Head and Neck Diseases by Alexandros G.Sfakianakis: 02/08/19

Παρασκευή 8 Φεβρουαρίου 2019

Deep Neck Space Infection: Study of 52 Cases

Abstract

Deep neck spaces are still common in developing countries like India, even though its less prevalent in developed nations. It can lead to serious complications like jugular vein thrombosis and dissemination of infection if not diagnosed early and intervened. This is a retrospective chart review of 52 patients from 2014 to 2017 in a tertiary care hospital. Only patients with infection deeper to the superficial fascia of neck were included. Submandibular space infection was the most common and precipitating factor being dental infection. Most common comorbid condition was diabetes mellitus. Klebsiella pneumoniae was the most common isolated organism and few patients had mixed culture with anaerobes. Injectable cephalosporin with metronidazole was the most effective antibiotic combination against such infections. Low threshold for early surgical intervention reduce hospital stay and enable quick recovery of patients. Usage of over the counter antibiotics masks the conditions and complicate diagnosis and treatment of this condition.

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Errors according to the number of registered markers used in navigation-assisted surgery of the mandible

Abstract

Background

The aim of this study was to evaluate the accuracy of navigation according to the number of markers in terms of target registration errors (TREs) at each anatomical location during the registration process of the navigation system for the mandible.

Methods

The TREs were measured in five different experiments, varying only in the number of registration reference markers, which ranged from three to seven. To measure the TREs according to the number of registration reference markers, two experimental navigation devices were used: 1) Cbyon navigation surgery equipment 2) Polaris optical tracker. Both experiments were conducted to obtain the TREs at the anatomical locations of the mandible according to the number of registration markers during the navigation process. Statistical analysis was performed using the SPSS 23.0 software.

Results

At all anatomical locations, errors were 2 mm or less. Further, significant differences in the target errors measured by the Cbyon system were found according to the number of registration markers. Significant differences in the target errors measured by the Polaris optical tracker were found according to the registration markers at the posterior border only. In both groups, the target errors did not decrease as the number of registration markers increased.

Conclusions

This study demonstrates that an increase in the number of registration markers is not associated with a decrease in the TRE, and that a specific number of registration markers could reduce the TREs at each anatomical site. It is important to determine the minimum number of image registration markers at which the smallest TRE would be observed for different surgical sites.

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Ectoine lozenges in the treatment of acute viral pharyngitis: a prospective, active-controlled clinical study

Abstract

Purpose

Acute pharyngitis is an uncomfortable disorder mostly caused by viruses and for which antibiotics are unwarranted. This study compared lozenges containing ectoine, a natural extremolyte, with hyaluronic acid lozenges and hypertonic saline gargle for symptomatic treatment of acute viral pharyngitis.

Methods

This prospective, controlled clinical study, recruited 90 patients with moderate-to-severe pharyngitis symptoms who chose to use either ectoine (n = 35), hyaluronic acid (n = 35), or saline gargle (n = 20). Patients applied their 7-day treatment from the inclusion visit (V1) until the end-of-study visit (V2). Patients' pharyngitis symptoms, general health, general treatment effectiveness and tolerability, and patient compliance were assessed by investigators and patients.

Results

The sum score for three primary symptoms (pain on swallowing, urge to cough, and hoarseness) decreased by 79.5% (ectoine), 72.2% (hyaluronic acid), and 44.8% (saline gargle). Both lozenges were significantly superior to saline gargle (P < 0.05). Regarding general health improvement, ectoine was significantly superior to saline gargle (72.5% vs. 45.2%, P < 0.05), but hyaluronic acid (63.3%) was not. At V2, 65.7% of patients receiving ectoine reported "very good" general health vs. 48.6% of those receiving hyaluronic acid and 20.0% using saline gargle. Ectoine was significantly superior (P < 0.05) to both hyaluronic acid and saline gargle in terms of tolerability and patient compliance. No patients taking ectoine reported unpleasant sensations while applying their treatment, whereas almost half of patients using hyaluronic acid lozenges and saline gargle did.

Conclusion

Treatment with ectoine lozenges significantly relieves moderate-to-severe symptoms of acute viral pharyngitis and is more effective and tolerable than treatments with hyaluronic acid lozenges and hypertonic saline gargle.

http://bit.ly/2Bsrgk6

Polymerization pattern characterization within a resin-based composite cured using different curing units at two distances

Abstract

Objectives

To investigate the relationship of the irradiance-beam-profile areas from six different light-curing units (LCUs) with the degree of conversion (DC), microhardness (KH), and cross-link density (CLD) throughout a resin-based composite (RBC) cured at two clinically relevant distances, and to explore the correlations among them.

Materials and methods

A mapping approach was used to measure DC using micro-Raman spectroscopy, KH using a Knoop indentor on a hardness tester, and %KH reduction after ethanol exposure, as an indicator for CLD within a nano-hybrid RBC increment (n = 3) at various depths. These sample composites were cured from two distances while maintaining the radiant exposure, using six different light-curing units: one quartz-tungsten-halogen; two single and three multiple-emission-peak light-emitting-diode units. Irradiance beam profiles were generated for each LCU at both distances, and localized irradiance values were calculated. Points across each depth were analyzed using repeated measures ANOVA. Correlations across multiple specimen locations and associations between beam uniformity corresponding with polymerization measurements were calculated using linear mixed models and Pearson correlation coefficients.

Results

Significant non-uniform polymerization patterns occurred within the specimens at various locations and depths. At 2-mm curing distance, the localized DC = 52.7–76.8%, KH = 39.0–66.7 kg/mm², and %KH reduction = 26.7–57.9%. At 8-mm curing distance, the localized DC = 50.4–78.6%, KH = 40.3–73.7 kg/mm², and %KH reduction = 28.2–56.8%. The localized irradiance values were weakly correlated with the corresponding DC, KH, and %KH reduction, with only a few significant correlations (p < 0.05).

Conclusions

Although significant differences were observed at each depth within the specimens, the localized irradiance values for all LCUs did not reflect the polymerization pattern and did not seem to have a major influence on polymerization patterns within the RBC, regardless of the curing distance.

Clinical relevance

Commonly used LCUs do not produce uniform polymerization regardless of the curing distance, which may contribute to the risk of RBC fracture.

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Visibility, location, and morphology of the primary maxillary sinus ostium and presence of accessory ostia: a retrospective analysis using cone beam computed tomography (CBCT)

Abstract

Objectives

This retrospective study evaluated the visibility, location, and morphology of the primary maxillary ostium (PMO), as well as the presence and number of accessory maxillary ostia (AMO) in the maxillary sinus using cone beam computed tomography (CBCT).

Materials and methods

CBCT scans with a large field of view with both maxillary sinuses entirely visible, acquired from February 2016 to February 2018, were initially screened. Patients were included if there was no history of surgical intervention/trauma in the sinus region. Two observers evaluated the CBCTs for PMO and AMOs independently. PMO and AMOs were evaluated in axial, coronal, and sagittal CBCT views. In case of disagreement, a third observer served as a referee. The findings were correlated with age, gender, condition of the sinus mucosa, and status of the dentition to assess for potential influencing factors.

Results

A total of 184 patients (368 maxillary sinuses) were included. PMO was present and patent in 346 (94.0%) of the 368 analyzed sinuses. Most of the PMOs were located above the attachment of and in the middle third of the inferior turbinate (76.1%) and exhibited a slit shape (71.1%). An AMO was present in 167 (45.5%) of the 368 analyzed sinuses, and 66 (17.9%) sinuses had multiple AMOs. Gender and sinus mucosa morphology were found to be influencing factors for the patency of the PMO. Furthermore, gender seems to be influencing the presence of an AMO.

Conclusions

Most of the analyzed maxillary sinus cavities in the present population had a patent PMO. Being male and having morphological changes of the sinus mucosa were factors associated with a reduced prevalence of a patent PMO.

Clinical relevance

A maxillary sinus with pathological findings of the mucosa seems to have a reduced prevalence of patent PMOs. Therefore, clinicians should take care to assess any clinical and radiographical sign indicating a potential maxillary sinusitis prior to surgical interventions in this region, especially in cases with planned sinus floor elevation.

http://bit.ly/2RPBKzo

Enhancement of gasworks groundwater remediation by coupling a bio-electrochemical and activated carbon system

Abstract

Here, we show the electrical response, bacterial community, and remediation of hydrocarbon-contaminated groundwater from a gasworks site using a graphite-chambered bio-electrochemical system (BES) that utilizes granular activated carbon (GAC) as both sorption agent and high surface area anode. Our innovative concept is the design of a graphite electrode chamber system rather than a classic non-conductive BES chamber coupled with GAC as part of the BES. The GAC BES is a good candidate as a sustainable remediation technology that provides improved degradation over GAC, and near real-time observation of associated electrical output. The BES chambers were effectively colonized by the bacterial communities from the contaminated groundwater. Principal coordinate analysis (PCoA) of UniFrac Observed Taxonomic Units shows distinct grouping of microbial types that are associated with the presence of GAC, and grouping of microbial types associated with electroactivity. Bacterial community analysis showed that β-proteobacteria (particularly the PAH-degrading Pseudomonadaceae) dominate all the samples. Rhodocyclaceae- and Comamonadaceae-related OTU were observed to increase in BES cells. The GAC BES (99% removal) outperformed the control graphite GAC chamber, as well as a graphite BES and a control chamber both filled with glass beads.

http://bit.ly/2GyLlbS

Expectations and Experience of Children with Unilateral Cochlear Implantation: A Parental Perspective

Abstract

To find out parental expectations regarding outcomes of unilateral cochlear implantation prior to surgery and experience received by them after cochlear implantation and 1 year of regular auditory verbal therapy, with respect to the communication abilities, social skills and participation. Total of 200 parents of hearing impaired children participated in the study. A closed ended questionnaire containing 13 questions were used to collect the data. The participants were instructed to complete all the questions provided based on their expectations and experiences. The descriptive statistics were used to determine the frequency and percentage. Among 200 parents, almost all (95%) of the parents expected to have improvement in all the subscale of communication abilities, social skills and participation. 68.5% of the parents experienced improvement in their child's communication abilities, such as, response to quiet sounds, repetition of words without seeing speaker's face, elimination of use of gestures, easy communication and verbal expression for needs, thoughts and feelings. 76% of the parents experienced improvement in social skills and participations, such as, good relationship with elders, siblings and peers, making friends outside the family, actively participating in the activity done by other children and easily accepted by peers in the classroom. A large number of parents met with their expectations and a small proportion of families were found to be disappointed due to high hopes and unrealistic expectation before implantation, which had adverse effect on the children's performance.

http://bit.ly/2SJDfUi

The prevalence of hearing loss and use of hearing aids among adults in Germany: a systematic review

Abstract

Background

Worldwide approximately 360 million people suffer from hearing impairment, 328 million of whom are adults. Up to now there has been no systematic evaluation of any representative epidemiological data on the prevalence of hearing loss among adults in Germany. The present paper is intended to investigate this within the framework of a systematic review.

Methods

A systematic literature search was carried out in electronic databases as well as by means of hand-searching. Studies published after 1975 and indicating the prevalence or incidence of hearing impairment among German adults were included. Study selection, data extraction and additional quality assessments were made by two independent reviewers.

Results

By means of a systematic literature search it was possible to identify 6 sources, which provided solely cross-sectional data, whereby the reported data are based on a study population of between some hundred and 10 million people living in Germany. The prevalences ascertained showed a broad range of between 16% and 25% and varied according to age, study setting, definition of hearing loss and method of data capture. At present there are no utilizable data on the extent of the use of hearing aids.

Discussion

The present review demonstrates clearly that evidence-based information relating to Germany can only be made on the basis of a clear definition of hearing loss within the framework of an up-to-date and representative epidemiological study carried out with appropriate methodology. In view of the high prevalence of illnesses causing hearing impairment and of the risks to health associated with untreated hearing impairment as well as of socio-economic costs, such an epidemiological study is of great social significance.

http://bit.ly/2UNmWmQ

Expectations and Experience of Children with Unilateral Cochlear Implantation: A Parental Perspective

Abstract

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Using multi-integrated biomarker indexes approach to assess marine quality and health status of marine organism: a case study of Ruditapes philippinarum in Laizhou Bay, China

Abstract

With the progress of technology and the deepening of understanding of biological monitoring, much more attention has been paid to the multiple evaluation of marine pollution monitoring. In view of this, our study aimed at establishing a multi-integrated biomarker indexes approach to evaluate marine condition systematically and comprehensively. In the current study, sampling was conducted in Laizhou Bay, China (S1, S2, and S3) in May, August, and October of 2015. And then, multi-integrated biomarker indexes approach was applied to assess marine PAHs pollution, select appropriate biomarkers, and evaluate marine environmental quality and health status of the clams of Ruditapes philippinarum. As the results showed, S2 was the most PAHs-polluted site while S1 was the least polluted site, and the levels of tPAHs in seawater and sediments ranged from 69.78 to 315.30 ng/L and 163.19 to 565.17 ng/g d.w., respectively. And all three sampling sites had different sources of PAHs. IBR represented DNA damage (F value), the expression of SOD, EROD activity, GST activity, and LPO could be served as biomarkers to monitor the PAHs pollution in Laizhou Bay. And MPI suggested the quality of all three sites: S1 was generally favorable, S2 was moderately polluted, and S3 was lightly polluted. BRI values showed that the order of health status of R. philippinarum was S1 > S3 > S2.

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Trends in the dermatology residency match from 2007 to 2018: Implications for the dermatology workforce

To the Editor: Dermatology services remain undersupplied in the United States, stemming from both the limited number and geographic distribution of dermatologists.1,2 As an important determinant of workforce growth, the quantity of dermatology residency positions may be a constraining factor.

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Bundled payment for actinic keratosis management: Pilot evaluation of developed models

There is an opportunity to explore alternate payment models in dermatology.

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CME examination

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Dermatologic care for lesbian, gay, bisexual, and transgender persons

More than 10 million lesbian, gay, bisexual, and transgender (LGBT) persons live in the United States. Improving their health is a public health priority. LGBT persons have specific health concerns and face health care disparities. Awareness of those issues and disparities can enable dermatologists to provide medically appropriate and culturally competent care to LGBT patients. This review highlights terminology important in caring for LGBT persons, LGBT demographics in the United States, health care disparities faced by LGBT persons, and approaches to caring for LGBT patients.

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Answers to CME examination

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Sunburn prevalence among US adults, National Health Interview Survey 2005, 2010, and 2015

To the Editor: Sunburn is a biologic indicator of acute overexposure to ultraviolet (UV) radiation, and sunburn at any age is associated with an increased risk for melanoma.1 Tracking changes in the national prevalence of sunburn over time can provide insight to our nation's progress toward increasing adequate use of sun protection and reducing skin cancer risk at a population level.2 We examined changes over time in sunburn among US adults during 2005-2015.

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February iotaderma (#300)

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Journal Based CME Instructions and Information

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Topical use of mammalian target of rapamycin inhibitors in dermatology: A systematic review with meta-analysis

Systemic mammalian target of rapamycin (mTOR) inhibitors are currently used in many dermatologic indications. Their topical use is recent and poorly codified.

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CME examination

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Editorial Board

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Dermatology Calendar

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JAAD Case Reports Article List

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Dermatologic care for lesbian, gay, bisexual, and transgender persons

Lesbian, gay, bisexual, and transgender (LGBT) persons face important health issues relevant to dermatologists. Men who have sex with men (MSM) are at higher risk of certain infectious diseases, including HIV, syphilis and other sexually transmitted diseases (STDs), methicillin-resistant Staphylococcus aureus infections, and invasive meningococcal disease, and might be at higher risk of non-infectious conditions, including skin cancer. Recommendations for preventive health care, including screening for HIV and other STDs, sexual health-related vaccinations, and HIV pre-exposure prophylaxis, differ for MSM compared with non-MSM.

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March iotaderma (#301)

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Orchard management under the effects of climate change: implications for apple, plum, and almond growing

Abstract

The authors analyzed certain species and varieties of fruit tree in which applied crop technology is used and also undergoes the effects of climate change. The aim is to extend productive crop varieties, resistant to disease and pests, in order to obtain superior yields. The research was conducted in orchards located in northwestern Romania (on 8.59 ha), intensively cultivated with apple, plum, and almond species. The blooming period of the species and fruit production was studied in 2009, the first year of the farm's commercial production, and then compared to figures from 2016 to see the changes that occurred. Climatic conditions were studied throughout the period of existence of the farm (2002–2016). To determine the influence of the climatic factor on the blooming and production periods, respectively, every year is considered having pre-blooming, blooming, and ripening periods. It was found that climate change influences the annual biological cycle of the trees: the vegetative rest period of the trees shortens, the tree vegetation begins earlier in the spring, and the blooming period is advanced by as much as 10 days compared to normal cultivated varieties. All these factors have direct repercussions on the quantity of production.

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Comparison of different sequential extraction procedures for mercury fractionation in polluted soils

Abstract

Three sequential extraction procedures (SEPs), modified Tessier, modified BCR, and CIEMAT, were compared for mercury fractionation in polluted soils. With satisfactory total mercury recovery, the modified Tessier and modified BCR SEPs were comparable with each other in terms of extraction efficiency in equivalent mercury fractions, whereas both SEPs were not as efficient as the CIEMAT SEP. However, the CIEMAT SEP might underestimate the oxidizable mercury fractions due to the humic and fulvic complexes instead of the organic matter of the other two SEPs. For mercury bioavailability identification, based on Pearson correlation analysis, all fractions in each SEP were significantly correlated with mercury uptake in Ipomoea aquatica, causing difficulty in comparison. Partial correlation analysis indicated that the mobile mercury fractions extracted by the first step in all three SEPs had a positive correlation with mercury uptake by plant, while mercury bound to organic matter extracted by both modified Tessier and modified BCR SEPs presented negative correlation with mercury uptake by plant which was in contrast to CIEMAT SEP. Meanwhile, clearly positive correlations between mercury fractions extracted by the former three steps of CIEMAT SEP and mercury uptake in Ipomoea aquatica were observed, demonstrating that CIEMAT SEP provided more accurate results related to Hg bioavailability than did the other two SEPs.

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Algae turf scrubber and vertical constructed wetlands combined system for decentralized secondary wastewater treatment

Abstract

Water shortage is a current problem faced by many regions. The deterioration of water bodies driven by the directly discard of untreated wastewater worsens the water shortage and implies in more costly treatments to meet local standards for water quality. In rural areas, the problem is even worse, once conventional centralized treatment plants do not encompass them. Decentralized treatment systems must present low-cost, local availability, standards-meeting efficiency, and simplified operation. The present study examines the combined use of algae turf scrubber and down-flow vertical constructed wetlands for a University's sanitary wastewater treatment. After a hydraulic detention time of 21 days, the unit was able to reach 49%, 48%, 98%, 82%, 99.2%, 70.1%, 44%, 83%, 72%, 86%, 69%, 95%, and 99.9% for conductivity, total soluble solids, turbidity, apparent color, N-NH₃, total nitrogen, P-soluble, total carbon, chemical oxygen demand, inorganic carbon, TOC, Escherichia coli, and total coliforms. In accord to the Brazilian standard ABNT 13969/97, the treated effluent is eligible for reuse in floor and sidewalks washing, garden irrigation, and landscaping purposes.

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Varenicline-induced symmetrical drug-related intertriginous and flexural exanthema

Chun-Yu Cheng, Chuang-Wei Wang, Fang-Ying Wang, Wen-Hung Chung

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):209-211

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Subclinical atherosclerosis and cardiovascular markers in patients with lichen planus: A case–control study

Soheila Nasiri, Afsaneh Sadeghzadeh-Bazargan, Reza Mahmoud Robati, Hamid Reza Haghighatkhah, Shima Younespour

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):138-144

Background: Lichen planus is an idiopathic and chronic inflammatory disease that affects the skin and the mucous membranes, and has been associated with an increased risk for cardiovascular diseases. Hyperhomocysteinemia has been regarded as a risk factor for atherosclerosis and cardiovascular diseases. Increased plasma fibrinogen levels are also associated with increased risk of myocardial infarction. Objective: The main aim of this study is the evaluation of common carotid artery mean intima media wall thickness, serum fibrinogen and homocysteine levels in patients with lichen planus. Methods: Forty-three patients with lichen planus and 43 age, gender and body mass index (BMI) matched healthy controls (from general population without the disease) were included in this study. Results: Compared to the healthy controls, patients had statistically significant greater mean intima media wall thickness of the common carotid artery. Moreover, a positive correlation was observed between lichen planus and increased serum homocysteine and c-reactive protein levels. Limitations: The main limitation of this study is the small sample size due to the time limitation and financial constraints. Conclusion: Early diagnosis of atherosclerosis in patients with lichen planus might afford better prophylaxis, including weight control and/or lipid profile monitoring. Measurement of the mean intima media wall thickness of the common carotid artery by duplex high-resolution B-mode ultrasound scanning could be beneficial as a valuable method for early diagnosis of atherosclerosis in lichen planus.

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Predictors of serological cure after treatment in patients with early syphilis: A retrospective observational study in Thailand

Charussri Leeyaphan, Preawphan Punyaratabandhu, Sukhum Jiamton, Natchaya Junsuwan, Pornchai Chirachanakul, Pattriya Chanyachailert, Viboon Omcharoen

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):235-235

Background: Some patients with early syphilis who receive appropriate treatment do not reach a serological cure and have a persistent titer which does not meet the criteria for treatment failure (serofast state). Aims: This retrospective study aimed to determine the prevalence of serological cure and the serofast state as well as the factors associated with serological cure after treatment of patients with early syphilis. Methods: A serological cure was defined as occurring when there was a ≥4-fold decrease in nontreponemal titer, whereas patients with a ≥4-fold increase were considered as having either a treatment failure or reinfection. Nontreponemal titers that neither increased nor decreased ≥4-fold after treatment were considered to be in a serofast state. Seroreversion was defined as occurring when there was a negative test within 12 months of treatment. Results: There were 179 patients with a mean age of 31.9 years; 174 (97.2%) were men, and 125 (70%) were HIV patients. Of the total, 174 (98%; 95% confidence interval 94.82–99.42%) patients achieved a serological cure, whereas five were in a serofast state 12 months after treatment. Those five serofast patients were all HIV-positive men, of which 4 (80%) had secondary-stage syphilis, a CD4 count ≤200 cells/μl and a titer <1:8. In a bivariate analysis, a serological cure was associated with a baseline Venereal Disease Research Laboratory >1:16 titers (P = 0.018), and a CD4 cell count >200 cells/μl in 6 months preceding treatment (P = 0.016). The median time to a serological cure was 96 days. Only 22 (12.3%) of the patients achieved seroreversion at 12 months after treatment. Limitations: A retrospective medical record review is likely to have a selection bias, and in our study, 196 (52%) patients were excluded due to missing information. Conclusions: Most patients with early syphilis who achieved a serological cure at 12 months after treatment had high baseline Venereal Disease Research Laboratory titers and CD4 cell counts. However, only 22 (12.3%) had a negative Venereal Disease Research Laboratory titer after 1 year of treatment.

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Psoriasis increases the risk of concurrent inflammatory bowel disease: A population-based nationwide study in Korea

Jin Yong Lee, Sungchan Kang, Jung Min Bae, Seong Jin Jo, Seong-Joon Koh, Hyun-Sun Park

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):145-152

Background: The epidemiology of the association between psoriasis and inflammatory bowel disease is poorly defined and remains controversial. Aim: To evaluate the prevalence of inflammatory bowel disease in patients with psoriasis compared with the general population. Methods: We searched the nationwide health claims database between 2011 and 2015 and evaluated the prevalence of inflammatory bowel disease, including Crohn's disease and ulcerative colitis. Results: Prevalence of inflammatory bowel disease, Crohn's disease and ulcerative colitis in patients with psoriasis vs the general population in 2011 were 0.16, 0.05 and 0.12% vs 0.08, 0.03 and 0.06%, respectively, which increased significantly with time between 2011 and 2015. Patients with psoriasis consistently revealed higher standardized prevalence (age and sex adjusted) of inflammatory bowel disease, Crohn's disease and ulcerative colitis compared with the general population. Subgroup analysis revealed the highest risk of prevalent inflammatory bowel disease in patients younger than 19 years (crude odds ratio 5.33, 95% confidence interval 3.74–7.59). Severe psoriasis demonstrated higher odds of inflammatory bowel disease (odds ratio 2.96, 95% confidence interval 2.54–3.45) than mild psoriasis (odds ratio 1.68, 95% confidence interval 1.51–1.88). Limitations: Limited data for doing adjustment and cross-sectional study design. Conclusions: Psoriasis patients revealed higher risk of inflammatory bowel disease. In particular, young patients and those with severe psoriasis may require closer monitoring and comprehensive management.

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Pentazocine induced skin ulcers: An 'easy to miss' diagnosis

Rajsmita Bhattacharjee, Rahul Mahajan

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):224-225

http://bit.ly/2WLNkQ1

Linking of psoriasis with osteopenia and osteoporosis: A cross-sectional study

Antonio Martinez-Lopez, Gonzalo Blasco-Morente, Maria Sierra Giron-Prieto, Miguel Angel Arrabal-Polo, Maria Luque-Valenzuela, Juan de Dios Luna-Del Castillo, Jesus Tercedor-Sanchez, Salvador Arias-Santiago

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):153-159

Background/Purpose: Psoriasis is a multisystem disease which has been related to vitamin-D deficiency through chronic inflammation. This psoriasis-related inflammatory state and vitamin-D deficiency may induce bone mineral density loss. The purpose of this study is to assess the relationship of psoriasis with bone mineral density, by comparing psoriatic patients with healthy controls and patients with osteopenia/osteoporosis. Methods: A total of 185 subjects were studied; 58 psoriatic patients who had not been under systemic or biological treatment were included. Age, gender, body mass index, phosphocalcic metabolic parameters and hip and lumbar (L4) bone mineral density data were collected. These variables were compared with those collected in 61 healthy controls and 67 patients with osteopenia/osteoporosis. Results: Psoriatic patients showed worse hip and lumbar spine bone mineral density levels than healthy controls (P = 0.001) and better levels than osteoporotic patients (P < 0.001). Multivariate analysis demonstrated a negative association of age and a positive association of body mass index in hip bone mineral density in psoriatic patients. Limitations: The main limitations are those of cross-sectional studies, such as a lack of follow up period, and a male predominance in the psoriatic group, which is corrected employing a multivariate analysis with an adjusted model for confounding factors. Conclusions: Bone mineral density levels in psoriatic patients are situated halfway between healthy controls and patients with osteopenia/osteoporosis. In addition, the higher body mass index in patients with psoriasis appears to confer a protective effect against further development of lower bone mineral density.

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Recurrent pyogenic granuloma over nevus flammeus

Sharma Shruti, Fouzia Siraj, Vasanthi Ramesh, V Ramesh

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):236-236

http://bit.ly/2WQEvEA

A randomized study to evaluate the efficacy and effectiveness of two sunscreen formulations on Indian skin types IV and V with pigmentation irregularities

Rashmi Sarkar, Vijay Kumar Garg, Annie Jain, Divya Agarwal, Anupama Wagle, Frederic Flament, Michèle Verschoore

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):160-168

Background: Regular exposure to ultraviolet rays is high in India, where most Indians present Fitzpatrick skin phototypes IV and V. Aims: To evaluate the efficacy and compare the effectiveness of two sunscreen products on Indian skin types IV and V with pigmentation irregularities. Methods: A randomized, uncontrolled and investigator-blinded, single-center study enrolled adult men and women (18–45 years) with Fitzpatrick skin phototypes IV (28° < individual typological angle <10°) and V (10° < individual typological angle < −30°) with pigmentary abnormalities seen on the face in adults (actinic lentigines and postinflammatory hyperpigmentation), who did not use sunscreens. Participants were randomized (1:1) to either of the two marketed sunscreen products, Product A (sun protection factor 50 PA+++) or Product B (sun protection factor 19 PA+++), applied twice daily before sun exposure for ≥2 h. Primary objectives aimed at assessing possible improvement in hyperpigmented spots and overall skin appearance after 12 weeks of use. Evaluation of skin radiance and skin color was done by means of L'Oréal color chart and colorimetric measurements (Chromameter®). Results: Among the 230 enrolled participants, 216 (93.91%) completed the study. The clinical assessment of the density of pigmented spots and skin radiance showed significant (P < 0.001) improvement in both groups during all visits. The qualitative (participant perception) and quantitative (Chromameter®) data indicated improvement in pigmentation from Week 0 to Week 12. Both products were well-tolerated. Limitations: The study was conducted over a rather short period of time (12 weeks) at a single location. Conclusions: This is the first study conducted on Indian skin phototypes IV and V under real-life conditions. It demonstrated the effect of regular sunscreen usage in the prevention of certain signs of skin photoaging such as increased pigmentation or pigmentary abnormalities, thus providing support and assistance to clinicians in suggesting the use of efficient sun-screening products to patients.

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The histopathological and dermoscopic correlation of primary cutaneous mucinous carcinoma

Chun-Yu Cheng, Yau-Li Huang, Tseng-Tong Kuo, Sindy Hu

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):215-220

http://bit.ly/2WQ99xL

Crusted nipple and areola: A new aetiology of secondary hyperkeratosis of the nipple and areola

Dhaifallah A Alenizi

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):169-170

Hyperkeratosis of the nipple and areola is a rare condition first described by Tauber in 1923. Less than 100 cases have been reported in the literature. Hyperkeratosis of the nipple and areola presents as hyperkeratotic, hyperpigmented plaques on the nipple and areola. It is more common in females. An 18-year-old female patient presented with hyperkeratotic, plaque-like, hard crusts on both nipples and areolas. The examining physician could successfully remove this crust using his finger. The crust had accumulated as a result of the patient's reluctance to touch or clean the breast area due to psychological issues. A crusted nipple and areola may occur as a secondary condition due to a patient's reluctance to touch or clean their breasts.

http://bit.ly/2RPVzqj

Bead retention test in koilonychia

T Muhammed Razmi, Dipankar De

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):229-230

http://bit.ly/2WTy0kb

Primary mucinous carcinoma of skin with a trichoadenomatous component: A rare case report

Athota Kavitha, Chennamsetty Kavya, Kovi Sneha, Chennamsetty Teja

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):171-174

Primary mucinous carcinoma of the skin is a rare subtype of eccrine sweat gland tumors. Differentiating it from metastatic adenocarcinomas is important in the management of this condition. We report the case of a 55-year-old female presenting with a painless nodule, which was subsequently diagnosed as primary mucinous carcinoma of skin with a trichoadenomatous component. The possibility of a metastatic adenocarcinoma was ruled out by performing ultrasound abdomen, total body computed tomography, mammogram and colonoscopy.

http://bit.ly/2RPtPlU

Syringocystadenoma papilliferum with coexisting hydrocystoma

Uma Keyal, Anil Kumar Bhatta, Yeqiang Liu

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):236-236

http://bit.ly/2WS3pU5

Ultrasound assessment of enthesis thickness in psoriasis and psoriatic arthritis: A cross-sectional study

Dario Graceffa, Claudio Bonifati, Viviana Lora, Pier Luigi Saraceni, Catia De Felice, Maria Sole Chimenti, Roberto Perricone, Aldo Morrone

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):175-181

Background: The inflammatory involvement of the enthesis in the course of psoriasis is accompanied by structural abnormalities detectable by ultrasound. The most common of these abnormalities is the thickening of the tendon at the insertion site. Aims: The aim of the present study was to compare the thickness of entheses of patients with psoriatic arthritis, only skin psoriasis, and healthy controls. Methods: A cross-sectional study was conducted in a cohort of patients affected with either only skin psoriasis or psoriatic arthritis as well as in a control group. Eight entheses sites were scanned by ultrasound bilaterally. The following entheseal characteristics were collected and recorded in a predefined database: entheseal thickness, bone erosions, enthesis calcifications (enthesophytes), presence of blood flow, and presence of bursitis. All the detected entheseal changes were scored, and the data was statistically analyzed. Results: The major differences in enthesis thickness between only skin psoriasis and psoriatic arthritis patients were found at the following sites: (i) olecranon tuberosity, (ii) superior pole of the patella, and (iii) medial epicondyle of femur. The thickness of the medial collateral ligament at the site of the femoral origin was increased in psoriatic arthritis, but not in both only skin psoriasis and healthy controls. The score obtained by adding the thickness of all the 8 examined entheses for each patient showed significant differences among the three groups (psoriatic arthritis: 81.3; only skin psoriasis 74.4; Controls: 67.6; P < 0.0001). Interestingly, we found that in psoriatic arthritis patients, the highest enthesis thickening was seen in entheses affected by bone erosions. Limitations: The small sample of patients studied is a limiting factor in this study. Conclusions: Our data demonstrated that the ultrasound measurement of the enthesis thickness enables a distinction between patients with psoriatic arthritis from those with only skin psoriasis. It is a useful method to improve diagnostic accuracy, especially in patients without clear clinical signs of enthesitis.

http://bit.ly/2RPtK1A

Medical device regulation in India: What dermatologists need to know

Sandeep Lahiry, Rajasree Sinha, Suparna Chatterjee

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):133-137

http://bit.ly/2WTbpoa

An observational study on glabellar wrinkle patterns in Indians

Amala Kamat, Trisha Quadros

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):182-189

Background: Botulinum A exotoxin is an established treatment for glabellar frown lines, crow's feet, and horizontal furrows of the forehead. The glabella is probably the most common site for botulinum toxin treatment in Asians. Five glabellar contraction patterns have been classified in earlier studies based on eyebrow approximation, depression, and elevation. Unfortunately, this was found to be confusing by many practitioners. Indians, as all Asians, have smaller muscles compared to the European population, and there is no consensus on the optimal dosage per injection site or concentration of toxin to be used. Aims: (a) Identification and classification of glabellar wrinkle patterns in Indians. (b) Optimization of the minimal effective dose of toxin per site. Materials and Methods: Retrospective photographic analysis of 200 patients who received botulinum toxin for the first time to treat glabellar wrinkles was conducted. The wrinkle patterns were identified and classified by the authors based on the prevalence of perpendicular and transverse glabellar lines, nasal, and forehead wrinkles. Results: Six patterns were identified: (1) 11 (2) U (3) Pi (4) X (5) W (6) I. The relevant muscles were identified and doses optimized for those sites. Limitations: The doses mentioned in this study are not universal for all patients and toxin units would have to be altered and individualized according to the bulk of the facial muscles and individual needs. Conclusion: The investigators classification, injection patterns, and dosage may provide valuable guidance to facial esthetic treatment.

http://bit.ly/2RPtC26

Primary cutaneous marginal zone B-cell lymphoma of vulva in a pregnant woman

Jiaoqing Tang, Jihui Chen, Hongjie Liu, Lin Wang

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):211-214

http://bit.ly/2WRGAA7

Onychomatricoma: Clinical, dermoscopy and ultrasound findings

Denise Gamé, Ane Jaka, Carlos Ferrándiz

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):190-191

http://bit.ly/2RPVxyH

Acquired acrodermatitis enteropathica secondary to sleeve gastrectomy

Birgül Özkesici Kurt, Ceren Memiş İrican, Betül Ünal, Mehmet A Çiftçioğlu, Soner Uzun

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):220-223

http://bit.ly/2WQErEQ

Bilateral agminated skin-colored papules and nodules on the dorsum of the hands

Adane Ayele, Georgios Kravvas, Richard B Weller, Asok Biswas

Indian Journal of Dermatology, Venereology, and Leprology 2019 85(2):192-194

http://bit.ly/2RLKhna

Effect of EDTA and NTA on cadmium distribution and translocation in Pennisetum purpureum Schum cv. Mott

Abstract

The primary objective of this research was to investigate the cadmium (Cd) distribution in Pennisetum purpurem (Napier grass) in the presence of 30 mg/L of Cd and different types and concentrations of chelating agents (ethylenediaminetetraacetic acid disodium dihydrate (EDTA), nitrilotriacetic acid (NTA), and EDTA-NTA mixtures). Plant samples were collected every 15 d during a 105-d experimental period. Accumulation of Cd in each part of the plant was determined using atomic absorption spectrometer (AAS), and the distribution of Cd was determined by laser ablation inductively coupled plasma mass spectrometer (LA-ICP-MS) and synchrotron radiation micro X-ray fluorescence (SR-micro-XRF). The highest concentrations of Cd accumulation of 889 ± 53 mg kg⁻¹ in the underground part (roots) and 265 ± 26 mg kg⁻¹ in the aboveground part (stems and leaves) in the presence of 1:1 M ratio of Cd:EDTA after 30 d of exposure were observed. Plants grown in the presence of either NTA or EDTA-NTA mixtures showed significant lower Cd accumulation levels. The LA-ICP-MS analysis showed that Cd was primarily accumulated in the aboveground part (stems and leaves), especially in the xylem and intercalary meristem. In addition, translocation factor was very low. Thus, P. purpurem could be considered as a candidate plant for cadmium phytostabilization.

http://bit.ly/2BuhKwW

Rapid and versatile pre-treatment for quantification of multi-walled carbon nanotubes in the environment using microwave-induced heating

Abstract

The concerns regarding potential environmental release and ecological risks of multi-walled carbon nanotubes (MWCNTs) rise with their increased production and use. As a result, there is the need for an analytical method to determine the environmental concentration of MWCNTs. Although several methods have been demonstrated for the quantification of well-characterized MWCNTs, applying these methods to field samples is still a challenge due to interferences from unknown characteristics of MWCNTs and environmental media. To bridge this gap, a recently developed microwave-induced heating method was investigated for the quantification of MWCNTs in field samples. Our results indicated that the microwave response of MWCNTs was independent of the sources, length, and diameter of MWCNTs; however, the aggregated MWCNTs were not able to convert the microwave energy to heat, making the method inapplicable. Thus, a pre-treatment process for dispersing bundled MWCNTs in field samples was crucial for the use of the microwave method. In the present paper, a two-step pre-treatment procedure was proposed: the aggregated MWCNTs loaded environmental samples were first exposed to high temperature (500 °C) and then dispersed by using an acetone-surfactant solution. A validation study was performed to evaluate the effectiveness of the pre-treatment process, showing that an 80–120% recovery range of true MWCNT loading successfully covered the microwave-measured MWCNT mass.

http://bit.ly/2TBxiG9

Limitations imposed by conventional fine bubble diffusers on the design of a high-loaded membrane bioreactor (HL-MBR)

Abstract

The operation of membrane bioreactors (MBRs) at higher than usual mixed liquor suspended solids (MLSS) concentrations may enhance the loading rate treatment capacity while minimizing even further the system's footprint. This requires operating the MBR at the highest possible MLSS concentration and biomass activity (e.g., at high loading rates and low solid retention times (SRTs)). Both a negative effect of the MLSS concentrations and a positive effect of the SRT on the oxygen transfer have been reported when using conventional fine bubble diffusers. However, most of the evaluations have been carried out either at extremely high SRTs or at low MLSS concentrations eventually underestimating the effects of the MLSS concentration on the oxygen transfer. This research evaluated the current limitations imposed by fine bubble diffusers in the context of the high-loaded MBR (HL-MBR) (i.e., high MLSS and short SRT—the latter emulated by concentrating municipal sludge from a wastewater treatment plant (WWTP) operated at a short SRT of approximately 5 days). The high MLSS concentrations and the short SRT of the original municipal sludge induced a large fraction of mixed liquor volatile suspended solids (MLVSS) in the sludge, promoting a large amount of sludge flocs that eventually accumulated on the surface of the bubbles and reduced the free water content of the suspension. Moreover, the short SRTs at which the original municipal sludge was obtained eventually appear to have promoted the accumulation of surfactants in the sludge mixture. This combination exhibited a detrimental effect on the oxygen transfer. Fine bubble diffusers limit the maximum MLSS concentration for a HL-MBR at 30 g L⁻¹; beyond that point is either not technically or not economically feasible to operate; an optimum MLSS concentration of 20 g L⁻¹ is suggested to maximize the treatment capacity while minimizing the system's footprint.

http://bit.ly/2BC5pan

Taking the bait: species taking oral rabies vaccine baits intended for raccoons

Abstract

Raccoon rabies in eastern USA is managed by strategically distributing oral rabies vaccine (ORV) baits. The attractiveness, palativity, density, and non-target species bait take affect ORV effectiveness. We examined raccoon and non-target species differences in investigating/removing fish-meal polymer and coated sachet baits applied to simulate two aerial bait distribution densities. Bait densities of 150 baits/km² and 75 baits/km² were evaluated, respectively, in zones expected to have high and low raccoon densities. Three primary non-target species visited baits: coyotes, white-tailed deer, and feral swine. The proportion of bait stations visited by raccoons during 1 week observation periods ranged from 50 to 70%, exceeding non-target species visitation. Raccoon take rates for visited baits averaged from 59 to 100%. Raccoon visitation was similar for both bait densities, indicating a proportionally greater quantity of baits were taken in the higher bait density zone. Coyote visitation rates ranged from 16 to 26%, with take rates for visited baits between 46 and 100%. Coyotes were expected to take baits intended for raccoons, because similar baits are applied to vaccinate coyotes. Deer regularly investigated but rarely took baits. Feral swine were in low abundance in the high bait density zone (higher human density) and visited ≤ 1% of baits there but visited baits at frequencies similar to coyotes and deer in the low-density zone and were likely to take encountered baits (63–100%). Non-target bait consumption could be a concern in some circumstances for achieving sufficient raccoon sero-conversion rates.

http://bit.ly/2TDsH6r

Wenn gehörlose Kinder hörend werden – Auswirkungen der CI-Versorgung von gehörlosen Kindern gehörloser Eltern auf deren Familiensituation

Laryngo-Rhino-Otol 2019; 98: 85-90
DOI: 10.1055/a-0790-0934

1993 wurden erstmalig gehörlose Kinder von gehörlosen Eltern mit CI versorgt. Die Situation dieser Kinder und ihrer Eltern ist immer wieder Gegenstand von Forschungen des seit 2000 bestehenden Münchner Forschungsprogramms „Gehörlose Eltern und Kinder mit CI". Zu diesem gehört die Teilstudie „Familiensituation von gehörlosen Eltern mit CI-Kindern". Eines der Ergebnisse dieser Studie ist, dass die implantierten Kinder die Rolle von Codas übernehmen. Das zeigt sich insbesondere in der Übernahme von Dolmetschleistungen für die Eltern.
[...]

Article in Thieme eJournals:
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http://bit.ly/2I2G1Ad

Sonografie von Schilddrüsenknoten

Laryngo-Rhino-Otol 2019; 98: 79-84
DOI: 10.1055/a-0790-0849

Die Sonografie gehört zu den Standardverfahren bei der Evaluation von Schilddrüsenknoten. Verschiedene sonografische Veränderungen sind mit einem erhöhten Malignitätsrisiko assoziiert. Basierend hierauf wurden in den letzten Jahren Klassifizierungssysteme entwickelt, um leichter diejenigen Knoten zu selektieren, welche einer weiteren Abklärung bedürfen (TI-RADS: thyroid imaging and reporting systems). Bis jetzt werden in diesen Systemen nur morphologische Kriterien eingeschlossen. Resultate einer Farbdoppler-Sonografie als ergänzendem Verfahren werden in diesen Klassifizierungen nicht berücksichtigt, obwohl eine erhöhte intranoduläre Vaskularisation bei follikulären Neoplasien mit einem erhöhten Malignitätsrisiko assoziiert ist. Aktuell werden die neuen Systeme evaluiert und müssen gegebenenfalls für die klinische Praxis optimiert werden. Außerdem gibt es erste Ansätze, die Dokumentation der Ultraschallergebnisse weiter zu standardisieren, um die diagnostischen Möglichkeiten der Ultraschalluntersuchung im Sinne der Verbesserung der Patientenversorgung zu optimieren.
[...]

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http://bit.ly/2GhpvKW

Beurteilung der Tubenfunktionsstörung mit dem ETDQ-7

Laryngo-Rhino-Otol 2019; 98: 72-74
DOI: 10.1055/a-0621-2000

Harju T et al. Eustachian Tube Dysfunction–Related Symptoms in Chronic Nasal Obstruction Caused by Inferior Turbinate Enlargement. Ann Otol Rhinol Laryngol 2017; 126: 798–803 Ärzte des Universitätskrankenhauses von Tampere, Finnland, beurteilten den Zusammenhang zwischen chronischer Nasenverstopfung durch Vergrößerung der unteren Nasenmuschel und Symptomen, die durch eine Eustachi-Tubendysfunktion bedingt sind, mit Hilfe des „Eustachian Tube Dysfunction Questionnaire" (ETDQ-7) als Instrument zur Evaluation einer Tubenfunktionsstörung.
[...]

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http://bit.ly/2HWvvu2

Kehlkopf-Karzinom: Wundbettbiopsien nach TLM-Behandlung sinnvoll

Laryngo-Rhino-Otol 2019; 98: 71-72
DOI: 10.1055/a-0785-0981

Hendriksma M et al. Evaluation of surgical margin status in patients with early glottic cancer (Tis-T2) treated with transoral CO2 laser microsurgery, on local control. Eur Arch Otorhinolaryngol 2018; 275: 2333–2340 Bei Patienten mit primärem Kehlkopf-Plattenepithelkarzinom (Tis-T2) beurteilten niederländische Kopf- und Hals-Chirurgen den Effekt des Resektionsrand-Status auf die lokale Kontrollrate nach Behandlung mit transoraler CO2-Laser-Mikrochirurgie (TLM). Darüber hinaus überprüften die Bedeutung zusätzlicher Wundbettbiopsien.
[...]

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http://bit.ly/2I2G2Eh

Kommentar der Schriftleitung

Laryngo-Rhino-Otol 2019; 98: 68-69
DOI: 10.1055/a-0784-9800

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Nachruf Prof. Dr. Heinz R. Stammberger

Laryngo-Rhino-Otol 2019; 98: 76-76
DOI: 10.1055/a-0828-5454

Article in Thieme eJournals:
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http://bit.ly/2GgV4EA

Assoziation von allergischer Rhinitis und Hypertonie untersucht

Laryngo-Rhino-Otol 2019; 98: 74-75
DOI: 10.1055/a-0651-4041

Sakallioglu O et al. Allergic rhinitis and arterial blood pressure: a population-based study. J Laryngol Otol 2018; 132: 418–422 Gibt es einen Zusammenhang von allergischer Rhinitis und arteriellem Blutdruck sowie Bluthochdruck? In einer bevölkerungsbasierten Untersuchung wollten türkische Ärzte diese Frage klären.
[...]

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http://bit.ly/2GiMftI

Spiegeluntersuchung in der HNO

Laryngo-Rhino-Otol 2019; 98: 77-78
DOI: 10.1055/a-0784-9833

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http://bit.ly/2GiYt5T

Faziale Hauttumore: Resektion und plastische Defektrekonstruktion – Teil 1

Laryngo-Rhino-Otol 2019; 98: 117-128
DOI: 10.1055/a-0784-9844

Die Häufigkeit von Tumoren der Gesichtshaut nimmt aufgrund der steigenden UV-Exposition und der zunehmenden Alterung der Bevölkerung zu. Gleichzeitig steigen die Ansprüche an die Funktion und Ästhetik der rekonstruktiven Chirurgie im Gesicht. Die In-sano-Resektion mit Sicherheitsabstand ist der entscheidende erste Schritt eines operativen Vorgehens. Die anschließende Rekonstruktion ist von patientenspezifischen und weiteren Faktoren abhängig.
[...]

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Retinovaskuläre Zeichen des Susac-Syndroms

Laryngo-Rhino-Otol 2019; 98: 108-113
DOI: 10.1055/a-0747-6968

Hintergrund Das Susac-Syndrom ist eine Vaskulopathie mit Manifestationen am zentralen Nervensystem, an der Retina und am Innenohr und ist gekennzeichnet durch die klinische Trias aus Enzephalopathie und/oder fokalen neurologischen Symptomen, Hörminderung und retinalen Arterienastverschlüssen. Bisher wurden nur etwa 300 Fälle in der medizinischen Literatur beschrieben. Patienten/Methoden Drei Patienten mit gesichertem Susac-Syndrom wurden retrospektiv auf das Vorhandensein krankheitstypischer retinaler Veränderungen untersucht. Ergänzend wurde der Krankheitsverlauf analysiert mit der Zielsetzung, ein besseres Krankheitsverständnis zu erreichen. Ergebnisse In allen 3 beschriebenen Fällen besteht eine okklusive retinale Mikroangiopathie mit einhergehenden Arterienastverschlüssen. In der cMRT zeigen sich bei 2 von 3 Fällen krankheitstypische, umschriebene „snowball"-artige Läsionen des Corpus callosum, die gemeinsam mit dem Netzhautbefund die diagnostische Zuordnung ermöglichten. Die klassische Trias aus Innenohrschwerhörigkeit, retinalen Arterienastverschlüssen und ZNS-Symptomatik war allerdings in keinem der Fälle bei ärztlichem Erstkontakt vollständig ausgeprägt. Schlussfolgerung Die Diagnosesicherung setzt eine enge interdisziplinäre Zusammenarbeit zwischen Neurologen, Psychiatern, HNO- und Augenärzten voraus. Die typischen okulären Zeichen einer segmentalen Mikrovaskulopathie mit Okklusion kleiner Arterien sollten auch bei isoliertem Auftreten Anlass dazu geben, das Krankheitsbild in die Differenzialdiagnose einer okklusiven retinalen Vaskulopathie mit einzubeziehen.
[...]

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http://bit.ly/2I033HR

Mindestmengen: Die Qual der Zahl oder Mittel der Qualitätssicherung?

Laryngo-Rhino-Otol 2019; 98: 114-116
DOI: 10.1055/a-0784-9855

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Fragen für die Facharztprüfung

Laryngo-Rhino-Otol 2019; 98: 129-130
DOI: 10.1055/a-0784-9866

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Erratum: Stellenwert der Sialendoskopie an deutschen HNO-Kliniken im Jahr 2016

Laryngo-Rhino-Otol 2019; 98: E1-E1
DOI: 10.1055/a-0849-2046

Article in Thieme eJournals:
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http://bit.ly/2GmzE9h

Fehlbildungschirurgie von Nase und Lippe

Laryngo-Rhino-Otol 2019; 98: 131-133
DOI: 10.1055/a-0784-9910

Article in Thieme eJournals:
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http://bit.ly/2I095IA

Eliminating health disparities in asthma: are we at the end of the beginning?

Health equity, defined as "the attainment of the highest level of health for all people",1 continues to be a fundamental but difficult-to-achieve goal in the United States (U.S.), where some racial and ethnic minority groups are disproportionately affected by respiratory diseases such as asthma. Indeed, the prevalence of asthma is higher in Puerto Ricans (14.3%) and African Americans (11.6%) than in non-Hispanic whites (8.3%) or Mexican-Americans (5.7%).2 Moreover, Puerto Ricans and African Americans have higher morbidity and mortality from asthma than non-Hispanic whites2,3.

http://bit.ly/2HYRRLz

Emerging Triggers of FPIES: Lessons from a Pediatric Cohort of 74 Children in the US

Food protein-induced enterocolitis syndrome (FPIES) is a rare non-IgE mediated gastrointestinal food-induced allergic disorder occurring predominantly in infants and young children. Common food triggers and the natural history of FPIES vary according to geographic location. It is a serious condition that is still under-recognized, resulting in a delay in diagnosis and appropriate management. FPIES is characterized by delayed onset of repetitive vomiting occurring approximately 1 to 4 hours after food ingestion.

http://bit.ly/2GgYqr1

Characteristics of Inner City Children with Life-Threatening Asthma

Poor children living in US inner cities have high prevalence of asthma as well as asthma related morbidity and mortality.(1-3) In 2013, there were 3,640 deaths due to asthma in the US; a rate of 1.1 deaths per 100,000 population.(4) Between 2007-2009, the death rate for African Americans aged 0–14 years was almost eight times greater than for whites in that age group(3). Several risk factors have been identified for fatal and near fatal asthma including a prior asthma admission to an intensive care unit (ICU), overuse of short acting beta agonists, underutilization of controller medication, poor recognition of asthma severity, psychosocial factors and multiple allergen sensitivity(5-8).

http://bit.ly/2HYRNvj

Methotrexate-associated lymphoproliferative disorder with multiple pulmonary nodules and bilateral cervical lymphadenopathy

As has been well recognized, methotrexate (MTX) leads to a state of immunosuppression and can provide a basis for the development of lymphoproliferative disorders (LPDs). MTX-associated LPDs can affect nodal sites as well as extranodal sites, though the manifestation of an LPD in the form of multiple pulmonary nodules is rare. Here, we report two cases of MTX-associated LPD with multiple bilateral pulmonary nodules, which was a finding suggestive of lung cancer, and bilateral cervical lymphadenopathy.

http://bit.ly/2E0Eq9X

Adjunctive antimicrobial photodynamic therapy using methylene blue/ethanol formulation in experimental periodontitis in diabetic rats: short-term results

Abstract

The aim of this study was to evaluate the effect of an MB experimental formulation (ethanol 20%) in aPDT used as an adjuvant to scaling and root planing (SRP) in the periodontal treatment of diabetic rats. Forty male Wistar rats received streptozotocin-intraperitonial injections to induce diabetes. After 14 days, 5 animals were allocated in the non-ligate group (NLG), and 35 animals received ligature at the first right mandibular molar to induce periodontitis. After 7 days, the ligature was removed and the animals were randomized into 4 groups: LG (without treatment, n = 5), SRPG (SRP, n = 10), aPDTW (SRP+aPDT-MB/water, n = 10), and aPDTEt (SRP + aPDT-MB/water/ethanol/carboxymethylcellulose, n = 10). Animals were euthanized after 7 days. Data of bone loss (BL) area, degree of inflammatory cell response, and collagen fibers percentages were statistically analyzed (p < 0.05). Percentage of animals that presented mild and severe inflammatory infiltrate was 10% and 40% for SRPG, 20% and 30% for aPDTW, and 50% and 0% for aPDTEt, respectively. BL area (mm²) was statistically higher in the LG (0.39 ± 0.15) than NLG (0.05 ± 0.02). aPDTEt showed the lowest value of BL (0.08 ± 0.03), followed by aPDTW (0.21 ± 0.15) and SRPG (0.31 ± 0.18). Statistical differences were verified between aPDTEt and SRPG. In relation to the LG, aPDTEt, aPDTW, and SRPG recovered the equivalent 80%, 46%, and 20% of the BL. aPDTEt showed collagen content statistically higher than SRPG and LG, and presented higher mean values than NLG (p > 0.05). Our findings showed aPDTEt presented promising results. aPDT using MB/ethanol can have potential as an adjunctive periodontal treatment in diabetics.

http://bit.ly/2GxL4pG

Navigation-guided fibula free flap for mandibular reconstruction – a proof of concept study

To analyze a novel technique of supporting fibula free flap harvest and fabrication with intraoperative navigation technology.

http://bit.ly/2USl903

Multiple lymphatic-venous anastomoses in reducing the risk of lymphedema in melanoma patients undergoing complete lymph node dissection. A retrospective case-control study

Sentinel lymph node biopsy (SLNB) is an indispensable surgical procedure in staging and management of intermediate-thick melanomas. Although recent studies have demonstrated that complete lymph node dissection (CLND) does not improve 3-years specific survival, its utility in increasing the disease-free period and the control of local disease remains confirmed. The most frequent complication related to CLND is lymphedema, which may affect up to 20% of patients undergoing CLND. The preventive use of lymphatic-venous micro-anastomoses could avoid this complication.

http://bit.ly/2tfupiZ

The Rationale for Endoscopic Inferior Meatal Antrostomy

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Background: Complete removal of some maxillary sinus pathologies may be challenging. We describe our experience in performing endoscopic inferior meatal antrostomy (EIMA) when approaching certain chronic maxillary sinus disease. Methods: Retrospectively reviewing charts of all patients whose surgery included EIMA between the years 2012 and 2015. EIMA was performed either after routine endoscopic middle meatal antrostomy (EMMA) failed to completely resect the lesion, or as the sole selected approach for specific maxillary pathologies. Results: A total of 56 patients were included in the study. Indications for EIMA included antrochoanal polyps (ACP), maxillary sinus chronic inflammatory disease, maxillary sinus pathology before sinus lift, and odontogenic maxillary sinusitis. In nearly one third of the patients, sinus surgery included only EIMA, of which, the majority were resection of ACP. Follow-up time ranged between 12 and 34 months (mean 14). Residual EIMA opening was variable in size. In the vast majority of our patients, the maxillary sinus cavities were cleared of disease. No major complications and no recirculation were observed in any of the patients. Conclusion: EIMA should be considered for various maxillary sinus pathologies. It provides better access to anteroinferior lesions of the maxillary sinus. EMMA is not mandatory for every maxillary sinus disease.
ORL 2019;81:41–47

http://bit.ly/2BqjSGf

“Platelet-rich plasma and its utility in the treatment of acne scars - A systematic review”

The field of dermatology has seen numerous therapeutic innovations in the past decade with platelet-rich plasma recently garnering significant interest in acne scarring. This review consolidates the available evidence of platelet rich plasma for the practicing dermatologist and evaluates the current evidence up to May 31, 2018. A search was conducted in the PubMed database for "platelet rich plasma" or "platelet releasate" or "platelet gel" or "PRP" and "dermatology" or "skin" or "hair" or "cutaneous" with thirteen articles meeting the inclusion criteria.

http://bit.ly/2Dr1OMq

Trends in Scholarly Productivity of Dermatology Faculty by Academic Status and Gender

http://bit.ly/2SijGTZ

Effects of acetaminophen in oxidative stress and neurotoxicity biomarkers of the gastropod Phorcus lineatus

Abstract

The growing use of pharmaceutical drugs has become a major environmental issue considering that these substances (or their metabolites) end up inevitably in sewage waters after excretion. In the wild, these chemicals may affect non-target organisms, and their potential toxicity is not sufficiently studied, a reality that is particularly true for marine organisms. Acetaminophen (also known as paracetamol) is known to be toxic in high dosages, namely, by triggering oxidative effects. These effects may be potentiated in marine organisms subjected to contamination resulting from large human settlements along coastal areas. In order to assess how different exposure regimes (acute vs. chronic) may affect aquatic wildlife, individuals of the gastropod species Phorcus lineatus were acutely (96 h) and chronically (28 days) exposed to ecologically relevant concentrations of acetaminophen. The effects were evaluated through the quantification of selected biomarkers—catalase (CAT), glutathione-S-transferase (GST), and cholinesterase (ChE) activities. The results from acute exposure showed no significant effects in all three biomarkers, but chronically exposed organisms showed significant increases in the activities of CAT and ChEs. The data show that P. lineatus triggered a defensive biological response in the presence of acetaminophen, and also show that realistically low levels of acetaminophen can exert adaptive changes with unknown consequences.

http://bit.ly/2WTbg3J

Primary midgut volvulus in a patient with Marfan syndrome

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Abstract

Marfan syndrome is a mutation in the fibrillin-1 gene resulting in a connective tissue disorder primarily affecting musculoskeletal, cardiovascular and ocular systems. However, patients with Marfan's rarely manifest gastrointestinal symptoms. Midgut volvulus is abnormal twisting of small bowel around its mesentery that can result in compromising blood flow to the bowel causing intestinal ischemia and obstruction. Primary midgut volvulus is a term used when there is no underlying cause for the volvulus. This case describes an 80-year-old female with Marfan syndrome presenting with primary midgut volvulus, which preoperatively was suspected based on imaging, and later confirmed upon operative exploration. The small bowel mesentery was long with a narrow base twisted around its mesentery 360°. The long narrow base and floppy mesentery likely contributed to hypermobility leading to volvulus and small bowel obstruction. To our knowledge, this is the first reported case of primary midgut volvulus associated with Marfan's syndrome.

http://bit.ly/2I9p47g

Paraneoplastic opsoclonus–myoclonus syndrome as a rare presentation of breast cancer

Abstract

Opsoclonus–myoclonus paraneoplastic syndrome is a medical condition that includes opsoclonus along with diffuse or focal body myoclonus and truncal titubation with or without ataxia and other cerebellar signs. This rare neurological syndrome is poorly understood and can result in long-term cognitive, behavioral and motor sequelae. We report a case of a 49-year-old woman with anti-Ri antibody opsoclonus–myoclonus syndrome and an invasive ductal carcinoma with axillary nodes involvement. Following the diagnosis of opsoclonus–myoclonus syndrome, a multimodal immunotherapy treatment, with partial remission of the neurological symptoms. The patient underwent lumpectomy and axillary node dissection and the surgical pathology confirmed the diagnosis of breast cancer stage IIA. This was followed by chemotherapy, radiotherapy and hormone therapy with tamoxifen. At the 6 months follow-up there was a partial improvement, anti-Ri antibody was subsequently reported as negative and there was no evidence of disease recurrence.

http://bit.ly/2I9p0o2

Colon adenocarcinoma with metastases to the scaphoid: a case report and review of the literature

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Abstract

Metastases to the hand and wrist are extremely rare, with <250 cases described in the literature. We present a case of acrometastasis of colon adenocarcinoma to the scaphoid in an 81-year-old male. Adenocarcinoma of the colon metastasizes to bone in an estimated 10% of cases; however, we are unaware of reports of this tumor metastasizing to the scaphoid or to any of the other carpal bones. We were able to identify only two cases of scaphoid metastases in the literature. This case highlights the potential for metastatic disease and other lesions to develop in the scaphoid and carpus.

http://bit.ly/2I1Dnuf

Postoperative hemiparesis following tonsillectomy

Abstract

We report a rare complication following a routine elective tonsillectomy. A 32-year-old woman woke up from general anaesthesia with left sided hemiparesis. She underwent extensive investigations, which were normal. At follow-up neurology clinic she was given a new diagnosis of hemiplegic migraine and commenced on treatment. This case draws attention to a rare cause of postoperative hemiparesis. Hemiplegic migraine is a differential diagnosis for postoperative motor deficit after exclusion of an acute neurological or metabolic event.

http://bit.ly/2I1DC8D

Laryngeal ulceration in Behçet’s disease: the role of centres of excellence in the UK

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Abstract

Introduction

Behçet's disease (BD) is a rare complex multisystem inflammatory condition characterized by the triad of symptoms: aphthous ulcers of the mouth and genitalia and uveitis.

Case report

We present the case of a 31-year-old Caucasian male who had a prolonged journey from first presentation until diagnosis of BD. For 11 years, he presented symptoms affecting the oral cavity and oropharynx, with worsening odynophagia and dysphagia and ultimately, development of stridor. Flexible laryngoscopy showed significant laryngopharyngeal ulceration and scarring. Treatment was with colchicine, corticosteroids and azathioprine and supervised by one of three newly established BD Centres of Excellence in the UK.

Discussion

Although uncommon, ENT manifestations in patients with BD should be taken into consideration to allow for early recognition and treatment of what can become a life-threatening condition. In such situations, early referral to a BD Centre of Excellence is essential to provide confirmation of diagnosis and supervision of treatment.

http://bit.ly/2GhLgKG

A rare case of small bowel obstruction secondary to activated charcoal administration

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Abstract

Intestinal obstruction is a rare complication of the administration of activated charcoal. We describe a 22-year-old patient who had received multiple-dose activated charcoal for carbamazepine intoxication. The patient presented with sudden-onset abdominal pain after discharge from the emergency room, and abdominal imaging examinations revealed findings consistent with small bowel obstruction. Laparoscopic-assisted exploration of the abdomen was offered, and a hard obstructing charcoal mass was found in the small bowel. Clinicians should be aware of the rare occurrence of gastrointestinal complication or obstruction following the administration of multiple-dose activated charcoal, especially in patients who ingested a drug that is potentially antiperistaltic.

http://bit.ly/2I1DzJZ

When breast cancer gets complicated. A case report of synchronous bilateral breast cancers with discordant tumor markers from the primary to nodes with findings of a sentinel internal mammary subpectoral lymph node

Abstract

This case reviews synchronous bilateral breast cancer with left infiltrating ductal carcinoma ER+/PR−, Her2− and right invasive lobular carcinoma ER+/PR−, Her2−. Independent primary bilateral breast tumors are present in 0.2–3.2% of breast cancer. Biopsy also showed differing ER status on the left breast versus the node which was triple negative. The final sentinel node was a left internal mammary node. Recent studies have found that the ER, PR and HER2 status of the primary tumor do not always correlate to the ER, PR and HER2 status of the metastatic sites. This can have deleterious effects on survival. There are no clear guidelines on course of treatment for these complex cases. A review of the current literature is supportive of treating the highest-risk breast malignancy. Despite the unusual pathology and severity of disease, our patient is doing well with treatment.

http://bit.ly/2Ghfxt2

Extra-gastrointestinal stromal tumor with a large cyst

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Abstract

Gastrointestinal stromal tumors (GISTs) arising at sites other than the alimentary tract are rare, and they are called extra-GISTs (EGISTs). We report a case of a large EGIST forming a cyst, probably arising in the mesentery of the transverse colon. A 64-year-old Japanese man presented to a hospital with an abdominal tumor forming a large cyst. Intraoperatively, the tumor was neither present in nor in contact with the alimentary tract. It was present in the mesentery of the transverse colon and was attached to the greater omentum and peritoneum, immediately anterior to the body of the pancreas. The tumor was resected with the spleen and a part of the pancreas. Histological examination of the tumor revealed that it belonged to the high-risk category of cystic EGISTs.

http://bit.ly/2Gi8z6N

Knee locked in flexion: incarcerated semitendinosus tendon around a proximal tibial osteochondroma

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Abstract

This case reports on a knee locked in flexion due to incarceration of the semitendinosus tendon around an osteochondroma in a patient with a history of multiple hereditary exostoses (MHE). An 18-year-old female with history of MHE presented with acute right medial knee pain and inability to extend her knee. Radiographs confirmed multiple lower extremity osteochondromas, notably a large, 3-cm pedunculated osteochondroma about her right medial proximal tibia. This was assessed as a locked knee secondary to incarcerated hamstring tendons around an osteochondroma. Excision of the osteochondroma restored normal flexion and extension of her knee. At the 3-month follow-up visit, she had returned to all activities with no recurrent medial knee pain or locking. The differential diagnosis for a locked knee joint can be broad, but tendon incarceration should be considered in appropriate patients with significant symptoms. In patients with a history of MHE, osteochondromas may be the cause of tendon entrapment.

http://bit.ly/2GfwGTH

Glioblastoma and prolactinoma: a rare simultaneous occurrence

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Abstract

The simultaneous development of two or more primary central nervous system (CNS) tumors of different cell types represents 0.9% of all diagnosed CNS tumors. To the best of our knowledge, the simultaneous occurrence of glioblastoma and pituitary adenomas has been reported four times in the English literature, with only two cases harboring prolactinoma and glioblastoma. We report a case of a 42-year-old male who was diagnosed with a sporadic co-occurrence of glioblastoma and a prolactin-secreting pituitary adenoma (prolactinoma). This case report discusses the clinical presentation, radiological/histopathological features, and outcome as well as reviewing the pertinent medical literature. Glioblastoma and a prolactin-secreting adenoma may be detected within the same patient. Further studies are required to delineate the tumorigenesis of the development and co-occurrence of multiple intracranial tumors.

http://bit.ly/2I9oXsm

Open brachiocephalic artery stent for static obstruction caused by acute type A aortic dissection

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Abstract

Brachiocephalic artery dissection complicated by acute type A aortic dissection occasionally causes cerebral malperfusion. Although immediate central aortic repair has been the standard treatment for aortic dissection, dissection in supra-aortic vessels frequently remains after the surgery. The residual brachiocephalic artery dissection is reported to be associated with late neurological events. Therefore, additional intervention for brachiocephalic artery dissection during central aortic repair should be considered in selected cases. In this report, we describe two cases requiring open brachiocephalic artery stenting simultaneous with central aortic repair. There were no neurological or stent induced complications at latest follow-up.

http://bit.ly/2GhT92D

Intraductal papilloma of the male breast: a case report and review of the literature

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Abstract

Intraductal papilloma is a benign neoplasm rarely found in the male breast. In this report, we present the case of a 55-year-old Caucasian man who presented with spontaneous bloody nipple discharge of the right breast. Ultrasonic and mammographic investigations revealed a sub-centimetre solid mass within a dilated duct. He underwent a total duct excision. Histopathologic examination confirmed a benign intraductal papilloma with no evidence of atypia or malignancy. A systematic review of the literature revealed six published cases of intraductal papillomas in men. Clinical presentation is the same as in women with single duct blood stained discharge being the most common presenting symptom. Surgical excision offers both histologic confirmation and definitive treatment. There is one case where the lump was not removed and progressed to malignancy years later. Male intraductal papillomas may be associated to medical treatments with hormonal activity given for other reasons or endocrine abnormalities.

http://bit.ly/2I9oV3I

Collapsed wall: destructive and reconstructive surgery of anterior abdominal wall tumour in a young girl

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ABSTRACT

Natural history of abdominal wall soft tissue sarcoma is still poorly understood due to its rarity. In unpublished data of our institution, only seven cases of abdominal wall soft sarcoma with ICD-10 coding of 49.4 were found for past 10 years. We illustrate a case of juvenile fibrosarcoma of anterior abdominal wall. This is a case of young girl with anterior abdominal wall tumour, underwent wide local excision with immediate reconstruction. There are few options of surgical treatment for this case, but which is the best. It is always a challenge in managing young patient with giant abdominal wall defect in view of long term effect namely weakened abdominal wall, pregnancy related issue and risk of herniation and surgical site recurrence as well.

http://bit.ly/2GhLcKW

Laparoscopic deroofing of a ruptured hepatic cyst presenting as an acute abdomen

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Abstract

The rupture of a nonparasitic hepatic cyst is a rare complication for which there is no optimal treatment strategy yet. Laparoscopic deroofing is the standard approach for the elective treatment of symptomatic NHCs but it has seldom been described as an option for a ruptured hepatic cyst. The authors report a case of a male patient presenting to the emergency room with an acute abdomen caused by the rupture of a hepatic cyst. The patient was successfully treated by urgent laparoscopic deroofing of the cyst. Laparoscopic surgery can be a valid option for treating urgent cases presenting the same efficacy and less morbidity than open surgery.

http://bit.ly/2I9oRRw

Bariatric surgery and the evaluation of subclinical systemic lymphedema

Abstract

The aim of the study was to report an improvement in clinical lymphedema in a patient who went from morbid obesity to overweight following bariatric surgery. A 52-year-old female patient reported having undergone bariatric surgery with a body mass index (BMI) of 51.2 kg/m², losing 40 kg and arriving at her current BMI of 37.1 kg/m². She would previously awake with bilateral edema that involved her feet and worsened throughout the day, corresponding to clinical stage II lymphedema, and currently no longer had this problem. Eight years after the surgery and weight loss, the patient was submitted to electrical bioimpedance analysis, which revealed an increase in total intracellular and extracellular fluids in the limbs and trunk. Active exercise and further weight loss were recommended. This study paves a path for a new line of investigation in the treatment of obesity and changes in the lymphatic system caused by obesity.

http://bit.ly/2GfSjn5

The tales of two neighbours: when cholecystitis does not preclude pancreatitis

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Abstract

An 83-year-old lady with no previous history of gallstones, presented with a sudden-onset severe epigastric pain radiating through to the back associated with nausea and vomiting. On examination, the patient's vital signs were normal. There was severe epigastric tenderness on palpation, as well as moderate right upper quadrant tenderness. Serological investigations showed raised inflammatory markers and serum lipase of 13 000, confirming the diagnosis of acute pancreatitis. Liver function tests were mildly deranged with a normal bilirubin of 12 μmol/L. An abdominal ultrasound demonstrated a distended gallbladder with multiple subcentimeter gallstones and diffuse wall thickening up to 7 mm, consistent with cholecystitis. A follow-up CT abdomen demonstrated evidence of pancreatitis with moderate peripancreatic fat stranding. The diagnosis of concomitant acute cholecystitis and gallstone pancreatitis was made based on the radiological and biochemical findings. The patient underwent an uncomplicated laparoscopic cholecystectomy. The histopathology confirmed cholelithiasis with acute on chronic cholecystitis.

http://bit.ly/2I9oQgq

Upper extremity distal dual bypass enables arteriovenous fistula construction in a critical limb ischemia

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Abstract

Background

Arteriovenous fistula (AVF) trouble in a dialysis patient sometimes results in severe forearm ischemia.

Case presentation

We present the case of 27-year-old man with severe steal syndrome complained of AVF malfunction. There was a condition where an upstream artery of AVF is occluded and AVF is maintained by regurgitation from the palmar arch with ischemic digits. The patient underwent distal dual bypass: proximal to peripheral artery arterioarterial and arteriovenous bypasses and brachial arterioplasty. His skin perfusion pressure improved from 17 to 90 mmHg with enough quantity of blood: 250 ml/min for hemodialysis.

Conclusions

In severe steal syndrome cases, it is often observed that proximal artery is occluded and AVF inflow was supplied from palmar circulation and collateral vessels. Distal dual bypass is effective to re-establish digital circulation and repair AVF malfunction simultaneously in PAD patients.

http://bit.ly/2GhPtO7

Αρχειοθήκη ιστολογίου

! # Ola via Alexandros G.Sfakianakis on Inoreader

Η λίστα ιστολογίων μου

Παρασκευή 8 Φεβρουαρίου 2019

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Αρχειοθήκη ιστολογίου