The cover image is based on the Correspondence Video head impulse test results suggest that different pathomechanisms underlie sudden sensorineural hearing loss with vertigo and vestibular neuritis: Our experience in fi fty‐two patients by Qingxiu Yao et al., https://doi.org/10.1111/coa.13196.
Eating disorders (EDs) and their subclinical variants are important health concerns for adolescent girls, and body dissatisfaction is a more common yet often debilitating experience that typically precedes the development of an ED. Despite this fact, little is known about what makes girls who are dissatisfied with their bodies more likely to engage in pathological eating behaviors. The present study explored eating pathology among a sample of adolescent girls from New Zealand and examined a variety of established risk factors that may moderate the relationship between body dissatisfaction (BD) and eating pathology.
Adolescent girls aged between 14 and 18 (N = 231) completed questionnaires assessing eating pathology, BD, negative affect, perfectionism, self-esteem, teasing and sociocultural pressure. Regression analyses tested for moderator effects to examine which variables moderated the relationship between BD and eating pathology.
The analyses indicated that high levels of socially prescribed and self-oriented perfectionism, negative affect, perceived pressure from the media, and low levels of self-esteem all strengthened the relationship between BD and eating pathology.
The results highlight potential factors that may make adolescent girls who are dissatisfied with their bodies more susceptible to eating pathology.
From: Healthline Media
Health News
Can Thyroid Screening During Pregnancy Protect Your Baby?
Experts have been debating the benefits of universal thyroid testing in pregnant women.
The post Can Thyroid Screening During Pregnancy Protect Your Baby? appeared first on American Thyroid Association.
From: Healthline Media
Health News
Can Thyroid Screening During Pregnancy Protect Your Baby?
Experts have been debating the benefits of universal thyroid testing in pregnant women.
The post Can Thyroid Screening During Pregnancy Protect Your Baby? appeared first on American Thyroid Association.
Hair restoration surgery is one of the fascinating fields of modern day cosmetic surgery. A good hair transplant is characterized by a naturalness in terms of strategic distribution of hair. A very important point which is very rarely taken care is the "posterior or occipital" hairline. It is formed by the posterior 1 cm of hair which are placed on the vertex or crown and constitute the part which is normally hidden by the long hair. Many surgeons while creating the slits in the recipient area forget this equally important point. And make the slits in the lines. As the care is taken while creating the slits in the anterior hairline, the same enthusiasm is required throughout the procedure especially the posterior part of the recipient area. The slits in the posterior hairline should also be created in a wavy, irregularly irregular fashion. The posterior hairline forms an important part of a hair restoration surgery. It contributes remarkably toward the overall naturalness of the results. A carefully executed posterior hairline reduces the chances of detection by the general public
Hair restoration surgery is one of the fascinating fields of modern day cosmetic surgery. A good hair transplant is characterized by a naturalness in terms of strategic distribution of hair. A very important point which is very rarely taken care is the "posterior or occipital" hairline. It is formed by the posterior 1 cm of hair which are placed on the vertex or crown and constitute the part which is normally hidden by the long hair. Many surgeons while creating the slits in the recipient area forget this equally important point. And make the slits in the lines. As the care is taken while creating the slits in the anterior hairline, the same enthusiasm is required throughout the procedure especially the posterior part of the recipient area. The slits in the posterior hairline should also be created in a wavy, irregularly irregular fashion. The posterior hairline forms an important part of a hair restoration surgery. It contributes remarkably toward the overall naturalness of the results. A carefully executed posterior hairline reduces the chances of detection by the general public
Publication date: Available online 17 November 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Katrina J. Allen, Jennifer J. Koplin
Publication date: Available online 17 November 2018
Source: Journal of Allergy and Clinical Immunology
Author(s): Amy S. Paller, Jonathan M. Spergel, Paola Mina-Osorio, Alan D. Irvine
The "atopic march" recognizes the increased occurrence of asthma and/or allergic rhinitis after atopic dermatitis (AD) onset. Mechanisms for developing atopic comorbidities after AD onset are poorly understood, but may involve the impaired cutaneous barrier, which facilitates cutaneous sensitization. The association may also be driven or amplified in susceptible individuals by a systemic Th2-dominant immune response to cutaneous inflammation. However, these associations may merely involve shared genetic loci and environmental triggers, including microbiome dysregulation, with the temporal sequence reflecting tissue-specific peak time of occurrence of each disease, suggesting more of a clustering of disorders than a march. Prospective longitudinal cohort studies provide an opportunity to explore the relationships between post-dermatitis development of atopic disorders and potential predictive phenotypic, genotypic, and environmental factors. Recent investigations implicate disease severity and persistence, age of onset, parental atopic history, FLG (filaggrin) mutations, polysensitization, and the non-rural environment among risk factors for development of multiple atopic comorbidities in young children with AD. Early intervention studies to repair the epidermal barrier or alter exposure to the microbiome or allergens may elucidate the relative roles of barrier defects, genetic locus alterations, and environmental exposures in the risk and sequence of occurrence of Th2 activation disorders.
Publication date: Available online 17 November 2018
Source: Allergologia et Immunopathologia
Author(s): L. Qian, L. Lu, L. Huang, Q. Wen, J. Xie, W. Jin, H. Li, L. Jiang
To investigate neonatal maternal separation (NMS) effects on airway inflammation of asthma and potential mechanism using a mouse model.
80 Balb/c neonatal male mice were randomly assigned to NMS and non-NMS groups. Feces were collected on PND21, 28, 35 and 42 to analyze microbiota and short-chain fatty acids (SCFAs). Non-NMS group were then divided into control (group A) and asthma groups (group B), while NMS group was assigned to NMS + asthma (group C) and NMS + SCFAs + asthma groups (group D). Inflammatory cells and eosinophils (EOS) in bronchoalveolar lavage fluid (BALF) were assessed. Pathological changes and cytokines in lung tissue were observed. Protein expression of Occludin and E-cadherin in airway epithelial was examined.
The number of S′, diversity index H′ and dominance index D′, as well as content butyric acid in NMS group C were significantly lower than non-NMS group B (p < 0.05). Mice in group C had a higher level of inflammatory cells and EOS compared with group A, B and D. EOS moderate infiltration was found in mice of group B, C and D. Mice in group C had significantly higher levels of cytokines and showed slightly increased bronchial epithelium goblet cells and a small amount of visceral secretions. Occludin and E-cadherin expression in lung in B, C and D groups was depressed, and protein level in group C was significantly lower than group B and D.
NMS is associated with exacerbated inflammation of adult asthma by changing intestinal microflora resulting in butanoic acid decline and airway epithelial barrier damage.
Publication date: Available online 17 November 2018
Source: Archives of Oral Biology
Author(s): Hui Wang, Yuchen Jiang, Hongning Wang, Zhenhua Luo, Yuanyuan Wang, Xiaobing Guan
The aim of the present study was to investigate the correlation between IL-25 expression and disease severity, and the potential immunoregulatory role of IL-25 expression in oral lichen planus (OLP).
The oral mucosal tissue samples obtained from OLP patients and healthy controls (HCs) were analyzed for IL-25 expression by real-time quantitative PCR (qPCR) and immunohistochemistry. Recombinant IL-25 was used to stimulate OLP patient-derived CD4 + T cells, and then IL-4 secretion and mRNA expression were evaluated by ELISA and qPCR, respectively. The efficiency of the siRNA-mediated knockdown of IL-25R expression in oral keratinocytes was determined by qPCR and Western blotting. Human oral keratinocyte cells were cultured with the recombinant human cytokines IL-25, IL-17 A and IL−17 F. The production of associated cytokines by keratinocytes was determined by qPCR. Statistical analyses of quantitative data were performed using SPSS software.
The IL-25 and IL-4 mRNA levels were elevated and correlated significantly with each other in specific OLP subtype lesions compared to HCs, while the numbers of IL-25 positive cells were also increased in local OLP lesions as compared to HCs. In vitro culture with recombinant IL-25 could significantly promote CD4 + T cells from both subtypes of OLP to produce IL-4 mRNA and remarkably elevate supernatant IL-4 levels in reticular OLP CD4 + T cell cultures, which may be attributed to the elevated expression of IL-25R in local OLP lesions. Statistical analyses demonstrated that the simultaneously increased levels of IL-4, CXCL8 and CCL20 in keratinocytes were induced by IL-25 but not IL-17 A or IL−17 F. Decreasing IL-25R subunit expression by siRNA-mediated knockdown significantly blocked the expression of all cytokine-produced inflammatory mediators in oral keratinocytes.
In OLP lesions, IL-25 can function to mediate the Th2 response in specific disease subtypes, which may be an important cause of OLP disease chronicity and persistent inflammation.
Synovial sarcoma of spine is an extremely rare malignancy with poor prognosis. It is often metastatic at the time of presentation. Its relative rarity and histological resemblance to other tumors make it diagnostically challenging, requiring the need of immunohistochemistry and cytogenetics for definite diagnosis. Surgery is the mainstay of therapy with adjunct chemotherapy, although survival rates are very low.
https://ift.tt/2qV614N
Publication date: Available online 17 November 2018
Source: Anesthesiology Clinics
Author(s): Davinder Ramsingh, Venkat Reddy Mangunta
Publication date: November–December 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 6
Author(s): Luis Gorospe, Rosa María Gómez-García, Juan Martínez San Millán
Publication date: November–December 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 6
Author(s): María Fernanda Vargas Gamarra, José María Perolada Vilmaña, Miguel Armengot Carceller
Publication date: November–December 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 6
Author(s): Paz Pérez-Vázquez, Virginia Franco-Gutiérrez, Andrés Soto-Varela, Juan Carlos Amor-Dorado, Eduardo Martín-Sanz, Manuel Oliva-Domínguez, Jose A. Lopez-Escamez
Benign paroxysmal positional vertigo is the most frequent episodic vestibular disorder. The purpose of this guide, requested by the committee on otoneurology of the Spanish Society of Otolaryngology and Head and Neck Surgery, is to supply a consensus document providing practical guidance for the management of BPPV. It is based on the Barany Society criteria for the diagnosis of BPPV. This guideline provides recommendations on each variant of BPPV, with a description of the different diagnostic tests and the therapeutic manoeuvres. For this purpose, we have selected the tests and manoeuvres supported by evidence-based studies or extensive series. Finally, we have also included a chapter on differential diagnosis and a section relating to general aspects in the management of BPPV.
El vértigo posicional paroxístico benigno (VPPB) es la causa más frecuente de vértigo vestibular episódico. EL propósito de esta guía, encomendada por la Comisión de Otoneurología de la SEORL CCC, es disponer de un documento de consenso que sirva de guía práctica para el manejo del VPPB en la clínica diaria. El punto de partida es la clasificación elaborada por la Barany Society, con sus variantes clínicas. Incluye una descripción de las pruebas diagnósticas y de las maniobras terapéuticas para cada una de las variantes establecidas, habiéndose seleccionado aquellas con estudios con nivel adecuado de evidencia o con suficientes series de soporte. Se ha incluido también un capítulo de diagnóstico diferencial, así como un apartado de aspectos generales básicos en el manejo de los pacientes con VPPB.
Publication date: November–December 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 6
Author(s): María Cecilia Salom, Fernando López, Esteban Pacheco, Gabriela Muñoz, Patricia García-Cabo, Laura Fernández, Vanessa Suárez, José Luis Llorente
Chemoradiotherapy is the treatment of choice for nasopharyngeal carcinoma. Local recurrences are one of the leading causes of death in these patients, and surgical salvage the treatment of choice. Our goal was to evaluate and compare the results of salvage surgery in the treatment of local recurrence of nasopharyngeal carcinomas comparing endoscopic to open approaches.
Twenty patients with local recurrence of nasopharyngeal carcinomas underwent surgery: 12 patients underwent open surgery and 8 endoscopic endonasal transpterygoid nasopharyngectomy. One patient was classified as rT1, three as rT2, two as rT3, and six as rT4 in the group of open approaches; in the endoscopic series, two patients were rT1, five rT2 and one rT3.
In 3 patients (25%) operated by an open approach (one rT4, one rT3 and one rT2) a complete gross resection was not achieved. Gross total resection was achieved in patients operated by endoscopic surgery. The complication rate in the group operated by an open approach was 92% (five minor complications, five moderate complications, and one serious complication) and in the group that underwent endoscopic surgery all patients had some complication (seven had minor complications and one patient developed a severe complication). Survival at 3 and 5 years was 53% and 42% with the open approach and 100% and 50% with the endoscopic approach, respectively.
Endoscopic approaches decrease the morbidity associated with open approaches and allow for favourable oncological control.
La quimiorradioterapia es el tratamiento de elección del carcinoma de nasofaringe. Las recurrencias locales son una de las principales causas de mortalidad en estos pacientes: el rescate quirúrgico o la reirradiación son el tratamiento de elección, según la disponibilidad. El objetivo fue evaluar y comparar los resultados de la cirugía de rescate en el tratamiento de las recidivas locales de los carcinomas nasofaríngeos mediante abordajes abiertos vs. endoscópicos.
Veinte pacientes con recidivas locales de carcinomas nasofaríngeos fueron intervenidos quirúrgicamente: 12 pacientes fueron intervenidos mediante cirugía abierta y 8 mediante un abordaje endoscópico endonasal transpterigoideo. Un paciente fue estadiado como rT1; 3 como rT2; 2 como rT3 y 6 como rT4 en el grupo de abordajes abiertos; en la serie endoscópica, 2 pacientes fueron rT1, 5 fueron rT2 y uno fue rT3.
En 3 de los pacientes (25%) intervenidos mediante cirugía abierta (un rT4, un rT3 y un rT2) no se logró una resección macroscópica completa). En el grupo endoscópico la resección fue completa en todos los pacientes. La tasa de complicaciones en el grupo intervenido mediante abordajes abiertos fue del 92% (5 complicaciones leves, 5 complicaciones moderadas y una complicación grave) y en el grupo intervenido mediante endoscopia fue del 100% (7 sufrieron complicaciones leves y un paciente una complicación grave). La supervivencia a los 3 y 5 años fue del 53 y del 42% en el abordaje abierto y del 100 y del 75% en el abordaje endoscópico, respectivamente.
Los abordajes endoscópicos disminuyen la morbilidad asociada a los abordajes abiertos y permiten obtener un control oncológico favorable.
Publication date: November–December 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 6
Author(s): Luis Roque Reis, Filipe Correia, Luis Castelhano, Pedro Escada
Epistaxis is the most common rhinological emergency seen in the emergency department. The purpose of this study was to evaluate epidemiological data of epistaxis in a southern European tertiary care hospital.
A retrospective study was conducted during the period between January 2009 and December 2015. We analyzed the distribution by cross-referencing the demographic variables, destination after medical discharge, inpatient characteristics (major comorbid diseases, medication, bleeding localization and treatment) and health-care costs with the disease.
Epistaxis accounted for approximately 1 in 30 visits to the ED and 77 out of a population of 100,000 was served by that ED. Overall, 71,624 patients were treated and 2371 patients presented with epistaxis (3.31%). One-thousand three-hundred and twenty-seven cases were male and 1044 female (p <.001). The mean age was 56 years (±26). Age distribution was bimodal, with peaks among those <10 years and >70 (p <.001). Epistaxis was more common in the winter months (p < 0.001). The main referral destinations (6.8%) included outpatient (2.9%) and inpatient (1.9%) services. Hospitalization was more frequent between the ages of 60 and 80 years (p =.029), and the major comorbidity was hypertension (47.8%). Medication interfering with haemostasis was documented in 30.4%. Most inpatient epistaxis was managed in a non-interventional manner and only. 5% of patients needed surgery. The mean total health-care cost was 69.8 € per episode.
Emergency epistaxis was more frequent in men, the elderly, patients with underlying comorbidities, during the winter months, and showed a higher risk of referral and hospitalization with increasing age (as a result of an aging population in western countries). The main hospital expenses for epistaxis are related to hospitalization and health care costs.
La epistaxis es la urgencia rinológica más comúnmente observada en el servicio de urgencias (SU). El objetivo de este estudio es evaluar los datos epidemiológicos de la epistaxis en un hospital de atención terciaria del sur de Europa.
Se realizó un estudio retrospectivo durante el periodo comprendido entre enero de 2009 y diciembre de 2015. Analizamos la distribución entrecruzando las variables demográficas, el destino tras el alta mèc)dica, las características hospitalarias (enfermedades comórbidas mayores, medicación, localización del sangrado y tratamiento) y los costes sanitarios con la enfermedad.
La presentación con epistaxis supuso aproximadamente una de 30 visitas al SU, donde se atendió a una población de 77 de cada 100.000 habitantes. En general se trataron 71.624 pacientes, de los cuales 2.371 se presentaron con epistaxis (3,31%). Mil trescientos veintisiete casos eran varones y 1.044 mujeres (p < 0,001). La edad media fue de 56 años (± 26). La distribución de la edad fue bimodal, con valores máximos entre ellos < 10 años y > 70 (p < 0,001). La epistaxis fue más común durante los meses invernales (p < 0,001). Los principales destinos de derivación (6,8%) incluyeron los servicios ambulatorios (2,9%) y hospitalarios (1,9%). Las hospitalizaciones fueron más frecuentes entre los 60 y 80 años (p = 0,029), siendo la hipertensión la mayor comorbilidad (47,8%). La medicación que interfirió con la hemostasia se documentó en el 30,4%. A la mayoría de pacientes hospitalarios con epistaxis se les trató de manera no intervencionista, y únicamente el 0,5% de los casos precisó cirugía. Los costes sanitarios totales medios fueron del 69,8 € por episodio.
La epistaxis de urgencia fue más frecuente en varones, personas mayores, pacientes con comorbilidades subyacentes, durante los meses invernales, y reflejó un mayor riesgo de derivación y hospitalización con el incremento de la edad (como resultado del envejecimiento de la población en los países occidentales). Los principales gastos hospitalarios en los casos de epistaxis guardan relación con la hospitalización y los costes de la atención sanitaria.
Publication date: November–December 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 6
Author(s): Yolanda Rebeca Peñaloza López, Xóchitl Daisy Orozco Peña, Santiago Jesús Pérez Ruiz
To evaluate the central auditory processing disorders in patients with multiple sclerosis, emphasizing auditory laterality by applying psychoacoustic tests and to identify their relationship with the Multiple Sclerosis Disability Scale (EDSS) functions.
Depression scales (HADS), EDSS, and 9 psychoacoustic tests to study CAPD were applied to 26 individuals with multiple sclerosis and 26 controls. Correlation tests were performed between the EDSS and psychoacoustic tests.
Seven out of 9 psychoacoustic tests were significantly different (P<.05); right or left (14/19 explorations) with respect to control. In dichotic digits there was a left-ear advantage compared to the usual predominance of RDD. There was significant correlation in five psychoacoustic tests and the specific functions of EDSS.
The left-ear advantage detected and interpreted as an expression of deficient influences of the corpus callosum and attention in multiple sclerosis should be investigated. There was a correlation between psychoacoustic tests and specific EDSS functions.
Evaluar los trastornos en procesos centrales de la audición, en pacientes con esclerosis múltiple, enfatizando en lateralidad auditiva mediante la aplicación de pruebas psicoacústicas e identificar la relación de estas con funciones de la Escala de Discapacidad en Esclerosis Múltiple (EDEM).
En 26 individuos con esclerosis múltiple y 26 controles se aplicaron escala de depresión (HADS), EDEM y 9 pruebas psicoacústicas para estudiar trastornos en los procesos centrales de la audición. Se efectuaron pruebas de correlación entre EDEM y pruebas psicoacústicas.
Siete de 9 pruebas psicoacústicas fueron diferentes significativamente (p < 0,05); derecha o izquierda (14/19 exploraciones) respecto al grupo control. En dígitos dicóticos la izquierda mostró ventaja de aciertos respecto al predominio usual de dígitos dicóticos en la derecha. Hubo correlación significativa en 5 pruebas psicoacústicas y funciones específicas de la Escala de Discapacidad en Esclerosis Múltiple.
Conviene investigar la ventaja del oído izquierdo detectada como expresión de influencias deficientes del cuerpo calloso y de atención en esclerosis múltiple. Hay correlación entre pruebas psicoacústicas con funciones específicas de EDEM.
Publication date: November–December 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 6
Author(s): Josep de Haro-Licer, Adela González-Fernández, Albert Planas-Comes, Josep Antón González-Ares
The most common cause of olfactory ENT disorders are colds and flu, chronic sinusitis, allergies and traumatic brain injury. Rarer aetiologies include certain neurological, psychiatric and metabolic injuries.
The aim of this paper was to check the sort of olfactory disorders found in people who have suffered a brain injury, excluding: cranial traumas, psychiatric diseases, epilepsy, Parkinson's and Alzheimer's disease, and synaesthesia.
A descriptive study based on 61 patients with diagnoses of various neurological injuries, which were tested by BAST-24 olfactometer. The results were compared with those of a control group (n=120).
The results show major impairment in these patients' olfactory sense. The neurological injury patients were able to detect from 60% to 77% of the odours, while the control group were able to detect between 98% and 100%. The neurological patients were able, at best, to identify, 11%–32% of the odours correctly, while the control group were able to correctly detect between 59% and 75%. The differences between odour detection and correct identification were statistically significant (P<.05).
We concluded: (a) Neurological injury, not caused by traumatic brain injury, psychiatric disorders or ENT diseases, ranged from 68% to 89% of the olfactory failures. (b) We must bear in mind that these sorts of injuries can cause olfactory disorders. (c) ENT and Neurologists should collaborate in the treatment of these disorders.
Las etiologías más frecuente de las patologías olfativas dentro de la otorrinolaringología suelen ser las producidas por resfriados, inflamaciones nasosinusales, alergias y traumatismos craneo-faciales, fuera de estas etiologías tenemos, con menor frecuencia, las enfermedades neurológicas, psiquiátricas, metabólicas. Nuestro servicio ha podido atender a pacientes con alteraciones neurológicas que presentan patologías olfativas.
Este trabajo tiene por finalidad verificar qué tipo de alteraciones olfativas se hallan en las personas que padecen lesiones del sistema nervioso central excluidos los traumatismos craneales, las enfermedades psiquiátricas, las epilepsias, las enfermedades de Parkinson y Alzheimer y las sinestesias.
Se trata de un estudio descriptivo basado en un grupo de 61 pacientes diagnosticados de diversas lesiones neurológicas y de un grupo control. Ambos grupos fueron valorados por medio del olfatómetro BAST-24. Se comparan los resultados con un grupo control de 120 personas.
Los resultados muestran que las personas con estos tipos de lesiones neurológicas tienen una capacidad de percibir olores que oscila entre el 60 y el 77% mientras que el grupo control se sitúa entre el 98 y el 100%. Respecto a la capacidad de reconocer correctamente los olores, los paciente neurológicos no superan el 32% de aciertos, mientras que el grupo control se sitúa entre el 59 y el 75% de aciertos, siendo las diferencias olor a olor presentado estadísticamente significativas (p<0,05) tanto para la detección como para el acierto.
a) Las alteraciones neurológicas no causadas por traumatismos craneales ni por alteraciones psiquiátricas pueden presentar una pérdida olfativa que oscila entre el 68 y el 89%. b) En este tipo de lesiones debe tenerse en cuenta la presencia de alteraciones olfativas. c) Hay alteraciones olfativas por afectación de otras áreas cerebrales distintas a las clásicas olfativas. d) Debe establecerse una colaboración entre los servicios de ORL y Neurología para poder atender dichas alteraciones.
Publication date: November–December 2018
Source: Acta Otorrinolaringologica (English Edition), Volume 69, Issue 6
Author(s): Avani Jain, Sunil Samdani, Man Prakash Sharma, Vinod Meena
(1) To compare the results of graft take-up and audiological outcome of temporalis fascia versus island cartilage graft in type 1 tympanoplasty. (2) To compare the rate of postoperative retraction of neotympanum in both.
A prospective study was conducted on 70 patients of ages ranging from 11 to 50 years with dry subtotal perforation. 35 underwent island cartilage tympanoplasty and 35 underwent type 1 tympanoplasty using temporalis fascia graft. Graft acceptance rates and post-operative audiograms were compared.
At one year follow up, the graft take-up rate for temporalis fascia and island cartilage graft were found to be 82.9% and 97.1% respectively, which was found to be statistically significant (p < 0.05). In the temporalis fascia group, two out of 35 patients (5.7%) had retraction of the neo tympanum. There was no incidence of retraction using island cartilage graft. There was no significant difference in the postoperative air-bone gap gain between temporalis fascia graft and island cartilage graft.
Island cartilage tympanoplasty shows a high degree of reliability in high risk cases. It has a higher graft take-up rate with no incidence of retraction of neotympanum. Moreover, it provided significant hearing improvement in our patients.
1) Comparar los resultados del injerto y el resultado audiológico de la fascia del músculo temporal versus injerto de cartílago en isla en la timpanoplastia tipo 1, y 2) Comparar la tasa de retracción postoperatoria del neotímpano en ambos.
Se realizó un estudio prospectivo en 70 pacientes de edades comprendidas entre los 11 y 50 años con perforación subtotal en seco. En 35 de ellos se realizó timpanoplastia con cartílago en isla y a los 35 restantes timpanoplastia tipo 1 mediante injerto de fascia de músculo temporal. Se compararon las tasas de aceptación del injerto y los audiogramas postoperatorios.
Al año de seguimiento, la tasa de toma del injerto de fascia de músculo temporal y el injerto de cartílago en isla fue del 82,9 y 97,1%, respectivamente, que resultó estadísticamente significativa (p < 0,05). En el grupo de fascia de músculo temporal, 2 de 35 pacientes (5,7%) tuvieron una retracción del neotímpano. No hubo incidencia de retracción en el injerto de cartílago en isla. No hubo diferencia significativa en cuanto a la ganancia en el umbral diferencial de audición entre los injertos de fascia de músculo temporal y cartílago en isla.
La timpanoplastia con cartílago en isla muestra un alto grado de fiabilidad en casos de alto riesgo. Tiene una mayor tasa de aceptación del injerto, sin incidencias de retracción del neotímpano. Además, aportó una importante mejora de audición a nuestros pacientes.
Publication date: Available online 17 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Paul M. Hoesly, Jason C. Sluzevich, Anokhi Jambusaria-Pahlajani, Elizabeth R. Lesser, Michael G. Heckman, Andy Abril
The clinical significance of antinuclear antibody (ANA) status in adults with dermatomyositis (DM) has yet to be fully defined.
We compared the incidence of amyopathic disease, risk of malignancy, and clinical findings in ANA-positive and ANA-negative patients with adult-onset DM.
This was a retrospective cohort study of patients with ANA-positive or ANA-negative adult-onset DM determined by enzyme-linked immunosorbent assay.
Of 231 patients, 140 (61%) were ANA-positive and 91 (39%) were ANA-negative. Compared to ANA-negative patients, ANA-positive patients had a lower frequency of dysphagia (15% vs 26%, P=0.033) and heliotrope rash (38% vs 53%, P=0.026). Fifty-four patients (23%) developed malignancy within 3 years of DM diagnosis. Eleven percent of ANA-positive patients developed malignancy versus 43% of ANA-negative patients (P<0.001). There was a strong association between ANA positivity and lower likelihood of malignancy in multivariable analysis (OR: 0.16, P<0.001). Conversely, ANA positivity was not associated with amyopathic disease (OR: 0.94, P=0.87).
The retrospective nature of the study was a limitation.
In patients with adult-onset DM, negative ANA is associated with increased likelihood of developing malignancy within three years of DM diagnosis. Particularly close follow-up and frequent malignancy screening may be warranted in ANA-negative individuals with DM.
Publication date: Available online 17 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Elisa Cinotti, Danila Galluccio, Marco Ardigò, Salvador Gonzalez, Ausila Maria Manganoni, Marina Venturini, Paolo Broganelli, Simone Ribero, Francesca Farnetani, Victor Desmond Mandel, Giovanni Pellacani, Linda Tognetti, Francesco Lacarrubba, Pascale Guitera, Ignazio Stanganelli, Iris Zalaudek, Edith Johanna Arzberger, Philippe Bahadoran, Caterina Longo, Giuseppe Spataro
Publication date: Available online 17 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Brett C. Neill, Isadore S. Tarantino, Anand Rajpara, Thomas L.H. Hocker
Publication date: Available online 17 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Astrid-Helene Ravn Jørgensen, Hans Christian Ring, Simon Francis Thomsen
Publication date: Available online 17 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Robert I. Rudolph
Publication date: Available online 17 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Romain Neugebauer, Katherine A. Su, Zheng Zhu, Monica Sokil, Mary-Margaret Chren, Gary D. Friedman, Maryam M. Asgari
The effectiveness of 5-fluorouracil compared to imiquimod for preventing keratinocyte carcinoma is unknown.
To compare the effectiveness of 5-fluorouracil and imiquimod in preventing keratinocyte carcinoma in a real-world practice setting.
We identified 5,700 subjects who filled prescriptions for 5-fluorouracil or imiquimod for actinic keratosis treatment in 2007. An intention-to-treat analysis controlling for potential confounding variables was used to calculate 2- and 5-year cumulative risk differences for subsequent keratinocyte carcinoma overall and in field-treated areas.
5-fluorouracil was associated with a statistically significant decreased risk of any keratinocyte carcinoma compared to imiquimod (adjusted hazard ratio [aHR] 0.86, 95% CI 0.76-0.97), but there were no significant differences in risk by tumor subtype (squamous cell carcinoma aHR 0.89, 95% CI 0.74-1.07; basal cell carcinoma aHR 0.87, 95% CI 0.74-1.03), or site-specific keratinocyte carcinoma (aHR 0.96, 95% CI 0.81-1.14). There were no significant differences in 2- or 5-year cumulative risk for keratinocyte carcinoma among those treated with 5-fluorouracil versus imiquimod.
Generalizability to other practice settings may be limited.
Whereas 5-fluorouracil was more effective in reducing keratinocyte carcinoma risk overall, we found no differences in the short- or long-term risk of subsequent site-specific keratinocyte carcinoma in a real-world practice setting.
Publication date: Available online 17 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Robert I. Rudolph
Publication date: Available online 17 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): William Fix, Jeremy R. Etzkorn, Thuzar M. Shin, Nicole Howe, Mehul Bhatt, Joseph F. Sobanko, Christopher J. Miller
Consensus guidelines recommend microscopic margin control based on high local recurrence risk features and tissue-rearranging reconstruction for keratinocyte carcinomas (KC) but not for cutaneous melanoma.
To compare high local recurrence risk features and frequency of tissue-rearranging reconstruction for head and neck KC versus melanoma.
Retrospective cohort study of KC versus melanoma treated at the Hospital of the University of Pennsylvania with Mohs micrographic surgery (MMS).
12,189 KCs (8,743 BCC, 3,343 SCC) and 1,475 melanomas (1065 melanomas in situ, 410 invasive melanomas) were identified from a prospectively updated MMS database. Compared to KCs, melanomas were significantly more likely to have high local recurrence risk features, including larger preoperative size [2.10 cm vs 1.30 cm, (p <0.0001)], recurrent status [5.08% vs 3.91%, (p = 0.031)], and subclinical spread [31.73% vs 26.52%, (p <0.0001)]. Tissue rearranging reconstruction was significantly more common for melanoma versus KCs [44.68% vs 33.02%, (p < 0.0001); OR 1.98 (p<0.0001)].
This was a retrospective study and did not compare outcomes to other treatment methods, such as "slow-Mohs" or conventional excision.
Melanomas of the head and neck have high local recurrence risk features and require tissue rearranging reconstruction more frequently than KCs.
Publication date: Available online 17 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Sara Wertenteil, Andrew Strunk, Amit Garg
Publication date: Available online 17 November 2018
Source: Journal of the American Academy of Dermatology
Author(s): Michelle van der Linden, Maaike H.M. Oonk, Helena C. van Doorn, Johan Bulten, Eleonora B.L. van Dorst, Guus Fons, Christianne A.R. Lok, Mariëtte I.E. van Poelgeest, Brigitte M.F. Slangen, Leon F.A.G. Massuger, Joanne A. de Hullu
Vulvar Paget disease (VPD) is a rare skin disorder, considered premalignant.
To assess the clinical course, treatment schedules and the effect of invasion and treatment on recurrence and survival in patients with VPD.
Data on women with VPD were retrieved from the medical files and pathology reports in all Dutch tertiary university medical centres. Disease free survival (DFS) and 5-year disease specific survival (DSS) were estimated using Kaplan-Meier curves.
Data of 113 patients diagnosed between 1991 and 2016 were analysed. Seventy-seven percent had non-invasive VPD. Most women underwent surgery (65%). Recurrences were reported in 40%. Of women with non-invasive VPD 8% developed invasion. There were no disease specific deaths reported in women with non-invasive VPD. The 5 year DSS was over 98% in non-invasive and micro-invasive VPD, but significantly worse in invasive VPD: 50% (p<0.0005).
The main limitations of this study are its retrospective character and that original pathology samples were not available for reassessment.
VPD is extremely rare and recurrence rates are high. Most patients have non-invasive VPD, which does not affect survival and should be considered a chronic disorder with a limited invasive potential. In case of invasive disease survival decreases significantly.
Metastasis to the pituitary gland is an infrequent clinical problem, and the symptoms caused by metastases have been reported in only 2.5–18.2% of the cases. However, metastasis to the suprasellar lesion has r...
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