brainer"; (b) altruism or scientific enquiry; (c) trust in clinicians, science, and institutions; (d) no consent—just do it; (e) respecting patient choice ("opt‐out"); (f) respectful timing of the request; (g) need for emotional/family support; (h) context of the biobanking request matters; and (i) factors for biobanking success.Discussion.These findings reinforced previous findings regarding high public trust in, and support for, biobanking. An initial opt‐in consent approach with the option of later opt‐out was favored by patients to respect and recognize donor generosity, whereas HCPs preferred an upfront opt‐out model. Factors impacting biobanking success included the context of the request for use in a trial or specific research question, pre‐existing patient and HCP rapport, a local institution champion, and infrastructure.Implications for Practice.Patients and health care professionals (HCPs) who experienced cancer biobanking consent were overwhelmingly supportive of biobanking. The motivations and approaches to seeking consent were largely mirrored between the groups. The findings of this study support the opt‐in model of biobanking favored by patients; however, HCPs preferred an opt‐out model. Both groups recognize the importance of making the request for biobanking at an appropriate time, preferably with emotional or family support, and respecting the timing of the request and privacy of the patient. Biobanking success can be promoted by hospital departments with a research focus by identifying an institutional biobanking champion and ensuring local infrastructure is available.

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Metabolic Stress and Inflammation: Implication in Treatment for Neurological Disorders

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Diabetes Mellitus to Neurodegenerative Disorders: Is Oxidative Stress Fueling the Flame?

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Hydrogen Sulfide in Physiological and Pathological Mechanisms in Brain

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Single-chain Fv Antibodies for Targeting Neurodegenerative Diseases

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Nutrition and Nutraceuticals in Neuroinflammatory and Brain Metabolic Stress: Implications for Neurodegenerative Disorders

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Oxidative Stress: Major Threat in Traumatic Brain Injury

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Autophagy and Mitochondria: Targets in Neurodegenerative Disorders

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Dehydroepiandrosterone (DHEA) for Depression: A Systematic Review and Meta-Analysis

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Bioinformatic Analysis Reveals Key Genes and Pathways in Aging Brain of Senescence-accelerated Mouse P8 (SAMP8)

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Reconstruction of the Nose

Nasal reconstructive techniques have advanced significantly over the past 50 years. Modern techniques in nasal reconstruction are based on the nasal aesthetic subunits. In order to achieve ideal outcomes, reconstructive surgeons must consider differences in tissue qualities across the nasal aesthetic subunits and formulate reconstructive plans based on these differences. Local flaps, skin grafts, and several types of interpolated flaps comprise the most commonly used techniques for nasal reconstruction. Defects that involve structural or internal lining defects require reconstruction of significantly higher complexity.

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Reconstruction of the Ear

Skin cancer is a common indication for reconstructive surgery of the ear. The unique anatomy of the external ear makes the restoration of form and function challenging for the reconstructive surgeon. This article reviews the relevant anatomy of the ear, defines the goals of reconstruction, outlines the assessment of defects based on location, and describes specific surgical techniques useful in auricular reconstruction.

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Jeffrey S. Moyer

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Mohs Micrographic Surgery

Mohs micrographic surgery (MMS) is the gold standard for treating various cutaneous tumors. MMS has evolved into a single-day, outpatient procedure. The tumor is excised, mapped, and processed with frozen, horizontal sections for immediate histologic evaluation. The process is repeated as necessary until the tumor is completely removed, with maximal conservation of normal tissue. Evaluation of 100% of the surgical margin allows for exceptional cure rates. The Mohs surgeon is trained in tumor excision, histopathology interpretation, and surgical reconstruction. The use of MMS is often part of a multidisciplinary approach to treating cutaneous tumors.

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Contributors

J. REGAN THOMAS, MD

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Reconstruction of Defects Involving the Lip and Chin

Successful perioral reconstruction is the result of consideration of both functional and esthetic goals. The lips are complex esthetic units with multiple tissue layers and distinct anatomic landmarks. Reconstruction can be difficult due to variables affecting the defect, such as size, depth, location, and involvement of adjacent subunits. There are many local flaps that can be used to match the complex tissue layers and anatomic landmarks. Use of the same reconstructive principles can be applied to secondary reconstruction to attain a successful outcome. This article focuses on local reconstructive options for defects of the lip and chin.

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Copyright

ELSEVIER

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The Role of Sentinel Lymph Node Biopsy in the Management of Cutaneous Malignancies

Sentinel lymph node biopsy uses the concept of selective lymphatic drainage and the lymphatic microvasculature to identify first-echelon nodes draining a given malignancy. Although initially considered difficult and unreliable in the head and neck, experience with the technique has improved and evolved significantly over the last 3 decades. It is now recognized to be accurate and reliable for regional nodal staging and detection of occult nodal metastasis in the head and neck. Although initially described for nodal staging of melanoma, the usefulness of sentinel lymph node biopsy continues to expand and is now extended to other cutaneous malignancies.

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Skin Cancer Treatment

FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA

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Forthcoming Issues

Facial Gender Affirmation Surgery

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State-of-the-Art in Skin Cancer Surgery

Skin cancer remains the most common cancer in the United States, affecting approximately 20% of Americans during their lifetime. Despite major advances in care delivery, including targeted drug therapies and immunotherapy, the primary treatment for early nonmelanoma skin cancer (NMSC) and melanoma continues to be careful surgical extirpation with clear margins, along with meticulous reconstruction that optimally addresses functional and aesthetic deficits.

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Reconstruction of the Forehead and Scalp

Tissue inelasticity and the hair-bearing nature of the scalp and forehead pose unique challenges during reconstruction. A thorough understanding of the surgical anatomy of the scalp and forehead is paramount for optimal reconstructive outcomes. Primary wound closure is usually preferred over secondary intention healing and skin grafting. Use of dermal alternatives and tissue expansion are adjunctive therapies to facilitate scalp wound closure. Local skin and soft tissue flaps are commonly used for most small to medium defects; however, microsurgical free tissue transfer can be considered for large full-thickness skin defects of the forehead and scalp.

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Adjuvant and Neoadjuvant Treatment of Skin Cancer

Skin cancer represents a broad classification of malignancies, which can be further refined by histology, including basal cell carcinoma, squamous cell carcinoma and melanoma. As these three cancers are distinct entities, we review each one separately, with a focus on their epidemiology, etiology including relevant genomic data, and the current evidence-based recommendations for adjuvant and neoadjuvant therapy. We also discuss future directions and opportunities for continued therapeutic advances.

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Reconstruction of the Cheek

The goal of cheek reconstruction is to restore an illusion of "normal." Attention must be directed toward the contralateral cheek skin color, texture, thickness, and contour, because this serves a template for reconstruction. The cheek is a peripheral facial subunit and largely frames the more central subunits (eyelids, nose, lips). As such, avoiding distortion or disfigurement of the central subunits is of paramount importance. The cheek possesses significant tissue laxity, elasticity, and mobility, thus allowing for the vast majority of cheek defects to be addressed with primary closure, local flaps, or locoregional flaps.

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Health Outcome Studies in Skin Cancer Surgery

As cutaneous cancers are the most common malignancies affecting US citizens, they represent a significant public health problem and health care cost burden. There are a variety of treatment options available to manage cutaneous malignancies, but limited data are available regarding outcomes, including quality of life, recurrence, and mortality. Here, we examine outcomes of skin cancer surgery as they relate to sociodemographic data and treatment factors.

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Radiotherapy for Skin Cancers of the Face, Head, and Neck

Radiotherapy plays a role in the definitive or adjuvant management of early and late stage skin cancers including nonmelanoma basal cell carcinoma and cutaneous squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The role of radiotherapy in skin cancers of the head and neck is reviewed including early and advanced-stage nonmelanoma skin cancers, melanoma, and Merkel cell carcinoma. In particular, the indications, oncologic outcomes, and technical aspects of radiotherapy for these diseases are discussed.

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Tissue Engineering and 3-Dimensional Modeling for Facial Reconstruction

Three-dimensional (3D) printing has transformed craniofacial reconstruction over the last 2 decades. For cutaneous oncologic surgeons, several 3D printed technologies are available to assist with craniofacial bony reconstruction and preliminary soft tissue reconstructive efforts. With improved accessibility and simplified design software, 3D printing has opened the door for new techniques in anaplastology. Tissue engineering has more recently emerged as a promising concept for complex auricular and nasal reconstruction. Combined with 3D printing, several groups have demonstrated promising preclinical results with cartilage growth. This article highlights the applications and current state of 3D printing and tissue engineering in craniofacial reconstruction.

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Management of Early-Stage Melanoma

Melanoma is a potentially aggressive skin cancer with a steadily rising incidence. Most melanomas are diagnosed at an early stage and associated with an excellent prognosis when treated appropriately. Primary treatment for melanoma is surgical. Wider surgical margins and a variety of techniques for comprehensive histologic margin assessment may be considered for lentigo maligna type melanoma on the head and neck, due to characteristic broad subclinical extension. For invasive melanoma, sentinel lymph node biopsy may be indicated for staging, and to guide further management and follow-up. Appropriate treatment guidelines for early-stage melanoma are reviewed and discussed.

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Periocular Reconstruction

Options for periorbital reconstruction include primary wound closure, local flaps, regional/distant flaps, or full-thickness skin grafts. Optimal aesthetic and functional outcomes are achieved by assessing regional contours, skin type, and facial aesthetic units. Like tissue should replace like tissue; for example, skin with skin, tarsus with tarsus (or equivalent material, eg, hard palate, ear cartilage, or autologous substitute), and conjunctiva with mucous membrane or like substitute (buccal mucous membrane, amniotic membrane). Patient characteristics including wound care needs, transportation needs, smoking status, and history of radiation can influence the reconstruction plan. Techniques most commonly used in our practice are reviewed.

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Nonmelanoma Skin Cancer

This article reviews the most common nonmelanoma skin cancers affecting the head and neck region. Although the most common of these malignancies rarely result in mortality, local morbidity caused by the tumors and their extirpation cannot be underestimated. Complete tumor extirpation with pathologically confirmed negative margins is the gold standard. Regional and distant metastases are rare, but must be treated appropriately should they occur. Although reconstructive surgery can be life changing for the patients and rewarding for the clinicians, it behooves the treating surgeons to remain true to oncologic principles above all else.

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Characteristics and Follow-Up of 13 pedigrees with Gitelman syndrome

Abstract

Context

Gitelman syndrome (GS) is clinically heterogeneous. The genotype and phenotype correlation has not been well established. Though the long-term prognosis is considered to be favorable, hypokalemia is difficult to cure.

Objective

To analyze the clinical and genetic characteristics and treatment of all members of 13 GS pedigrees.

Methods

Thirteen pedigrees (86 members, 17 GS patients) were enrolled. Symptoms and management, laboratory findings, and genotype–phenotype associations among all the members were analyzed.

Results

The average ages at onset and diagnosis were 27.6 ± 10.2 years and 37.9 ± 11.6 years, respectively. Males were an average of 10 years younger and exhibited more profound hypokalemia than females. Eighteen mutations were detected. Two novel mutations (p.W939X, p.G212S) were predicted to be pathogenic by bioinformatic analysis. GS patients exhibited the lowest blood pressure, serum K⁺, Mg²⁺, and 24-h urinary Ca²⁺ levels. Although blood pressure, serum K⁺ and Mg²⁺ levels were normal in heterozygous carriers, 24-h urinary Na⁺ excretion was significantly increased. During follow-up, only 41.2% of patients reached a normal serum K⁺ level. Over 80% of patients achieved a normal Mg²⁺ level. Patients were taking 2–3 medications at higher doses than usual prescription to stabilize their K⁺ levels. Six patients were taking spironolactone simultaneously, but no significant elevation in the serum K⁺ level was observed.

Conclusion

The phenotypic variability of GS and therapeutic strategies deserve further research to improve GS diagnosis and prognosis. Even heterozygous carriers exhibited increased 24-h Na⁺ urine excretion, which may make them more susceptible to diuretic-induced hypokalemia.

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Editorial Board

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Neuromodulatory treatment of recalcitrant plaque psoriasis with onabotulinumtoxinA

To the Editor: The role of neurocutaneous pathways in the pathogenesis of psoriasis has been suggested in cases of dermatomal improvement in psoriatic plaques following central or peripheral nerve damage1-3; however, few studies have assessed the effect of nerve-targeting treatments,4,5 especially in plaque psoriasis. This study investigated the effect of onabotulinumtoxinA injections on psoriasis severity, epidermal nerve fiber (ENF) density, and expression of the neuropeptides substance P (SP) and calcitonin gene–related peptide (CGRP).

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Author index∗∗July, pp. 1-182; August, pp. 183-406; September, pp. 407-598; October, pp. 599-788; November, pp. 789-986; December, pp. 987-1226.

Aaserud S (see Veierød et al). 2018;79:118-25 (Original article)

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JAAD Case Reports Article List

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Reply to: “Comment on ‘Oral diabetes medications other than dipeptidyl peptidase-4 inhibitors are not associated with bullous pemphigoid: A Finnish nationwide case control study’”

To the Editor: We thank Dr Kridin for his interest in our recent publications.1,2 The limitation that we may have not been able detect the association between newer diabetes drugs and bullous pemphigoid (BP) was already acknowledged in our previous article.1 The unpublished finding of Dr Kridin's group that the use of linagliptin is associated with BP is not surprising and further confirms the significance of the use of dipeptidyl peptidase 4 inhibitors (DPP4is) (or gliptins) as a risk factor for BP.

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Comment on “Oral diabetes medications other than dipeptidyl peptidase-4 inhibitors are not associated with bullous pemphigoid: A Finnish nationwide case control study”

To the Editor: We read with great interest the study performed by Varpuluoma et al.1 The authors conducted a nationwide case-control study aiming to estimate the prevalence of administration of oral antidiabetics among patients with bullous pemphigoid (BP) versus among matched control subjects. No association was found between exposure to any oral diabetes medications other than dipeptidyl peptidase-4 inhibitors (DPP4is) and the development of BP.1 DPP4is, particularly vildagliptin, have emerged as a risk factor for the development of BP.

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December Iotaderma #298

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Anti-aging effects of ingenol mebutate for patients with actinic keratosis

To the Editor: Ingenol mebutate (IM) gel has been approved by the Food and Drug Administration as a topical field-directed therapy for actinic keratosis (AK) and has been shown to cure subclinical and clinically apparent AKs.1 Recently, there have been reports of improvements in skin elasticity, wrinkles, and mottled pigmentation after the application of IM gel in patients with multiple AK lesions.2,3 In this study, we aimed to investigate histologic and molecular alterations after field cancerization by using topical IM gel in patients with multiple AK lesions and elucidate the mechanism underlying the skin-rejuvenating effect of IM gel.

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Information for Readers

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November iotaderma (#297)

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Journal Based CME Instructions and Information

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Answers to CME examination

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JAAD Virtual Journal Club

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CME examination

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Subject index

Abortion

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Answers to CME examination

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Cover Sheet for Index

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CME examination

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Dermatology Calendar

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Suture‐ligature technique for the closure of tracheocutaneous fistula in adults

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Magnetic resonance imaging with cochlear implants and auditory brainstem implants: Are we truly practicing MRI safety?

Objective

Our objective is to evaluate the safety in patients with cochlear implants (CIs) and auditory brainstem implants (ABI) undergoing 1.5 Tesla (T) magnetic resonance imaging (MRI). Secondly, we want to raise awareness on CI and MRI safety, and advocate for continued improvement and advancement to minimize morbidity for our CI patients.

Methods

Retrospective case series from 2006 to 2018 at a single tertiary academic center. Data was collected on patients with CI or auditory brainstem implants undergoing MRI. Outcomes collected include demographic data, age at time of MRI, MRI characteristics, complications, CI manufacturer, and image quality.

Results

Eighteen patients with CI or ABI collectively underwent a total of 62 MRI scans. Five of 15 (33%) CI patients with magnet had complications: five total of 24 MRI scans (21%). Two patients had magnet removal prior to 29 MRI scans without complications. Four of five MRI‐related complications were equipped with a U.S. Food and Drug Administration‐approved head wrap. Three of five required a trip to the operating room to explore and reposition the CI magnet; two could not complete MRI secondary to pain. Of the complications, two were Cochlear (Sydney, Australia), two Advanced Bionics (Valencia, CA), and one MED‐EL (Innsbruck, Austria). Synchrony model (MED‐EL) had 0 of seven complications, with a total of 19 MRI scans, which features a freely rotating and self‐aligning magnet.

Conclusion

Our series offers a diverse number of CI manufacturers and is in accordance with other literature that CI MRI‐related adverse events are occurring at an unacceptable frequency. We can promote CI MRI safety through our institutions' MRI CI patient protocols, raise awareness that diagnostic MRI benefits must outweigh CI‐related complications, and advocate for continued industry technological innovation.

Level of Evidence

4 Laryngoscope, 2018

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Continuous laryngoscopy during provocation in the assessment of inducible laryngeal obstruction

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Postoperative respiratory complications and racial disparities following inpatient pediatric tonsillectomy: A cross‐sectional study

Objectives/Hypothesis

To study rates of respiratory complications/interventions among inpatient tonsillectomy patients in the United States and identify risk factors for these events.

Study Design

Retrospective database review.

Methods

Children (age < 18 years) undergoing tonsillectomy with or without adenoidectomy in 2006, 2009, and 2012 were studied using the Kids Inpatient Database, Healthcare Cost and Utilization Project, Agency for Healthcare Research and Quality. Outcomes were analyzed for respiratory events (complications/interventions) and racial disparities. Pearson χ#lary27405-bib-0002 test was used to analyze categorical data and regression analysis was used for continuous variables. Respiratory events were analyzed by racial identity using logistic regression analysis. A P < .05 was considered significant.

Results

The study included 30,617 patients (41% female, 51% white, 24% African American, 23% Hispanic, 3.0% Asian). The mean age was 5.2 years, and mean length of stay 2.3 days. The overall complication rate was 6.0%, and overall intervention rate was 3.6%. Respiratory events were more common among African American children (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.3‐1.6) and less common among white children (OR: 0.8, 95% CI: 0.8‐0.9). These differences were significant after controlling for age, gender, obesity, obstructive sleep apnea, and asthma. The mortality rate was 0.05% with no ethnic predilection.

Conclusions

Respiratory events after inpatient tonsillectomy included laryngo/bronchospasm, pneumonia, pulmonary edema, intubation, prolonged intubation, and ventilation. Although uncommon, these were more common among African American children. Further research is needed to understand the etiology of this disparity.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2Dbi3i2

Modified endoscopic endonasal approach with a minimally invasive transoral approach—an adjunct to infrapetrous approaches

Objectives/Hypothesis

To evaluate the potential of a minimally invasive transoral–transpalatal approach (MITA) to the retrocarotid petrous apex, as an adjunct to endoscopic endonasal approaches (EEAs).

Study Design

Cadaver study.

Methods

Five cadaveric specimens were dissected raising an inverted U‐shaped palatal mucoperiosteal flap, and drilling a rectangular palatotomy (between the greater palatine foramens, and just anterior to the palatine aponeurosis). This allowed a transpterygoid EEA with cross‐court access (contralateral line of sight), followed by an extradural clivectomy that exposed the petroclival junction bilaterally. Surgical targets were marked on the posterior and medial surface of the petrous internal carotid artery (ICA), at its anterior genu, midhorizontal portion, and posterior genu. For each target and approach, the surgical freedom and angles of approach (in the horizontal and vertical planes) were calculated and statistically compared.

Results

Compared to EEA, the MITA resulted in greater surgical freedom for all targets, with the highest values at the anterior genu (1,661.37 mm² vs. 312.76 mm², P <.001), and maintaining superiority in this regard all the way to the posterior genu (847.84 mm³ vs. 138.91 mm³, P < .005). MITA also offered greater angles of approach for all targets.

Conclusions

This study suggests that the MITA may be indicated to supplement the exposure provided by a transpterygoid EEA. This technique, associated with low potential morbidity, offers an alternative to internal carotid lateralization while managing extradural lesions that are adjacent to the petrous ICA.

Level of Evidence

NA Laryngoscope, 2018

https://ift.tt/2PPLIEd

Decision aid prototype for treatment of pediatric sleep disordered breathing: A randomized pilot study

Objectives

1) To examine the feasibility and usability of a decision aid prototype (DA) for pediatric obstructive sleep apnea (OSA). 2) to estimate parameters for a future randomized controlled trial.

Study Design

Multicenter randomized pilot trial.

Methods

Ninety‐nine parents of children ( < 6 years of age) undergoing consultation for adenotonsillectomy for sleep‐disordered breathing were prospectively enrolled. Families were randomly assigned to receive the DA or to follow standard care procedures. All consultations were video‐recorded and coded with the observing patient involvement in decision making (OPTION) instrument. Following the consultation, parents completed the Decisional Conflict Scale (DCS) and Shared Decision‐Making Questionnaire (SDM‐Q‐9), whereas otolaryngologists completed the physician version (SDM‐Q‐Doc). A subset of parents and surgeons were interviewed to assess the usability of the DA.

Results: Overall, a significantly negative correlation between DCS and SDM‐Q‐9 was observed (P < 0.001). Interviews showed that parents found the DA helpful but wanted more time to read and contemplate the information. Both parents and surgeons indicated that instructions on how to use the DA would be beneficial. For parents receiving the DA, the mean total OPTION score was 13.83 out of 40 (standard deviation 5.24), compared to 11.95 (standard deviation 5.21) in those not receiving the DA (P = 0.11). There were no significant differences in the decisional conflict or shared decision making when using the DA.

Conclusion: The DA was feasible but used differently among surgeons. The need to improve SDM techniques was suggested by both surgeons and parents. Future studies training otolaryngologists on effective SDM techniques and how to appropriately utilize decision aids may improve SDM for pediatric OSA.

Level of Evidence

1B. Laryngoscope, 2018

https://ift.tt/2Dd8SNS

Do preoperative corticosteroids benefit patients with chronic rhinosinusitis with nasal polyposis?

https://ift.tt/2PMKjOO

Subglottic stenosis: An evaluation of an elderly treatment‐seeking population

Objectives/Hypothesis

To evaluate the demographics, etiology, intraoperative findings, and treatment outcomes of patients with subglottic stenosis (SGS), comparing those patients aged <65 years to an elderly population aged ≥65 years.

Study Design

Retrospective cohort study.

Methods

Nine‐year retrospective review of patients with SGS. Forty‐eight adults presented for evaluation and treatment of SGS between January 2008 and December 2016. At the time of presentation, 41 were aged <65 years and seven were aged ≥65 years.

Results

Comparing the aged <65 years group to the aged ≥65 years group, the etiology was idiopathic SGS in 50.0% versus 42.8%, intubation‐related SGS in 22.5% versus 28.6%, and granulomatosis with polyangiitis in 27.5% versus 28.6%, respectively. No statistically significant difference was noted in the two groups when comparing the demographics, etiology, treatment, intraoperative findings, or intertreatment interval (ITI).

Conclusions

We sought to analyze an older patient population with SGS and found no statistically significant differences compared to a younger population. ITI trended toward older patients requiring surgery more frequently but was not significant.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2DbhR2i

Interesting case of late Gore‐Tex extrusion following medialization laryngoplasty

A 65‐year‐old female presented with a foreign body sensation following an asthmatic attack associated with severe coughing. Six years earlier, the patient underwent medialization laryngoplasty (ML), which was complicated by a small tear (2 mm) in the right ventricle. One year following this, the patient developed Gore‐Tex extrusion but elected only for partial removal. Healing was complete until 5 years later; on examination, the patient had evidence of Gore‐Tex extrusion through the right ventricle. Implant extrusion is a recognized complication of ML. This case demonstrates several important surgical steps that can benefit otolaryngologists at all stages of their surgical career. Laryngoscope, 2018

https://ift.tt/2PK8rl9

Aspiration in children with unilateral vocal fold paralysis

Objectives/Hypothesis

To describe the prevalence of aspiration in children with unilateral vocal fold paralysis who underwent objective assessment of swallow function.

Study Design

Retrospective chart review.

Methods

A study of patients presenting to our institution with unilateral vocal fold paralysis in 2015 was conducted. All patients were diagnosed using flexible laryngoscopy. Patients were included if they underwent at least one modified barium swallow (MBS) study for evaluation of their swallowing function due to recurrent respiratory issues and/or feeding difficulty.

Results

Twenty‐eight patients diagnosed with unilateral vocal fold paralysis underwent an MBS study at our institution in 2015. Median age at the time of MBS study was 1.7 years (interquartile range: 0.4–4.3). Twenty‐six patients (92.9%) had dysphagia. Sixteen patients were found to aspirate on MBS study. All patients who aspirated did so without overt signs (silent aspiration). Eighteen patients had congenital heart disease (64.3%) and nine had a history of prematurity (32.1%). Eight patients (28.6%) presented with developmental delays.

Conclusions

Patients who present with unilateral vocal fold paralysis and recurrent respiratory and/or feeding issues may be affected by prominent issues such as swallowing dysfunction and silent aspiration. Clinicians should be aware of this risk and evaluate patients for any signs of feeding or swallowing difficulties.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2DdrHk3

The Prevalence of Cricopharyngeal Webs in Elderly Cadavers

Objective

Cricopharyngeal webs (CPW) are a frequent cause of solid food dysphagia. They are difficult to diagnose and are often missed on swallowing fluoroscopy. The prevalence of CPWs is uncertain. The purpose of this study was to determine the prevalence of CPWs in elderly cadavers.

Methods

Direct laryngoscopy and cervical esophagoscopy were performed in 19 embalmed cadavers by independent two‐clinician consensus. Cadaver demographics and the presence and laterality of a CPW were recorded. The prevalence of CPW was calculated, and the size of the cricopharyngeus muscle (CPM) was quantified.

Results

The mean age of the cohort was 83 ( ± 12) years. Fifty‐three percent were female, and the mean body mass index was 19.7 ( ± 3). The causes of death were cardiovascular disease (10 of 19), cancer (5 of 19), and respiratory failure (4 of 19). A CPW was present in 68% (13 of 19) of cadavers. Forty‐seven percent (9 of 19) had a unilateral web, and 21% (4 of 19) had a bilateral web. There was no laterality predominance (P > 0.05). Forty‐two percent (8 of 19) had no CPM prominence; 32% (6 of 19) had a small/moderate CPM prominence; and 26% (5 of 19) had a significant CPM prominence.

Conclusion

The prevalence of cricopharyngeal webs in elderly cadavers is high (68%). The clinician should maintain a high index of suspicion for CPWs in patients with no other identifiable etiology of solid food dysphagia.

Level of Evidence

3b. Laryngoscope, 2018

https://ift.tt/2PNj0DT

Is a schirmer's test necessary before blepharoplasty?

https://ift.tt/2DgRKqT

Does anatomic subsite influence oral cavity cancer mortality? A SEER database analysis

Objective

To determine if there are differences in mortality from oral cavity squamous cell carcinoma (OCSCC) based on oral cavity (OC) subsites.

Methods

Using the Surveillance, Epidemiology, and End Results Program (SEER) 9 database, patients with sequence number 0 or 1 squamous cell OCSCC were analyzed by OC subsite for 5‐year cause‐specific mortality (CSM) from OCSCC. Proportional hazards regression determined the association between 5‐year CSM and OC subsites while controlling for treatment modality, stage, and demographic characteristics using hazard ratios. Significance was set at alpha = 0.05.

Results

20,647 OC patients were included in the regression analysis. The most commonly diagnosed sites were floor of mouth (34.4%) and oral tongue (34.3%). Floor of mouth, upper gum, and retromolar trigone were associated with lower CSM compared to oral tongue. Not receiving surgery and receiving radiation were associated with increased CSM, and CSM increased with cancer staging when distant or regional disease was compared to localized disease. Also, patients diagnosed at 60 years or older and black patients had increased CSM.

Conclusion

Among OCSCC patients, those with oral tongue cancer are more likely to experience CSM than patients with floor of mouth, upper gum, and retromolar trigone cancer. It is important to understand these mortality related differences in the management of OCSCC patients. Understanding subsite‐specific mortality may benefit prognosis counseling of OCSCC patients and elicit subsite‐directed research as a means to improve outcomes.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2PNj0nn

Topical Application of 5‐Aminolevulinic Acid Is Sufficient for Photodynamic Therapy on Vocal Folds

Objectives

To evaluate the feasibility of topical photodynamic therapy (PDT) using 5‐aminolevulinic acid (5‐ALA) for vocal fold leukoplakia.

Study Design

Ex vivo and in vivo.

Methods

5‐ALA was applied topically as a 20% solution to ex vivo canine vocal folds. The penetration depth and concentrations of 5‐ALA in tissue were quantified using frozen sectioning and fluorescamine derivatization after 5‐ALA contact incubation or topical spraying. Then, 5‐ALA solution was sprayed on leporine vocal folds once, twice, or given systemically in vivo. Protoporphyrin IX (PPIX) location was visualized using fluorescence microscopy, and PPIX concentrations were measured using a fluorescent quantitative method. Hematoxylin and eosin (H&E) staining was performed to visualize the histological changes of vocal folds after PDT for each group.

Results

Topical incubation of 15 minutes with 5‐ALA achieved a penetration depth of over 2 mm and similar concentrations within the superficial 500 μm of epithelium, compared with longer incubation times. Topical spraying of 5‐ALA produced sufficient concentrations in vocal folds, but the retention time is short. An in vivo leporine model showed that laryngeal spraying of 20% 5‐ALA induced similar penetration depth and concentrations of PPIX compared to systemic administration of 5‐ALA. Two sprays of 20% 5‐ALA solution with an interval of 30 minutes are needed to produce complete exfoliation of vocal fold epithelium.

Conclusion

Topical PDT with laryngeal spraying of 20% 5‐ALA solution achieves sufficient therapeutic effects and is potentially applicable for the treatment of vocal fold leukoplakia.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2DbhpkC

Evaluation of early oral cavity cancer treatment quality at a single institution

Objective

To evaluate the adherence to oral cavity quality guidelines endorsed by the American Head and Neck Society (AHNS) at a large tertiary care hospital.

Methods

This retrospective study identified patients treated for early‐stage oral tongue squamous cell carcinoma at a tertiary care hospital from 1992 to 2013. Patient charts were reviewed for 26 process quality measures and four key indicator process quality measures as endorsed by the AHNS. Patients were then grouped by diagnosis date either before (historical group, 1992–2007) or after (current treatment group, 2008–2013) the published process quality measures from the AHNS. Descriptive statistics were used to evaluate the rates of adherence for each process quality measure within the 2 groups.

Results

Of the 57 patients identified, 29 were female (51%). The mean age was 62.3 years. A majority of the oral cavity cancers were stage I (59.6%), followed by stage II (35.1%) and stage III (5.3%). Compliance with the process quality measures was in the acceptable range in both cohorts. However, several areas demonstrated lower adherence in both cohorts. Statistically significant improvements were noted between the two cohorts, which showed a measurable improvement in adherence to process quality measures in several key areas over time.

Conclusion

Using the process quality measures proposed by the AHNS, adherence to the process quality measures for early‐stage oral cavity cancer care at a tertiary care center was successfully evaluated. In general, good compliance with the proposed process quality measures was found and several areas for improvement were identified.

Level of Evidence

2c. Laryngoscope, 2018

https://ift.tt/2PK8qxB

Canal wall up surgery with mastoid and epitympanic obliteration in acquired cholesteatoma

Objectives/Hypothesis

The objective of this study was to evaluate surgical outcome and residual and recurrence rates of canal wall up (CWU) surgery with obliteration of the mastoid and epitympanum.

Study Design

Retrospective cohort study in a tertiary referral center.

Methods

Patients with (sequelae of) acquired cholesteatoma treated with primary or revision CWU surgery with obliteration of the epitympanum and mastoid were identified retrospectively from 2010 to 2014. Obliteration was performed with cartilage chips or a periosteal midtemporal flap in combination with bone pâté and/or hydroxyapatite. Patients were followed up with micro‐otoscopy and magnetic resonance imaging (MRI) with diffusion‐weighted imaging (DWI).

Results

Ninety‐nine ears in 96 patients were managed with obliteration of the epitympanum and mastoid following CWU surgery. Mean postoperative follow‐up was 39.6 (standard deviation [SD] = 16.3). Mean follow‐up until the last MRI‐DWI was 29.7 months (SD = 16.0). In total, 74 ears in 72 adult patients (mean age = 46.8 years) were operated and 25 ears in 24 pediatric patients (mean age = 12.8 years). The overall recurrence rate was 7.1%, and the residual rate was 7.1%. In comparison, before the introduction of obliteration, the residual rate in our clinic was 24.4% and the recurrence rate 39.7%. After CWU surgery with obliteration, recurrence in pediatric patients (16.0%) was more frequent than in adults (4.1%). Although this difference was not statistically significant, a trend was observed (P = .066).

Conclusions

Obliteration of the epitympanum and mastoid is a reliable and safe technique following CWU surgery for cholesteatoma, resulting in low residual and recurrence rates.

Level of Evidence

4 Laryngoscope, 2018

https://ift.tt/2Dev5eL

Measurement reliability of phonation threshold pressure in pediatric subjects

Objectives/Hypothesis

Phonation threshold pressure (PTP), the minimum subglottal pressure (P_s) required for phonation, is sensitive to changes in laryngeal biomechanics and is often elevated with pathology. Little is reported on PTP in children; challenges with task performance and measurement reliability represent barriers to routine clinical assessment.

Study Design

Pilot study evaluating PTP and P_s measurement reliability in children using labial and mechanical interruption.

Methods

Twenty‐two subjects aged 4 to 17 years (10.7 ± 3.9 years) participated. Ten trials were performed for each method; task order was randomized. For labial interruption, subjects produced /pα/ five times at softest (onset PTP) and comfortable amplitude. For mechanical interruption, subjects produced a sustained /α/ while a balloon valve interrupted phonation five times for 250 ms each; mechanical interruption was performed with a mouthpiece and mask. PTP was recorded as the difference between P_s and supraglottal pressure at phonation cessation (offset PTP). Mean PTP and P_s and intrasubject coefficients of variation were compared. Correlations with age were evaluated.

Results

Mean PTP (P < .001) and P_s (P = .005) were higher for labial interruption. Intrasubject coefficients of variation for PTP (P = .554) and P_s (P = .305) were similar across methods. Coefficient of variation was related to age for mechanical‐mask trials only (r = −0.628, P = .00175).

Conclusions

Differences in means are likely related to differences in task and PTP hysteresis effect. Reliability is comparable with all methods; using a mouthpiece may be preferable to a mask for mechanical interruption. Measurement of PTP is noninvasive, reliable, and may be a useful adjunct in pediatric voice assessment.

Level of Evidence

3b Laryngoscope, 2018

https://ift.tt/2POgpth

Real steak knives of cincinnati: Repeated foreign body ingestion with novel endoscopic removal

Repeated ingestion of foreign objects presents a multidisciplinary endoscopic dilemma. We report a 32‐year‐old female patient with history of multiple previous foreign body ingestions requiring several past exploratory laparotomies, who presents with a knife blade in the esophagus. We present a novel method of using a rigid cervical esophagoscope with a salivary bypass tube. The tip of the knife was isolated into the cervical esophagoscope, and the salivary bypass tube advanced off the cervical esophagoscope over the knife, shielding the serrated edge during removal preventing laceration to the esophagus.

https://ift.tt/2DdqQ32

I dream of Gini: Quantifying inequality in otolaryngology residency interviews

Objectives

Otolaryngology applicants routinely decry conflicting interview dates because this limits the number of interviews that one can attend, despite being offered an interview. Conversely, applicants also perceive that a large number of interviews are offered to a minority of applicants. We sought to verify and quantify the inequality in distribution of interviews attended.

Study Design

Retrospective analysis of the National Resident Matching Program (NRMP) 2016 Charting Outcomes in the Match and Electronic Residency Application Service (ERAS) historic specialty data.

Methods

The Gini coefficient, a commonly used indicator of economic inequality, was calculated using data from the 2016 Charting Outcomes in the Match to estimate the distribution of interviews attended. This data was compared to nine other specialties, comprising a wide range of competitiveness and specialty size.

Results

26% (110 of 416) of otolaryngology applicants accounted for half (1,721 of 3,426) of all possible interview positions. The Gini coefficient ranged from 0.43 to 0.84 across 10 specialties, with a higher coefficient indicating higher inequality. The Gini coefficient among otolaryngology applicants was 0.43, indicating lower inequality than most other specialties. When including only applicants who interviewed, the Gini coefficient was 0.23.

Conclusion

There is an unequal distribution of interview invitations, which likely reflects the reality of asymmetry in applicant competitiveness. Otolaryngology demonstrates the greatest equality in distribution, which may stem from a greater burden of hoarding. The specialty's perceived competitiveness mitigates factors such as cost and time, essentially encouraging more people to take as many interviews as they can.

Level of Evidence

NA. Laryngoscope, 2018

https://ift.tt/2PRIUq3

What defines asymmetric sensorineural hearing loss?

https://ift.tt/2D98tw9

CD8‐positive Pseudolymphoma in Lues maligna and HIV with monoclonal TCR‐beta rearrangement

A 42‐year‐old Caucasian man suffered from disseminated plaques and ulcerated nodules for six weeks. He had weight loss and generalized lymphadenopathy. Underlying diseases were not known up till then. Based on a skin biopsy the diagnosis of CD8‐positive cutaneous T‐cell lymphoma, type mycosis fungoides was made in a pathological reference center for lymphoma. A reproducible TCR‐beta rearrangement was detectable. Before starting therapy, a new biopsy was taken and the previous diagnosis was re‐evaluated taking clinical images and symptoms into account. Based on both, the diagnosis of a CD8+ pseudolymphoma in lues maligna and HIV was made.

We highlight histopathologic clues for the correct diagnosis, and we emphasize the indispensability of clinical‐pathological correlation. Furthermore, we discuss the differential diagnosis of CD8+ lymphoproliferative disorders.

https://ift.tt/2SYrHdf

Eosinophilic dermatosis of hematologic malignancy: Correlation of molecular characteristics of skin lesions and extracutaneous manifestations of hematologic malignancy

Background

Skin diseases are frequent in patients with chronic lymphocytic leukemia and other hematological neoplasias. Eosinophilic dermatosis of hematologic malignancy (ED) has long been considered a nonspecific cutaneous reaction pattern. Recently neoplastic cells have been shown to be present in ED thus challenging the classification as a nonspecific dermatosis.

Methods

We report 5 patients with ED in association with chronic lymphocytic leukemia (CLL). We further investigated the presence of neoplastic B‐cells in the skin infiltrate by immunohistochemistry and immunoglobulin heavy chain rearrangement and compared these to extracutaneous manifestations of CLL.

Results

The phenotype of the lymphocytic infiltrate was predominately CD3+ (range: 60‐90%). CD20+ and CD79a+ lymphocytes were less frequent accounting for up to 15% (range: absent – 15%). CD23+ lymphocytes represented up to 20% (range: absent – 20%) of the infiltrate. The analysis of the immunoglobulin heavy chain rearrangement in the skin specimens showed clonal rearrangements in 4/5 patients and in 3 of these 4 patients clones were identical to extracutaneous CLL manifestations.

Conclusion

Our data show that neoplastic B‐cells are very frequently found in ED when systematically evaluated. This findings support the hypothesis that leukemic cells play a pathogenetic role in eosinophilic dermatosis of hematologic malignancy.

https://ift.tt/2zCgvKk

Primavera: A new therapeutical approach to vulvo‐vaginal atrophy

Abstract

Vulvovaginal atrophy is a condition that affects women, although it is mainly associated with the onset of menopause mainly due to hormonal changes vulvovaginal laxity and mucosal atrophy can also affect women at different life stages such as after pregnancy or for cancer patients who have undergone chemo or endocrine therapy. This condition negatively influence quality of life, sexual desire, and self‐confidence. Many therapies have been considered mainly with inconclusive or transient results in terms of benefit factor. Recently, a new non‐invasive product, containing hyaluronic acid, oligopeptides, and antioxidants was introduced to the market. Its name is "Primavera," by Renaissance, Italy. The aim of this product is to allow a vulvo‐vaginal biostimulation and considered simple, safe, and satisfactory.

https://ift.tt/2RLVWTc

Primavera: A new therapeutical approach to vulvo‐vaginal atrophy

Abstract

https://ift.tt/2RLVWTc

Performance of a constructed wetland as an upstream intervention for stormwater runoff quality management

Abstract

In most developing countries, stormwater runoff has had significant impacts on aquatic environment by directly causing pollution of receiving water and reduction in treatment performance of wastewater treatment plants. With increasing encroachment on natural wetlands in Uganda, constructed wetlands offer a feasible option for the environment to cope up and buffer the impact of pollutants from the ever-increasing urban masses. This study investigated the performance efficiencies of three configurations (varied by the substrate used) of microcosm wetlands to remove physicochemical parameters from stormwater runoff in Uganda. The parameters monitored included chemical oxygen demand (COD), total suspended solids (TSS), total nitrogen (TN), and total phosphorus (TP). Hydraulic retention times (HRTs) of 2, 4, 6, and 8 days were studied. The mean concentrations of the physicochemical parameters in the runoff were 219.4 ± 12.8 mg/L COD, 77.4 ± 8.3 mg/L TSS, 9.0 ± 0.4 mg/L TN, and 1.6 ± 0.1 mg/L TP. Configuration A, vegetated with cattail (Typha latifolia) and bulrush (Scirpus lacustris), achieved maximum COD removal of 75.9% (HRT = 6 days), TN removal of 72.8% (HRT = 8 days), and TP removal of 62.8% (HRT = 8 days). Configuration C, the control, with no substrate, achieved the highest TSS removal of 75.6%. The results suggest that vegetated microcosm constructed wetlands can potentially be used to pre-treat stormwater within the catchment. However, an upstream sedimentation process unit is required to enhance their performance and to avoid premature clogging of the wetlands by TSS. The pre-treated stormwater reduces pollutant load into wastewater treatment plants and consequently better raw water quality for water treatment plants.

https://ift.tt/2qB4TmU

Greenhouse gas emissions vary in response to different biochar amendments: an assessment based on two consecutive rice growth cycles

Abstract

The efficiency of biochar to mitigate greenhouse gas (GHG) emission from rice paddy soils is not consistent. Furthermore, which factor dominates this mitigation efficiency is not clear. In the present 2-year greenhouse experiment, the effects of biochars derived from two feedstocks (wheat straw and saw dust) and two pyrolysis temperatures (500 °C and 700 °C), and applied at two different rates (0.5 wt% and 3 wt%) on methane (CH₄) and nitrous oxide (N₂O) emissions, and the total global warming potential (GWP_t), and GHG intensity (GHGI) were measured. The results showed that biochar applications did not alter GHG emission flux patterns in either rice cycle. In 2015, the N₂O emissions were 24.6–71.2% lower under six biochar treatments than under the urea control treatment. Moreover, total CH₄ emissions were mitigated by 13.3–92.6% and 27.7–53.5% under six and five biochar treatments in 2015 and 2016, respectively. Overall, lower GWP_t and GHGI were observed under most of the biochar treatments compared with the urea control treatment in both rice cycles. The multivariate analysis of variance (MANOVA) results of the data from both years suggested that the biochar effects on reducing GHG emissions changed with either individual factors or their interactive effects. The responses of the GWP_t and GHGI varied mainly with biochar application rate and pyrolysis temperature (P < 0.005); compared with that derived from a relatively low pyrolysis temperature and applied at a relatively low rate, biochar derived from a relatively high pyrolysis temperature and applied at a relatively high rate exerted relatively higher GWP_t and GHGI mitigation efficiencies. The influence of the feedstock source was not as prominent as the application rate and pyrolysis temperature, which will expand the scope of biochar applications.

https://ift.tt/2FfgthK

Cost‐of‐illness of Melanoma in Europe – a systematic review of the published literature

Abstract

Malignant melanoma accounts for the vast majority of skin cancer deaths. Primary prevention is used to increase knowledge about skin cancer and set incentives for a change in behaviour, which leads to a decrease in cases. Primary prevention may be cost‐effective or even cost saving. Cost‐of‐illness studies provide information on such potential savings.

The purpose of this study is to give an overview on cost‐of‐illness studies in European countries and to compare the cost‐of‐illness in total and by cost categories. The results can be used to model potential cost savings from prevention.

We conducted a systematic literature research in PubMed using the PRISMA checklist. All costs were converted into Euro and adjusted for the reference year 2012. For the ranking of countries according to their cost‐of‐illness, all costs were adjusted for the purchasing power parity.

Studies focusing on stage III–IV melanoma all include information on hospital, hospice, and outpatient treatment. Costs for the treatment of advanced melanoma range between € 2,972 in Italy and € 17,408 in Sweden after adjusting for PPP.

Most studies on stage I–IV melanoma include costs of hospitalisation, outpatient treatment and GP consultation. Direct costs range from € 923 in Sweden to € 9,829 in Denmark. Three articles also include information on indirect costs. Mortality costs vary between € 3,511 in Sweden and € 20,408 in England, morbidity costs between € 103 in Sweden and € 4,550 in England.

We showed that costs for the treatment of skin cancer are moderately high in the included countries. Since after publication of the articles new costly drugs were approved in Europe, treatment costs of melanoma in Europe may be expected to have risen in the last few years, which means that there is a high expectable potential for prevention programmes to become cost‐effective or even cost saving.

https://ift.tt/2PjQDh3

Decreasing sunbed use in the German population between 2001–2015: survey in 155,679 working persons

Abstract

Background

UV radiation is a proven cause of skin cancer. Use of sunbeds has been shown to provide an attributable risk.

Objective

To evaluate the proportion of regular sunbed use in Germany based on large‐scale population‐based surveys over 15 years.

Methods

Skin cancer screenings by dermatologists were conducted between 2001 and 2015 in more than 500 German companies, including a clinical examination and interviews on the risk behavior related to sunburns and sunbeds.

Results

Among 155,679 persons included regular sunbed use significantly declined from 11.0% in 2001 to 1.6% in 2015 (p < 0.001). There were significantly higher rates of sunbed use in women (12.5% / 2.0%) versus men (7.3% / 1.3%; p < 0.001), in younger persons and in participants with darker skin (type II and III) versus fair skin (type I). Individuals with sunburns in childhood were significantly more often sunbed users (5.1% vs. 4.6%; p = 0.002). A remarkable decline of sunbed use was observed after 2009 (7.0% in 2001–2008 and 2.2% in 2009–2015). This reduction occurred in the time of a legal ban of sunbed use for minors but also with the start of the national skin cancer screening program.

Conclusion

Use of sunbeds in the German adult population has dropped by more than 85% in the past decade. Primary prevention, including the large public awareness following the legal ban of sunbed use for young people and the effects of the statutory skin cancer screening program may have contributed to this.

https://ift.tt/2QwQhAo

A novel role of angiotensin II in epidermal cell lineage determination: Angiotensin II promotes the differentiation of mesenchymal stem cells into keratinocytes through the p38 MAPK, JNK and JAK2 signalling pathways

Summary

Background

Recent evidence suggests that angiotensin II (Ang II) plays a role in cutaneous wound healing. Mesenchymal stem cells (MSCs) are known as a rich source of cells that re‐establish healed skin. However, the potential impact of Ang II on MSC differentiation into keratinocytes is still unknown.

Objective

The present study was conducted to explore the effect of Ang II on differentiation of bone marrow‐derived MSCs (BM‐MSCs) into keratinocytes.

Methods

BM‐MSCs were isolated from rat bone marrow and cultured. The expression of Ang II type 1 (AT₁) and type 2 (AT₂) receptors was examined by immunofluorescence staining. The differentiation of BM‐MSCs into keratinocytes was investigated by flow cytometry or/and histological observation.

Results

The BM‐MSCs constitutively expressed both AT₁ and AT₂ receptors. The differentiation of BM‐MSCs into keratinocytes was successfully induced. Interestingly, incubation of BM‐MSCs with Ang II further promoted the differentiation of BM‐MSCs into keratinocyte, which was abolished by pre‐treatment with losartan, an AT₁ receptor antagonist, but not by PD123319, an AT₂ receptor antagonist. Moreover, the p38 mitogen‐activated protein kinase (MAPK) inhibitor SB203580, the c‐Jun N‐terminal kinase (JNK) inhibitor SP600125 and the Janus‐activated kinase (JAK)2 inhibitor AG490 suppressed Ang II‐induced differentiation of BM‐MSCs into keratinocytes. The phosphoinositide‐3 kinase (PI3K) inhibitor wortmannin and MEK1/2 inhibitor U0126 had no effect on BM‐MSC differentiation into keratinocytes.

Conclusions

Our data demonstrated for the first time that Ang II plays a promotive role in the differentiation of BM‐MSC into keratinocytes through the AT₁ receptor, and that the p38 MAPK, JNK and JAK2 signalling pathways are involved in this process.

https://ift.tt/2Qs1LVI

Mannosylerythritol lipids inhibit melanogenesis via suppressing ERK‐CREB‐MiTF‐tyrosinase signaling in normal human melanocytes and a three‐dimensional human skin equivalent

Abstract

Hyperpigmentation is caused by excessive production of melanin in melanocytes. Mannosylerythritol lipids (MELs) are glycolipid biosurfactants that are abundantly produced by yeasts and used commercially in cosmetics. However, the potential depigmenting efficacy of MELs has not been evaluated. In this study, the depigmentary effect of MELs was tested in primary normal human melanocytes (NHMs), α‐melanocyte‐stimulating hormone (MSH)‐stimulated B16 cells (murine melanoma cells) and a human skin equivalent (MelanoDerm) using photography, Fontana‐Masson (F&M) staining, and two‐photon microscopy. MELs significantly decreased the melanin contents in NHMs and α‐MSH‐stimulated B16 cells. Consistent with these findings, MELs treatment had a clear whitening effect in a human skin equivalent, brightening the tissue color and reducing the melanin content. The molecular mechanism underlying the anti‐melanogenic effect of MELs treatment was examined by real‐time PCR and Western blotting. Mechanistically, MELs clearly suppressed the gene expression levels of representative melanogenic enzymes, including tyrosinase, Tyrp‐1, and Tyrp‐2, by inhibiting the ERK/CREB/MiTF signaling pathway in NHMs. This work demonstrates for the first time that MELs exert whitening effects on human melanocytes and skin equivalent. Thus, we suggest that MELs could be developed as a potent anti‐melanogenic agent for effective whitening, beyond their use as a biosurfactant in cosmetics.

https://ift.tt/2PkiLk5

Three strategies for displaying the postcricoid space and pyriform sinus: a matched case‐controlled study of 50 patients

Abstract

The postcricoid space and pyriform sinus are difficult to completely display under routine laryngoscopy examination.

We present the results obtained from 50 patients who were randomly recruited to receive a laryngoscopy examination via a routine, Valsalva manoeuvre combined with anterior cervical skin traction (V‐ACST), followed by a Valsalva manoeuvre combined with the modified Killian method (V‐MK).

The routine method is not suitable for displaying the postcricoid space.

In general, both the V‐ACST and V‐MK displayed the postcricoid space and pyriform sinus very well.

The V‐ACST displayed significantly more of the postcricoid space, whilst the V‐MK was clear better at exposing the pyriform sinus.

https://ift.tt/2FfekTe

Design of Skin Islands for a Myocutaneous Serratus Anterior Free Flap ‐ An Anatomical Study and Clinical Implication for Pharyngeal Reconstruction after Laryngopharyngectomy

Abstract

Objectives

The main purpose of this study was to evaluate flap size and flap design of skin islands in myocutaneous serratus anterior free flaps (SAFFs) in fresh cadavers and to further investigate whether myocutaneous SAFFs are suitable flaps for pharyngeal reconstruction after laryngopharyngectomy.

Methods

Dissection and injection of methylene blue was performed in 20 hemithoraces of 13 fresh cadavers to evaluate flap size and location of skin islands. Based on these preclinical data, we performed pharyngeal reconstruction with myocutaneous SAFF in 5 patients after laryngopharyngectomy.

Results

Perfused skin paddles were found in all specimens with a mean size of perfused skin islands of 85.6 ± 49.8 cm². Lengths and widths of skin islands ranged from 10‐21 cm and 6‐20.5 cm, respectively. Flap size did not significantly differ between males and females (p=0.998), left compared to right hemithoraces (p=0.468) and between paired specimens (p=0.915). All skin islands were found within the upper 29.3% to 51.7% of hemithorax (calculated from axilla to costal arch), and between latissimus dorsi muscle posteriorly and anterior axillary line anteriorly. Accordingly, myocutaneous SAFFs were used for pharyngeal reconstruction after laryngopharyngectomy in 5 patients with advanced hypopharyngeal carcinomas. Three patients had uneventful courses, while one patient developed immediate intraoperative flap loss and another patient developed partial necrosis of SAFF on postoperative day 7.

Conclusion

Skin islands of SAFF have reliable blood supply, which allow harvest of large myocutaneous SAFFs that can be used also for pharyngeal reconstruction after laryngopharyngectomy.

https://ift.tt/2qBGIoe

The influences of age, gender and geometric pattern of visual image on the verticality perception: a subjective visual vertical (SVV) study among Malaysian adults

Abstract

Objectives

Subjective visual vertical (SVV) is a simple, quick and reliable test for measuring utricular function. The literature on the effects of fundamental demographic variables such as age and gender on SVV is inconclusive and should be supported by research with larger samples. The aim of the present study was to determine the influences of age, gender and geometric pattern of visual image on SVV among healthy adults.

Study Design

This study employed a repeated measures design.

Settings

Otorhinolaryngology Clinic, Hospital Universiti Sains Malaysia, Malaysia.

Participants

Eligible Malaysian adults (N=187, aged 21‐75 years) were recruited and categorized into young (N=60), middle‐aged (N=66) and older (N=61) groups. Most of them were Malay and 51.3% were men.

Main outcome measures

SVV angles (in degrees) were determined from each participant in a static upright condition using a computerized SVV device. They were asked to indicate their verticality perception for three types of visual images (solid line, dotted line and arrow pattern).

Results

Three‐way mixed ANOVA revealed insignificant influences of age and gender on SVV results (P>.05). In contrast, mean SVV angles were significantly higher for the arrow pattern than for other visual images (P=.004).

Conclusion

While the insignificant influences of age and gender on static SVV are further ascertained with larger samples, the perception of verticality is less accurate when aligning a more geometrically complex visual image (i.e. arrow pattern). Further SVV research on vestibular‐disordered patients is beneficial, particularly to verify the normative data obtained with this complex visual image.

https://ift.tt/2FeLjXT

The use of video‐laryngoscopy in head and neck surgery

Abstract

Direct visualisation of the upper aerodigestive tract is a fundamental skill for ENT surgeons. Rigid endoscopes themselves have seen little transformation since they were first developed for gastroscopy by Kussmaul in 1868¹. In an era of ultra high definition and 3D technology, a straight, rigid metal tube with adjoining light source carrier to inspect mucosal surfaces up to 40cm from the surgeon's eye could benefit from updating. In our department, we favour the use of the video‐laryngoscope, specifically the C‐MAC system from Karl Storz.

https://ift.tt/2qCOvCx

Monitoring polychlorinated dibenzo-p-dioxins/dibenzofurans and dioxin-like polychlorinated biphenyls in Africa since the implementation of the Stockholm Convention—an overview

Abstract

Polychlorinated dibenzo-p-dioxin (PCDDs), polychlorinated dibenzofurans (PCDF), and dioxin-like polychlorinated biphenyl (dl-PCB) are groups of toxic compounds released into the environment as unintentional by-products of combustion. They persist, bioaccumulate through the food chain, and cause adverse health effects. This review attempts to collate available information on the release of PCDD/Fs and dl-PCBs and other critical data relevant to their monitoring in Africa during the existence of the Stockholm Convention (SC). Much as the implementation of the SC may be lagging, literature showed that there has been encouraging efforts that have been made with respect to PCDDs/Fs and dl-PCBs monitoring in Africa. Results from a global monitoring study showed that PCDD/Fs released to air in Africa stood at 18–532 fg WHO₉₈ TEQ/M³ while dl-PCBs were 7–278 fg WHO₉₈ TEQ/m³. In human milk, the total concentration of PCDD/Fs, i.e., WHO 2005 TEQ LB has been reported to range from 0.5 ng/g fat to 12 ng/g fat. Fourteen laboratories in Africa participated in inter-laboratory assessments of persistent organic pollutants (POPs) with two specifically for PCDD/Fs analysis. This shows that some efforts are being made to boost capacity in Africa. Levels of PCDDs/Fs and dl-PCBs in clay consumed by pregnant women have been reported in Cameroon, Democratic Republic of Congo (DRC), Nigeria, Zimbabwe, Ĉote d'Ivoire, and Uganda with a maximum concentration of 103 pg TEQ/g. This finding was very significant since women are the most impacted through exposure to POPs, a fact that is acknowledged by the SC.

https://ift.tt/2AXTNyu

ID Proteins May Reduce Aggressiveness of Thyroid Tumors

Abstract

ID genes have an important function in the cell cycle, and ID proteins may help identify aggressive tumors, besides being considered promising therapeutic targets. However, their role in thyroid tumors is still poorly understood. We examined ID expression and their correlation with diagnostic and prognostic features aiming to find a clinical application in differentiated thyroid carcinoma (DTC) cases. mRNA levels of ID1, ID2, ID3, and ID4 genes were quantified and their expression was observed by immunohistochemistry in 194 thyroid samples including 68 goiters, 16 follicular adenomas, 75 classic papillary thyroid carcinomas, 18 follicular variants of papillary thyroid carcinoma, 5 follicular thyroid carcinomas, and 1 anaplastic thyroid cancer, besides 11 normal thyroid tissues. DTC patients were managed according to standard protocols and followed up for M = 28 ± 16 months. ID2, ID3, and ID4 mRNA levels were higher in benign (2.0 ± 1.9; 0.6 ± 0.6; and 0.7 ± 1.0 AU, respectively) than those in malignant nodules (0.30 ± 0.62; 0.3 ± 0.3; and 0.2 ± 0.3 AU, respectively, p < 0.0001 for all three genes) and were associated with no extra thyroid invasion or metastasis at diagnosis. ID3 nuclear protein expression was higher in benign than that in malignant cells (5.2 ± 0.9 vs 3.0 ± 1.8 AU; p < 0.0001). On the contrary, the cytoplasmic expression of ID3 was higher in malignant than that in benign lesions (5.7 ± 1.5 vs 4.0 ± 1.4 AU; p < 0.0001). Our data indicate that ID genes are involved in thyroid tumorigenesis and suggest these genes act impeding the evolution of more aggressive phenotypes. The different patterns of their tissue expression may help identify malignancy and characterize thyroid lesion aggressiveness.

https://ift.tt/2qFf4qK

Identification of Pen m 4 as a potential cause of occupational asthma to Gammarus shrimp

We present the case of a 34-year-old male patient employed for 8 years in a company manufacturing and packaging animal feed. The patient developed occupational asthma to dry Gammarus powder. The diagnosis was ...

https://ift.tt/2PmgmWm

Systematic review of outcomes and complications in non-implant based mastopexy surgery

Mastopexy is one of the most performed cosmetic surgery procedures in the U.S. Numerous studies of mastopexy techniques have been published in the past decades including case reports, retrospective reviews and prospective studies. However, to date, no study has investigated the overall complications or satisfaction rates associated with the wide spectrum of techniques.

https://ift.tt/2z0ChIt

Propeller Flap Reconstruction of Irradiated Sarcoma Defects: A Comparison

: The treatment for soft tissue sarcomas has evolved to include radiotherapy, wide local excision and plastic surgical reconstruction. Goals of reconstruction for these irradiated defects are introduction of non-irradiated healthy tissue, tension-free closure and obliteration of potential dead-space. While many defects once required free tissue transfer for reconstruction, greater anatomical vascular pattern knowledge has led to the increasing use of propeller perforator flaps, islanded and transposed into the defect.

https://ift.tt/2OATq0i

The Importance of Sleep for Governmental Sectors, General Population and Industry – Asia-Pacific Economic Cooperation (APEC) Sleep Technology Agenda

Sleep is a field of study that encompasses several areas relevant to many of every country's governmental sectors, as well as industry and general population. The focus of this Letter will be to address how researching sleep can reduce health expenses, increase national productivity, bring awareness to public safety and facilitate health and medical related industry development based on the Sleep Technology Agenda (STA) [1] presented at the Asia-Pacific Economic Cooperation (APEC) meeting in Ho-Chi-Ming City, Vietnam, August 2017.

https://ift.tt/2Fcgjrt

The antifungal agent of silver nanoparticles activated by diode laser as light source to reduce C. albicans biofilms: an in vitro study

Abstract

Candida albicans is a normal flora caused fungal infections and has the ability to form biofilms. The aim of this study was to improve the antifungal effect of silver nanoparticles (AgNPs) and the light source for reducing the biofilm survival of C. albicans. AgNPs were prepared by silver nitrate (AgNO₃) and trisodium citrate (Na₃C₆H₅O₇). To determine the antifungal effect of treatments on C. albicans biofilm, samples were distributed into four groups; L + P+ was treatment with laser irradiation and AgNPs; L + P− was treatment with laser irradiation only; L − P+ was treatment with AgNPs only (control positive); L − P− was no treatment with laser irradiation or AgNPs (control negative). The growth of fungi had been monitored by measuring the optical density at 405 nm with ELISA reader. The particle size of AgNPs was measured by using (particle size analyzer) and the zeta potential of AgNPs was measured by using Malvern zetasizer. The PSA test showed that the particle size of AgNPs was distributed between 7.531–5559.644 nm. The zeta potentials were found lower than − 30 mV with pH of 7, 9 or 11. The reduction percentage was analyzed by ANOVA test. The highest reduction difference was given at a lower level irradiation because irradiation with a density energy of 6.13 ± 0.002 J/cm² resulted in the biofilm reduction of 7.07 ± 0.23% for the sample without AgNPs compared to the sample with AgNPs that increased the biofilm reduction of 64.48 ± 0.07%. The irradiation with a 450-nm light source had a significant fungicidal effect on C. albicans biofilm. The combination of light source and AgNPs provides an increase of biofilm reduction compared to the light source itself.

https://ift.tt/2FeWxvh

Surgical management of onychopapilloma, onychomatricoma, and subungual osteochondroma: Case series

Swagata A Tambe, Saba M M Ansari, Chitra S Nayak, Ramya Chokkar, Priyanka D Patil

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):143-147

The clinical diagnosis of benign and malignant nail tumors can be difficult. Dermoscopy can provide a clue to the diagnosis but nail biopsy is the gold standard in establishing the diagnosis. Here, we report three cases of rare nail tumors, that is, onychopapilloma, onychomatricoma, and subungual osteochondroma, which were diagnosed on histopathology and managed surgically.

https://ift.tt/2PRERtG

Fourth dimension in reconstruction of defects following excision of basal cell carcinoma of head and neck!

Kandasamy Mahadevan, Sridhar Sruthi, Shanmugam Sridevi, Rajamanoharan Vivek

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):110-119

Background: Basal cell carcinomas (BCCs) are the most common skin tumors of the face. Excision results in soft tissue defects that require reconstruction with the focus on form, function, and patient satisfaction. Aim: To analyze the reconstruction of BCC excision defects of the head and neck region using local flaps and skin grafts with respect to the four dimensions of oncological reconstruction: clearance, form, function, and patient satisfaction. Materials and Methods: This is a prospective study conducted on 88 patients who presented with BCC of the head and neck region and who were operated in our hospital from January 2015 to December 2016 with a minimum follow-up period of 6 months up to June 2017. All patients underwent wide local excision and reconstruction using appropriate local flaps or split-thickness skin graft (SSG). Patients were analyzed with respect to age, sex, site, size, reconstruction method, complications, and patient satisfaction using the customized Patient Satisfaction Questionnaire (PSQ), derived from PSQ III. Results: A total of 77.3% defects were immediately reconstructed using local flaps and 18.2% underwent SSG. All flaps and grafts survived well with a complication rate of 6.8%. Approximately 72.7% of patients had good satisfaction with the medical care and reconstruction. Conclusion: Post-excisional defects of BCC in the head and neck region have to be reconstructed with equal weightage to the four pillars of oncological reconstruction: clearance, form, function, and patient satisfaction. Flap reconstruction is ideal as it brings about reconstruction with patient satisfaction, which is indeed the fourth dimension in any reconstructive surgery.

https://ift.tt/2DdMtA1

Harmonic devices: The workhorse for surgical resection of vascular malformations

Chirayu Parwal, Lalit Choudhary, Anurag Pandey, Vivek Kumar, Puran Singh, Jessy Ragi

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):157-160

Management of vascular malformations is multimodal with documented role of surgical resection in specific facets of this condition. Surgical resection of these lesions is technically challenging owing to diffuse and relatively ill-defined extent with involvement of multiple tissue planes limitation of access and excessive intra-operative bleeding. An observational study was conducted in 24 cases taken up for surgical resection of vascular malformations. The cases were divided into two groups based on the hemostasis technique used: Group A: Harmonic shears (n = 12) (Ethicon Inc. Somerville, New Jersey, United States). Group B: Electrosurgery (monopolar/bipolar) with standard knot tying (n = 12). We conclude that use of harmonic scalpel in surgical resection causes less parallel tissue damage, secures haemostasis promptly, does not impede vision and aids surgical dissection thereby significantly reducing the operative time and improving the surgical outcome, typically in large vascular malformations of head and neck region.

https://ift.tt/2PMLQ7o

Gentle is better: The original “gentle technique” for fat placement in breast lipofilling

Pietro Gentile, Barbara De Angelis, Verdiana Di Pietro, Vittoria Amorosi, Maria G Scioli, Augusto Orlandi, Valerio Cervelli

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):120-126

Context: Breast lipofilling usually involves three different stages (harvesting, processing, and placement), and in each of these phases, adipocyte cells can be damaged. Our technique of fat placement is quite different from the others as we focus our attention on the last stage of fat graft procedure, which could explain the better results in graft survival. Aims: Our method is focused on eliminating any unnecessary manipulation of the graft so as to optimize graft retention and clinical outcomes: Controlled movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater survival rate of adipocytes. Settings and Design: This was a retrospective cohort study. Materials and Methods: Of 120 patients (average age 41,5 years) affected by breast soft tissue defects, 60 were managed with the lipofilling procedure using fat graft injected by "Gentle technique." To establish the effects of the injection's procedure, we compared the results obtained in fat graft maintenance with a control group made up of 60 patients, treated with fat graft injection according to Coleman procedure. Statistical Analysis Used: Values are expressed as mean plus standard error and analyzed using Student's t test. Results: In patients treated with Gentle technique, we observed a 60.5% + 12.5% maintenance of contour restoring and three-dimensional volume after 1 year (P < 0.0001 vs. control group); we compared the results obtained with only 39% + 4.4% of the control group treated with fat graft injected according to Coleman. Conclusions: Controlled 26 movement and slow rate of fat injection are the cornerstone of our technique and guarantee a nontraumatic fat transfer and a greater 27 survival rate of adipocytes.

https://ift.tt/2DdRdG8

Maintenance of the anatomic contours in auricular reconstruction: The button technique

Brandon Worley, Joel L Cohen

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):150-152

Background and Objective: Reconstructing the contours of the auricle is a unique challenge. Various bolster techniques have been tried to help prevent complications such as hematoma, seroma, and morbidity. Here, we describe a simple technique using a button to maintain the natural ear contour when it is at risk of a poor aesthetic outcome. Materials and Methods: A 77-year-old man underwent resection of a squamous cell carcinoma of the postauricular skin on the right ear, which involved the helical margin. A skin graft was chosen to close the defect. However, on initial inspection of the repair, buckling of the scaphoid fossa, collapse of the antihelical fold, and notching of the helix were observed. When these buckling changes persisted even after the anesthesia-related swelling resolved the following day, a button bolster was placed for 2.5 weeks to provide support for the cartilage. Results: Standardized digital imaging revealed maintenance of the original contours and sulci of the ear with an excellent cosmetic result. Conclusion: Recreation of the auricular contours is critical for an excellent cosmetic outcome. Using a button bolster is worth considering as it is of low cost, can easily fit into the natural ear contours, and can provide a rigid structure to ensure maintenance of the ear shape.

https://ift.tt/2PRvcn3

Comparative (quantitative and qualitative) analysis of three different reagents for preparation of platelet-rich plasma for hair rejuvenation

Sukhbir Singh

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):127-131

Objective: The aim of this study was to compare the quantity and quality of platelets in platelet-rich plasma (PRP) samples prepared using three different reagents, namely, ethylenediaminetetraacetic acid (EDTA), sodium citrate, and acid citrate dextrose-A (ACD-A) solution. Materials and Methods: A prospective study was carried out in which all the 50 patients who attended the outpatient department for hair rejuvenation were enrolled for the study. All the patients had a history of hair fall with diffuse thinning of hair, Norwood Grades 2 and 3. Patients with complete hair loss were not included in the study. No specific randomization was carried out. All the patients were explained about the procedure and the use of vials containing the aforementioned three reagents. Then, 40mL blood was taken from each patient. Both quantitative and qualitative analyses of platelets were carried out on PRP samples. Quantitative analysis was done by using an automatic cell counter and cross-checking manually. Qualitative analysis was carried out by preparing smears from each of the three samples from each vial. All the patients were followed up at 4 weekly intervals for a duration of 6 months and then at the end of 1 year. All the patients received six sessions of PRP. Results: All the data were subjected to statistical analysis using Student's t-test, and P value of <0.001 was obtained in samples from ACD-A vials, which was statistically significant. In all the 50 patients, the samples collected in vials containing ACD-A yielded the maximum quantitative count and the best morphology of platelets under smear examination. Conclusion: Within the limits of this study, we would like to conclude that ACD-A vials should be used for collecting and processing blood for PRP preparation to obtain best results in hair rejuvenation.

https://ift.tt/2DemiZZ

Objective quantification of liposuction results

Alain J Azzi, Ann-Sophie Lafrenière, Alex Viezel-Mathieu, Thomas M Hemmerling, Mirko Gilardino

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):105-109

Currently, no reliable gold standard exists for the objective outcome measurement following liposuction. The purpose of this systematic review was to summarize reported methods of monitoring liposuction results by objectively measuring subcutaneous adipose tissue. A systematic literature search was performed to identify relevant articles that described techniques for objectively quantifying adipose tissue following traditional liposuction. The search included published articles in three electronic databases—Ovid MEDLINE, Embase, and PubMed. Subcutaneous adipose tissue was estimated using the following techniques: ultrasound, dual-energy X-ray absorptiometry, magnetic resonance imaging, computed tomography, and three-dimensional imaging volumetric analysis. Reported benefits of liposuction objective measurements included providing patients with a quantitative assessment of the liposuction results pre- and postoperatively, detecting significant changes in body fat deposits, and following patterns of fat redistribution. This review provides a summary of various techniques for quantification of liposuction results. More studies are needed to study the clinical relevancy and impact of the various imaging modalities reviewed as well as to develop automated volumetric measurement technology with improved accuracy, efficacy, and reproducibility.

https://ift.tt/2PMbadK

Mondor’s disease after aesthetic breast surgery: A case series and literature review

Alberto Goldman, Uwe Wollina

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):132-135

Background: Mondor's disease of the subcutaneous veins of the breast is an uncommon disorder. The etiology of Mondor's disease remains unclear. Usually, it is a self-limited disease. This condition has been associated with trauma, surgical biopsies, breast surgery (including silicone breast implant), physical activity, and a manifestation of breast cancer. Materials and Methods: This is a retrospective analysis of 652 female patients who underwent aesthetic breast surgery in the last 10 years. Results: We found three cases of Mondor's disease after plastic surgery of the breast (0.46%) and performed an analysis of the clinical aspects and therapeutic measures. The disease onset was a couple of weeks to 2 years after surgery, never within the first 2 weeks after surgery. We did not observe ulceration or breast cancer. Treatment was unnecessary in two patients, whereas hot compresses and nonsteroidal medical drugs were prescribed in one patient. All lesions healed within 2–3 weeks. Conclusion: Mondor's disease is a possible complication after aesthetic breast surgery but often runs a self-limiting course with spontaneous remission. It is important to exclude breast cancer. The patient should be informed that the disease runs a benign and self-limiting course.

https://ift.tt/2DeDkYh

Innovative skin hook

Saurabh Gupta, Devi P Mohapatra, Ravi K Chittoria, Elankumar Subbarayan, Sireesha K Reddy, Vinayak Chavan, Abhinav Aggarwal, Likhitha C Reddy

Journal of Cutaneous and Aesthetic Surgery 2018 11(3):148-149

Skin hook is an important instrument for skin surgeries. There are situations, such as operating in a health camp or operating at a peripheral health center with a limited number of instruments, where skin hook is not available in the operation theater. We present an innovative design of skin hook, which can be prepared by surgeons in the operation theater with the help of readily available materials. The innovative skin hook is a simple, safe, and effective solution for performing skin surgeries in a limited-resource setup.

https://ift.tt/2PMsMX0

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Παρασκευή 9 Νοεμβρίου 2018

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