Purpose of review Acute invasive fungal rhinosinusitis (AIFRS) is a rare and often fatal disease, that remains incompletely understood. Case series and literature reviews constitute most of the literature on AIFRS, and act as the standards by which we treat these extremely complex patients. This review discusses management of AIFRS, with focuses on optimal diagnostic and therapeutic strategies. Recent findings Mortality rates remain high, around 50% overall, though some recent studies have shown higher survival rates with early diagnosis and complete surgical resection. Some recent publications on AIFRS have focused on the utility of frozen section analysis both to diagnose and potentially guide the completeness of endoscopic surgical debridement. It was also recently shown that complete endoscopic resection of disease leads to higher survival than when disease was incompletely resected. Additionally, a new antifungal agent was recently approved by the FDA, which has a more favorable pharmacologic and side effect profile, though more studies are necessary to determine its utility. Summary Early diagnosis requires identification of sinusitis symptoms in immunocompromised patients, followed by intranasal biopsy and frozen section analysis. Early surgical debridement and antifungal therapy then remain the cornerstones of AIFRS management. Video abstract See Video, Supplemental Digital Content 1, http://bit.ly/2BKeblx. Correspondence to John R. Craig, MD, Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA. Tel: +1 313 971 9320; fax: +1 313 916 7263; e-mail: JCraig1@hfhs.org. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://bit.ly/2QPN9Uo). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
http://bit.ly/2BGEFVj
Τρίτη 25 Δεκεμβρίου 2018
Hepatic portal venous gas related to appendicitis
Abstract
Background: Hepatic portal venous gas (HPVG) is rare with high mortality. There are few reports on HPVG's association with appendicitis. Here we report a case of HPVG associated with appendicitis. Case presentation: A 79-year-old man presented with acute abdominal pain. Physical examination suggested peritoneal irritation. Blood tests indicated acute inflammation, metabolic acidosis, renal dysfunction and disseminated intravascular coagulation. Contrast-enhanced abdominal computed tomography revealed HPVG, a contrast defect in the small intestine, and minor ascites around the intestine. Urgent laparotomy was performed as intestinal ischemia was suspected. There were no findings of intestinal ischemia, but the appendix was discolored with wall thickening. We confirmed a clinical diagnosis of peritonitis caused by gangrenous appendicitis. We performed appendectomy and abdominal drainage. After surgery, the patient needed intensive care for septic shock. He left the ICU 7 days after the surgery and was discharged 10 days later. Conclusion: Thus, appendicitis may cause HPVG.http://bit.ly/2VanGDK
The Melanocortin 1 receptor and its influence on naevi and melanoma in dark‐skinned phenotypes
Abstract
It is well appreciated that melanocortin 1 receptor variants can produce a fair skinned and red‐haired phenotype that has a strong association with increased melanoma risk. These patients are easily recognised and given appropriate attention. What may not be appreciated is that darker‐skinned individuals may also carry melanocortin 1 receptor variant alleles and that they can also be at increased risk of melanoma. Considering that melanocortin 1 receptor is crucial for melanocyte proliferation, regulation and differentiation do the naevi of these darker‐skinned individuals have specific features that help identify them as carrying one of these melanocortin 1 receptor variants and do melanomas that develop in dark‐skinned melanocortin 1 receptor variant carriers have particular characteristics?
http://bit.ly/2EIMpJz
Dermatoscopic findings of penile intraepithelial neoplasia: Bowenoid papulosis, Bowen disease and erythroplasia of Queyrat
Abstract
Background/Objectives
The clinical diagnosis of penile intraepithelial neoplasia is challenging. No specific dermoscopic criteria for penile intraepithelial neoplasia have been described in the literature. This study aimed to describe and evaluate the dermoscopic features of penile intraepithelial neoplasia.
Methods
Clinical and dermoscopic images of 11 patients with histopathologically confirmed penile intraepithelial neoplasia were recorded and evaluated.
Results
The most frequent dermoscopic features were the presence of structureless areas (100%, structureless pink 72.7%) and vascular structures (81.8%), particularly dotted vessels (72.7%). Other findings included the absence of a pigment network (100%); scale (45.5%); scar‐like areas (45.5%); erosions (27.3%); and pigmentation consisting of brown‐grey dots and globules (27.3%).
Conclusions
The dermoscopic features that characterise penile intraepithelial neoplasia are structureless pink areas and a prominent vascular pattern (mainly clustered dotted vessels). Dermoscopy is a useful tool that can aid in the diagnosis and surveillance of penile intraepithelial neoplasia.
http://bit.ly/2EOJjVg
The Melanocortin 1 receptor and its influence on naevi and melanoma in dark‐skinned phenotypes
Abstract
It is well appreciated that melanocortin 1 receptor variants can produce a fair skinned and red‐haired phenotype that has a strong association with increased melanoma risk. These patients are easily recognised and given appropriate attention. What may not be appreciated is that darker‐skinned individuals may also carry melanocortin 1 receptor variant alleles and that they can also be at increased risk of melanoma. Considering that melanocortin 1 receptor is crucial for melanocyte proliferation, regulation and differentiation do the naevi of these darker‐skinned individuals have specific features that help identify them as carrying one of these melanocortin 1 receptor variants and do melanomas that develop in dark‐skinned melanocortin 1 receptor variant carriers have particular characteristics?
http://bit.ly/2EIMpJz
Dermatoscopic findings of penile intraepithelial neoplasia: Bowenoid papulosis, Bowen disease and erythroplasia of Queyrat
Abstract
Background/Objectives
The clinical diagnosis of penile intraepithelial neoplasia is challenging. No specific dermoscopic criteria for penile intraepithelial neoplasia have been described in the literature. This study aimed to describe and evaluate the dermoscopic features of penile intraepithelial neoplasia.
Methods
Clinical and dermoscopic images of 11 patients with histopathologically confirmed penile intraepithelial neoplasia were recorded and evaluated.
Results
The most frequent dermoscopic features were the presence of structureless areas (100%, structureless pink 72.7%) and vascular structures (81.8%), particularly dotted vessels (72.7%). Other findings included the absence of a pigment network (100%); scale (45.5%); scar‐like areas (45.5%); erosions (27.3%); and pigmentation consisting of brown‐grey dots and globules (27.3%).
Conclusions
The dermoscopic features that characterise penile intraepithelial neoplasia are structureless pink areas and a prominent vascular pattern (mainly clustered dotted vessels). Dermoscopy is a useful tool that can aid in the diagnosis and surveillance of penile intraepithelial neoplasia.
http://bit.ly/2EOJjVg
Rhegmatogenous retinal detachment in a patient with choroidal melanoma simulating choroidal detachment: a case report
Ophthalmologists and retina specialists may consider choroidal detachment if patients with rhegmatogenous retinal detachment present with choroidal elevation. That misdiagnosis may lead to inappropriate treatm...
http://bit.ly/2Rkjge8
Secondary extramedullary plasmacytoma of sigmoid colon in a patient with multiple myeloma: a case report
Extramedullary plasmacytoma is an uncommon tumor that most often involves the nasopharynx or upper respiratory tract. Extramedullary plasmacytoma is a type of plasma cell neoplasm that can present as a primary...
http://bit.ly/2GHoVHg
Dysregulation of T cell immunoglobulin and mucin domain 3 (TIM-3) signaling in peripheral immune cells is associated with immune dysfunction in autistic children
Publication date: February 2019
Source: Molecular Immunology, Volume 106
Author(s): Sheikh F. Ahmad, Mushtaq A. Ansari, Ahmed Nadeem, Saleh A. Bakheet, Laila Y. AL-Ayadhi, Moureq R. Alotaibi, Ali R. Alhoshani, Musaad A. Alshammari, Sabry M. Attia
Abstract
Evidence suggests that immune dysregulation is associated with autism spectrum disorder (ASD). T cell immunoglobulin and mucin domain-3 (TIM-3) has a critical role in several inflammatory disorders; however, the role of TIM-3 signaling has not been demonstrated in ASD. In the present study, we assessed the role of TIM-3 signaling in children with ASD. We expected that increased numbers of TIM-3+ cells could alter immune function in children with ASD. We revealed production of TIM-3 on CD3+, CD4+, CD8+, CD11a+,b+, CD14+, CD62P+, and CXCR5+ PBMCs in children with ASD and typically developing (TD) controls using immunofluorescent staining. We further demonstrated the production of IL-1β, IFN-γ, IL-17 A, and Foxp3 in TIM-3+ PBMCs of TD controls and individuals with ASD. We also observed the mRNA expression levels of TIM-3, CD11a,b, CD14, IL-1β and IFN-γ using RT-PCR. We further assessed the protein levels of TIM-3, IL-1β, CXCR5, and IFN-γ using western blotting. The results showed that children with ASD had increased numbers of CD3+TIM-3+, CD4+TIM-3+, CD8+TIM-3+, CD11a,b+TIM-3+, CD14+TIM-3+, CD62P+TIM-3+ and CXCR5+TIM-3+ cells compared with TD controls. Our results further showed that children with ASD had increased IL-1β+TIM-3+, IFN-γ+TIM-3+, and IL-17+TIM-3+, and decreased Foxp3+TIM-3+ production compared with that in TD controls. Our results indicated that children with ASD significantly induced TIM-3, CD11a,b, CD14, CXCR5, IL-1β and IFN-γ mRNA and protein expression levels compared with TD controls. The results suggested that detection of TIM-3 signaling could contribute to the early diagnoses of ASD.
http://bit.ly/2ELmEs3
Peptidoglycan recognition proteins in insect immunity
Publication date: February 2019
Source: Molecular Immunology, Volume 106
Author(s): Qiang Wang, Meijia Ren, Xiaoyong Liu, Hengchuan Xia, Keping Chen
Abstract
Insects lack an acquired immune system and rely solely on the innate immune system to combat microbial infection. The innate immunity of insects mainly depends on the interaction between the host's pattern recognition receptor (PRR) and pathogen-associated molecular pattern (PAMP). The peptidoglycan recognition proteins (PGRPs) family is the most important pattern recognition receptor (PRR) for insects. It can recognize the main component of the cell wall of the pathogenic microorganism, peptidoglycan (PGN), and plays an important role in the innate immunity of insects. In this paper, the structure, classification, and function of PGRPs is summarized, and the role of PGRPs in the innate immunity of insects is also discussed.
http://bit.ly/2ENd8pd
Adenoma pleomorfo de epiglotis
Publication date: Available online 24 December 2018
Source: Acta Otorrinolaringológica Española
Author(s): Fabián Alzate Amaya, Liliana Invencio da Costa, Mercedes Álvarez-Buylla Blanco
http://bit.ly/2AfA2kV
Spontaneous pharyngeal perforation secondary to cervical osteophytosis
Publication date: Available online 24 December 2018
Source: Acta Otorrinolaringológica Española
Author(s): Miguel Mayo-Yáñez, Jaime Villares-Soriano
http://bit.ly/2SiFD11
The Role of the Basolateral Amygdala in Dreaming
Publication date: Available online 25 December 2018
Source: Cortex
Author(s): Yvonne Blake, David Terburg, Ross Balchin, Jack van Honk, Mark Solms
Abstract
Neuroimaging studies have repeatedly shown amygdala activity during sleep (REM and NREM). Consequently, various theorists propose central roles for the amygdala in dreaming - particularly in the generation of dream affects, which seem to play a major role in dream plots. However, a causal role for the amygdala in dream phenomena has never been demonstrated. The traditional first step in determining this role is to observe the functional effects of isolated lesions to the brain structure in question. However, circumscribed bilateral amygdala lesions are extremely rare. Furthermore, the treatment of the amygdala as a unitary structure is problematic, as the basolateral and centromedial amygdala (BLA and CMA) may serve very different functions.
We analysed 23 dream reports collected from eight adult patients with bilateral calcification of the BLA as a result of a very rare genetic condition called Urbach-Wiethe Disease (UWD). We compared these dream reports to 52 reports collected from 17 matched controls. Given that the BLA has been implicated in various affective processes in waking life, we predicted that the emotional content of the patients' dreams would differ from that of controls. Due to the exploratory nature of this research, a range of different dream characteristics were analysed.
A principal components analysis run on all data returned three key factors, namely pleasantness, length and danger. The UWD patients' dream reports were significantly more pleasant and significantly shorter and less complex than control reports. No differences were found in levels of threat or danger.
The results support some current hypotheses concerning the amygdala's role in dreaming, and call others into question. Future research should examine whether these UWD patients show generally impaired emotional episodic memory due to BLA damage, which could explain some of the current findings.
http://bit.ly/2Re8ciR
Less “Story” and more “Reliability” in cognitive neuroscience
Publication date: Available online 25 December 2018
Source: Cortex
Author(s): David E. Huber, Kevin W. Potter, Lucas D. Huszar
http://bit.ly/2GETtt4
Market forces influence editorial decisions
Publication date: Available online 25 December 2018
Source: Cortex
Author(s): P. Alexander Arguello
http://bit.ly/2EMwSZT
Transcending humanness or: Doing the right thing for science
Publication date: Available online 24 December 2018
Source: Cortex
Author(s): Michael Inzlicht
http://bit.ly/2ELkNDG
Barriers and solutions for early career researchers in tackling the reproducibility crisis in cognitive neuroscience
Publication date: Available online 24 December 2018
Source: Cortex
Author(s): Leah Maizey, Loukia Tzavella
http://bit.ly/2ERtUU2
Anatomo-Functional Characterisation Of The Human “Hand-Knob”: A Direct Electrophysiological Study
Publication date: Available online 24 December 2018
Source: Cortex
Author(s): L. Viganò, L. Fornia, M. Rossi, H. Howells, A. Leonetti, G. Puglisi, M. Conti Nibali, Bellacicca A, M. Grimaldi, L. Bello, G. Cerri
Abstract
The cortical area within the human primary motor cortex (M1) that hosts the representation of the hand and fingers is known as the 'hand-knob' and is essential for voluntary hand movement. The anatomo-functional heterogeneity described within the monkey primary motor cortex (M1) in a rostro-caudal direction suggests an internal subdivision in two sectors originating different systems of connections to the spinal cord. Direct investigation of the human hand-knob has been prevented, so far, by methodological constraints. The unique setting of brain tumour resection with the brain mapping technique in awake patients enables direct electrophysiological investigation of the functional properties of the human hand-knob. Motor-evoked potentials (MEPs) elicited by Direct Electrical Stimulation (DES) at high frequency (HF-DES) delivered along the hand-knob in rostro-caudal direction, i.e. from the central to the precentral sulcus, were recorded from the hand/arm muscles in patients at rest. The sites located near the precentral sulcus identified with HF-DES were then stimulated with low-frequency DES (LF-DES) during a hand manipulation task (HMt) to assess whether DES affected task execution. From the stimulated sites, corticofugal projections and U-shaped tracts connecting with adjacent gyri were traced using diffusion tensor and spherical deconvolution tractography. Analysis of MEPs showed a rostro-caudal gradient of cortical excitability along the hand-knob (the rostral sector being less excitable). Stimulation of rostral sites during the HMt impaired the task by inducing dysfunctional recruitment or, alternatively, suppression of distal muscles. Diffusion tractography showed different patterns of rostro-caudal connectivity for the U-shaped tracts. Overall data suggests, in humans, the anatomo-functional subdivision of the human hand-knob in two sectors, possibly subserving different roles in motor control.
http://bit.ly/2EMMzj9
Simultaneous Intra-operative Sclerotherapy and Surgical Resection of Cervicofacial Venous Malformations
Publication date: Available online 25 December 2018
Source: International Journal of Pediatric Otorhinolaryngology
Author(s): Carol J. MacArthur, Gary Nesbit
Abstract
Objectives
To review simultaneous intra-operative sclerotherapy (IOS) with immediate surgical resection for the treatment of cervicofacial venous malformations (VMs) at a single institution. While pre-operative sclerotherapy (POS) has been reported in the literature, simultaneous intra-operative sclerotherapy and surgery in the operating room has not.
Methods
The database from the Hemangioma and Vascular Birthmarks Clinic was reviewed. All patients in both groups had biopsy-proven VMs.
Results
IOS was used in 11 surgical patients with average age 17 years. Sclerotherapy was performed with sodium tetradecyl sulfate 3%, absolute alcohol or bleomycin. Immediately after IOS, and under the same anesthetic, all patients had either complete resection or debulking of the VMs. Eight patients had complete resolution of their VM and 3 had improvement. Average duration of the combined procedures done under a single anesthetic was 121 minutes.
The POS approach was used for 6 surgical patients with average age 7 years. Sclerotherapy agents used were absolute alcohol or sodium tetradecyl sulfate 3%. All patients underwent complete resection of the VM 24-72 hours after sclerotherapy under a separate surgical session. Five patients experienced complete resolution of their VM and one has had further sclerotherapy for recurrent disease. Interventional Radiology suite sclerotherapy times were on average 70 minutes. Surgical times were on average 142 minutes. Total combined anesthesia times for the two procedures added together were 212 min. Treatment time was significantly shorter in the IOS group (p=0.0015).
Conclusions
Simultaneous IOS at the time of surgical resection has been successful in our hands. IOS has the advantage of a single procedure and decreased cost to the patient. In the era of reducing pediatric exposure to anesthesia, this approach is especially attractive in the pediatric population. As well, at approximately $100/minute cost to the patient to be in either the Interventional Radiology Suite or in the operating room, the reduced length of the procedures seen in the IOS approach results in lower overall cost to the patient.
http://bit.ly/2QRtNy0
Human salivary proteins and their peptidomimetics: values of function, early diagnosis, and therapeutic potential in combating dental caries
Publication date: Available online 24 December 2018
Source: Archives of Oral Biology
Author(s): Kun Wang, Xuedong Zhou, Wei Li, Linglin Zhang
Abstract
Saliva contains a large number of proteins that play various crucial roles to maintain the oral health and tooth integrity. This oral fluid is proposed to be one of the most important host factors, serving as a special medium for monitoring aspects of microorganisms, diet and host susceptibility involved in the caries process. Extensive salivary proteomic and peptidomic studies have resulted in considerable advances in the field of biomarkers discovery for dental caries. These salivary biomarkers may be exploited for the prediction, diagnosis, prognosis and treatment of dental caries, many of which could also provide the potential templates for bioactive peptides used for the biomimetic management of dental caries, rather than repairing caries lesions with artificial materials. A comprehensive understanding of the biological function of salivary proteins as well as their derived biomimetic peptides with promising potential against dental caries has been long awaited. This review overviewed a collection of current literature and addressed the majority of different functions of salivary proteins and peptides with their potential as functional biomarkers for caries risk assessment and clinical prospects for the anti-caries application.
http://bit.ly/2SeKcJE
New trends in mucosal immunology and allergy
Publication date: January 2019
Source: Allergology International, Volume 68, Issue 1
Author(s): Hiroshi Kiyono, Kenji Izuhara
http://bit.ly/2Q2HLIn
Surgical Pearl: Use of surgical scrub sponge for auricular dressing
Publication date: Available online 25 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Daphne van Loenen, Roel E. Genders
http://bit.ly/2GGSCrY
The Skindex-mini: a streamlined QOL measurement tool suitable for routine use in clinic
Publication date: Available online 25 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Robert A. Swerlick, Chao Zhang, Aakash Patel, Mary Margaret Chren, Suephy Chen
http://bit.ly/2Rf7dPl
All-cause and cause-specific mortality in psoriasis: a systematic review and meta-analysis
Publication date: Available online 24 December 2018
Source: Journal of the American Academy of Dermatology
Author(s): Ashar Dhana, Hsi Yen, Hsuan Yen, Eunyoung Cho
Abstract
Background
An overview of mortality risk associated with psoriasis is lacking.
Objective
To perform a systematic review and meta-analysis of mortality risk in psoriasis.
Methods
We included studies reporting all-cause or cause-specific mortality risk estimates in psoriasis patients compared with general population or subjects free of psoriasis. We calculated pooled relative risks (RRs) and 95% confidence intervals (CIs).
Results
We included 12 studies. The pooled RRs for all-cause mortality were 1.21 (95% CI 1.14-1.28) in psoriasis, 1.13 (95% CI 1.09-1.16) in mild psoriasis, and 1.52 (95% CI 1.35-1.72) in severe psoriasis. The pooled RRs for cardiovascular mortality were 1.15 (95% CI 1.09-1.21) in psoriasis, 1.05 (95% CI 0.92-1.20) in mild psoriasis, and 1.38 (95% CI 1.09-1.74) in severe psoriasis. For noncardiovascular causes, mortality risk from liver disease, kidney disease, and infection was significantly increased in psoriasis, regardless of disease severity. The mortality risk from liver and kidney disease was the highest. There was also significantly increased mortality risk from neoplasms in severe psoriasis patients and from chronic lower respiratory disease in all and mild psoriasis patients.
Limitations
Although associations were consistent, their magnitude was heterogenous.
Conclusion
Psoriasis is associated with increased mortality from all-causes in a dose-response manner with disease severity and from several specific causes.
http://bit.ly/2GFXcqj
Editorial Board
Publication date: January 2019
Source: Journal of Autoimmunity, Volume 96
Author(s):
http://bit.ly/2EORoZZ
Crosstalk between tumor necrosis factor-alpha signaling and aryl hydrocarbon receptor signaling in nuclear factor –kappa B activation: A possible molecular mechanism underlying the reduced efficacy of TNF-inhibitors in rheumatoid arthritis by smoking
Publication date: Available online 25 December 2018
Source: Journal of Autoimmunity
Author(s): Takuro Nii, Kentaro Kuzuya, Daijiro Kabata, Toshihiro Matsui, Atsuko Murata, Takeshi Ohya, Hidetoshi Matsuoka, Takashi Shimizu, Eri Oguro, Yasutaka Okita, Chikako Udagawa, Maiko Yoshimura, Eriko Kudo-Tanaka, Satoru Teshigawara, Yoshinori Harada, Yuji Yoshida, Kentaro Isoda, So-Ichiro Tsuji, Shiro Ohshima, Jun Hashimoto
Abstract
Objectives
To examine the influence of smoking on biologics treatment against different therapeutic targets, such as TNFα, IL-6, and T cell, in rheumatoid arthritis (RA) and elucidate the underlying molecular mechanism.
Methods
The association between drug-discontinuation due to poor therapeutic response and smoking status was analyzed individually in biologics against different therapeutic targets by a multivariable logistic regression analysis using the "NinJa" Registry, one of the largest cohorts of Japanese RA patients. In vitro enhancement of TNFα-induced NF-κB activation and subsequent proinflammatory cytokine production by cigarette chemical components was examined by RT-PCR, qPCR, ELISA, and western blotting using an immortalized rheumatoid synovial cell line, MH7A.
Results
The rate of drug-discontinuation due to poor therapeutic response was higher in the current smoking group than in the never- or ever-smoking groups (the odds ratio of current/never smoking: 2.189, 95%CI; 1.305–3.672,P = 0.003; current/ever: 1.580, 95%CI; 0.879–2.839,P = 0.126) in the TNF inhibitor (TNFi) treatment group. However, this tendency was not observed in either the IL-6 or T cell inhibitor treatment groups. Cigarette smoke chemical components, such as benzo[α]pyrene, known as aryl hydrocarbon receptor (AhR) ligands, themselves activated NF-κB and induced proinflammatory cytokines, IL-1β and IL-6. Furthermore, they also significantly enhanced TNFα-induced NF-κB activation and proinflammatory cytokine production. This enhancement was dominantly inhibited by Bay 11-7082, an NF-κB inhibitor.
Conclusions
These results suggest a crosstalk between TNFα signaling and AhR signaling in NF-κB activation which may constitute one of the molecular mechanisms underlying the higher incidence of drug-discontinuation in RA patients undergoing TNFi treatment with smoking habits.
http://bit.ly/2EInAgS
Disparities in adherence to head and neck cancer follow‐up guidelines
Objectives
In this study, we aim to determine the frequency of adherence to National Comprehensive Cancer Network follow‐up guidelines in a population of head and neck cancer patients who received curative treatment. We will also assess the impact of race, ethnicity, socioeconomic status, and treatment setting on utilization of follow‐up care.
Methods
This study included patients with biopsy‐proven, nonmetastatic oropharyngeal or laryngeal cancer treated with radiotherapy between January 1, 2014, and June 30, 2016, at a safety‐net hospital or adjacent private academic hospital. Components of follow‐up care analyzed included an appointment with a surgeon or radiation oncologist within 3 months and posttreatment imaging of the primary site within 6 months. Univariable and multivariable analyses were conducted using a logistic regression model to estimate odds ratios and corresponding 95% confidence intervals.
Results
Two hundred and thirty‐four patients were included in this study. Of those, 88.8% received posttreatment imaging of the primary site within 6 months; 88.5% attended a follow‐up appointment with a radiation oncologist within 3 months; and 71.1% of patients attended a follow‐up appointment with a surgeon within 3 months. On multivariable analysis, private academic hospital treatment versus safety‐net hospital treatment was associated with increased utilization of both surgical and radiation oncology follow‐up. Non‐Hispanic black (NHB) patients, Hispanic patients, and those with a low socioeconomic status were also less likely to receive follow‐up.
Conclusion
Safety‐net hospital treatment, socioeconomic status, Hispanic ethnicity, and NHB race were associated with decreased follow‐up service utilization. Quality improvement initiatives are needed to reduce these disparities.
Level of Evidence
2b. Laryngoscope, 2018
http://bit.ly/2CwUlvY
Opioid prescription patterns and use among patients undergoing endoscopic sinus surgery
Objectives/Hypothesis
Opioid‐related deaths in the United States have increased 200% since 2000, in part due to prescription diversion from patients who had a surgical procedure. The purpose of this study was to characterize provider prescription patterns and assess patient‐reported opioid use after endoscopic sinus surgery (ESS).
Study Design
Retrospective chart review.
Methods
Patients who underwent ESS between May 2017 and May 2018 were included. Opioid prescription, operative details, and postoperative opioid use data were extracted. The Massachusetts Prescription Awareness Tool (MassPAT) was queried to determine if patients filled their prescription.
Results
One hundred fifty‐five patients were included. Nearly all patients received an opioid prescription (94.8%). An average of 15.6 tablets was prescribed per patient. Among 116 patients with MassPAT data, 91.4% filled their prescription. Among 67 patients who reported the number of tablets they had used at the time of first follow‐up appointment, 73.1% reported taking no opioids. Mean number of tablets prescribed was significantly greater among patients who underwent primary versus revision surgery (16.5 vs. 13.5, P = .0111) and those who had splints placed (21.5 vs. 15.1, P = .0037). Predictors of opioid use included concurrent turbinate reduction (58.3% vs. 14.3%, P < .0001) and concurrent septoplasty (45.5% vs. 21.6%, P = .039).
Conclusions
Nearly all patients who underwent ESS were prescribed an opioid, and nearly all patients filled their prescription. However, the vast majority of patients did not require any opioid medication for postoperative pain control. As the opioid epidemic continues to persist, these findings have immediate relevance to current prescribing patterns and pain management practices.
Level of Evidence
4 Laryngoscope, 2018
http://bit.ly/2TcSiCP
Implication of Fusobacterium necrophorum in recurrence of peritonsillar abscess
Objective
Peritonsillar abscess (PTA) is a common infectious complication of pharyngeal infection managed by otolaryngologists and emergency room physicians. Streptococcus and Fusobacterium (e.g., Fusobacterium necrophorum, FN) species are commonly isolated pathogens. The aim of this study was to determine the implication of culture results on abscess recurrence following drainage.
Methods
Single‐institution retrospective review of patients treated at the University of Michigan between 2000 and 2017. Demographic and clinical outcome data were analyzed, including treatment details, culture data, and recurrence.
Results
One hundred fifty‐six of the 990 patients in our study developed recurrence of their abscess (16%). The age ranges most susceptible to recurrence included adolescent (22.9%) and young adult groups (17.1%). Recurrent patients were more likely to have experienced acute progression of symptoms (79% vs. 71%, P = 0.03), trismus (67% vs. 55%, P = 0.006), voice changes (65% vs. 57%, P = 0.04), and dysphagia (72% vs. 61%, P = 0.01) compared to nonrecurrent patients. They were also more likely to have clinical lymphadenopathy noted on initial examination (67% vs. 56%, P = 0.009). Culture data was sent for 852 patients (86%). The presence of FN was significantly more prevalent in the recurrent group (P < 0.0001).
Conclusion
There is a high observed prevalence of FN species within PTA aspirates in the recurrent PTA population. PTA aspirate should be sent for anaerobic growth to screen for Fusobacterium species. In addition, follow‐up and lower threshold for subsequent tonsillectomy should be considered in this at‐risk group.
Level of Evidence
3. Laryngoscope, 2018
http://bit.ly/2CxhkqP
Voice outcomes following medialization laryngoplasty with and without arytenoid adduction
Objective
Voice outcomes following medialization laryngoplasty (ML) for unilateral vocal fold paralysis (UVFP) were compared to those who underwent ML plus arytenoid adduction (AA) (ML+AA).
Methods
Single institution retrospective review of patients with UVFP undergoing ML and ML+AA (2009–2017). Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative Voice Handicap Index‐10 (VHI‐10) and Consensus Perceptual Auditory Evaluation of Voice (CAPE‐V) were assessed.
Results
Of 236 patients, 119 met study criteria. Of those, 70 (59%) underwent ML and 49 (41%) underwent ML+AA. Significant differences between groups at baseline were found for age at time of thyroplasty (P = 0.046), VHI‐10 scores (P < 0.001), and CAPE‐V scores (P = 0.007). Baseline VHI‐10 scores for ML+AA (28 ± 7) were greater than those for ML alone (24 ± 7). At 12 months, overall VHI‐10 scores improved compared to baseline for both groups (ML+AA = 9 ± 7, ML = 16 ± 9); however, there was greater improvement for the ML+AA group compared to ML group (P = 0.001). CAPE‐V scores at 3 or 12 months improved, but differences between the groups were not statistically significant once controlled for covariates.
Conclusion
Based on current findings, patients who undergo ML+AA likely have greater voice handicap at baseline compared to those undergoing ML alone. Patients selected for ML+AA improve as much or more than those who underwent ML alone. This highlights the importance of appropriate selection of candidates for AA.
Level of Evidence
4. Laryngoscope, 2018
http://bit.ly/2T7LVAD
Common practices in botulinum toxin injection for spasmodic dysphonia treatment: A national survey
Objectives/Hypothesis
Although no clear guidelines exist, protocols in the treatment of spasmodic dysphonia (SD) vary among physicians. Previously published work comes from relatively few centers.
Study Design
A descriptive survey among experts (laryngologists who practice Botulinum toxin injections for SD).
Methods
An online 58‐item survey was sent to all otolaryngologists who self‐identify as laryngologists on the American Academy of Otolaryngology–Head and Neck Surgery website. Items surveyed included botulinum toxin injection technique, laterality, and dosage.
Results
An 80% response rate was achieved (70 completed the survey). Participants collectively reported treating >4,000 SD patients in the past year (mean, 71 ± 68 patients/laryngologist). Eighty‐seven percent perform injections exclusively in the office; the remainder both in the office and operating room. For adductor SD injections, 88% use electromyographic (EMG) guidance alone via cricothyroid approach. The remainder use anatomical landmarks alone (9%) or EMG with endoscopic guidance (3%). Sitting is the preferred patient position (70%; supine, 30%). A substantial majority (87%) begin with bilateral injections (starting dosage mode, 1.25 units/side). For abductor SD injections, 67% use EMG guidance alone and 31% use endoscopic guidance with or without EMG. Sitting is the preferred patient position (84%; supine, 16%). The preferred approach is anterior‐translaryngeal (51%), followed by lateral‐retrolaryngeal with rotation (34%). A considerable majority (79%) begin with unilateral injections (starting dosage mode, 5 units). When deciding on initial dosage, the most influential factor was balancing patients' desire/needs, followed by patients' frailty and risk of aspiration. The typical planned interval between injections is 3 to 4 months.
Conclusions
Laryngologists follow fairly uniform protocols in the treatment of SD with some important and previously unpublished differences. This study documents areas of agreement and discordance among laryngologists in the United States for the treatment of SD.
Level of Evidence
4 Laryngoscope, 2018
http://bit.ly/2CzynZn
Recurrent laryngeal nerve paralysis after thyroid cancer surgery and intraoperative nerve monitoring
Objectives/Hypothesis
This study aimed to investigate the risk of postoperative recurrent laryngeal nerve paralysis (RLNP) with and without the use of intraoperative nerve monitoring (IONM) during thyroid cancer surgery.
Study Design
Retrospective cohort study.
Methods
This study utilized a nationwide claims database in Japan. Patients who underwent thyroid cancer surgery with and without IONM were included, and postoperative RLNP incidence was compared.
Results
The study included 5,804 patients. Multivariable logistic regression analysis revealed that use of IONM was not associated with increased RLNP risk (odds ratio: 1.15; 95% confidence interval: 0.67‐1.96). There was no significant effect on RLNP prevention when stratified by tumor or nodal classification. Rather, the patients who had T4 or N1b classifications who received IONM had higher incidences of RLNP.
Conclusions
Use of IONM did not significantly reduce the risk of RLNP. The results for the T4 and N1b populations may be explained by indication bias or unmeasured confounders.
Level of Evidence
NA Laryngoscope, 2018
http://bit.ly/2T4jYJY
Systemic safety of serial intralesional steroid injection for subglottic stenosis
Objectives/Hypothesis
Serial intralesional steroid injection (SILSI) has recently been proposed as an effective scar‐modifying therapy for subglottic stenosis (SGS). We aimed to explore the systemic absorption of steroid following SILSI and to characterize the magnitude and chronicity of any effect observed. Specifically, we aimed to show that any effect resolves prior to the next intralesional injection.
Study Design
Prospective, observational pilot study.
Methods
Patients were injected intralesionally with 40 to 200 mg triamcinolone. Serum cortisol, as well as white cell counts and inflammatory markers were measured at day 0 (baseline), 1, 7, and 28. Salivary cortisol was measured at baseline and for 7 consecutive days following injection.
Results
Six patients with idiopathic SGS were recruited. At baseline, serum cortisol measured 284.0 ± 61.4 nmol/L and fell significantly to 15.5 ± 4.3 nmol/L 1 day following triamcinolone injection (P = .03). At day 7, serum steroid levels showed significant recovery to 221.8 ± 78.9 nmol/L (P = .03) and further rose to 279.5 ± 29.9 nmol/L at 28 days (P = .07). Salivary cortisol exhibited a similar pattern with significant recovery by day 6 (P = .04) and suggestion of exponential clearance of triamcinolone systemically. White cell counts were also affected by systemic absorption of exogenous steroid. No significant change in inflammatory markers was observed.
Conclusions
Our findings demonstrate systemic absorption of steroid following SILSI, with acute hypothalamic–pituitary–adrenal (HPA) axis suppression. However, normalization of HPA axis function by day 7 suggests that although acute steroid side effects should be discussed with patients, no cumulative systemic steroid side effect would occur with serial injections.
Level of Evidence
2 Laryngoscope, 2018
http://bit.ly/2CzQj65
Type I thyroplasty: A safe outpatient procedure
Objectives/Hypothesis
Overnight hospitalization is routinely advocated following type I thyroplasty (TP) because of concerns for airway compromise. Hospitalization increases cost and patient inconvenience, and may not necessarily be appropriate. This study evaluated complications following surgery and identified predictors for same to assess which patients benefit most from hospitalization.
Study Design
Retrospective chart review.
Methods
A study was conducted on patients who underwent TP with or without arytenoid repositioning procedures between June 2008 and March 2017. The demographic data of the subjects, characteristics, etiology of glottic insufficiency, interventions performed, and subsequent complications were evaluated.
Results
Of 147 patients reviewed, 100 underwent TP alone, 41 underwent TP with arytenoid adduction, and six patients underwent TP with adduction arytenopexy. Iatrogenic vocal fold paralysis was the most common indication. Major complications, which included transient airway compromise and hematoma requiring reoperation, occurred in 7% of patients. Revision surgery and thyroplasty combined with arytenoid repositioning maneuvers were associated with increased risk of major complications.
Conclusions
In general, TP is a safe procedure, with a major complication rate that is lower than that of outpatient thyroidectomy. Overnight hospitalization should be considered in patients undergoing revision surgery and in those requiring concurrent arytenoid repositioning procedures.
Level of Evidence
4 Laryngoscope, 2018
http://bit.ly/2T7LGWf
Drug‐induced sleep endoscopy: new insights in lateral head rotation compared to lateral head and trunk rotation in (non)positional obstructive sleep apnea patients
Objective
To compare the effect of lateral head rotation to lateral head and trunk rotation on upper airway patency during drug‐induced sleep endoscopy (DISE) in nonpositional obstructive sleep apnea (OSA) patients (NPP) and positional OSA patients (PP).
Methods
Prospective cohort study.
Results
In total 92 patients were included. Seventy‐five patients were male (82%) with a mean age of 47.2 ± 11.3 years, a body mass index of 27.0 ± 3.3 kg/m2, and a median apnea–hypopnea index of 16.7 per hour (8.7, 26,5). Of all patients, 75% were PP. Lateral head rotation and lateral head and trunk rotation findings are similar in NPP at each possible level of obstruction, with exception of the oropharynx but not in PP. In PP, lateral head rotation and both lateral head and trunk observations were different at every possible obstruction site.
Conclusion
The effect of lateral head rotation and lateral head and trunk rotation on upper airway patency during DISE is significantly different in PP. In NPP, similar results regarding the degree of upper airway obstruction were found at the level of the velum, tongue base, and epiglottis.
Level of Evidence
2B Laryngoscope, 2018
http://bit.ly/2CxhTAJ
Prenatal Programming of Stress Responsiveness and Behaviours: Progress and Perspectives
Abstract
Parental exposure to stress or glucocorticoids either before or during pregnancy can have profound influences on neurodevelopment, neuroendocrine function and behaviours in offspring. Specific outcomes are dependent on the nature, intensity and timing of the exposure, as well as species, sex and age of the subject. Most recently, it has become evident that outcomes are not confined to first‐generation offspring and that there may be intergenerational and transgenerational transmission of effects. There has been intense focus on the mechanisms by which such early exposure leads to long‐term and potential transgenerational outcomes, and there is strong emerging evidence that epigenetic processes (histone modifications, DNA methylation, and small non‐coding RNAs) are involved. New knowledge in this area may allow the development of interventions that can prevent, ameliorate or reverse the long‐term negative outcomes associated with exposure to early adversity. This review will focus on the latest research, bridging human and pre‐clinical studies, and will highlight some of the limitations, challenges and gaps that exist in the field.
This article is protected by copyright. All rights reserved.
http://bit.ly/2BFhYAR
Personal (Self) Perceptions of Submental Fat Among Adults in the United States
BACKGROUND Satisfaction with discrete facial areas influences self-perceptions of attractiveness, self-esteem, and quality of life. Currently, there is a lack of understanding of how the submental area impacts feelings and behaviors. OBJECTIVE To characterize the effects of submental fat (SMF) on feelings/emotions and actions/behavior among adults in the United States. METHODS Online health-based surveys recruited approximately 400 adults (18–65 years) in each of 5 categories based on the respondent's assessment of their SMF. Respondents either agreed or disagreed with 17 statements regarding their feelings/emotions and actions/behaviors related to the area underneath their chin. RESULTS Overall, 1996 respondents were included (equal distribution of males/females; mean age, 41.9 years). Even a slight amount of chin fat was associated with negative feelings and behaviors. As SMF increased, so did the number of respondents reporting negative self-perceptions such as being embarrassed by the area under their chin. In general, a greater percentage of female compared with male respondents reported negative feelings and behavioral changes due to their submental area. CONCLUSION Excess SMF can have a substantial negative effect on a person's feelings of attractiveness and behaviors. Reduction of SMF may not only improve one's appearance, but also may enhance one's self-esteem.http://bit.ly/2EQBj5S
Oral Hedgehog Pathway Inhibition as a Means for Ocular Salvage in Locally Advanced Intraorbital Basal Cell Carcinoma
BACKGROUND Basal cell cancer is the most common cutaneous malignancy. It rarely presents with locally advanced or metastatic disease. Rare presentations such as intraorbital invasion remain a difficult clinical problem with significant potential morbidity. There is no review of sonic hedgehog pathway inhibitors (HPIs) for intraorbital basal cell cancer, and evidence regarding optimal management is limited. OBJECTIVE To evaluate the evidence for the management of intraorbital basal cell cancer with HPIs. METHODS A search to identify evidence for treatment intraorbital basal cell cancers with HPIs to date was performed in PubMed database and OVID using the phrases "basal cell cancer/carcinoma/BCC," "intraorbital," "orbital," "ocular," "periocular," "vismodegib," "GDC-0449," "sonidegib," and "LDE224," in various combinations with Boolean operators "AND" and "OR." RESULTS Rigorous clinical trials have previously reported the use of vismodegib and sonidegib in locally advanced and metastatic basal cell carcinoma (BCC). However, specific descriptions of treatment of intraorbital tumors are rarely presented in detail adequate for analysis. Twenty-two cases of intraorbital BCC treated with vismodegib have been described in the literature, and no cases using sonidegib were identified. These vary in quality, but highlight important questions regarding optimal treatment duration, follow-up, and adjunctive therapies. Reports describing locally advanced BCC in various facial and periocular locations, but without specific mention of intraorbital invasion, were excluded. CONCLUSION Vismodegib is an attractive eye and vision-sparing option in patients with locally advanced intraorbital basal cell cancer whose other options often include exenteration, radiation, or other radical surgery.http://bit.ly/2EJrKF7
Association of Hypothyroidism With Nonmelanoma Skin Cancer in the Multiethnic Cohort Population-Based Study
No abstract availablehttp://bit.ly/2EQ0C8p
Cosmetic and Functional Outcomes of Second Intention Healing for Mohs Defects of the Lips
BACKGROUND The lips are a common location for skin cancer and thus for Mohs micrographic surgery (MMS). There are few studies looking at second intention healing of Mohs defects of the lips, and none have used a scar assessment scale. OBJECTIVE To evaluate the acceptability of second intention healing of the vermilion lips following MMS using a patient questionnaire and the Patient and Observer Assessment Scale (POSAS). METHODS Eligible patients were found through chart review. A patient questionnaire and the patient scale of the POSAS were performed over the phone. For patients who were able to come to clinic, the observer scale of the POSAS was performed. RESULTS Forty-seven phone interviews and 21 clinic assessments were performed. Overall, patients noted excellent functional outcomes, and good to excellent cosmetic outcomes, and were satisfied with healing time. There was not a significant difference between the patient and observer total scores (p = .63) or overall scores (p = .59). CONCLUSION Second intention healing can have satisfactory functional and cosmetic outcomes and healing times with few complications and should be considered for surgical defects on the vermilion lips as large as 2.8 cm2 even when there is involvement of the cutaneous lip and muscular layer.http://bit.ly/2EJrsy1
Ectopic Extramammary Paget Disease Occurring on the Nose
No abstract availablehttp://bit.ly/2EQ0upr
A Predictive Model for Primary Closure Lengths in Mohs Surgery Based on Skin Cancer Type, Dimensions, and Location
BACKGROUND Surgical scar length is a common concern among patients undergoing Mohs micrographic surgery (MMS). OBJECTIVE This study evaluates 3 metrics of preoperative lesion size to determine which correlates best with primary linear closure lengths for nonmelanoma skin cancers (NMSCs) treated with MMS. This metric is then used to develop predictive models for linear closure lengths in 10 different anatomical regions. MATERIALS AND METHODS A retrospective study of 4,049 NMSCs treated with MMS and repaired with primary linear closure was conducted. Primary closure lengths were plotted against preoperative lesion circumference, area, and short axis length. Linear regression analysis was performed. RESULTS Preoperative NMSC circumference correlated best with closure length. Twenty-one of the 28 regression models had coefficients of determination (R2) above 0.5. Closure lengths increased by 0.52 to 1.1 mm, depending on location, for every millimeter increase in preoperative NMSC circumference. CONCLUSION Preoperative lesion circumference is directly proportional to primary closure length and is a better indicator of closure length than preoperative area and short axis for MMS of NMSCs. Closure lengths located on the nasal tip, supratip, or periocular areas are most sensitive to differences in NMSC size. These data might aid Mohs surgeons with preoperative planning for wound reconstruction and patient counseling.http://bit.ly/2EJrgPj
Sodium Deoxycholate for Contouring of the Jowl: Our Preliminary Experience
No abstract availablehttp://bit.ly/2ENeKz7
Reconstruction of Preauricular Wounds Using a Flipped Island Pedicle Flap
BACKGROUND Island pedicle flaps (IPFs) are a frequently used reconstructive option in dermatologic surgery. With variations in its execution, the flap can be used for an assortment of facial defects. OBJECTIVE To describe the execution of a flipped IPF for the reconstruction of medium to large preauricular wounds after Mohs micrographic surgery. MATERIALS AND METHODS An analysis of the flipped IPF reconstruction of 12 preauricular defects is presented. Patient demographics, surgical defects, aesthetic outcomes, and complications are described. RESULTS Twelve patients with 12 preauricular tumors (9 basal cell carcinomas, 2 squamous cell carcinomas, and 1 malignant melanoma) were treated using Mohs micrographic surgery. A flipped IPF reconstruction was successfully used with good cosmetic outcomes and no complications in all 12 patients. CONCLUSION In this series, the authors demonstrate the effective use of flipped IPFs for the reconstruction of medium to large preauricular defects with good aesthetic outcomes and no complications.http://bit.ly/2EIAmMi
Association of Postoperative Antibiotics With Surgical Site Infection in Mohs Micrographic Surgery
BACKGROUND Surgical site infection (SSI) is the most frequent complication of Mohs micrographic surgery. Previous studies have identified risk factors for SSI, but it is not known whether antibiotic prophylaxis mitigates this risk. OBJECTIVE To measure the association between antibiotic prophylaxis and SSI in a convenience sample of Mohs cases and to report on the utility of propensity scoring to control for confounding by indication in registry data. METHODS Data were drawn from a pilot quality improvement registry of 816 Mohs cases. The relationship between antibiotic prophylaxis and SSI was assessed with logistic regression modeling using propensity score methods to adjust for confounding. RESULTS One hundred fifty-one cases were prescribed antibiotic prophylaxis (18.5%). Of 467 cases with follow-up, 16 (3.4%) developed SSI. Infection rates were higher in subjects prescribed prophylaxis, but propensity adjustment reduced this effect. Adjusted odds of infection were 1.47-fold higher in subjects prescribed antibiotics and not statistically significant (95% confidence interval 0.29–7.39; p = .64). CONCLUSION Although there was no significant difference in SSI among patients prescribed prophylactic antibiotics, statistical precision was limited by the low incidence of infection. Larger population-based prospective registry studies including propensity adjustment are needed to confirm the benefit of prophylactic antibiotics in high-risk surgical cases.http://bit.ly/2EJdkVr
Basal Cell Carcinoma Arising at the Site of a Lip Piercing
No abstract availablehttp://bit.ly/2ENHYxO
Review of Common Alternative Herbal “Remedies” for Skin Cancer
BACKGROUND Alternative herbal remedies for skin cancer are commonly found on the Internet. Many websites contain inaccurate or false information regarding side effects and efficacy. OBJECTIVE To review the evidence behind several commonly advertised herbal remedies that claim to cure skin cancer: black salve, eggplant, frankincense, cannabis, black raspberry, milk thistle, St. John's wort, and turmeric. METHODS A PubMed search was performed using the common and scientific names of frequently advertised herbal remedies along with the terms "nonmelanoma skin cancer," or "basal cell carcinoma" or "squamous cell carcinoma," or "melanoma." RESULTS Some preclinical studies have shown positive evidence that these substances can induce apoptosis in skin cancer, but clinical studies proving efficacy are either insufficient, nonexistent, or show negative evidence. Botanicals that were excluded are those that do not have published studies of their efficacy as skin cancer treatments. CONCLUSION Online advertising may tempt patients to use botanical agents while citing efficacy found in preclinical studies. However, many agents lack strong clinical evidence of efficacy. Dermatologists must be aware of common herbal alternatives for skin cancer treatment to maintain effective patient communication and education.http://bit.ly/2ENQTPb
Geographic Distribution of U.S. Mohs Micrographic Surgery Workforce
No abstract availablehttp://bit.ly/2EOwNVQ
Emerging Nonsurgical Therapies for Locally Advanced and Metastatic Nonmelanoma Skin Cancer
BACKGROUND Locally advanced and metastatic nonmelanoma skin cancer (NMSC) not amenable to surgical resection requires a different approach to therapy. OBJECTIVE To review the efficacy and adverse effects of emerging treatment options for locally advanced and metastatic NMSC. MATERIALS AND METHODS A comprehensive search on PubMed was conducted to identify relevant literature investigating the role of program cell death 1 (PD-1) inhibitor, cytotoxic T-lymphocyte–associated antigen 4 (CTLA-4) inhibitor, epidermal growth factor receptor (EGFR) inhibitor, and Hedgehog pathway inhibitors in the treatment of NMSC. RESULTS PD-1 inhibitor and CTLA-4 inhibitor have shown promising efficacy with tolerable side-effect profiles in the treatment of NMSC, although the number of cases reported is limited. Currently, 3 larger-scale clinical trials are investigating PD-1 inhibitor therapy for NMSC. Similarly, EGFR inhibitor demonstrated marginal success in unresectable cutaneous squamous cell carcinomas. Hedgehog pathway inhibitors were approved by the US FDA for treatment of locally advanced and metastatic basal cell carcinomas and have shown favorable efficacy. Common adverse effects included muscle spasm, alopecia, and dysgeusia. CONCLUSION Systemic therapies including PD-1 inhibitors and CTLA-4 inhibitors have demonstrated early promising results for difficult-to-treat NMSC. Future studies are necessary to optimize treatment outcome.http://bit.ly/2EMiQrb
Hooked on Hooks? A Study in the Utilization of Skin Hooks
BACKGROUND The skin hook is a valuable instrument used in the practice of dermatologic surgery. However, because of numerous factors, the degree of its use varies extensively. OBJECTIVE The purpose of this study was to examine practice trends among dermatologic surgeons regarding the use of skin hooks, as well as analyze factors influencing their use. METHODS A survey comprising 14 questions was distributed to members of the American College of Mohs Surgery and the American Society for Dermatologic Surgery. Results were recorded, and statistical analysis was conducted using the 2-sample z-test to compare 2 population proportions. RESULTS Five hundred seventy-one responses were received, with comments. 85.1% of respondents reported using skin hooks. Their use was further characterized as minimal (20.7%), moderate (29.0%), and extensive (35.4%). The utilization of skin hooks was additionally categorized based on age, gender, fellowship training, number of years in practice, practice setting, and history of experience/observance of a sharps exposure. Only the presence or absence of fellowship training demonstrated a statistically significant difference in the use of skin hooks. CONCLUSION Skin hooks are highly used tools among dermatologic surgeons. Their use requires appropriate training and experience, and care must be taken to minimize risk of exposure.http://bit.ly/2EIdOLI
A Randomized, Split-Face, Evaluator-Blind Clinical Trial Comparing Monopolar Radiofrequency Versus Microfocused Ultrasound With Visualization for Lifting and Tightening of the Face and Upper Neck
BACKGROUND Over the past decade, 2 major modalities for noninvasive skin tightening have emerged: monopolar capacitive-coupled radiofrequency (MRF) and microfocused ultrasound with visualization (MFU-V). Up to date, no comparative clinical trials have been performed. OBJECTIVE To compare the efficacy and safety of MRF versus MFU-V for the lifting and tightening of the face and neck. MATERIALS AND METHODS Twenty subjects with mild to moderate skin laxity received MFU-V over one-side of the face and MRF over the other side of the face at the same time. Subjects were followed for 6 months. RESULTS Both MRF and MFU-V led to a decrease in the Fasil Face and Neck Laxity Grading Scale (FLR). These differences became significant at Day 30 and remained significantly improved through Days 90 and 180 in both groups. There was no statistically significant difference in the FLR Scale between MRF-treated and MFU-V–treated sides. Subjects' Global Aesthetic Improvement Scale showed improvement at Day 30, 90, and 180. CONCLUSION Both MRF and MFU-V led to significant improvement in face and neck laxity. There were no statistical differences between MRF and MFU-V in standardized investigator measures of face and neck laxity, patient satisfaction, and adverse events.http://bit.ly/2EOufH0
Laser Ablation of the Recipient Area With Platelet-Rich Plasma–Enriched Epidermal Suspension Transplant in Vitiligo Surgery: A Pilot Study
BACKGROUND Noncultured epidermal cell suspension transplantation is a very popular surgical modality for treating vitiligo. However, the procedure can be modified to improve results. OBJECTIVE To study the extent of repigmentation with noncultured trypsinized fragmented epidermal suspension using platelet-rich plasma (PRP) as a suspending agent and pixel erbium yttrium aluminium garnet laser for ablation of recipient area in patients with stable vitiligo. MATERIALS AND METHODS Autologous noncultured tiny epidermal fragments suspended in PRP were grafted on superficially pixel erbium YAG laser-ablated vitiligo lesions in 10 patients. The repigmentation was evaluated over a period of 6 months using a digital image analysis system. RESULTS Repigmentation was observed as early as 2 weeks after the treatment. Of 20 lesions, 12 (60%) showed excellent response; of which 10 lesions (50%) showed complete repigmentation in 8 weeks only. There were no milia or keloid formation, donor-site scarring, stuck on appearance at recipient site or infection. CONCLUSION This study indicates that PRP-enriched epidermal suspension transplant (LA-PEEST) has the potential to improve the rate of healing and repigmentation in vitiligo patches. Further investigations and larger controlled trials are required to establish this technique as a rapid surgical method to restore pigmentation.http://bit.ly/2EI7Pq9
Involvement of non melanocytic skin cells in vitiligo
Abstract
Despite melanocytes are the key players in vitiligo, a continuous cross‐talk between epidermal and dermal cells may strictly affect their functionality, in both lesional and non‐lesional skin. Focusing on this interplay, we have reviewed existing literature supporting evidence on cellular and functional alterations of surrounding epidermal keratinocytes, extracellular matrix (ECM) proteins and fibroblasts in the underlying dermal compartment that may contribute to melanocyte disappearance in vitiligo. We have also examined some clinical and therapeutic aspects of the disease to sustain the non‐exclusive involvement of melanocytes within vitiligo. As a result, a different and more complex scenario has appeared that may enable to provide better understanding about origins and progress of vitiligo and that should be considered in the evaluation of new treatment approaches.
This article is protected by copyright. All rights reserved.
http://bit.ly/2T9WOlf
Primary Ewing sarcoma of the squamous temporal bone with intracranial and extracranial extension: A rare cause of sudden sensorineural hearing loss
Abstract
Background
Primary Ewing sarcoma of the cranial bone is rare, accounting for only 1% of all Ewing sarcomas. Primary Ewing sarcoma arising in the squamous temporal bone is particularly rare.
Methods
A 16‐year‐old male was seen with signs of sudden sensorineural hearing loss (SSNHL). After 1 week of SSNHL and new‐onset headache, imaging studies showed a mass that originated in the left squamous temporal bone with intracranial and extracranial extension. Histopathological study revealed that the mass was a Ewing sarcoma.
Results
The patient manifested the diagnostic EWSR1 mutation and was treated with adjuvant multidrug chemotherapy and focal radiotherapy after surgery according to the Children's Oncology Group interval compression arm of AEWS0031 with a regimen of vincristine, doxorubicin, and cyclophosphamide alternating with ifosfamide/etoposide.
Conclusions
This case showed an extremely uncommon location, as well as unusual symptoms of primary Ewing sarcoma.
http://bit.ly/2EKSmpg
Changes in incidence and prevalence of human papillomavirus in tonsillar and base of tongue cancer during 2000‐2016 in the Stockholm region and Sweden
Abstract
Background
Tonsillar and base of tongue squamous cell carcinoma (TSCC/BOTSCC) has increased. In Stockholm, the proportion of human papillomavirus (HPV)‐positive cases and the incidence of TSCC rose between 1970 and 2006 then stabilized. Here, HPV‐prevalence, and TSCC/BOTSCC incidence 2000‐2016, in Stockholm and Sweden were followed.
Methods
Incidence data for 2000‐2016 were obtained from the Swedish Cancer Registry. TSCC/BOTSCC biopsies, 2013‐2016 from Stockholm, were examined for HPV DNA and p16INK4a, or data obtained from medical reports. For cases 2000‐2012, data were available from previous studies.
Results
The incidence of TSCC/BOTSCC has continued to rise in Stockholm and Sweden 2000‐2016, especially after 2008. HPV DNA and p16INK4a analysis was determined for 795 Stockholm cases from 2000 to 2016, with 72% being HPV DNA and p16INK4a positive 2013‐2016, and 70% positive 2000‐2016.
Conclusion
During 2000‐2016, especially after 2008, the incidence of TSCC/BOTSCC has continued to increase in Stockholm and Sweden, with an HPV‐prevalence of approximately 70% in Stockholm.
http://bit.ly/2EMcwA5
Outcomes of parathyroidectomy for primary hyperparathyroidism with nonlocalizing preoperative imaging
Abstract
Background
The purpose of this study was to evaluate our surgical experience in patients with primary hyperparathyroidism (PHPT) with nonlocalizing sestimibi and ultrasound scans.
Methods
A retrospective review of 521 patients treated from April 2005 to July 2017 at Loma Linda University Medical Center who received parathyroidectomy for PHPT. One hundred forty‐seven patients (28%) had double negative localization (nonlocalizing sestamibi and ultrasound).
Results
Surgical cure for PHPT was 97.3% and 99.2% with nonlocalized and localized disease, respectively, and complication rates were similar between groups. Preoperative parathyroid hormone and gland weight were significantly lower with nonlocalization. The incidence of multigland disease (MGD) was greater in patients with nonlocalization on sestamibi and ultrasound.
Conclusion
Nonlocalization of parathyroid glands was not associated with decreased cure rate or increased morbidity. The presence of MGD and requirement for more extensive surgery were greater in patients with nonlocalizing disease.
http://bit.ly/2EHsUkm
Recurrent unilateral peripheral facial palsy in a patient with an enlarged styloid process
Abstract
Background
Recurrent peripheral facial paresis is a rare symptom that may be caused by multiple pathologic conditions.
Methods
We report a case of recurrent peripheral facial palsies caused by an ipsilateral enlarged styloid process. A surgical excision of the process was performed.
Results
The treatment was well tolerated. Postoperatively, no further recurrent paresis was observed.
Conclusion
To the best of our knowledge, this is the first case study of an enlarged styloid process with facial paresis. A detailed workup, including imaging, should be performed in cases with recurrent facial paresis and/or cases with a history of trauma and facial paresis and, of course, to exclude a neoplastic etiology.
http://bit.ly/2EOnyES
Tumor multifocality with vagus nerve involvement as a phenotypic marker of SDHD mutation in patients with head and neck paragangliomas: A 18F‐FDOPA PET/CT study
Abstract
Background
18F‐FDOPA PET/CT was proved to be a highly sensitive imaging method for detecting head and neck paraganglioma (HNPGL). The primary aim of the study was to evaluate the relationship between tumor characteristics and the SDHx‐mutational status in a large series of patients with HNPGL evaluated by 18F‐FDOPA PET/CT.
Methods
A total of 104 patients with HNPGL (65 sporadic/39 SDHx‐mutated) were included.
Results
In comparison to SDHB/SDC/SDHx‐negative cases, patients with SDHD were younger at diagnosis and had a higher rate of multifocal, vagal, and carotid paraganglioma. In patients with SDHD, vagal paraganglia represented the primary site of tumor origin. Multicentric involvement of the vagus nerve alone or in association with other locations was found to be a typical feature of SDHD cases compared to other cases (odds ratio = 59.4).
Conclusion
The present study shows that tumor multifocality within the vagus nerve is a phenotypic marker of SDHD mutation. This information is essential in the choice of the therapeutic strategy.
http://bit.ly/2EMojgL
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