Withdrawn: Prenatal thoraco-amniotic chest drain insertion to manage a case of fetal hydrops secondary to FOXC2

http://bit.ly/2MCL7l4

Prophylactic human papilloma virus vaccination in head and neck: indications and future perspectives

Purpose of review To gain the evidence-based knowledge concerning the efficacy of HPV vaccination for oropharyngeal sites and to highlight the trials and strategies for vaccine administration in HPV-dependent head and neck diseases. Recent findings Vaccination can be provided in two injections. There is increasing anecdotal evidence that therapeutic vaccination is effective in treatment of recurrent respiratory papillomatosis. Summary The availability and broadening spectrum of HPV vaccines make possible the prevention of cervical and other HPV-dependent diseases. Vaccination is now included in the national immunization programs of most industrial countries and will be used, it is hoped, in developing countries within the next few years. In developing countries, few women are screened for cervical precancerous lesions, making immunization even more important. In affluent countries and matured societies, with high coverage of cervical screening, the focus of interest will shift to other HPV-related diseases. The HPV vaccination is effective in preventing oral infection with types targeted by the vaccines. Correspondence to Professor Frederik G. Dikkers, MD, PhD, Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Tel: +31 20 566 3789; e-mail: f.g.dikkers@amc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2G7H0fM

Systemic treatment in elderly head and neck cancer patients: recommendations for clinical practice

Purpose of review Despite the constantly growing number of elderly patients with squamous cell carcinoma of the head and neck (SCCHN), the majority of clinical trials have been focusing on their younger counterparts. However, because of age-related changes and the resulting higher prevalence of frailty, senior people need an adapted evidence-based approach. Recent findings Recommendations presented in this article proceed from those relevant for the general patient population taking into consideration the individual process of aging. In this respect, categorization into fit, vulnerable and frail elderly patients was used to guide systemic treatment. Summary The fit and vulnerable subgroups with locoregionally advanced SCCHN may still benefit from curative treatment, whereas for the remaining cases only palliative measures are usually appropriate. Advanced calendar age is not a contraindication for cisplatin making part of the standard regimens in locally advanced (high-dose 3-weekly schedule concurrent with radiotherapy) and recurrent/metastatic disease (in combination with 5-fluorouracil and cetuximab). In the latter setting, modern immunotherapy with immune checkpoint inhibitors, particularly the antiprogrammed cell death protein-1 (anti-PD-1) agents nivolumab and pembrolizumab, changed clinical practice. These drugs have a favourable toxicity profile making them good candidates even for management of vulnerable patients. Regardless of the chosen strategy, attentive supportive care is of paramount importance. Correspondence to Petr Szturz, MD, PhD, Medical Oncology, Department of Oncology, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel: +41 079 556 76 67; e-mail: szturz@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2FWXiZI

Unknown primary of the head and neck: a new entry in the TNM staging system with old dilemmas for everyday practice

Purpose of review To summarize the most recent nuances in diagnosis, management, and prognostic stratification of carcinoma of unknown primary of the head and neck (CUPHN), in light of its recent re-assessment in the eighth edition of the TNM Classification Manual. Recent findings At least in Western Countries, most CUPHN are expected to be Human Papilloma Virus (HPV)-positive with an oropharyngeal origin. Their appropriate diagnosis starts with fine needle aspiration cytology and/or core biopsy of pathologic lymph node(s) with staining for p16 by immunohistochemistry and subsequent HPV detection by PCR. If these exams are negative (especially in Eastern Countries), in-situ hybridization for Epstein–Barr virus detection should be added. Thorough clinical examination should encompass white light videoendoscopy with the adjunction of bioendoscopic techniques (such as narrow band imaging). Radiologic workup (by CT, MR and/or PET) should be limited to cases that are persistently negative after comprehensive endoscopic evaluation. Invasive diagnostic procedures, such as unilateral or bilateral palatine tonsillectomy and base of tongue mucosectomy, may play a staging as well as a therapeutic role in CUPHN management. Summary Every effort should be made to identify and remove the primary site of a CUPHN: in doing so, possible subsequent de-intensification protocols by irradiation of the neck alone (with or without previous neck dissection according to the cN category, patient's risk profile, and general status) can be taken into consideration on a case-by-case basis. Correspondence to Cesare Piazza, MD, Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Via Giacomo Venezian 1, 20133 Milan, Italy. E-mail: cesare.piazza@istitutotumori.mi.it, ceceplaza@libero.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2GeWbUe

Glucose control in the ICU

Purpose of review Critically ill patients usually develop hyperglycemia, which is associated with adverse outcome. Controversy exists whether the relationship is causal or not. This review summarizes recent evidence regarding glucose control in the ICU. Recent findings Despite promising effects of tight glucose control in pioneer randomized controlled trials, the benefit has not been confirmed in subsequent multicenter studies and one trial found potential harm. This discrepancy could be explained by methodological differences between the trials rather than by a different case mix. Strategies to improve the efficacy and safety of tight glucose control have been developed, including the use of computerized treatment algorithms. Summary The ideal blood glucose target remains unclear and may depend on the context. As compared with tolerating severe hyperglycemia, tight glucose control is well tolerated and effective in patients receiving early parenteral nutrition when provided with a protocol that includes frequent, accurate glucose measurements and avoids large glucose fluctuations. All patient subgroups potentially benefit, with the possible exception of patients with poorly controlled diabetes, who may need less aggressive glucose control. It remains unclear whether tight glucose control is beneficial or not in the absence of early parenteral nutrition. Correspondence to Greet Van den Berghe, MD, PhD, Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU Leuven, Herestraat 49, B-3000, Leuven, Belgium. Tel: +32 16 344021; fax +32 16 344015; e-mail: greet.vandenberghe@kuleuven.be Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2DGGzHt

Thoracic trauma in military settings: a review of current practices and recommendations

Purpose of review To examine current literature on thoracic trauma related to military combat and to explore its relevance to the civilian population. Recent findings Damage control resuscitation (DCR) has improved the management of hemorrhaging trauma patients. Permissive hypotension below 110 mmHg and antifibrinolytic use during DCR is widely accepted, whereas the use of freeze-dried plasma and whole blood is gaining popularity. The Modified Physiologic Triaging Tool can be used for primary triage and it may have applications in civilian trauma systems. Although Tactical Combat Casualty Care protocol recommends the Cric-Key device for surgical cricothyroidotomies, other devices may offer comparable performance. Recommendations for regional anesthesia after blunt trauma are not well defined. Increasing amounts of evidence favor the use of extracorporeal membrane oxygenation for refractory hypoxemia and resuscitative endovascular balloon occlusion of the aorta (REBOA) for severe hemorrhage. REBOA outcomes are potentially improved by partial occlusion and small 7 Fr catheters. Summary The Global War on Terror has provided opportunities to better understand and treat thoracic trauma in military settings. Trauma registries and other data sources have contributed to significant advancements in the management of thoracic trauma in military and civilian populations. Correspondence to Robert Mansky, 545 First Ave, Apt 8I, New York, NY 10016, USA. Tel: +1 516 672 5589; e-mail: rmansky@gmail.com Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2UoSVJW

Noninvasive ventilation versus oxygen therapy in patients with acute respiratory failure

Purpose of review High-flow nasal cannula oxygen therapy (HFOT) is becoming an alternative to noninvasive ventilation (NIV) and standard oxygen in management of patients with acute respiratory failure. Recent findings Patients with de novo acute respiratory failure should be managed with HFOT rather than NIV. Indeed, the vast majority of patients with de novo respiratory failure meet the criteria for ARDS, and NIV does not seem protective, as patients generate overly high tidal volume that may worsen underlying lung injury. However, NIV remains the first-line oxygenation strategy in postoperative patients and those with acute hypercapnic respiratory failure when pH is equal to or below 7.35. During preoxygenation, NIV also seems to be more efficient than standard oxygen using valve-bag mask to prevent profound oxygen desaturation. In postoperative cardiothoracic patients, HFOT could be an alternative to NIV in the management of acute respiratory failure. Summary Recent recommendations for managing patients with acute respiratory failure have been established on the basis of studies comparing NIV with standard oxygen. Growing use of HFOT will lead to new studies comparing NIV versus HFOT in view of more precisely defining the appropriate indications for each treatment. Correspondence to Jean-Pierre Frat, Médecine Intensive Réanimation, CHU de Poitiers, 2 rue la Milétrie, 86021 Poitiers Cedex, France. Tel: +33 5 49 44 40 07; e-mail: jean-pierre.frat@chu-poitiers.fr Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2DJ5pa0

The effectiveness of noise interventions in the ICU

Purpose of review Excessive noise has direct adverse physiological and psychological effects, and may also have indirect negative health consequences by reducing sleep quality and quantity. This review presents a synthesis of the epidemiology of noise in the ICU, and the potential interventions designed to attenuate noise and protect patients. Recent findings Noise increases cortisol release, oxygen consumption, and vasoconstriction. ICU noise levels are excessive throughout the 24-h cycle, irrespective of level of intervention or whether the patient is in a side room or open ward. Direct measurement suggests that noise is a substantial contributor to poor sleep quantity and quality in the ICU and is frequently recalled by survivors of critical illness as a negative experience of ICU admission. Noise abatement, environmental masking and pharmacological interventions may all reduce the impact of noise on patients. However, the sustainability of behavioural interventions remains uncertain and high-quality evidence demonstrating the benefit of any intervention on patient-centered outcomes is lacking. Summary Noise levels in the ICU are consistently reported to reach levels likely to have both direct and indirect adverse health consequences for both patients and staff. Noise reduction, abating the transmission of noise and pharmacological modulation of the adverse neural effects of noise are all potentially beneficial strategies, although definitive evidence of improved patient-centered outcomes is lacking. Correspondence to Lori Delaney, MIHM, MN, PGD Crit Care, PGC Ed, Faculty of Nursing, Queensland University of Technology, Kelvin Grove, QLD 4059, Australia. E-mail: Lori.delaney@qut.edu.au Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2UpOJJV

Telemedicine in the ICU: clinical outcomes, economic aspects, and trainee education

Purpose of review The evidence base for telemedicine in the ICU (tele-ICU) is rapidly expanding. The last 2 years have seen important additions to our understanding of when, where, and how telemedicine in the ICU adds value. Recent findings Recent publications and a recent meta-analysis confirm that tele-ICU improves core clinical outcomes for ICU patients. Recent evidence further demonstrates that comprehensive tele-ICU programs have the potential to quickly recuperate their implementation and operational costs and significantly increase case volumes and direct contribution margins particularly if additional logistics and care standardization functions are embedded to optimize ICU bed utilization and reduce complications. Even though the adoption of tele-ICU is increasing and the vast majority of today's medical graduates will regularly use some form of telemedicine and/or tele-ICU, telemedicine modules have not consistently found their way into educational curricula yet. Tele-ICU can be used very effectively to standardize supervision of medical trainees in bedside procedures or point-of-care ultrasound exams, especially during off-hours. Lastly, tele-ICUs routinely generate rich operational data, as well as risk-adjusted acuity and outcome data across the spectrum of critically ill patients, which can be utilized to support important clinical research and quality improvement projects. Summary The value of tele-ICU to improve patient outcomes, optimize ICU bed utilization, increase financial performance and enhance educational opportunities for the next generation of providers has become more evident and differentiated in the last 2 years. Correspondence to Christian D. Becker, MD, PhD, Division of Pulmonary and Critical Care Medicine, Department of Medicine, New York Medical College, Valhalla, NY 10595, USA. Tel: +1 914 493 1040; fax: +1 914 493 8373; e-mail: christian.becker@wmchealth.org Copyright © 2019 YEAR Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2DHWsxz

Systemic treatment in elderly head and neck cancer patients: recommendations for clinical practice

Purpose of review Despite the constantly growing number of elderly patients with squamous cell carcinoma of the head and neck (SCCHN), the majority of clinical trials have been focusing on their younger counterparts. However, because of age-related changes and the resulting higher prevalence of frailty, senior people need an adapted evidence-based approach. Recent findings Recommendations presented in this article proceed from those relevant for the general patient population taking into consideration the individual process of aging. In this respect, categorization into fit, vulnerable and frail elderly patients was used to guide systemic treatment. Summary The fit and vulnerable subgroups with locoregionally advanced SCCHN may still benefit from curative treatment, whereas for the remaining cases only palliative measures are usually appropriate. Advanced calendar age is not a contraindication for cisplatin making part of the standard regimens in locally advanced (high-dose 3-weekly schedule concurrent with radiotherapy) and recurrent/metastatic disease (in combination with 5-fluorouracil and cetuximab). In the latter setting, modern immunotherapy with immune checkpoint inhibitors, particularly the antiprogrammed cell death protein-1 (anti-PD-1) agents nivolumab and pembrolizumab, changed clinical practice. These drugs have a favourable toxicity profile making them good candidates even for management of vulnerable patients. Regardless of the chosen strategy, attentive supportive care is of paramount importance. Correspondence to Petr Szturz, MD, PhD, Medical Oncology, Department of Oncology, University Hospital of Lausanne (CHUV), Rue du Bugnon 46, 1011 Lausanne, Switzerland. Tel: +41 079 556 76 67; e-mail: szturz@gmail.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2FWXiZI

Prophylactic human papilloma virus vaccination in head and neck: indications and future perspectives

Purpose of review To gain the evidence-based knowledge concerning the efficacy of HPV vaccination for oropharyngeal sites and to highlight the trials and strategies for vaccine administration in HPV-dependent head and neck diseases. Recent findings Vaccination can be provided in two injections. There is increasing anecdotal evidence that therapeutic vaccination is effective in treatment of recurrent respiratory papillomatosis. Summary The availability and broadening spectrum of HPV vaccines make possible the prevention of cervical and other HPV-dependent diseases. Vaccination is now included in the national immunization programs of most industrial countries and will be used, it is hoped, in developing countries within the next few years. In developing countries, few women are screened for cervical precancerous lesions, making immunization even more important. In affluent countries and matured societies, with high coverage of cervical screening, the focus of interest will shift to other HPV-related diseases. The HPV vaccination is effective in preventing oral infection with types targeted by the vaccines. Correspondence to Professor Frederik G. Dikkers, MD, PhD, Department of Otorhinolaryngology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands. Tel: +31 20 566 3789; e-mail: f.g.dikkers@amc.nl Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2G7H0fM

Unknown primary of the head and neck: a new entry in the TNM staging system with old dilemmas for everyday practice

Purpose of review To summarize the most recent nuances in diagnosis, management, and prognostic stratification of carcinoma of unknown primary of the head and neck (CUPHN), in light of its recent re-assessment in the eighth edition of the TNM Classification Manual. Recent findings At least in Western Countries, most CUPHN are expected to be Human Papilloma Virus (HPV)-positive with an oropharyngeal origin. Their appropriate diagnosis starts with fine needle aspiration cytology and/or core biopsy of pathologic lymph node(s) with staining for p16 by immunohistochemistry and subsequent HPV detection by PCR. If these exams are negative (especially in Eastern Countries), in-situ hybridization for Epstein–Barr virus detection should be added. Thorough clinical examination should encompass white light videoendoscopy with the adjunction of bioendoscopic techniques (such as narrow band imaging). Radiologic workup (by CT, MR and/or PET) should be limited to cases that are persistently negative after comprehensive endoscopic evaluation. Invasive diagnostic procedures, such as unilateral or bilateral palatine tonsillectomy and base of tongue mucosectomy, may play a staging as well as a therapeutic role in CUPHN management. Summary Every effort should be made to identify and remove the primary site of a CUPHN: in doing so, possible subsequent de-intensification protocols by irradiation of the neck alone (with or without previous neck dissection according to the cN category, patient's risk profile, and general status) can be taken into consideration on a case-by-case basis. Correspondence to Cesare Piazza, MD, Department of Otorhinolaryngology, Maxillofacial, and Thyroid Surgery, Fondazione IRCCS National Cancer Institute of Milan, University of Milan, Via Giacomo Venezian 1, 20133 Milan, Italy. E-mail: cesare.piazza@istitutotumori.mi.it, ceceplaza@libero.it Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

http://bit.ly/2GeWbUe

Genome‐wide association study of inhaled corticosteroid response in admixed children with asthma

Abstract

Background

Inhaled corticosteroids (ICS) are the most widely prescribed and effective medication to control asthma symptoms and exacerbations. However, many children still have asthma exacerbations despite treatment, particularly in admixed populations, such as Puerto Ricans and African Americans. A few genome‐wide association studies (GWAS) have been performed in European and Asian populations, and they have demonstrated the importance of the genetic component in ICS response.

Objective

We aimed to identify genetic variants associated with asthma exacerbations in admixed children treated with ICS, and to validate previous GWAS findings.

Methods

A meta‐analysis of two GWAS of asthma exacerbations was performed in 1,347 admixed children treated with ICS (Hispanics/Latinos and African Americans), analyzing 8.7 million genetic variants. Those with p≤5x10^‐6 were followed up for replication in 1,697 asthmatic patients from six European studies. Associations of ICS response described in published GWAS were followed up for replication in the admixed populations.

Results

A total of 15 independent variants were suggestively associated with asthma exacerbations in admixed populations (p≤5x10^‐6). One of them, located in the intergenic region of APOBEC3B and APOBEC3C, showed evidence of replication in Europeans (rs5995653, p = 7.52x10^‐3) and was also associated with change in lung function after treatment with ICS (p = 4.91x10^‐3). Additionally, the reported association of the L3MBTL4‐ARHGAP28 genomic region was confirmed in admixed populations, although a different variant was identified.

Conclusions & Clinical Relevance

This study revealed the novel association of APOBEC3B and APOBEC3C with asthma exacerbations in children treated with ICS and replicated previously identified genomic regions. This contributes to the current knowledge about the multiple genetic markers determining responsiveness to ICS which could lead in the future the clinical identification of those asthma patients who are not able to respond to such treatment.

This article is protected by copyright. All rights reserved.

http://bit.ly/2RVbuJ0

Cutaneous granulomatous lesions in a patient with mucosa‐associated lymphoid tissue (MALT) lymphoma

http://bit.ly/2Ba8ON3

Inherited desmoplastic trichoepitheliomas

http://bit.ly/2WoosO5

Cutaneous granulomatous lesions in a patient with mucosa‐associated lymphoid tissue (MALT) lymphoma

http://bit.ly/2Ba8ON3

Inherited desmoplastic trichoepitheliomas

http://bit.ly/2WoosO5

Placental chorioangioma associated with polyhydramnios and hydrops fetalis

A 27-year-old multigravida woman was noted on routine growth scan at 27 weeks gestation to have a central placental hypoechoic area measuring 6.7x6.0x4.4 cm. A subsequent magnetic resonance scan confirmed a solid mass in the placenta lying anteriorly; therefore, a preliminary diagnosis of giant placental chorioangioma was made. A repeat ultrasound scan at 30 weeks gestation indicated that the mass had increased, with the presence of polyhydramnios. The patient experienced reduced fetal movements at 31 weeks gestation. There was persistent fetal tachycardia at 33 weeks gestation, and consequently the neonate was delivered by emergency caesarean section. The placenta revealed a large chorioangioma. The neonate's birth weight was 2.85 kg and non-immune hydrops fetalis was diagnosed. The neonate improved significantly in the neonatal intensive care unit and is currently well with no medical problems.

http://bit.ly/2Upm4ET

Takotsubo cardiomyopathy triggered by status epilepticus: case report and literature review

Takotsubo cardiomyopathy (TC) is acute stress-induced cardiomyopathy with characteristic transient wall motion abnormalities. TC has a clinical presentation similar to an acute coronary syndrome, including chest pain or dyspnoea, ECG changes and elevated cardiac enzymes. TC often occurs after emotional stress. There are approximately 50 TC cases reported related to seizure activity, and our review revealed 15 articles which were associated with status epilepticus. This condition can be a serious complication of seizures. We report a case of TC after status epilepticus in a patient who had been seizure-free for 20 years.

http://bit.ly/2DI3TVy

Stroke or side effect? dofetilide associated facial paralysis after direct current cardioversion for atrial fibrillation

Dofetilide is a class III antiarrhythmic drug that has proven efficacious in maintaining sinus rhythm in up to 60% of patients with persistent atrial fibrillation. Dofetilide's most concerning adverse effect is QT prolongation and polymorphic VT, but providers should be aware of other rare significant side effects. We report a case of dofetilide associated Bell's palsy masquerading as stroke that developed shortly after a cardioversion. The patient's facial weakness, a side effect of dofetilide, resolved relatively quickly after discontinuation of the medication and a short course of oral corticosteroids.

http://bit.ly/2UsZSd3

Intra-atrial course of the right coronary artery: depiction of a potentially hazardous entity on dual-source CT

http://bit.ly/2Upm8o7

Proximal tibiofibular joint dislocation: a rare entity

A 37-year-old woman was diagnosed with an isolated proximal tibiofibular joint dislocation (PTJD) after an accident during gymnastic exercise. The dislocation has a low incidence rate and is often missed in the emergency department as physical and radiology signs are subtle. Treatment consists of closed or open reduction and immobilisation. When it is not recognised it is associated with significant peroneal nerve injury.

http://bit.ly/2DIVcuc

Erythema ab igne as a complication of cannabinoid hyperemesis syndrome

http://bit.ly/2DI1cmH

Bacteraemia and multiple liver abscesses due to Fusobacterium nucleatum in a patient with oropharyngeal malignancy

Fusobacterium infections can have a wide clinical spectrum, ranging from mild infections to severe sepsis and abscess formation. This range depends partly on the patient's underlying conditions, such as immunosuppression or malignancy. Fusobacteria are commensal rods in the oropharyngeal cavity and digestive tract, but should mucosal barrier disruption occur, in the presence of the above-mentioned predisposing conditions, fusobacteria can spread and cause infections in the soft tissues, liver and so on. An elderly woman was admitted with an altered level of consciousness (lethargy). The ensuing workup revealed a posterior oral cavity tumour (squamous cell carcinoma), Fusobacterium nucleatum bacteraemia and liver abscesses. Due to the severe sepsis, the patient was referred to our intensive care unit, but she passed away despite antibiotic treatment.

http://bit.ly/2Upm1sH

Alports syndrome and intracranial aneurysm: mere coincidence or undiscovered causal relationship

A 44-year-old Caucasian man with a history of deceased donor renal transplant for end-stage renal disease from Alport's syndrome (AS), presented with a spontaneous subarachnoid haemorrhage and hydrocephalus. Following an external ventricular drain for the hydrocephalus, a CT angiography revealed a dissection of the left vertebral artery extending into vertebro-basilar junction necessitating a bypass between left occipital artery to left posterior inferior cerebellar artery. He had a posterior fossa Craniectomy, C1 laminectomy and coiling off, of the left vertebral artery. Postprocedure course was prolonged but uneventful with complete recovery and normal renal function 18 months postpresentation. AS, a disease caused by abnormalities in the synthesis of type IV collagen, can cause aneurysms with severe and permanent neurological sequalae. We present a case of AS with intracranial arterial dissection with potential life-threatening consequences and discuss the genetic and molecular basis of AS along with review of the relevant literature.

http://bit.ly/2DI3Vg8

Disseminated intestinal basidiobolomycosis with mycotic aneurysm mimicking obstructing colon cancer

Basidiobolomycosis is a rare fungal infection that may affect the gastrointestinal tract. It is caused by Basidiobolus ranarum and less than 80 cases have been reported in the literature. The incidence seems to be higher in the Middle East and in particular Saudi Arabia where most cases are diagnosed in the south-western region. An 18-year-old woman presented to the emergency department with an obstructing caecal mass initially suspected to be malignant. Surgical resection was complicated by bowel perforation, histology and cultures confirmed basidiobolomycosis infection. The postoperative course was complicated by an enterocutaneous fistula, fungal intra-abdominal abscesses, liver and lung abscesses, formation of mycotic hepatic artery aneurysm and meningoencephalitis. The patient eventually expired due to sepsis despite aggressive treatment. Diagnosis and management of such rare cases are very challenging and require a multidisciplinary approach. Complications are common and associated with a high mortality.

http://bit.ly/2UplW8n

Fusobacterium necrophorum sepsis after tonsillitis/pharyngitis

Fusobacterium necrophorum is a rare infection most notable for causing Lemierre's syndrome. This consists of a primary oropharyngeal infection and septic thrombophlebitis, and one or more metastatic focus. Prior to the widespread use of antibiotics, Lemierre's syndrome commonly followed a rapidly progressing course, with a high mortality. We describe a case of a previously well 18-month-old boy who presented to the emergency department with a 3-week history of progressive, right-sided, painful neck swelling and systemic sepsis. He was initially treated conservatively with intravenous antibiotics, but ultimately required surgical drainage. Lemierre's syndrome is a rare condition with increasing incidence which can have significant adverse outcomes including death. Early recognition and treatment are essential, but identifying Lemierre's disease is challenging.

http://bit.ly/2DJfFPp

Emergency management of massive haemoptysis

In this manuscript, we present a rare case of massive haemoptysis secondary to rupture of a pulmonary artery aneurysm, which was unusual for having occurred in the absence of tuberculosis or a vasculitis. We describe the emergency management of this that ultimately resulted in the patient's survival from both an anaesthetic and surgical perspective, as well as discuss the role of interventional radiology in this situation.

http://bit.ly/2UwbJqV

Invasive aspergillosis complicating treatment with tyrosine kinase inhibitors

We describe three cases of pulmonary aspergillosis (PA) in three patients without traditional risk factors for invasive aspergillosis infection, such as prolonged neutropenia or high dose systemic corticosteroid therapy. All three patients developed PA while taking tyrosine kinase inhibitors (TKI) and sustained greater clinical improvement once TKI were withdrawn. Our case series supports the theory TKI treatment can increase susceptibility to PA without causing neutropenia. Recognition that TKI treatment may predispose to invasive aspergillosis will allow for rapid recognition of affected patients and more effective management of future cases.

http://bit.ly/2UplJlB

Tubulointerstitial nephritis and uveitis syndrome in a female adult

Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare disease characterised by the association of acutetubulointerstitial nephritis and uveitis. It affects mainly children and young women. Drugs and infections may be precipitating factors. It is a diagnosis of exclusion. The mainstays of treatment are topical and systemic corticosteroids. Prognosis is usually favourable. We report a case of TINU which occurred in our unit. A 37-year-old woman presented with an influenza-like illness, bilateral ocular pain and blurred vision. Ophthalmological evaluation revealed bilateral anterior uveitis and later renal involvement was seen as acute tubulointerstitial nephritis. A diagnosis of TINU was assumed after exclusion of other systemic diseases. She was treated with topical corticosteroids for the uveitis and evolved favourably, with resolution of ocular symptoms and normalisation of serum creatinine and proteinuria. This case highlights the importance of a high degree of clinical suspicion to make the diagnosis of TINU syndrome.

http://bit.ly/2DK2EVT

Acute ischaemic stroke-related choreoathetosis treated with arterial thrombectomy

A rare case of acute choreoathetosis after acute stroke is presented. This 66-years-old, right-handed Caucasian woman presented with weakness of her right arm and right leg with dysarthria, which resolved by the time she arrived in the emergency department. No obvious focal sign apart from the abnormal choreoathetoid movement of the right arm and leg and of the neck was present. Her medical history included atrial fibrillation without anticoagulation. CT head was nil acute (Alberta Stroke Program Early CT Score of 10). CT angiography of the carotids showed a hyperdense M2 segment of the left middle cerebral artery. Intravenous thrombolysis immediately followed by thrombectomy was decided. Using the Penumbra aspiration device (ACE 68) two clots were removed with two aspirations. A small distal clot remained but partial recanalisation (Thrombolysis in Myocardial Infarction/Thrombolysis in Cerebral Infarction 2b) was achieved. 30 seconds after restoring blood flow, the choreoathetoid movements ceased. The patient was brought to intensive care for further monitoring, which was uneventful.

http://bit.ly/2Um2CsG

Persistent sciatic artery resembles a soft-tissue sarcoma in presentation

Persistent sciatic artery (PSA) is a rare vascular anomaly with estimated incidence of 0.03%–0.06%. It has high incidence of complications including aneurysmal formation and ischaemia that may lead to amputation. During early embryonic development, the sciatic artery (which usually supply fetal lower buds and caudal part) disappears when the superficial femoral artery develops properly and the lower limbs grow. On clinical examination, usually a pulsating gluteal mass (the aneurysm) is appreciated with weak or absent femoral artery (Cowie's sign). However, our patient had presented in a different way. She was referred from peripheral clinic as a case of possible liposarcoma in the gluteal region. On examination, there was obvious asymmetry between both buttocks. The affected side was hard, firm in consistency with no appreciable pulsation. Nevertheless, on auscultation there was a bruit of low grade. Peripheral pulses were palpable. Our clinical impression was towards a sarcoma namely a liposarcoma. MRI was requested to evaluate the mass. The radiology report suggested that most probably it is an angiosarcoma with slim possibility of being a cavernous haemangioma. The trucut biopsy was deferred, in view of the high vascular nature of the lesion. The plan was as follow: To do angiography and embolisation of the main feeding vessels, with the possibility of biopsy in a second incident if indicated.During the conventional angiography, the pathology revealed itself. The patient was type 3 according to Pillet-Gauffre classification (PSA is limited to gluteal area and the popliteal artery arising from the femoral artery) associated with huge arteriovenous malformation. Embolisation with different materials including coils, beads and foam was ineffective. Finally, the radiologist excluded the root of the sciatic artery by a stent bridging from common iliac to external iliac artery. This successfully occluded the PSA.

http://bit.ly/2DIn55e

Congenital lateral cleft palate with unilateral craniofacial microsomia and lateral ankyloglossia

Craniofacial microsomia is a group of anomalies that occur due to developmental defects in the first and second branchial arches during the embryological period. The disease has various craniofacial and extracraniofacial presentation patterns. Lateral cleft palate is distinct from the most common palate clefts because it is located lateral to the uvula. The presence of a lateral cleft palate has been very rarely reported in the literature, and the aetiopathogenesis of the disease is still not well understood. We aimed to report a case of the coexistence of lateral cleft palate and craniofacial microsomia and discuss the aetiopathogenesis of these diseases.

http://bit.ly/2Un2mte

Headache and inflammatory bowel disease: think cerebral vein!

Cerebral vein thrombosis is a severe complication of inflammatory bowel disease, can cause non-specific symptoms and hence lead to delay in diagnosis. We report the case of an adolescent with inflammatory bowel disease who developed extensive cerebral vein thrombosis requiring a ventriculoperitoneal shunt. Diagnosis was markedly delayed due to repeated misinterpretation of clinical signs and laboratory findings and the lack of reconsidering the working diagnosis despite the involvement of several medical subspecialties. The patient does not suffer from any neurological impairment. This case report highlights the need for clinicians to maintain vigilance for complications of chronic disease and encourages to cast doubt on the working diagnosis constantly.

http://bit.ly/2DI3Tow

Rivaroxaban-related acute kidney injury in a patient with IgA vasculitis

Anticoagulants have recently been recognised as a cause of acute kidney injury (AKI). We describe the case of a 75-year-old man with IgA vasculitis and atrial fibrillation treated with rivaroxaban, who presented with macroscopic haematuria and an acute decline in renal function. Two months before referral, he noted palpable purpuric lesions and was diagnosed with IgA vasculitis based on skin biopsy findings; the skin lesion disappeared following treatment with a steroid external preparation. Renal biopsy revealed glomerular haemorrhage and red blood cell casts. Although rivaroxaban was withdrawn, his kidney function worsened and he was started on haemodialysis. His renal function did not recover. To the best of our knowledge, this is the first case of direct oral anticoagulant (DOAC)-related AKI in systemic vasculitis. During DOAC therapy, close monitoring of a patient's urinalysis results and their renal function may be required for patients with systemic vasculitis to avoid AKI.

http://bit.ly/2DImUqA

Synovial sarcoma in an HIV-positive pregnant woman and review of literature

We present a first case of synovial sarcoma in an HIV-positive pregnant woman. This 28-year-old woman was diagnosed with synovial sarcoma, a high-grade malignant soft tissue sarcoma, involving her left thigh during the first trimester of her pregnancy. She underwent surgical treatment in the form of hip disarticulation at 30 weeks' gestation. She was subsequently delivered by emergency caesarean section (CS) at 34 weeks' gestation when she presented with wound sepsis and a scan revealed static growth in a small for gestational age fetus. Prompt diagnosis and treatment of this aggressive tumour is important and should involve a multidisciplinary approach, with a balanced consideration of the maternal and fetal outcomes.

http://bit.ly/2UrKCgi

Gross anterior segment ischaemia following vitreoretinal surgery for sickle-cell retinopathy

We report the case of a 32-year-old Afrocaribbean man with known stage 3 proliferative sickle-cell retinopathy who presented with a mixed picture of tractional and rhegmatogenous macula off detachment. He underwent left primary 25 g vitrectomy with silicone oil, delamination and endolaser photocoagulation under a general anaesthetic. He, however, presented 48 hours postoperatively with gross anterior segment ischaemia. His pain and ocular signs settled over the course of a few days following administration of supplemental oxygen, oral steroids, analgesia and intravenous hydration. Examination showed resolution of his proptosis and orbital signs as well as anterior segment inflammation. He remains under follow-up.

http://bit.ly/2DImO2c

Ingestion of plastic fragments by the Guri sea catfish Genidens genidens (Cuvier, 1829) in a subtropical coastal estuarine system

Abstract

One of the most recognized anthropogenic impacts in marine environments is solid waste pollution, especially plastic, which can be ingested by fish, thus interfering with their health. In this context, the aim of this study is to describe the ingestion of plastic fragments and to identify the possible effect of this contamination in the condition factor of Genidens genidens in the Laguna Estuarine System. The stomach contents of 92 G. genidens (26 juveniles and 66 adults) were analyzed. The Index of Relative Importance was performed to identify the contribution of each prey item. Condition factor (CF) was used to analyze the effect of plastic ingestion on the fish's body condition (by comparing individuals in the same ontogenetic phase). For the juveniles, eight items were observed, the most important of which were Penaeidae, followed by Portunidae and plastic. For the adults, 12 items were observed, the most important of which were Penaeidae, Portunidae, Polychaeta, and plastic. The analysis of CF demonstrated higher values for individuals without plastic in the stomach, which indicated a better health condition. The CF of a fish may be affected by variations in the physiological condition, environmental stresses, and nutritional and biological variations, and could be used to compare the body condition or health of a fish species. The ingestion of plastic could significantly influence the worst body condition of the individuals that were analyzed in the present study. The plastic pollution in marine coastal waters is associated with the appropriate waste management levels.

http://bit.ly/2Wt6VEp

Tanycytes: a rich morphological history to underpin future molecular and physiological investigations

Abstract

Tanycytes are located at the base of the brain and retain characteristics from their developmental origins – as radial glial cells ‐ throughout their life span. With transport mechanisms and modulation of tight junction proteins, tanycytes form a bridge connecting the cerebrospinal fluid with the external limiting basement membrane. They also retain the powers of self‐renewal and can differentiate to generate neurons and glia. Like radial glia, they are a heterogeneous family with distinct phenotypes. Although the four subtypes so far distinguished display distinct characteristics, further research is likely to reveal new subtypes. In preparation for this review we re‐visited the work of the pioneers in the field revealing forgotten work waiting to inspire new research with today's cutting‐edge technologies. We have conducted a systematic ultrastructural study of α‐tanycytes that resulted in a wealth of new information, generating numerous questions for future study. We also consider median eminence pituicytes, a closely‐related cell type to tanycytes, and attempt to relate pituicyte fine morphology to molecular and functional mechanism. Our rationale was that future research should be guided by a better understanding of the early pioneering work in the field, which may currently be overlooked when interpreting newer data or designing new investigations.

This article is protected by copyright. All rights reserved.

http://bit.ly/2G7V74O

Treatment of Ethylene Glycol Poisoning with Oral Ethyl Alcohol

Ethylene glycol poisoning is not uncommon in India. The ill effects are primarily caused by its toxic metabolites: glycolic acid and oxalic acid. A 70-year-old female presented to our hospital with ataxia after ingestion of ethylene glycol. The reported case describes the management of ethylene glycol poisoning using oral ethyl alcohol as an alternative to the recommended intravenous ethyl alcohol and fomepizole that are not available for use in India. The need for high degree of clinical suspicion, targeted investigations, and early instigation of treatment is of prime importance in cases of ethylene glycol poisoning as it can lead to long-term complications or even death.

http://bit.ly/2B9Jbfs

Comparison of NOSE Scores Following Functional Septorhinoplasty Using Autologous versus Cadaveric Rib

Facial plast Surg
DOI: 10.1055/s-0039-1677718

In functional septorhinoplasty (FSRP), alternative grafting material is used if septal cartilage is insufficient for reconstructive needs. Autologous costal cartilage (ACC) and irradiated homologous costal cartilage (IHCC) are compared via the Nasal Obstruction Symptom Evaluation (NOSE) scale. One-hundred forty-one patients who underwent FSRP with ACC or IHCC between January 2013 and March 2018 were administered the NOSE scale pre- and postoperatively at 2, 4, 6, and 12 months. There was no significant difference in mean NOSE scores between the ACC and IHCC cohorts at the preoperative visit (68.5 [standard deviation, SD 24.1] and 71.7 [20.1], respectively; p < 0.6) or first postoperative visit (30.4 [26.6] and 33.9 [30.4], respectively; p < 0.6) or subsequent visits. NOSE scores demonstrated a clinically and statistically significant improvement at all follow-up time points for both the ACC and IHCC groups. Patients who underwent grafting with IHCC were significantly older than those with ACC; average age of 55.6 [SD: 17.3] versus 40.1 [SD:12.1]; (p < 0.001). Two IHCC (0.05%) patients had postoperative infections; both resolved with antibiotics, but one required revision surgery. Both ACC and IHCC provide reliable grafting material when septal cartilage is insufficient. In FSRP for nasal airway obstruction, ACC and IHCC both provide a clinically and statistically significant reduction in NOSE scores postoperatively that remain stable between follow-up time points. The authors find no difference in NOSE scores between the ACC and IHCC groups; however, IHCC did have a higher rate of postoperative infection. Both materials should be discussed with patients and are an important part of the informed consent process.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://bit.ly/2sSFUN1

M1b Disease in the 8th Edition of TNM Staging of Lung Cancer: Pattern of Single Extrathoracic Metastasis and Clinical Outcome

AbstractBackground.The 8th edition of TNM staging of non‐small cell lung cancer (NSCLC) has revised M classification and defined M1b disease with single extrathoracic metastasis, which is distinguished from M1c with multiple extrathoracic metastases. We investigated the prevalence, characteristics, and overall survival (OS) of M1b disease in patients with stage IV NSCLC.Methods.The study reviewed the medical records and imaging studies of 567 patients with stage IV NSCLC to determine M stage using the 8th edition of TNM staging. Clinical characteristics and OS were compared according to M stages.Results.Among 567 patients, 57 patients (10%) had M1b disease, whereas 119 patients (21%) had M1a disease and 391 patients (69%) had M1c disease. Squamous histology was more common in M1b (16%) than in M1a (6%) and M1c (6%; p = .03). The median OS of patients with M1b disease was 14.8 months, compared with 22.6 months for patients with M1a and 13.4 months for those with M1c disease (p < .0001). Significant OS differences of M1b compared with single‐organ M1c and multiorgan M1c groups were noted (single‐organ M1c vs. M1b: hazard ratio [HR], 1.49; p = .02; multiorgan M1c vs. M1b: HR, 1.57; p = .01) in multivariable analyses adjusting for smoking and systemic therapy types. Among patients with M1b disease, the brain was the most common site of single metastasis (28/57; 49%), followed by bone (16/57; 28%). Single brain metastasis was more frequently treated with local treatment (p < .0001).Conclusion.M1b disease was noted in 10% of patients with stage IV NSCLC. Squamous histology was more common in M1b group than others. The brain was the most common site of single metastasis and was often treated locally.Implications for Practice.The newly defined group of M stage consists of a unique subset among patients with stage IV non‐small cell lung cancer that can be studied further to optimize treatment approaches.

http://bit.ly/2WvUNlQ

Refining the Use of Adjuvant Oxaliplatin in Clinical Stage II or III Rectal Adenocarcinoma

AbstractBackground.Current guidelines include the use of adjuvant oxaliplatin in clinical stage II or III rectal adenocarcinoma. However, its efficacy is supported by a single phase II trial. We aimed to examine whether oxaliplatin confers survival benefit in this patient population.Methods.Using the National Cancer Database (2006–2013) we identified 6,868 individuals with clinical stage II or III rectal adenocarcinoma treated with neoadjuvant chemoradiotherapy, surgery, and adjuvant chemotherapy. We used multivariate Cox regression to evaluate survival differences according to treatment intensity and change from clinical to pathological stage.Results.We demonstrated an association with improved overall survival with the use of doublet adjuvant chemotherapy in pathological stage III rectal adenocarcinoma (hazard ratio [HR], 0.78; 95% confidence interval [CI], 0.67–0.92). This association was confirmed in patients with clinical stage III and subsequent pathological stage III disease (HR, 0.69; 95% CI, 0.57–0.83) and was not observed in patients who progressed from clinical stage II to pathological stage III disease. Doublet adjuvant chemotherapy was not associated with improved overall survival in patients with pathological stage 0 or I disease, regardless of their clinical stage.Conclusion.Adjuvant oxaliplatin following neoadjuvant chemoradiotherapy in rectal adenocarcinoma was confirmed in patients with clinical stage III and subsequent pathological stage III disease. Omission of oxaliplatin can be considered in pathological complete response or pathological stage I disease.Implications for Practice.Current guidelines include the use of oxaliplatin as part of adjuvant chemotherapy (AC) in patients with clinical stage II or III rectal adenocarcinoma (RAC). However, its efficacy is supported only by a single phase II trial. This study found an association with improved overall survival with the use of doublet AC in patients diagnosed with clinical stage III and subsequent pathological stage III, and not in patients with pathological stage 0 or I, regardless of their clinical stage. Therefore, omission of oxaliplatin can be considered in patients with either pathological complete response or pathological stage I RAC, thereby avoiding oxaliplatin‐induced neuropathy.

http://bit.ly/2RmirOd

Bridge: Person‐Centered Collaborative Care for Patients with Serious Mental Illness and Cancer

AbstractBackground.Individuals with serious mental illness (SMI) experience increased cancer mortality due to inequities in cancer treatment. Psychiatric care at cancer diagnosis may improve care delivery, yet models for integrating psychiatry and cancer care are lacking. We assessed the feasibility and acceptability of a person‐centered collaborative care trial for SMI and cancer.Subjects, Materials, and Methods.We developed the Bridge intervention for patients with SMI (schizophrenia, bipolar disorder, and severe major depression) and cancer. Bridge includes proactive identification of SMI, person‐centered care from a psychiatrist and case manager, and collaboration with oncology. We conducted a 12‐week, single‐group trial in patients with SMI and a new breast, gastrointestinal, lung, or head/neck cancer. We assessed the feasibility of patient identification, enrollment and study completion; evaluated acceptability and perceived benefit with exit interviews with patients, caregivers, and oncology clinicians; and examined change in psychiatric symptoms with the Brief Psychiatric Rating Scale (BPRS).Results.From November 2015 to April 2016, 30/33 eligible patients (90.9%) enrolled, and 25/29 (86.2%) completed assessments at all timepoints, meeting feasibility criteria. Of 24 patients, 23 (95.8%) found meeting with the psychiatrist helpful; 16/19 caregivers (84.2%) shared that Bridge addressed key caregiving challenges. Oncology clinicians evaluated Bridge as "very" or "most" useful for 94.3% of patients. Exit interviews with all participant groups suggested that Bridge fostered patient‐clinician trust, increased access to psychiatric treatment, and enabled patients to initiate and complete cancer treatment. Psychiatric symptoms on the BPRS improved from baseline to 12 weeks.Conclusion.Bridge is a feasible and acceptable care delivery model for patients with SMI, their caregivers, and oncology clinicians. Randomized trials are warranted to assess the efficacy of improving cancer outcomes in this underserved population.Implications for Practice.Serious mental illness affects 13 million U.S. adults who experience increased cancer mortality. To improve outcomes, new models of integrated oncology and mental health care are urgently needed. This study found that it was feasible to identify, enroll, and retain patients with serious mental illness and a new cancer in a trial of integrated mental health and cancer care (Bridge). Patients, caregivers, and oncologists reported that Bridge facilitated the initiation and completion of cancer care. Randomized trials are warranted to investigate the impact on cancer outcomes. Trial procedures may inform consent, engagement, and trial retention for patients with mental illness.

http://bit.ly/2WsCdeI

Clinicopathological and Preclinical Findings of NUT Carcinoma: A Multicenter Study

AbstractBackground.NUT carcinoma is a rare aggressive disease caused by BRD4/3‐NUT fusion, and C‐MYC upregulation plays a key role in the pathogenesis. Here, we report on the clinicopathological characteristics of Korean patients with NUT carcinoma and the in vitro efficacy of MYC‐targeting agents against patient‐derived NUT carcinoma cell lines.Materials and Methods.Thirteen patients with NUT carcinoma were evaluated for p53, C‐MYC, epidermal growth factor receptor (EGFR), HER2, and programmed cell death ligand 1 (PD‐L1) by immunohistochemistry. The half maximal inhibitory concentration (IC50) values of NUT carcinoma cell lines (SNU‐2972‐1, SNU‐3178S, HCC2429, and Ty‐82) were determined using MYC‐targeting agents, including bromodomain and extraterminal (BET) inhibitors (I‐BET, OTX‐015, AZD5153) and histone deacetylase (HDAC) inhibitors (vorinostat, romidepsin, panobinostat, CUDC‐907).Results.Primary tumor sites included head and neck (n = 9) and lung (n = 4). The patient age ranged from 8 to 73 years with the male/female ratio of 1.2:1. Nine patients died at 3–23.6 months (median, 10.6) after diagnosis. Eight patients had been misdiagnosed initially with other diseases. One patient with metastatic NUT carcinoma who received mass excision plus metastasectomy followed by chemoradiotherapy was a long‐term survivor (>27 months). Although expressions of C‐MYC (8/12, 73%) and p53 (12/12, 100%) were commonly observed, EGFR, HER2, and PD‐L1 expressions were observed in 2 of 7 (29%), 2 of 8 (25%), and 1 of 12 (8.3%) patients, respectively. BET and HDAC inhibitors showed variable but limited in vitro efficacy. However, a dual HDAC/PI3K inhibitor, CUDC‐907, was most potent against NUT carcinoma cells, with an IC50 of 5.5–9.0 pmol/L. Consistent with these findings, kinome short interfering RNA screening showed a positive hit for PI3KCA in NUT carcinoma cells. Panobinostat (IC50, 0.4–1.3 nmol/L) and a bivalent BET inhibitor, AZD5153 (IC50, 3.7–8.2 nmol/L), also showed remarkable efficacies.Conclusion.East Asian patients with NUT carcinoma showed dismal survival outcomes like Western patients, and CUDC‐907 might be promising in NUT carcinoma treatment.Implications for Practice.NUT carcinoma (NC) is a disease caused by BRD‐NUT fusion leading to C‐MYC upregulation. NC is often misdiagnosed and very aggressive, requiring development of effective therapeutic strategy. This article presents the clinicopathological features of the largest series of NCs in East Asians and preclinical sensitivities to MYC‐targeting agents in NC cell lines. Patients with NC had grave outcomes and poor response to treatment. Among MYC‐targeting agents, including BET and HDAC inhibitors, CUDC‐907 (a dual PI3K/HDAC inhibitor) was most effective against NC cells, followed by panobinostat (an HDAC inhibitor) and AZD5153 (a bivalent BET inhibitor). CUDC‐907 might be promising in NC treatment.

http://bit.ly/2Ru5y4M

Book Review:Prevention and Recovery from Eating Disorders in Type 1Diabetes:Injecting Hope

http://bit.ly/2Wt05id

Preoperative Angiography for Free Fibula Flap Harvest: A Meta-Analysis

J reconstr Microsurg
DOI: 10.1055/s-0038-1677012

Background The necessity for routine preoperative imaging for free fibula harvest is controversial. The primary objective of this meta-analysis is to determine if lower extremity angiography is necessary to detect abnormalities that may alter flap selection. The secondary objective is to determine if physical examination alone is sufficient to predict these abnormalities. Methods A literature search was performed using Cochrane, CENTRAL, MEDLINE, CINAHL, and EMBASE. Studies were selected for inclusion if they included patients undergoing free fibula flap harvest with preoperative imaging, with or without physical examination findings. Data extraction was performed independently and in duplicate, including a change in flap selection and the level of agreement between physical examination and imaging. Pooled proportions were calculated using a random-effects model and 95% confidence intervals (CI). Results Sixteen studies were included for analysis. Mean sample size was 42 patients (range: 5–123). Included studies were of low methodologic quality. Pooled proportion of patients who had flap selection change secondary to abnormalities identified on preoperative angiography was 20.1% (95% CI: 9.6–33.2%). A pooled proportion of 71.5% (95% CI: 5–88.7%) of cases requiring change in flap selection was missed by physical examination findings alone. Conclusions There is low-quality evidence suggesting a necessity for routine preoperative angiography for all patients undergoing free fibula flap harvest. Physical examination alone is insufficient in detecting vascular abnormalities that may result in limb compromise or an inability to successfully harvest a free fibula. Further investigation is warranted for cost-effectiveness of preoperative imaging protocols.
[...]

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

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

http://bit.ly/2B98j5S

Dissemination of resistance genes in duck/fish polyculture ponds in Guangdong Province: correlations between Cu and Zn and antibiotic resistance genes

Abstract

Duck/fish polyculture farming is a typical farming model in the Pearl River delta in southern China. We examined soil, water, and sediment samples from three duck-fish farms in Guangdong Province in September and December 2014. We determined the abundance of three metal resistance genes, 16S rDNA, and 23 antibiotic resistance genes encoding resistance to tetracycline, sulfonamides, quinolones, chloramphenicol, and β-lactamases. Microbial community structure was quantified by Illumina high-throughput sequencing of 16S rDNA genes. We found a prevalence of antibiotic resistance genes and the sul1, sul2, tetA, tetM, aac(6′)-Ib, and floR genes were the most abundant. Levels of Cu and Zn were significantly correlated with numerous ARG types and sul2, floR, and tetM were identified as potential antibiotic resistance gene indicators. Cu levels were significantly and positively correlated with the relative abundance of sul3, tetT, tetW, qnrB, qnrS, fexB, sul1, sul2, tetM, and qnrA. Zn was significantly correlated to relative abundance of sul2, sul3, tetM, tetA, tetT, tetW, qnrA, qnrB, qnrS, aac(6′)-Ib, qepA, bla_SHV, cmlA, floR, fexA, cfr, and fexB. The levels of Acinetobacter, Brevibacillus, and Wautersiella showed significant positive correlations with metal resistance genes as well as qnrB, oqxA, oqxB, and bla_SHV (p > 0.8). Sphingobacterium, Flavobacterium, Acidothermus, and Corynebacterium had significant correlations with abundance of tetracycline resistance genes, sulfonamide resistance genes, bla_TEM, bla_CTX, and cfr (p > 0.8). Sphingobacterium, Flavobacterium, Acidothermus, and Corynebacterium were most abundant in soil samples while Acinetobacter, Brevibacillus, and Wautersiella were most abundant in water samples. Dissemination of antibiotic resistance genes in aquaculture environments is extensive and tracing their origins is necessary to establish risk assessment methods required for aquatic environmental protection.

http://bit.ly/2UoUAiB

Detecting the recruitment phenomenon in adults using 80-Hz auditory steady-state response

The ASSR is used widely as an objective measurement of hearing in clinical settings because of its high frequency specificity. The recruitment phenomenon is generally detected using subjective evaluations which require direct communication with the patient. If the recruitment phenomenon can be detected with ASSR, it would facilitate diagnosis in patients with developmental disorders and infants.

http://bit.ly/2CQO2lV

Electrokinetic remediation of antibiotic-polluted soil with different concentrations of tetracyclines

Abstract

This study investigated the efficacy of electrokinetic remediation of soils polluted with different concentrations of tetracyclines (TCs). Three widely used TCs (oxytetracycline, chlortetracycline, and tetracycline) were selected, and concentrations of 0, 5, 10, 20, and 50 mg/kg (C0, C5, C10, C20, C50) were selected for comparison. Antibiotic-polluted soils with no electric field served as controls. The average removal rates of TCs in different treatments ranged from 25 to 48% after 7-day remediation. The contributing ratios of electrokinetics to TCs removal varied from 22 to 84%. The concentrations of NH₄⁺ increased in soils and electrolytes, which indicated the decomposition of TCs in the electric field. The highest removal amount of TCs was obtained in the C50 treatment, due to efficient reactions of TCs with oxidative radicals generated during the electrolysis. The fluctuant range of pH in the electrolytes was decreased with increasing concentration of TCs, while the soil pH was increased. The removal rate of antibiotic-resistant bacteria (ARB) in the C5 treatment was significantly higher than that in other treatments. The abundance of antibiotic resistance genes (ARGs) increased with the concentrations of TCs in soils. It might result from the induction of increasing selective pressure of antibiotics. Significant removal of ARGs occurred in the C50 treatment (38–60%). In terms of controlling ARB and ARGs, which were more resistant, the electrokinetic technology showed advantageous effects. Above all, electrokinetic technology provides an effective remediation method, especially for TC-polluted soil with a concentration of 20–50 mg/kg.

http://bit.ly/2B7Gjje

Use of Aloe Vera and Turmeric Paste as a Supplementary Medicine in Oral Submucosal Fibrosis: A Pilot Study

Abstract

Oral submucosal fibrosis is the major health issue affecting 2.5 million Indian population under the age of 40 years. All the available treatments give only symptomatic relief which is short lived.The incidence of Oral submucosal fibrosis still rising alarmingly and there is a dire need to search for an effective and safe remedy because of lack of present therapies to either provide a complete cure or treating the patients at the cost of adverse effects. A total of 140 clinically diagnosed patients with Oral submucosal fibrosis (diagnosed on the basis of reduction in interincisal distance on maximum mouth opening and palpable fibrous bands involving oral mucosa) within the age range of 18–50 years with decreased interincisal opening were selected (time period 1.5 year). These patients were given Inj. Triamcinolone (40 mg) and Inj Hyaluronidase every 21 days. Pt was divided in 2 groups (each containing both males and females) those receiving Triamcinolone ointment alone BD (control) and those receiving Triamcinolone ointment BD along with turmeric & aloe vera paste combination (test). A statistically significant improvement was seen in both burning sensation and mouth opening in both males and females. The result of the study shows that the synergistic action of these herbs results in higher efficacy and highly potent Oral submucosal fibrosis treatment.

http://bit.ly/2RpyzhM

Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo

Abstract

VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix–Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p < 0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.

http://bit.ly/2WpEszg

Plasma TNF‐α and adiponectin levels differentiate psoriatic arthritis from psoriasis patients

Abstract

Psoriasis (PsO) and psoriatic arthritis (PsA) are inflammatory disorders. Circulating biomarkers of inflammation such as interleukin‐6 (IL‐6), Tumor Necrosis Factor‐α (TNF‐α), and C‐reactive protein (CRP) have been associated with disease severity and progression of PsO and PsA. Adiponectin and leptin are adipose derived cytokines, recognized as key regulator of body weight and metabolism². Whether circulating levels of these inflammatory and metabolic biomarkers may predict the risk of PsA in psoriasis populations remains unclear.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sTKgnh

Physician Perceptions of Primary Care‐based Skin Cancer Screening in a Veterans Affairs Pilot Study

Abstract

Understanding primary care practitioner (PCP) barriers and facilitators to performing clinical skin examination (CSE) for skin cancer screening is necessary before widespread implementation. Time constraints, competing comorbidities, and patient embarrassment have been reported as obstacles. In 2016, the United States Preventative Services Task Force deemed the worldwide evidence as insufficient to assess the balance of benefits versus harms of skin cancer screening (I statement), neither recommending for nor against CSE. While the impact of primary care‐based skin cancer screening on melanoma incidence and mortality has been investigated, qualitative studies describing PCP feedback and diverse contextual factors that may help or hinder program implementation are lacking.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MEgtYK

Plasma TNF‐α and adiponectin levels differentiate psoriatic arthritis from psoriasis patients

Abstract

Psoriasis (PsO) and psoriatic arthritis (PsA) are inflammatory disorders. Circulating biomarkers of inflammation such as interleukin‐6 (IL‐6), Tumor Necrosis Factor‐α (TNF‐α), and C‐reactive protein (CRP) have been associated with disease severity and progression of PsO and PsA. Adiponectin and leptin are adipose derived cytokines, recognized as key regulator of body weight and metabolism². Whether circulating levels of these inflammatory and metabolic biomarkers may predict the risk of PsA in psoriasis populations remains unclear.

This article is protected by copyright. All rights reserved.

http://bit.ly/2sTKgnh

Physician Perceptions of Primary Care‐based Skin Cancer Screening in a Veterans Affairs Pilot Study

Abstract

Understanding primary care practitioner (PCP) barriers and facilitators to performing clinical skin examination (CSE) for skin cancer screening is necessary before widespread implementation. Time constraints, competing comorbidities, and patient embarrassment have been reported as obstacles. In 2016, the United States Preventative Services Task Force deemed the worldwide evidence as insufficient to assess the balance of benefits versus harms of skin cancer screening (I statement), neither recommending for nor against CSE. While the impact of primary care‐based skin cancer screening on melanoma incidence and mortality has been investigated, qualitative studies describing PCP feedback and diverse contextual factors that may help or hinder program implementation are lacking.

This article is protected by copyright. All rights reserved.

http://bit.ly/2MEgtYK

Use of Aloe Vera and Turmeric Paste as a Supplementary Medicine in Oral Submucosal Fibrosis: A Pilot Study

Abstract

Oral submucosal fibrosis is the major health issue affecting 2.5 million Indian population under the age of 40 years. All the available treatments give only symptomatic relief which is short lived.The incidence of Oral submucosal fibrosis still rising alarmingly and there is a dire need to search for an effective and safe remedy because of lack of present therapies to either provide a complete cure or treating the patients at the cost of adverse effects. A total of 140 clinically diagnosed patients with Oral submucosal fibrosis (diagnosed on the basis of reduction in interincisal distance on maximum mouth opening and palpable fibrous bands involving oral mucosa) within the age range of 18–50 years with decreased interincisal opening were selected (time period 1.5 year). These patients were given Inj. Triamcinolone (40 mg) and Inj Hyaluronidase every 21 days. Pt was divided in 2 groups (each containing both males and females) those receiving Triamcinolone ointment alone BD (control) and those receiving Triamcinolone ointment BD along with turmeric & aloe vera paste combination (test). A statistically significant improvement was seen in both burning sensation and mouth opening in both males and females. The result of the study shows that the synergistic action of these herbs results in higher efficacy and highly potent Oral submucosal fibrosis treatment.

http://bit.ly/2RpyzhM

Vestibular Evoked Myogenic Potentials After Epleys Manoeuvre Among Individuals with Benign Paroxysmal Positional Vertigo

Abstract

VEMP abnormalities in individuals with BPPV are often reported to be associated with utricle and saccule degeneration. The aim of the present study is to assess the frequency of VEMP abnormalities using vestibular evoked myogenic potentials in individuals with Posterior canal Benign Paroxysmal Positional Vertigo (BPPV) after Epley's manoeuvre. 36 individuals (36 ears) with definite posterior canal BPPV and 36 healthy controls were considered for the present study. All the them underwent otoscopic examination, Dix–Hallpike manoeuvre to diagnose posterior canal BPPV. Further Audiological Evaluation including pure tone audiometry was carried out to rule out vestibular disorders associated with hearing loss. Epley's manoeuvre was performed on all individuals with BPPV by an experienced otorhinolaryngologist. Cervical and Ocular Vestibular Evoked Myogenic Potentials (VEMP) were used to investigate the saccule and utricle functions following Epley's manoeuvre. Cervical VEMP and ocular VEMP abnormalities were observed in 8/36 (22.22%) and 18/36 (50%) affected ears with BPPV respectively. Cervical VEMP responses were reduced in amplitude among 1/36 (2.77%) and absent in 7/36 (19.44%) of affected ears with BPPV. Ocular VEMP responses were reduced in amplitude on 11/36 (30.55%), followed by absent responses in 5/36 (13.88%) ears with BPPV. Two patients with posterior canal BPPV i.e., 4/64 (5.55%) ears had bilateral absence of ocular VEMP responses. Two ears with BPPV 2/36 (5.55%) had absence of both cervical and ocular VEMP responses in BPPV affected ear. T test showed significant difference (p < 0.01) in the amplitude of ocular VEMP among posterior canal BPPV individuals when compared to cervical VEMP. The present study highlights individuals with Posterior canal BPPV may have otoconia dislodgement or macular degeneration of utricle, saccule, both utricle and saccule unilaterally, or bilaterally. VEMP may be useful in evaluating degeneration of both otolith organs associated with BPPV.

http://bit.ly/2WpEszg

Pediatric simulation training: Tips to make it effective for medics

Educators need to provide realistic simulation training to ensure pediatric patient clinical competence

http://bit.ly/2BaRxDD

Protective effects of quercetin supplementation against short-term toxicity of cadmium-induced hematological impairment, hypothyroidism, and testicular disturbances in albino rats

Abstract

The aim of this study was to evaluate the probable protective effect of quercetin (QUE) against cadmium (Cd)-induced sub-chronic toxicity in rats. Adult male rats were given either Cd (as cadmium chloride; 5 mg/kg) alone or in combination with QUE (50 mg/kg) daily for 4 weeks by oral gavage. At the end of the experimental period, Cd accumulation, and selected hematological, thyroid, and reproductive markers were assessed. Results revealed that Cd treatment significantly increased Cd concentrations in blood, thyroid gland, and testicular tissue of rats. Cd also caused a decline in hemoglobin content, hematocrit value, and total erythrocyte and leucocyte counts. Further, significant suppressions in the blood levels of hormones related to thyroid gland function, and male reproductive hormones (i.e., testosterone, luteinizing hormone and follicle-stimulating hormone), were observed in Cd-treated rats compared to the control. In parallel, low sperm count and sperm motility, increased sperm abnormalities, and marked pathology occurred in testis. Combination with QUE recorded amelioration of the deleterious effects of Cd, involving regulation of hematological toxicity and thyroid hormonal levels and subsequently modulation of testicular function. In conclusion, it appears that dietary QUE can rescue from Cd-induced hematological dysfunctions and testicular damage by reversing the hypothyroid state.

http://bit.ly/2FVfG53

Follow‐up of large thyroid nodules without surgery: Patient selection and long‐term outcomes

Abstract

Background

The management of large thyroid nodules remains controversial. Mandatory resection is recommended by some authors.

Methods

All patients with thyroid nodules ≥3 cm between January 2009 and January 2013 were followed until August 2017. Follow‐up data were collected using an integrated hospital‐community system.

Results

A total of 141 nodules were included. Of these, 37/141 (26%) nodules were initially referred to surgery, resulting in a 32% malignancy rate (12/37). The remaining 104/141 (74%) were referred to follow‐up. During the follow‐up period, 24 additional operations were done, resulting in a 4% malignancy rate (1/24). An indication of nonbenign cytology was significantly associated with malignancy compared with other indications. Median follow‐up was 53.5 months. No patient developed regional or distal diseases. The mean change in nodule size during the follow‐up period was a 7% reduction, with no significant trend of change over time.

Conclusion

Careful patient selection based on clinical, sonographic, and cytologic features can reduce diagnostic surgery allowing for safe follow‐up of large thyroid nodules without surgery.

http://bit.ly/2WuUvf1

Prognostic factors and treatment outcomes of advanced maxillary gingival squamous cell carcinoma treated by intra‐arterial infusion chemotherapy concurrent with radiotherapy

Abstract

Background

The aim of this study was to evaluate the prognostic factors and treatment outcomes of advanced maxillary gingival squamous cell carcinoma (SCC) treated with intra‐arterial infusion chemotherapy concurrent with radiotherapy.

Methods

A total of 46 patients were reviewed retrospectively in this study. The treatment schedule comprised intra‐arterial chemotherapy (total, 60 mg/m² docetaxel and 150 mg/m² cisplatin) and three‐dimensional computed tomography based, daily conventional radiotherapy (total, 60 Gy/30 fr) for 6 weeks.

Results

The median follow‐up period was 40 months (range, 3‐110 months). The 3‐year overall survival and locoregional control rates for all patients were 64.3% and 84.3%, respectively. The OS rate of the patients with N0‐1 was significantly higher than that of the patients with N ≥ 2 (P < .05). No grade 5 toxicities were observed.

Conclusions

Intra‐arterial infusion chemotherapy concurrent with radiotherapy was effective for advanced maxillary gingival SCC.

http://bit.ly/2Rr6y9w

Performance of a 31‐gene expression profile test in cutaneous melanomas of the head and neck

Abstract

Background

We report the performance of a gene expression profile test to classify the recurrence risk of cutaneous melanoma tumors of the head and neck as low‐risk Class 1 or high‐risk Class 2.

Methods

Of note, 157 primary head and neck cutaneous melanoma tumors were identified. Survival analyses were performed using Kaplan‐Meier and Cox methods.

Results

Gene expression profile class and node status stratified tumors into significantly different 5‐year survival groups by Kaplan‐Meier method (P < .0001 for all end points), and both were independent predictors of recurrence in multivariate analysis. Overall, 74% of distant metastases and 88% of melanoma‐specific deaths had Class 2 risk.

Conclusion

The gene expression profile test identifies cases at increased risk for metastasis and death independent of a clinically or pathologically negative nodal status, suggesting that incorporation of this molecular tool could improve clinical management of patients with head and neck cutaneous melanoma, especially in those with a negative sentinel lymph node biopsy.

http://bit.ly/2WsW4KL

JCD Editorial January 2019

http://bit.ly/2RWRqWN

Issue Information

http://bit.ly/2CSLxiZ

JCD Editorial January 2019

http://bit.ly/2RWRqWN

Issue Information

http://bit.ly/2CSLxiZ

The Capital Gazette Shooter: Injustice Collector

Violence and Gender, Ahead of Print.


http://bit.ly/2RWP7TD

Revisiting the Significance of Prominent C Cells in the Thyroid

Abstract

C cell hyperplasia is considered a precursor lesion for hereditary forms of medullary thyroid carcinoma. It has therefore been suggested as a morphological marker to distinguish hereditary from sporadic medullary thyroid carcinoma and to triage genetic testing in resource poor settings. However, numerous definitions for C cell hyperplasia have been suggested, and there is surprisingly little data regarding the number of C cells present in thyroid glands removed for conditions other than medullary carcinoma. We therefore sought to investigate the specificity of different criteria for C cell hyperplasia. We examined the number of C cells and solid cell nests (ultimobranchial body remnants) present in 118 completion thyroidectomy specimens from patients without medullary carcinoma and with no risk factors for MEN2. Morphological review was performed on all H&E-stained slides, and immunohistochemistry for calcitonin was performed on one block from each case. Solid cell nests were found in 4 (3.3%) of thyroids. Increased numbers of C cells sufficient to fulfil criteria for C cell hyperplasia were found in 5 (4.2%) to 36 (30.5%) cases depending on the criteria used. We conclude that large numbers of C cells are commonly found in thyroids not associated with medullary carcinoma. Therefore, regardless of which criteria are used, the presence of C cell hyperplasia is not a specific marker for hereditary medullary thyroid carcinoma.

http://bit.ly/2MEImjj

Spatiotemporal variability of heavy metals and identification of potential source tracers in the surface water of the Lhasa River basin

Abstract

The Lhasa River basin is the economic and population center of Tibet and has abundant resources. Due to its harsh weather condition, high elevation, and inconvenient accessibility, few studies have focused on heavy metal distributions in this region. In the present study, to investigate the dissolved trace metal pollution and its controlling factors, 57 water samples from the Lhasa River and its tributaries were collected during three water flow regimes in 2016. The data on the dissolved fraction revealed that the Lhasa River basin appeared to have no to low pollution levels. However, the Lhasa River water showed alkaline characteristics which may affect the presence of heavy metal elements in a dissolved fraction. The concentration of heavy metal elements in colloidal or particulate matter therefore needs attention. Multivariate analyses were performed to determine the significant relationship between the data and to identify controlling factors for dissolved heavy metals in the study area. The results suggested that Mn, Cd, Cu, and Zn originated from a natural geological background, whereas Pb originated from mining drainage and As was influenced by geothermal flows. The concentration of dissolved heavy metals in the Meldromarchu tributary was greatly affected by the mining drainage water, while that in the Tölungchu tributary was greatly influenced by the geothermal water sources. This paper provides the first comprehensive analysis of dissolved heavy metal pollution characteristics and the controlling factors of pollution during the three different water flow regimes of the Lhasa River basin.

http://bit.ly/2CQev2W

Previous, current, and cumulative dose effect of waterpipe smoking on LDL and total cholesterol

Abstract

The popularity of waterpipe smoking is dramatically increasing in Lebanon, reaching 36.9%, the highest among countries in the region. To the best of our knowledge, no studies have assessed the impact of waterpipe smoking on lipid levels in the Lebanese population. Therefore, the objective of the study was to evaluate the correlation between waterpipe smoking and LDL-C and total cholesterol levels in exclusive Lebanese waterpipe smokers compared to non-smokers. This cross-sectional study was conducted between October 2016 and February 2017, enrolling 308 patients (156 non-smokers and 147 waterpipe smokers) from four laboratories. Current and previous WS (beta = 66.64 and beta = 71.49) were significantly associated with higher LDL scores. Current WS was significantly associated with and total cholesterol levels (beta = 34.12). Cumulative WS (number of waterpipes per week × duration in years) was significantly associated with higher LDL-C and total cholesterol levels respectively (p < 0.001 for all 3 variables). The university level of education (beta = 8.89) and current alcohol drinking (beta = 8.81) were significantly associated with higher LDL scores. Our study demonstrated an association between previous or current waterpipe smoking and lipid level. Future research are needed to detect the direct cause of the relation between waterpipe smoking and CVD. Concerned authorities should set up awareness campaigns to increase alertness on dangers of WS and dependence, and encourage these young adults to embrace health-promoting behaviors.

http://bit.ly/2RYXfmz

Eruptive Epidermoidzysten nach Imiquimod-Therapie eines rezidivierenden Basalzellkarzinoms

Zusammenfassung

Eruptive Epidermoidzysten stellen eine seltene Nebenwirkung von Imiquimod zur Behandlung von Basalzellkarzinomen dar. Bis dato wurden 8 Fälle in der Literatur beschrieben. Wir präsentieren den Fall einer 75-jährigen kaukasischen Patientin mit einem 8‑mal rezidivierten Basalzellkarzinom der Nase. Nach mehrfachen Exzisionen und Therapie mit Vismodegib erhielt die Patientin schließlich Imiquimod 5 % Creme in der Standarddosierung 5‑mal wöchentlich für die Dauer von 6 Wochen. Zwei Monate nach dem Absetzen von Imiquimod zeigten sich eruptive Epidermoidzysten.

http://bit.ly/2SbZQZD

Consequences of hearing aid acclimatization on ALLRs and its relationship with perceived benefit and speech perception abilities

Abstract

Objective

The study aimed to track long latency responses over a period of hearing aid use in naïve hearing aid users, and study its relationship with change in speech perception abilities and perceived benefit.

Methods

Thirty adults in the age range of 23–60 years with moderate sensorineural hearing loss participated in the study. Auditory late latency responses (ALLRs), signal-to-noise ratio − 50 (SNR-50), and scores of speech spatial and qualities questionnaire (SSQ) were measured three times over a period of 2 months of hearing aid use.

Results

ALLRs showed a significant decrease in the P1 and N1 latency across the three measurements. Significant increase in the scores of SSQ and significant decrease in the SNR-50 were also found. The change in ALLRs did not correlate with change in scores of either SSQ or SNR-50.

Conclusions

The study provides evidence for improvements in neural processing of auditory cortical areas with hearing aid acclimatization. The improvements seen in perceived benefit and speech perception are not related to the improvements in ALLRs. This is the first study in the domain with a younger group compared to the previous studies and the results show evidence for neural plasticity influencing hearing aid acclimatization benefits.

http://bit.ly/2RUPhdT

Tinnitus: psychosomatische Aspekte

Zusammenfassung

Tinnitus ist ein häufiges Symptom unklarer Genese, das multifaktoriell bedingt und aufrechterhalten sein kann. Es ist oftmals, aber nicht zwingend, mit Hörverlust assoziiert. Emotionale Belastung oder maladaptive Copingstrategien, die sich in Reaktion auf Tinnitus entwickeln oder durch ihn verstärkt werden können, stellen Schlüsselfaktoren für psychosoziale Interventionen dar. Hierzu eignen sich – nach Abklärung somatischer Einflussfaktoren – entkatastrophisierende Informationsvermittlung und ggf. psychotherapeutische Interventionen. Maßnahmen zur Verbesserung der Hörwahrnehmung (z. B. Hörgeräte oder Cochleaimplantate) können über direkte (Verbesserung der Hörwahrnehmung) oder indirekte Effekte (Verbesserung des emotionalen Befindens oder der Lebensqualität) ebenfalls zur Tinnitushabituation beitragen.

http://bit.ly/2HEIy35

Ethnic Variation of Sinonasal Anatomy on CT Scan and Volumetric Analysis

Abstract

To determine Ethnic differences in the frequency of the relatively common anatomical variants along with difference in anatomy of sinonasal region with surgical importance. A study was conducted to determine the frequency of anatomical variants, volumes of paranasal sinuses using computed tomography and to identify any difference between Group A consisting of people of Indian subcontinent and Group B consisting of people from north east Asian region. Volumetric analysis done using cumulative of area multiplied by slice thickness. The results were compared using Chi square test, p value < 0.05 was considered statistically significant. Among the common and uncommon anatomical variants (Agger nasi, pneumatized uncinate, concha bullosa etc.) there was no significant difference between the two groups. In both the groups Keros Type 1 was the most common type of ethmoid roof seen. On volumetric analysis sphenoid sinus volume was found to be higher in Indians without mongoloid features. Hence it's ideal that in this era of endoscopic sinus surgery we tailor make approaches to address individual anatomical variation.

http://bit.ly/2UonIqk

Ulcères de jambe nécrotiques après application locale de chlorméthine

Publication date: Available online 28 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): C. Gary, V. Gautier, I. Lazareth, M. Bagot, R. Asgari, P. Priollet

Résumé

Introduction

La chlorméthine en applications locales est très largement utilisée, et ce depuis plusieurs années, dans le traitement du mycosis fongoïde de stade précoce. Les réactions cutanées à type d'irritation et de prurit représentent ses principaux effets secondaires. Nous rapportons un effet indésirable rare, mais sévère, à type d'ulcères de jambe nécrotiques.

Observation

Une femme de 82 ans, hypertendue, se présentait pour des ulcérations cutanées des membres inférieurs évocatrices d'angiodermite nécrotique atypique. Ces ulcérations étaient survenues à la suite d'un traumatisme local, un mois après le début d'applications locales de chlorméthine (Valchlor^®) pour un mycosis fongoïde. Le bilan étiologique trouvait une artériopathie oblitérante des membres inférieurs modérée, qui constituait un facteur aggravant, mais ne pouvait expliquer qu'en partie la survenue de ces ulcérations du fait de leur aspect clinique. De plus, devant leur chronologie de survenue, une origine médicamenteuse était suspectée. Le traitement par chlorméthine était remplacé par des dermocorticoïdes et des soins locaux étaient prodigués sur les ulcères. L'évolution était favorable.

Conclusion

L'imputabilité de cet effet indésirable potentiel de la chlorméthine repose sur des critères chronologiques et sémiologiques. Il implique des conséquences thérapeutiques pratiques. Il s'agit du premier cas publié d'ulcère de jambe induit par le Valchlor^®.

Summary

Background

Topical chlormethine has been widely used in the early stages of mycosis fungoides for many years. Cutaneous reactions (skin irritation and itch) are the most frequent adverse effects. Herein we report a rare side effect: severe necrotic leg ulcers.

Patients and methods

An 82-year-old woman with a history of high blood pressure developed hyperalgesic necrotic ulcers on the lower limbs following local trauma one month after initiation of topical chlormethine (Valchlor^®) to treat mycosis fungoides. Aetiological examination showed moderate peripheral arterial disease which, while constituting an aggravating factor, did not account fully for these skin ulcers. Moreover, drug-induced ulcer was suspected on account of the chronology. Dermal corticoids and topical treatment were prescribed in place of chlormethine and led to a favourable outcome.

Conclusion

Incrimination of chlormethine was based on the chronological and semiological criteria. This is the first published case of leg ulceration induced by Valchlor^®.

http://bit.ly/2Sg4vd4

Methotrexate efficacy and tolerance in plaque psoriasis. A prospective real-life multicentre study in France

Publication date: Available online 28 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): A. Tournier, A. Khemis, F. Maccari, Z. Reguiai, E. Bégon, A.-C. Fougerousse, M. Amy de la Breteque, N. Beneton, J. Parier, T. Boyé, M. Avenel-Audran, C. Girard, V. Pallure, J.-L. Perrot, M. Bastien, E. Mahé, A. Beauchet, GEM Resopso

Summary

Background

Methotrexate (MTX) is a major systemic treatment for moderate to severe plaque psoriasis. A randomized trial has recently been published evaluating a single weekly dosage (17.5 mg), but few prospective real-life data are available. The main objective of this study was to prospectively evaluate the efficacy of MTX in real-life. The secondary objectives were to evaluate predictive parameters for treatment efficacy and the frequency of adverse events.

Patients and methods

A prospective cohort involving consecutive at in 25 centres belonging to GEM RESOPSO included all adults with plaque psoriasis in whom MTX treatment was initiated. The efficacy criterion was achievement of PASI 75 at week (W) 12/16. The impact of demographic data, psoriasis characteristics (duration, topography, rheumatism), dosage (W12/16 dosage, cumulative dose after 4 weeks), and mode of administration (subcutaneous vs. oral, concomitant use of folic acid) on efficacy was evaluated. Intention-to-treat (ITT),per protocol (PP), and multivariate analyses were performed.

Results

Two hundred and fifty-six patients (F/M: 105/151; mean age: 45.0 years; rheumatism: 12.6%) with plaque psoriasis were included. 99 patients were not analysed at W12/16 (16 because of inefficacy, 16 because of intolerance, 56 were lost to follow-up or had data missing). PASI 75 was achieved in 98 patients, with efficacy of 38.3% in the ITT analysis and 58.3% in the PP analysis. In the ITT analysis, absence of previous use of cyclosporine (P = 0.01) and a cumulative dose of MTX > 60 mg after 4 weeks (P < 0.0001) were associated with higher PASI 75 rates. In the PP analysis, only absence of previous use of cyclosporine (P = 0.0009) was associated with a better PASI 75 results. There was no association between PASI 75 and patient characteristics (including body mass index), clinical aspects of psoriasis, route of administration, combination with folic acid, or W12/16 dose. Adverse events were reported by 34.8% of patients. These consisted mainly of digestive disorders (nausea, abdominal pain), asthenia and moderate hepatic cytolysis. The frequency of adverse events was correlated with methotrexate dosage.

Discussion

The efficacy of MTX in plaque psoriasis in this real-life study of 256 patients is consistent with the data in the literature, including the recently published randomized trial (41% PASI 75). This rate was unaffected by patient weight, route of administration and combined use of folic acid. Absence of previous use of cyclosporine appears to be associated with better efficacy although there is no clear explanation for this. The initial dosage (high dose in the first month) appears to be associated with superior efficacy for W12/W16.

Résumé

Le méthotrexate (MTX) est un des traitements systémiques du psoriasis en plaques modéré à sévère. Peu de données sont disponibles en pratique quotidienne. L'objectif de cette étude était d'évaluer de façon prospective l'efficacité du MTX en pratique quotidienne. Les objectifs secondaires étaient d'évaluer les paramètres prédictifs de l'efficacité du traitement, et la fréquence des évènements indésirables.

Patients et méthode

Cohorte prospective par inclusions consécutives dans 25 centres du GEM RESOPSO de tous les patients adultes présentant un psoriasis en plaques chez qui était débuté un traitement par MTX. Le critère d'efficacité était l'obtention d'un PASI75 à la semaine (S) 12/S16. Les paramètres évalués pouvant modifier l'efficacité étaient les paramètres démographiques, les caractéristiques du psoriasis (ancienneté, topographie, rhumatisme), la dose (dose à S12/S16, dose cumulée à 1 mois), le mode d'administration (sous-cutané vs oral), l'utilisation concomitante d'acide folique. Des analyses en intention de traiter (ITT) et per protocole (PP) ont été réalisées ainsi qu'une analyse multidimensionnelle.

Résultats

Deux cent cinquante-six patients (F/H : 105/151 ; âge moyen : 45,0) ont été inclus (analyse ITT), 168 (analyse en PP) ont été analysés à S12/S16 (16 arrêts pour échec, 16 pour intolérance, 56 perdus de vue ou avec données manquantes). Un PASI 75 était obtenu chez 98 patients, soit un taux d'efficacité de 38,3 % en ITT et 58,3 % en PP. En ITT, la non-utilisation préalable de ciclosporine (p = 0,01), la dose cumulée de MTX > 60 mg le premier mois (p < 0,0001), la dose cumulée moyenne à S4 (p < 0,0001) et la dose à S12/S16 > 20 mg (p = 0,005) étaient associées à un taux de PASI75 plus élevé. En PP, la non-utilisation préalable de ciclosporine (p = 0,0009) et la dose cumulée moyenne à S4 (p = 0,047) étaient associées à un taux de PASI75 plus élevé. Ni les caractéristiques des patients, ni leurs comorbidités, ni les aspects cliniques du psoriasis, ni le mode d'administration, ni l'association à de l'acide folique ou la dose à S12/S16 n'étaient associés à une augmentation de fréquence d'obtention du PASI75. Des évènements indésirables ont été rapportés par 34,8 % des patients. Il s'agissait principalement de troubles digestifs (nausées, douleurs abdominales), asthénie et cytolyse hépatique modérée. La fréquence des évènements indésirables non graves était directement corrélée à la dose de méthotrexate.

Discussion

Le taux d'efficacité du MTX dans le psoriasis en plaques dans cette étude menée en pratique quotidienne portant sur 256 patients est concordant avec les données de la littérature dont l'essai randomisé récemment publié (41 % de PASI75). Ni le poids du patient, ni la voie d'administration ou l'association à de l'acide folique ne semblent modifier ce taux efficacité. La non-utilisation préalable de ciclosporine serait associée à une meilleure efficacité, sans que l'on ait d'explication. Une dose cumulée élevée pendant premier mois serait associée à une meilleure efficacité à S12/S16.

http://bit.ly/2HE2ZgI

Léiomyomes cutanés et carcinome rénal

Publication date: Available online 28 January 2019

Source: Annales de Dermatologie et de Vénéréologie

Author(s): M. Fialek, C. Desvignes, M. Levavasseur, C. Lavogiez, D. Staumont-Sallé

http://bit.ly/2Sh8d5W

Ethnic Variation of Sinonasal Anatomy on CT Scan and Volumetric Analysis

Abstract

To determine Ethnic differences in the frequency of the relatively common anatomical variants along with difference in anatomy of sinonasal region with surgical importance. A study was conducted to determine the frequency of anatomical variants, volumes of paranasal sinuses using computed tomography and to identify any difference between Group A consisting of people of Indian subcontinent and Group B consisting of people from north east Asian region. Volumetric analysis done using cumulative of area multiplied by slice thickness. The results were compared using Chi square test, p value < 0.05 was considered statistically significant. Among the common and uncommon anatomical variants (Agger nasi, pneumatized uncinate, concha bullosa etc.) there was no significant difference between the two groups. In both the groups Keros Type 1 was the most common type of ethmoid roof seen. On volumetric analysis sphenoid sinus volume was found to be higher in Indians without mongoloid features. Hence it's ideal that in this era of endoscopic sinus surgery we tailor make approaches to address individual anatomical variation.

http://bit.ly/2UonIqk