Publication date: Available online 12 December 2017
Source:Annales de Chirurgie Plastique Esthétique
Author(s): H. Tilliet Le Dentu, U. Lancien, O. Sellal, F. Duteille, P. Perrot
IntroductionLe pectus excavatum est la malformation congénitale thoracique la plus fréquente et constitue un motif de consultation courant en chirurgie plastique. Notre attitude consiste le plus souvent en un comblement de la dépression par une prothèse sur mesure en silicone. L'objectif de ce travail était d'évaluer les gains apportés par la conception assistée par ordinateur (CAO) dans la fabrication des implants en comparaison de la méthode classique de moulage plâtré.Patients et méthodeNous avons colligé l'ensemble des cas ayant bénéficié de la mise en place d'implants sur mesure en silicone au sein du service de chirurgie plastique du CHU de Nantes. Les critères de jugement étaient la qualité des résultats évaluée par le patient, et par l'équipe chirurgicale en aveugle sur photographies et par questionnaires standardisés. Les délais pré-opératoires, les durées d'interventions et d'hospitalisation, le nombre de reprises chirurgicales à visée cosmétique, les suites et complications postopératoires, étaient relevés.RésultatsEntre 1990 et 2016, 29 implants thoraciques en silicone ont été posés dans notre service. Avant 2012, les implants étaient conçus par moulage plâtré (n=13). Après cette date, les implants étaient conçus par CAO (n=16). Les patients jugeaient leurs résultats « bons » ou « excellents » dans 77 % et 86 % des cas respectivement dans les groupes Plâtre et CAO. Les notes attribuées par l'équipe chirurgicale aux reconstructions par implants CAO étaient meilleures que dans le groupe Plâtre : 8,17 versus 6,96 (p=0,001). Les implants CAO étaient significativement moins perceptibles que les implants du groupe Plâtre. La durée opératoire était réduite dans le groupe CAO : 60,2 versus 74,7minutes dans le groupe Plâtre (p=0,04), de même que la durée d'hospitalisation : 3,5 versus 5,3jours (p=0,01). Il n'y avait pas de différences significatives entre les deux groupes en termes de complications postopératoires.ConclusionLa prise en charge des pectus excavatum par pose d'un implant en silicone sur mesure constitue une méthode peu invasive et pourvoyeuse de bons résultats cosmétiques. La conception de ces implants est facilitée et améliorée qualitativement par la CAO.IntroductionPectus excavatum is the most common congenital chest malformation and is a common reason for consultation in plastic surgery. Our attitude is most often a filling of the depression with a custom-made silicone prosthesis. The objective of this work was to evaluate the interest of computer-aided design (CAD) of implants compared to the conventional plaster molds method.Patients and methodsWe have collected all the cases of custom-made silicone implants to treat funnel chests in our plastic surgery department. The quality of the results was evaluated by the patient, and in a blind manner by the surgical team using photographs and standardized surveys. The pre-operative delays, the operating time and length of hospital stays, the number of surgical recoveries, and the post-operative surgical outcomes were recorded.ResultsBetween 1990 and 2016, we designed 29 silicone thoracic implants in our department. Before 2012, implants were made from plaster chest molds (n=13). After this date, implants were designed by CAD (n=16). Patients rated their results as "good" or "excellent" in 77% and 86% of cases respectively in the plaster and CAD groups. The surgical team's ratings for CAD implant reconstructions were better than in the plaster group: 8.17 versus 6.96 (P=0.001). CAD implants were significantly less detectable than the plaster group implants. The operating time was reduced in the CAO group: 60.2 compared to 74.7minutes in the plaster group (P=0.04), as was the length of hospitalization: 3.5 versus 5.3 days (P=0.01). There were no significant differences between the two groups in terms of post-operative complications.ConclusionThe management of pectus excavatum by a custom-made silicone implant is a minimally invasive method that provides good cosmetic results. The design of these implants is facilitated and qualitatively improved by CAD.
Τρίτη 12 Δεκεμβρίου 2017
Apport de la conception assistée par ordinateur (CAO) à la réalisation des implants thoraciques sur mesure pour correction des pectus excavatum. Expérience du CHU de Nantes
Management of actinic keratosis at specific body sites in patients at high risk of carcinoma lesions: expert consensus from the AKTeam™ of expert clinicians
Abstract
Background
Actinic keratoses (AK) arise on sun-exposed regions of the skin. If left untreated, AK may progress to invasive squamous cell carcinoma (SCC), although the rate of progression is low. A practical treatment algorithm for the treatment of AK in standard situations has been published by the AKTeam™ expert panel. However, management of particular situations of AK with increasing/higher carcinoma risk or AK progressing into carcinomas with increased aggressiveness due to their anatomical location (risky areas), or in patients with an increased risk of SCC requires further discussion. These include AK on the dorsal hands, forearms, legs, periorbital region, eyelids, ears, or lips, and organ transplant recipients, patients undergoing treatment with carcinogenic agents, and patients with chronic lymphocytic leukemia.
Objective
The main objective was to propose therapeutic strategies for the treatment of AK located in risky areas, and in patients with more invasive/aggressive lesions and a higher risk of progression to SCC.
Methods
A systematic review of the literature was initially performed, and results were discussed by the experts to propose best management practices in specific situations. Finally, adapted management strategies for AK occurring in risky areas and in high-risk patients are presented, taking into account the experts' own clinical experience and current guidelines.
Results
In most of these 'at-risk' situations, patients can be treated according to the AKTeam™ treatment algorithm. Difficult-to-treat lesions should be treated more aggressively due to their higher risk of transformation. For patients with skin that is highly susceptible to actinic damage, monitoring and sun-protection strategies are mandatory and patients should undergo more regular follow up. Further assessment of newer therapies in clinical trials is necessary to determine optimal treatment conditions.
Conclusion
This expert consensus provides guidance for the management of AK in risky body sites, and in patients with an increasing/higher risk for SCCs.
This article is protected by copyright. All rights reserved.
Synchronous Premaxillary Osteotomy with Primary Cheiloplasty for BCLP Patients with Protrusion of the Premaxillae
Craniofacial Reconstruction by a Cost-Efficient Template-Based Process Using 3D Printing
Tratamiento con imiquimod al 5% durante 12 días para las queratosis actínicas: estudio de la eficacia y la reacción local
Publication date: Available online 12 December 2017
Source:Actas Dermo-Sifiliográficas
Author(s): C. Serra-Guillén, E. Nagore, B. Llombart, O. Sanmartín, C. Requena, L. Calomarde, C. Guillén
Introducción y objetivosEl imiquimod es un excelente tratamiento para las queratosis actínicas, sin embargo, su pauta prolongada de 4 semanas y la reacción local que produce pueden limitar su utilización. Los objetivos del estudio son demostrar la eficacia del imiquimod al 5% para las queratosis actínicas aplicado en una pauta continuada de 12 días y correlacionar el grado de reacción local con la eficacia.Pacientes y métodosSe incluyeron pacientes con al menos 8 queratosis actínicas que se trataron con imiquimod en crema al 5% durante 12 días seguidos. Se evaluó la reacción local como leve, moderada o intensa. El estudio estadístico de la correlación entre la reacción local y la respuesta clínica se realizó con la prueba χ2 de Pearson y el test de correlación rho de Spearman.ResultadosUn total de 65 pacientes completaron el estudio. Se obtuvo un 52,3% de respuestas completas y un 75,4% de respuestas parciales. Encontramos una asociación estadísticamente significativa entre el grado de reacción local y la respuesta al tratamiento tanto en la prueba χ2 de Pearson como en el test de correlación rho de Spearman.ConclusionesLa pauta continuada de imiquimod al 5% aplicado durante 12 días es eficaz para el tratamiento de las queratosis actínicas. El grado de reacción local durante el tratamiento se correlaciona con la respuesta clínica.Introduction and objectivesImiquimod is an excellent option for patients with actinic keratosis, although its use may be limited by the long course of treatment required (4 weeks) and the likelihood of local skin reactions. The objectives of the present study were to demonstrate the effectiveness of a 12-day course of imiquimod 5% for the treatment of actinic keratosis and to examine the association between treatment effectiveness and severity of local reactions.Patients and methodsWe included patients with at least 8 actinic keratoses treated with imiquimod 5% cream for 12 consecutive days. Local reactions were classified as mild, moderate, or severe. The statistical analysis of the association between local reactions and clinical response was based on the Pearson χ2 test and the Spearman rank correlation test.ResultsSixty-five patients completed the study. Complete response was recorded in 52.3% and partial response in 75.4%. We found a statistically significant association between severity of the local reaction and response to treatment in both the Pearson χ2 test and the Spearman rank correlation test.ConclusionsA 12-day course of imiquimod 5% proved effective for the treatment of actinic keratosis. Severity of local reactions during treatment was correlated with clinical response.
Graphical abstract
The intra-conduit release method is useful for avoiding migration of metallic stents during EUS-guided hepaticogastrostomy (with video)
Abstract
Purpose
Although EUS-guided hepaticogastrostomy (EUS-HGS) with a covered self-expandable metal stent (SEMS) is a useful procedure, it is associated with severe adverse events, including stent migration. We, therefore, developed an intra-conduit release method, and investigated whether the technique yields a safer and more stable procedure.
Methods
The intra-conduit release method is a procedure to release the SEMS in the working channel conduit of the scope for anchoring between the liver and stomach to avoid stent migration. Forty-three patients who underwent EUS-HGS at two high-volume centers in Japan were enrolled in this retrospective study, and the safety and usefulness of this method were evaluated retrospectively.
Results
The intra-conduit release method was applied in 36 cases. The technical success rate of EUS-HGS with the intra-conduit release method was significantly higher in comparison with the conventional method. Additionally, the rate of early adverse events was significantly lower than that for the conventional method.
Conclusion
The intra-conduit release method during EUS-HGS is useful for a stable procedure that avoids early adverse events.
Acral melanoma foot lesions. Part 2: clinical presentation, diagnosis, and management
Summary
Acral melanoma (AM) is a rare subtype of cutaneous malignant melanoma found on acral skin, primarily on the soles of the feet. Although rare, it is the most common subtype of melanoma found in patients of African or Asian ethnicity and has a poor prognosis, often because of the more advanced stage of presentation at diagnosis. In the second of this two-part series, we review the clinical presentation, histopathology, diagnosis and management of AM. Clinically, AM presents as a variegated lesion with blue–black pigment and irregular borders on acral skin. A parallel-ridge pattern is a very specific dermoscopic finding for AM. The differential diagnoses of AM include acral naevus, pyoderma gangrenosum, pyogenic granuloma, verrucous carcinoma and peripheral neuropathy-induced foot ulcers. If there is a clinical suspicion of AM, an excisional biopsy should be taken. Once diagnosis is confirmed by histology, surgical excision is the standard treatment. Overall, dermoscopy and histopathology are key tools in the diagnosis of AM. A greater emphasis on melanoma screening and awareness is essential in minority populations to improve survival outcomes in AM.
Perforator mapping reduces the operative time of DIEP flap breast reconstruction: a systematic review and meta-analysis of preoperative ultrasound, computed tomography and magnetic resonance angiography
Publication date: Available online 12 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ryckie G. Wade, James Watford, Justin C.R. Wormald, Russell Bramhall, Andrea Figus
BackgroundPrior to DIEP flap breast reconstruction, mapping the perforators of the lower abdominal wall using ultrasound, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) reduces the risk of flap failure. This review aimed to investigate the additional potential benefit of a reduction in operating time.MethodsWe systematically searched the literature for studies concerning adult women undergoing DIEP flap breast reconstruction, which directly compared the operating times and adverse outcomes for those with and without preoperative perforator mapping by ultrasound, CTA or MRA. Outcomes were extracted, data meta-analysed and the quality of the evidence appraised.ResultsFourteen articles were included. Preoperative perforator mapping by CTA or MRA significantly reduced operating time (mean reduction of 54 minutes [95% CI 3, 105], p=0.04), when directly compared to DIEP flap breast reconstruction with no perforator mapping. Further, perforator mapping by CTA was superior to ultrasound, as CTA saved more time in theatre (mean reduction of 58 minutes [95% CI 25, 91], p<0.001) and was associated with a lower risk of partial flap failure (RR 0.15 [95% CI 0.04, 0.6], p=0.007). All studies were at risk of methodological bias and the quality of the evidence was very low.ConclusionsThe quality of research regarding perforator mapping prior to DIEP flap breast reconstruction is poor and although preoperative angiography appears save operative time, reduce morbidity and confer cost savings, higher quality research is needed.RegistrationPROSPERO ID CRD42017065012
Cosmetic, minimally invasive, partial matricectomy of ingrown toenails with granulation tissue
Publication date: Available online 12 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Ning Zhang, Zheng Huang, Song-Hua Cao, Yang Wang, Yong Hu
Outcome predictors in elderly head and neck free flap reconstruction: a retrospective study and systematic review of the current evidence
Publication date: Available online 12 December 2017
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): Cindy Siaw-Lin Goh, Yee-Onn Kok, Cheryl Pei-Chyi Yong, Esther Wan-Xian Tan, Lee-Gan Goh, Khong-Yik Chew, Constance Ee-Hoon Teo, Terence Lin-Hon Goh
Free flap tissue transfer has become the gold standard for reconstruction of composite head and neck defects. We sought to investigate the efficacy and morbidity of these procedures in the elderly. We retrospectively reviewed 245 head and neck free flap procedures (234 patients). Patients were stratified by age group (≥ or <65 years). Univariate and multivariate analyses were used to evaluate the following primary outcomes – free flap survival, postoperative medical and surgical complications and 30-day mortality. We found that free flap success and surgical complication rates were similar between the two age groups. Overall flap success and perioperative mortality rates were 94.3% and 2.1% respectively. Medical complications were significantly more common in the elderly group (p<0.001) and this correlated with comorbidity (OR=2.81, p=0.044) and advanced tumour stage (OR=10.20, p=0.029). Age was not independently associated with poor outcomes in our cohort. We then performed a systematic review of similar case-control studies worldwide and compared their findings with our results. We conclude that advanced age does not preclude free flap success in head and neck reconstruction. Rather, the presence of comorbidity appears to predict the development of medical complications postoperatively. Elderly patients with low comorbidity scores may be offered free flap reconstruction with less reservation.
Impact of Comprehensive, Minimally Invasive, Multimodal Aesthetic Treatment on Satisfaction With Facial Appearance: The HARMONY Study
Ausgezeichnete Innovationen
Im Rahmen einer Gala in Berlin ist der von Springer Medizin gestiftete Galenus-von-Pergamon-Preis für pharmazeutische Innovationen verliehen worden. Mit dem CharityAward wurde auch ehrenamtliches Engagement gewürdigt.
Technical specifications of the Global Allergy and Asthma European Network (GA 2 LEN) chamber: a novel mobile allergen exposure chamber
Abstract
Background
Field trials are the traditional approach for clinical trials in allergy but are under criticism for lack of standardization as they are affected by uncontrollable parameters such as environmental conditions, pollen counts, or lifestyle. Stationary allergen exposure chambers with a defined concentration of allergens under stable and standardized environmental conditions have been used to overcome these restrictions but have not allowed multicenter studies. We here describe the technical specifications and validation of a novel mobile pollen chamber specifically designed for multicenter studies — the GA2LEN chamber.
Methods
Two inter-connectable standard-sized container frames were used as a structural basis for the newly developed allergen exposure chamber. One container accommodates an observation room, also used as an office, and a changing room. The other container houses the test chamber itself and the technical installations. A customized air condition system was integrated and several environmental sensors were installed in the test chamber. Environmental tests have been performed at various outside conditions. The airflow in the test chamber was designed to prevent unspecific symptoms. To allow for an individual particle exposure at each seat, a new particle disperse and distribution system was developed, patented and validated.
Results
Technical and clinical validation tests have been successfully performed with Phleum pratense, Betula pendula, and mixtures of Dermatophagoides farinae, and Dermatophagoides pteronyssinus. The newly developed particle disperse system enable individual verum and placebo exposure, an even particle distribution at every seating position. The built-in air-conditioner is able to generate a tightly controlled, standardized and comfortable environment and the airflow did not provoke clinically significant irritation to lower respiratory tract, nose, or eyes. The chamber transportation has proven to be flexible and cost-effective.
Conclusion
The GA2LEN chamber provides a novel mobile exposure chamber technology for research and clinical trials allowing a fast, affordable, and standardized multicenter approach.
Milben-Rhinitis: SLIT bei Jugendlichen effektiv
Was bringt die sublinguale spezifische Immuntherapie gegen Hausstaubmilben bei Jugendlichen mit einer entsprechenden allergischen Rhinitis? Die gepoolte Auswertung zweier großer Phase-III-Studien gibt Antworten.
Der Flickenteppich im 4. Quartal 2017
Die allergologische Versorgungslandschaft in Deutschland ist ein Flickenteppich aus unterschiedlichen Regelungen. Lesen Sie hier nach, in welchem KV-Bezirk es aktuell qualifikationsgebundene Zusatzvolumina für allergologische Leistungen gibt und wo die subkutane Immuntherapie als förderungswürdig eingestuft wird.
Groß teurer als klein — wie geht das?
Kann es tatsächlich sein, dass Arzneimittelgroßpackungen in manchen Fällen teurer sind als Kleinpackungen? Dies schrieb die Kassenärztliche Vereinigung (KV) Baden-Württemberg in einem Antwortschreiben an den Ärzteverband Deutscher Allergologen. Auf Rückfrage erklärte die KV dieses Kuriosum nun genauer.
Hautpflege bei AD: Was gelangt in den Körper?
Kinder mit atopischer Dermatitis brauchen eine intensive Hautpflege. Doch was da alles durch die Epidermis in den Körper gelangt, ist bisher kaum untersucht. Eine Studie quantifizierte Emollenzienverbrauch sowie Phthalat- und Paraben-Systembelastung bei Kindern mit und ohne Neurodermitis.
Kälteurtikaria mit IgE-Antikörper behandeln?
Wenn Antihistaminika die Symptome einer Kälteurtikaria nicht ausreichend unterdrücken, ist der monoklonale Antikörper Omalizumab offenbar eine wirksame Alternative.
AIT-Studien: Implikationen für Katzenhaarallergiker und Kinder
Neben einer Vielzahl anderer Themen wurden im Rahmen des diesjährigen Paul-Ehrlich-Seminars die Gründe für hohe Placeboeffekte in AIT-Studien und die Hürden für Kinderstudien sowie deren praktische Konsequenzen diskutiert. In beiden Fällen müssen Patienten weiter auf eine wirkungsvolle Therapie warten: Katzenallergiker, weil ein komplettes Studienprogamm auf Eis gelegt wurde, und Kinder, weil es mangels geeigneter Studien an Zulassungen fehlt.
Aktuelle Entwicklungen rund um die Anaphylaxie
Zusammenfassung
Methoden
In diesem Review werden aktuelle Trends der Anaphylaxie dargestellt, die bei der vierten internationalen NORA (Network for Online-Registration of Anaphylaxis)-Konferenz im April 2017 in Berlin erörtert wurden.
Ergebnisse
Aktuelle Daten aus dem AnaphylaxieRegister zeigen, dass weiterhin Insektengift, Nahrungsmittel und Medikamente zu den häufigsten Auslösern einer Anaphylaxie gehören. Unter den seltenen Auslösern einer nahrungsmittelabhängigen Anaphylaxie finden sich Chicoree, Kardamom, Spargel oder Goji-Beeren. In einer Metaanalyse zu aktuellen Trends der Insektengiftanaphylaxie wird erstmals belegt, dass die Daten zur Wirksamkeit der Insektengiftimmuntherapie zwar limitiert sind, jedoch das Auftreten schwerer Reaktionen bei erneutem Stich verhindert werden kann und die Lebensqualität betroffener Patienten verbessert wird. Die molekulare Diagnostik der Insektengiftanaphylaxie hat die diagnostische Sensitivität und Spezifität deutlich verbessert. Die Selbstbehandlung der Anaphylaxie ist sehr wichtig. Neueste Daten aus dem Anaphylaxie-Register zeigen eine Zunahme der Selbstbehandlung (von 23 % im Jahr 2014 auf 29 % im Jahr 2016) der Anwendung des gemäß der Leitlinien empfohlenen Adrenalins. Eine Umfrage zur Umsetzung der Leitlinien aus den Zentren des Anaphylaxie-Registers unterstreicht die Wahrnehmung und Umsetzung der Leitlinie. Berichte zu verschiedenen Fällen aus dem Anaphylaxie-Register verdeutlichen die Vielfalt dieser potenziell lebensbedrohlichen Reaktion.
Fazit
Die komponentenbasierte Diagnostik kann helfen, das Sensibilisierungsprofil bei der Anaphylaxie zu spezifizieren, insbesondere in Hinblick auf das Risiko für schwere Reaktionen. Aktuelle Studien zur Wahrnehmung der Anaphylaxie zeigen, dass Schulungsmaßnahmen wirksam sind, wobei Zielgruppen und Lernmethoden in den nächsten Jahren weiter wissenschaftlich untersucht werden sollten.
GA 2 LEN-Kammer für Multizenterstudien geeignet
Eine mobile Kammer für die Exposition gegenüber Aeroallergenen soll multizentrische klinisch-allergologische Studien ermöglichen. Entwickelt hat sie eine Arbeitsgruppe von Medizinern und Technikern.
Update Insektengiftallergie: Fragen und Antworten aus der Allergieforschung
Am 19. und 20. Mai 2017 fand zum 11. Mal das Arbeitsgespräch der Arbeitsgruppe Insektengiftallergie der Deutschen Gesellschaft für Allergologie und klinische Immunologie (DGAKI) in Fulda statt. Initiiert wurde diese Veranstaltung vor 31 Jahren mit dem 1. Symposium in Hemmenhofen. Seitdem treffen sich alle drei bis vier Jahre Allergologen aus Deutschland, Österreich und der Schweiz, um die aktuellen Forschungsergebnisse zur Insektengiftallergie zu präsentieren.
Fischallergie per Anamnese und sIgE analysieren
Kreuzreaktivitäten bei Fischallergie sind häufig, manche Patienten berichten aber auch über eine Toleranz gegenüber einzelnen Spezies. Eine kleine Studie korrelierte erstmals Ergebnisse einer Nahrungsmittelprovokation mit verschiedenen Fischarten und spezifischen IgE-Reaktivitäten.
Modified Island Technique for Prominent Ears
Abstract
There have been several methods described for the correction of prominent ears, including techniques that excise, bend, suture, score, or cut the auricular cartilage. The Island Technique, proposed by Pitanguy, is based on the creation of a cartilage island to define the antihelix and correct the conchoscaphal angle. Visibility of sharp edges has been the main criticism of this technique. To avoid them, we advise performing an internal bevel incision to round off the edges and achieve a more natural look. Also, sometimes prominent ears are asymmetric with different conchoscaphal angles, determining a residual but protruding upper pole, thus requiring different treatment on each side. For such cases, we propose the additional excision of a cartilage strip from the lower border of the auricular scapha, with a greater conchoscaphal angle. In this way, cartilage islands of similar width and identical antihelixes for both ears are created and a symmetric result is achieved.
Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
Pedicle De-epithelialization in Reduction Mammoplasty: A Systematic Review of the Literature
Abstract
Background
Reduction mammoplasty is among the most commonly performed plastic surgery procedures. The reduction pedicle is traditionally de-epithelialized. Many practitioners propose that preservation of the subdermal blood supply results in improved circulation for the nipple-areolar complex. However, this is a time-consuming step of the procedure. Presumed benefits have not been definitively demonstrated.
Objective
To evaluate current evidence regarding pedicle de-epithelialization in inferior pedicle reduction mammoplasty.
Methods
The MEDLINE database was searched for studies evaluating pedicle de-epithelialization in reduction mammoplasty surgery. Studies reporting outcomes after reduction mammoplasty with pedicle de-epithelialization and deskinning were included. Additionally, reports detailing novel techniques or modification for pedicle de-epithelialization were evaluated and included.
Results
One hundred and thirty-eight articles were identified on a systematic review. Thirty-six articles met the study criteria. This includes 23 reporting outcomes after reduction mammoplasty procedures and 13 describing novel techniques for pedicle de-epithelialization. Of the 23 studies reporting outcomes, 6 studies evaluated deskinning of the pedicle. Two of the six studies directly compared deskinning and de-epithelialization. They reported no significant difference in outcomes. The remaining 17 articles described outcomes of inferior pedicle reduction mammoplasty with pedicle de-epithelialization. Studies evaluating deskinning reported ischemic nipple-areolar complex complication rates between 0 and 1.4%. Studies evaluating de-epithelialization reported ischemic nipple-areolar complex complication rates between 0 and 11.1%.
Conclusions
Pedicle de-epithelialization is commonly performed despite limited definitive evidence evaluating its surgical necessity or benefits. Available evidence suggests deskinning may yield acceptable results; however, further investigation is necessary.
Level of Evidence III
This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
The impact of pediatric skin disease on self-esteem
Pediatric skin disorders can affect children's self-esteem, relationships with caregivers and peers, and performance in school and activities.
Transcriptional profile of in vitro expanded human epidermal progenitor cells for the treatment of non-healing wounds
Human epithelium is continuously renewing tissue, characterized with high regenerative potential. This feature is connected mainly to the presence of stem cells putatively located in the stratum basale of the epidermis and in a bulge region of the hair follicle [1–3]. Both, the slow-cycling epidermal stem cells and more rapidly cycling committed epidermal progenitor cells (EPCs), play an important role in skin homeostasis and chronic wounds pathogenesis [4,5]. The wounds, which do not undergo spontaneous healing, known as non-healing wounds, are found in approximately 2-4% of the world population and are a serious clinical, social and psychological concern [6,7].
Ubiquitination-proteasome system: a new player in the pathogenesis of psoriasis and clinical implications
Ubiquitination is an important post-translational modification that regulates a myriad of biological processes such as inflammation, immune response, cell differentiation and proliferation. During the last decade, progress in proteomics contributed to the identification of new E3 ligases and their substrates. Hence, deregulated ubiquitination events are found to be involved in several inflammatory disorders, exemplifying by systemic lupus erythematosus (SLE), type 1 diabetes, rheumatoid arthritis (RA) and psoriasis.
Assessment of the health status and risk of genotoxic and cytotoxic damage in Argentinian adolescents living near horticultural crops
Abstract
In some rural areas in Argentina, adolescents may be considered as a group indirectly exposed to agrochemicals because their parents plant small crops near their homes. This could become a health risk to children and adolescents who may be more sensitive to exposure to chemicals than adults. The objective of this study was to evaluate the health status of two different groups of Argentinian adolescents using biochemical parameters, dietary information, and cytogenetic biomarkers of genotoxicity and cytotoxicity. The study groups included 32 adolescents from Montecarlo, who were indirectly exposed to agrochemicals, and 30 unexposed adolescents from Exaltación de la Cruz. The values of total cholesterol, LDL cholesterol, triglycerides, gamma glutamyltransferase, and butyrylcholinesterase (BuChE) were higher (p < 0.05) in males from Exaltación de la Cruz compared with those from Montecarlo. The BuChE activity was also higher (p < 0.05) in females from this region. Furthermore, the consumption of citrus, vegetable-like fruits, tubers, and red meat was more frequent (p < 0.05) in Montecarlo. On the other hand, differences in frequency of biomarkers of genetic damage in lymphocytes were not found (p > 0.05). However, the cytome assay in buccal cells showed that karyorrhectic and pyknotic cells were more frequent (p < 0.05) in the Montecarlo group; whereas, the frequencies of cells with nuclear buds, condensed chromatin and karyolysis were higher (p < 0.05) in the Exaltación de la Cruz group. Despite the differences between the parameters and biomarkers evaluated, the adolescents of Montecarlo did not present health impairment probably due to the type and level of exposure to agrochemicals.
Metal pollution across the upper delta plain wetlands and its adjacent shallow sea wetland, northeast of China: implications for the filtration functions of wetlands
Abstract
Grain size and concentrations of organic carbon (Corg) and particulate metals (PMs) As, Cd, Cr, Cu, Hg, Pb, Zn, Al, Fe, and Mn of 373 surface sediment samples, salinities in 67 surface water samples, were analyzed in various environments, including the upper delta plain wetlands (UDPW), its adjacent shallow sea wetland (SSW) in the Liaodong Bay, and river channels that are running through the Liaohe Delta, to evaluate the spatial distribution, transportation environmental dynamics of metals, and the provenance of metal pollution and assess the filtration functions of wetlands. The concentrations of PMs for UDPW were generally higher by a factor of ~ 10–22% compared with its analogues in SSW, suggesting the accumulation of PMs within the UDPW indicates that the UDPW systems are efficiently physical and chemical traps for PMs of anthropogenic sources by retaining and storing pollutants flowing into the sea. However, there was sever sewage irrigation-induced Cd pollution with a geo-accumulation index of 0.62–3.11 in an area of ~ 86 km2 of the adjacent shallow sea wetland, where large amount wetlands were historically moved for agriculture in the UDPW. Remarkably, the distributions of PMs were controlled by salinity-induced desorption and re-adsorption mechanisms and significantly dispersed the contamination coverage by the three-dimensional hydrodynamic and sedimentation processes that dominated by inputs of freshwater and ocean dynamics including NE-SW tidal currents and NE-E longshore drifts in the SSW of the Liaodong Bay. A high agreement between the UDPW and the SSW datasets in principal component analysis essentially reflects that the characteristics of PM sources in the SSW were actually inherited from that in the UDPW, with a much closer relationship among metals, organic matter, and fine particulates in SSW than that of UDPW, which was judged by their correlation coefficient range of 0.406–0.919 in SSW against those of 0.042–0.654 in UDPW.
Mohs micrographic surgery and dermatopathology concordance; An analysis of 1421 Mohs cases over 17 years
Mohs micrographic surgery depends on the surgeon's ability to correctly interpret intraoperative frozen sectionsWe reviewed 1421 Mohs cases and 6407 slides for possible disagreement between fellowship trained-Mohs surgeons and dermatopathologists; the concordance rate was 99.79%Fellowship-trained Mohs surgeons are proficient at interpreting histopathology slides in the setting of Mohs micrographic surgery
Association of Very Preterm Birth with Decreased Risk of Eczema: A Systematic Review and Meta-analysis
It is debated whether preterm infants are prone to developing eczema.This meta-analysis of 18 studies showed that very preterm birth is associated with a decreased risk of eczema.The underlying mechanisms of this association warrant further study.
Metformin and skin cancer risk in Taiwanese patients with type 2 diabetes
Metformin, an antidiabetic drug, is associated with decreased cancer risk, but its effect on skin cancer is unknown.
Monitoring and research of microcystins and environmental factors in a typical artificial freshwater aquaculture pond
Abstract
Freshwater aquaculture ponds are important artificially regulated aquatic ecosystems which provide a large number of freshwater fish products in China. The cyanobacteria bloom and microcystin (MC) pollution caused by anthropogenic eutrophication have attracted much attention due to their toxic effects. To provide an insight into the cyanobacterial problem in the ponds, the environmental parameters and MCs of a typical artificial pond in the Yangtze River Delta region of China were monitored and studied from May to December 2015. During the monitoring period, the ponds were in serious eutrophication with total phosphorus (TP) concentrations between 0.95 and 1.80 μg/L, and total nitrogen (TN) concentrations between 1.1 and 4.86 μg/L. High feed coefficient and high fish stock were the main reasons for the eutrophication. The results showed that the water temperature was the key factor that affected the cyanobacteria blooming in the pond. The chlorophyll a concentration was significantly positively correlated with the cyanobacteria density during the blooming season. MC-LR and MC-RR existed simultaneously and showed a significant positive correlation. The peak concentrations of dissolved MC-LR and MC-RR in the pond water were 40.6 and 4.7 μg/L, respectively, which is considered highly toxic. Free MC-LR and MC-RR were also found in the aquaculture products. MC-LR concentrations in the bighead carp (Aristichthys nobilis) liver and shrimp (Macrobrachium nipponense) muscle were up to 2.64 and 4.17 μg/kg, respectively. MC-RR concentration was up to 1.89 μg/kg in the black carp (Mylopharyngodon piceus) liver. The results implied the potential health risks for citizens and pets caused by current artificial freshwater aquaculture pond systems.
Cosmetic, minimally invasive, partial matricectomy of ingrown toenails with granulation tissue
An ingrown toenail, also known as onychocryptosis, is a common, painful, and debilitating condition that occurs when the lateral edges of the nail penetrate the skin.1 The selection of treatment depends on the stage and severity of the condition. In the patients with granulation tissue, surgical intervention is required. Currently, toenails not only protect the fingers and surrounding soft tissues, but also serve a cosmetic role, especially for women.2-4 Therefore, the ideal treatment option for ingrown toenails should be effective and result in a cosmetically acceptable outcome.
Perforator mapping reduces the operative time of DIEP flap breast reconstruction: a systematic review and meta-analysis of preoperative ultrasound, computed tomography and magnetic resonance angiography
Prior to DIEP flap breast reconstruction, mapping the perforators of the lower abdominal wall using ultrasound, computed tomography angiography (CTA) or magnetic resonance angiography (MRA) reduces the risk of flap failure. This review aimed to investigate the additional potential benefit of a reduction in operating time.
Outcome predictors in elderly head and neck free flap reconstruction: a retrospective study and systematic review of the current evidence
Free flap tissue transfer has become the gold standard for reconstruction of composite head and neck defects. We sought to investigate the efficacy and morbidity of these procedures in the elderly. We retrospectively reviewed 245 head and neck free flap procedures (234 patients). Patients were stratified by age group (≥ or <65 years). Univariate and multivariate analyses were used to evaluate the following primary outcomes – free flap survival, postoperative medical and surgical complications and 30-day mortality.
Invited Commentary: Outcome of In Situ Septoplasty and Extracorporeal Subtotal Septal Reconstruction in Crooked Noses: A Randomized Self-Controlled Study
Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors http://ift.tt/18t7xNj.
The persistence and photostabilizing characteristics of benzotriazole and 5-methyl-1H-benzotriazole reduce the photochemical behavior of common photosensitizers and organic compounds in aqueous environments
Abstract
Benzotriazole (BT) and 5-methyl-1H-benzotriazole (5-MeBT) are broadly used in industrial applications, such as anti-icing fluids and dishwashing detergent, and act as the primary building blocks for UV absorbers and photostabilizers. This study examined the occurrence of these two compounds in the environment and their unique photochemical behavior affecting photosensitizers and other micro-organic pollutants in aqueous environments. BT and 5-MeBT were detected in all river water samples from the major rivers in Taipei City in the concentration ranges of 147 to 1560 ng/L and 22 to 235 ng/L, respectively, and both compounds persisted through a conventional wastewater treatment plant. The direct photolysis half-lives of BT and 5-MeBT were 56.9 and 14.0 h, respectively. The half-life of photolysis in river water for BT was 44.2 h, whereas the half-life of 5-MeBT was 24.7 h. The long half-lives in real-water matrices resulted in their prevalence in water bodies, and these compounds were also found to minimize the photosensitizing ability of nitrate and dissolved organic matter (DOM) and increase the persistence of other micro-organic pollutant. With BT present, the production of ·OH in nitrate photolysis was reduced, the degradation of DOM under sunlight was hindered, and the photodegradation of pharmaceutical residues in surface water, such as methotrexate, was completely impeded. This study suggests that in cases in which BT and 5-MeBT are highly concentrated, the effectiveness of natural attenuation process, i.e., photodegradation, in the aqueous environment is diminished, which increases the persistence of the pollutants as well as the risk of exposure.
Catalytic degradation of sulfaquinoxalinum by polyester/poly-4-vinylpyridine nanofibers-supported iron phthalocyanine
Abstract
Iron (II) phthalocyanine (FePc) supported on electrospun polyester/poly-4-vinylpyridine nanofibers (PET/P4VP NFs) was prepared by stirring in tetrahydrofuran. The resulting product was confirmed and characterized by ultraviolet-visible diffuse reflectance spectroscopy, attenuated total reflection Fourier transform infrared spectra, X-ray photoelectron spectroscopy, gas chromatography/mass spectrometry, and ultra-performance liquid chromatography. More than 95% of sulfaquinoxalinum (SQX) could be removed by the activation of hydrogen peroxide in the presence of FePc-P4VP/PET with a PET and P4VP mass ratio of 1:1. This system exhibited a high catalytic activity across a wide pH and temperature range. The degradation rates of SQX achieved 100, 95, and 78% at a pH of 3, 7, and 9, respectively, and the degradation rates of SQX are more than 80% at the temperature ranging from 35 to 65 °C. DMSO2 could be detected by gas chromatography/mass spectrometry after the addition of DMSO, suggesting the formation of the high-valent iron intermediates in this catalytic system. In addition, the electron paramagnetic resonance experiments proved that free radicals did not dominate the reaction in our system. Therefore, the high-valent iron intermediates were proposed to the main active species in the FePc-P4VP/PET/hydrogen peroxide system. In summary, the heterogeneous catalytic processes with non-radical catalytic mechanism might have better catalytic performance for the removal of organic pollutants, which can potentially be used in wastewater treatment.
Impacts of integrated nutrient management on methane emission, global warming potential and carbon storage capacity in rice grown in a northeast India soil
Abstract
Rice soil is a source of emission of two major greenhouse gases (methane (CH4) and nitrous oxide (N2O)) and a sink of carbon dioxide (CO2). The effect of inorganic fertilizers in combination with various organics (cow dung, green manure (Sesbania aculeata) Azolla compost, rice husk) on CH4 emission, global warming potential, and soil carbon storage along with crop productivity were studied at university farm under field conditions. The experiment was conducted in a randomized block design for 2 years in a monsoon rice (cv. Ranjit) ecosystem (June–November, 2014 and 2015). Combined application of inorganic (NPK) with Sesbania aculeata resulted in high global warming potential (GWP) of 887.4 kg CO2 ha−1 and low GWP of 540.6 kg CO2 ha−1 was recorded from inorganic fertilizer applied field. Irrespective of the type of organic amendments, flag leaf photosynthesis of the rice crop increased over NPK application (control). There was an increase in CH4 emission from the organic amended fields compared to NPK alone. The combined application of NPK and Azolla compost was effective in the buildup of soil carbon (16.93 g kg−1) and capacity of soil carbon storage (28.1 Mg C ha−1) with high carbon efficiency ratio (16.9). Azolla compost application along with NPK recorded 15.66% higher CH4 emission with 27.43% yield increment over control. Azolla compost application significantly enhanced carbon storage of soil and improved the yielding ability of grain (6.55 Mg ha−1) over other treatments.
Mill pond sediments as the indicator of the environment of the drainage area (an example of Liswarta River, Odra basin, Poland)
Abstract
The geochemical characteristics of sediments deposited within a channel-type reservoir situated behind the weir of a water mill on the River Liswarta (southern Poland) were studied in relation to land use in the catchment. The catchment in question is an agricultural one with large forest areas. The contamination of sediments with trace elements was assessed using the geoaccumulation index. The sediments studied were moderately to heavily contaminated with As, Cu, Co, Ni and Ba. They were also heavily contaminated with Sr. Additionally, V and Cr contamination ranged from heavy to extreme. The basic composition of sediments and the trace elements present in them indicate both natural and anthropogenic sources of pollution. Mill impoundments provide zones where the sediments transported by rivers accumulate. Within the Liswarta catchment, their removal may cause the remobilisation of contaminated alluvial deposits.
Atmospheric heavy metal deposition in agro-ecosystems in China
Abstract
Atmospheric deposition has become one of the main sources of heavy metals in crops in developed and industrial zones in China for the past several years. However, lack of data of the agro-ecosystems on the vast areas of China makes it difficult to assess the impacts of air pollution on the heavy metal accumulation in crops. In this study, with deposit samples from 67 sites located at different agro-ecosystems (typical, factory nearby, town nearby, roadside, and remote) of four natural regions [Huanghuai (HH), Southeast (SE), Southwest (SW) and upper-mid Yangzi River (Up-mid YR)], atmospheric heavy metal deposition in agro-ecosystems on a large scale in China was studied. The results showed that during the growing season, the deposition fluxes of Cr, Ni, As, Cd, and Pb in typical agro-ecosystems were 0.60–36.86, 0.65–25.37, 0.05–8.88, 0.12–5.81, and 0.43–35.63 μg m−2 day−1, respectively, which varied greatly between the four different regions. The average deposition fluxes of Cr, Ni, Cd, and Pb in the HH region, as well as the fluxes of As in the SW region, were significantly higher than those in the SE region. Heavy metal deposition rates among agro-ecosystems were very similar, except for the sites around cement factory in flat HH region. In mountainous SW region, however, deposition rates varied widely with sites nearby towns relatively higher and remote regions much lower. Higher correlation coefficients were observed between Cr, As, Pb, and Ni deposition rates, suggesting that they had similar sources. Samples from the SW and SE regions exhibited higher 207Pb/206Pb and 208Pb/206Pb ratios than those from the HH and Up-mid YR regions. Airborne Pb in SW agro-ecosystems were mainly derived from vehicle exhaust and local smelting, whereas that in the HH region from burning of northern Chinese coal.
Artificial intelligence and regression analysis for Cd(II) ion biosorption from aqueous solution by Gossypium barbadense waste
Abstract
In this study, batch biosorption experiments were conducted to determine the removal efficiency of Cd(II) ion from aqueous solutions by Gossypium barbadense waste. The biosorbent was characterized by Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM) connected with energy dispersive X-ray (EDX). The sorption mechanism was described by complexation/chelation of Cd2+ with the functional groups of O–H, C=O, –COO–, and C–O, as well as, cation-exchange with Mg2+ and K+. At initial Cd(II) ion concentration (C o), 50 mg/L, the adsorption equilibrium of 89.2% was achieved after 15 min under the optimum experimental factors of pH 6.0, biosorbent dosage 10 g/L, and particle diameter 0.125–0.25 mm. Both Langmuir and Freundlich models fitted well to the sorption data, suggesting the co-existence of monolayer coverage along with heterogenous surface biosorption. Artificial neural network (ANN) with a structure of 5–10–1 was performed to predict the Cd(II) ion removal efficiency. The ANN model provided high fit (R 2 0.923) to the experimental data and indicated that C o was the most influential input. A pure-quadratic model was developed to determine the effects of experimental factors on Cd(II) ion removal efficiency, which indicated the limiting nature of pH and biosorbent dosage on Cd(II) adsorption. Based on the regression model (R 2 0.873), the optimum experimental factors were pH 7.61, biosorbent dosage 24.74 g/L, particle size 0.125–0.25 mm, and adsorption time 109.77 min, achieving Cd2+ removal of almost 100% at C o 50 mg/L.
Effects of exposure to malathion on blood glucose concentration: a meta-analysis
Abstract
Exposure to malathion (an organophosphate pesticide widely used around the world) has been associated with alterations in blood glucose concentration in animal models. However, the results are inconsistent. The aim of this meta-analysis was to evaluate whether malathion exposure can disturb the concentrations of blood glucose in exposed rats. We performed a literature search of online databases including PubMed, EBSCO, and Google Scholar and reviewed original articles that analyzed the relation between malathion exposure and glucose levels in animal models. The selection of articles was based on inclusion and exclusion criteria. The database search identified thirty-five possible articles, but only eight fulfilled our inclusion criteria, and these studies were included in the meta-analysis. The effect of malathion on blood glucose concentration showed a non-monotonic dose-response curve. In addition, pooled analysis showed that blood glucose concentrations were 3.3-fold higher in exposed rats than in the control group (95% CI, 2–5; Z = 3.9; p < 0.0001) in a random-effect model. This result suggested that alteration of glucose homeostasis is a possible mechanism of toxicity associated with exposure to malathion.
Occurrence of antimicrobial agents, drug-resistant bacteria, and genes in the sewage-impacted Vistula River (Poland)
Abstract
Antimicrobial agents (antimicrobials) are a group of therapeutic and hygienic agents that either kill microorganisms or inhibit their growth. Their occurrence in surface water may reveal harmful effects on aquatic biota and challenge microbial populations. Recently, there is a growing concern over the contamination of surface water with both antimicrobial agents and multidrug-resistant bacteria. The aim of the study was the determination of the presence of selected antimicrobials at specific locations of the Vistula River (Poland), as well as in tap water samples originating from the Warsaw region. Analysis was performed using the liquid chromatography-electrospray ionization-tandem mass spectrometry method. In addition, the occurrence of drug-resistant bacteria and resistance genes was determined using standard procedures. This 2-year study is the first investigation of the simultaneous presence of antimicrobial agents, drug-resistant bacteria, and genes in Polish surface water. In Poland, relatively high concentrations of macrolides are observed in both surface and tap water. Simultaneous to the high macrolide levels in the environment, the presence of the erm B gene, coding the resistance to macrolides, lincosamides, and streptogramin, was detected in almost all sampling sites. Another ubiquitous gene was int1, an element of the 5′-conserved segment of class 1 integrons that encode site-specific integrase. Also, resistant isolates of Enterococcus faecium and Enterococcus faecalis and Gram-negative bacteria were recovered. Multidrug-resistant bacteria isolates of Gram-negative and Enterococcus were also detected. The results show that wastewater treatment plants (WWTP) are the main source of most antimicrobials, resistant bacteria, and genes in the aquatic environment, probably due to partial purification during wastewater treatment processes.
Dinoflagellate cyst abundance is positively correlated to sediment organic carbon in Sydney Harbour and Botany Bay, NSW, Australia
Abstract
There is growing public concern about the global expansion of harmful algal bloom species (HABs), with dinoflagellate microalgae comprising the major portion of the harmful taxa. These motile, unicellular organisms have a lifecycle involving sexual reproduction and resting cyst formation whereby cysts can germinate from sediments and 'seed' planktonic populations. Thus, investigation of dinoflagellate cyst (dinocyst) distribution in sediments can provide significant insights into HAB dynamics and contribute to indices of habitat quality. Species composition and abundance of dinocysts in relation to sediment characteristics were studied at 18 stations in two densely populated temperate Australian estuaries, Sydney Harbour (Parramatta River/Port Jackson; PS) and Botany Bay (including Georges River; GB). Eighteen dinocyst taxa were identified, dominated by Protoceratium reticulatum and Gonyaulax sp.1 in the PS estuary, together with Archaeperidinium minutum and Gonyaulax sp.1 in the GB estuary. Cysts of Alexandrium catenella, which is one of the causative species of paralytic shellfish poisoning (PSP), were also detected in both estuaries. Out of the measured sediment characteristics (TOC, Cd, Cr, Cu, Fe, Pb, Mn, Ni, Zn and polycyclic aromatic hydrocarbons), TOC was the parameter explaining most of the variation in dinocyst assemblages and was positively correlated to most of the heavy metals. Given the significant relationship between sediment TOC and dinocyst abundance and heavy metal concentrations, this study suggests that sediment TOC could be broadly used in risk management for potential development of algal blooms and sediment contamination in these estuaries.
The N-shaped environmental Kuznets curve: an empirical evaluation using a panel quantile regression approach
Abstract
We evaluate the N-shaped environmental Kuznets curve (EKC) using panel quantile regression analysis. We investigate the relationship between CO2 emissions and GDP per capita for 74 countries over the period of 1994–2012. We include additional explanatory variables, such as renewable energy consumption, technological development, trade, and institutional quality. We find evidence for the N-shaped EKC in all income groups, except for the upper-middle-income countries. Heterogeneous characteristics are, however, observed over the N-shaped EKC. Finally, we find a negative relationship between renewable energy consumption and CO2 emissions, which highlights the importance of promoting greener energy in order to combat global warming.
A study on the causal effect of urban population growth and international trade on environmental pollution: evidence from China
Abstract
This study seeks to contribute to the recent literature by empirically investigating the causal effect of urban population growth and international trade on environmental pollution of China, for the period 1980–2014. The Johansen cointegration confirmed a long-run cointegration association among the utilised variables for the case of China. The direction of causality among the variables was, consequently, investigated using the recent bootstrapped Granger causality test. This bootstrapped Granger causality approach is preferred as it provides robust and accurate critical values for statistical inferences. The findings from the causality analysis revealed the existence of a bi-directional causality between import and urban population. The three most paramount variables that explain the environmental pollution in China, according to the impulse response function, are imports, urbanisation and energy consumption. Our study further established the presence of an N-shaped environmental Kuznets curve relationship between economic growth and environmental pollution of China. Hence, our study recommends that China should adhere to stricter environmental regulations in international trade, as well as enforce policies that promote energy efficiency in the urban residential and commercial sector, in the quest to mitigate environmental pollution issues as the economy advances.
Composite hemangioendothelioma of the forehead and right eye; a case report
Abstract
Background
Hemangioendothelioma includes several types of vascular neoplasms, as well as both benign and malignant growth.
Case presentation
This study evaluated a case of a 78-year-old female diagnosed with composite hemangioendothelioma (CHE). This patient had an 18-month history of painless inflammatory lesions and erythema on the left forehead and right upper eyelid. The clinical and pathologic characteristics of the CHE were evaluated in the present study.
Conclusion
The evidence of the coexistence of variable components of the CHE in our study emphasized the importance of distinctive morphology and biology, and should be considered in the differential diagnosis of other vascular lesions.
Do GSTM1 and GSTT1 polymorphisms influence the risk of developing mitochondrial diseases in a Tunisian population?
Abstract
Mitochondria play an essential role to supply the cell with metabolic energy in the form of adenosine triphosphate (ATP) through oxidative phosphorylation (OXPHOS). As a consequence, they are also the primary source of cellular reactive oxygen species (ROS) which can cause oxidative damage of individual respiratory chain complexes. Indeed, affected OXPHOS subunits result in decreases in ATP production and increases in ROS formation which generate oxidative phosphorylation deficiency leading to mitochondrial dysfunctions. It has been suggested that ROS play a vital role in the pathogenesis of mitochondrial diseases. To the best of our knowledge, this is the first study which aimed to investigate the genetic variant effect of the antioxidant enzymes GSTM1 and GSTT1 on mitochondrial disease among a Tunisian population. In this report, 109 patients with mitochondrial disease and 154 healthy controls were genotyped by multiplex PCR amplification, and data were analyzed by SPSS v20 software. The results showed that GSTM1 null genotype was found to be associated with mitochondrial disease with a protective effect; however, no significant association of GSTT1 polymorphism with mitochondrial disease risk was revealed. But, interestingly, our findings highlight that GSTM1 active and GSTT1 null genotype combination increased by three fold the risk of developing mitochondrial disease with p c = 0.020, notably mitochondrial myopathy with p c = 0.046 and Leigh syndrome with p c = 0.042. In conclusion, this study suggests that GSTM1 active and GSTT1 null genotype combination might be a risk factor in developing mitochondrial disease.
State of the Art in Eukaryotic Nitrogenase Engineering
Diversity and Complexity of flavodiiron NO/O2 reductases
Overexpression of PDR16 confers resistance to complex sphingolipid biosynthesis inhibitor aureobasidinA in yeast Saccharomyces cerevisiae
Influence of excess branched-chain amino acid uptake by Streptococcus mutans in human host cells
Preliminary Results of the Use of a Stabilized Hypochlorous Acid Solution in the Management of Ralstonia Pickettii Biofilm on Silicone Breast Implants
Forecasting and Targeting a Rare Cancer with Hypoxia-Inducible Factor
By Jamshed Arslan Pharm.D.
Cancers of nerve, adipose, and other soft tissues are called soft tissue sarcomas (STS). Malignant peripheral nerve sheath tumor (MPNST) is an example of a rare and hard-to-treat STS; even after the surgical removal (which is the only viable option), the tumor often relapses causing poor patient survival. The search for novel treatment targets led a team of researchers in Japan [1] to a transcription factor called hypoxia-inducible factor (HIF). Normally, HIF-1α adapts cells to hypoxic conditions by localizing to the nucleus where it regulates cell growth with the help of transcriptional co-activators p300 and CBP. The team found that increased nuclear HIF-1α indicated poor prognosis in MPNST, and most importantly, inhibiting HIF-1α signaling by a small molecule called chetomin, resulted in apoptosis in MPNST cells. Hence, HIF-1α can serve both as a poor prognostic marker and a therapeutic target in MPNST.
The researchers established the clinical significance of HIF-1α by showing that two thirds of the 82 specimens from MPNST patients were positive for nuclear HIF-1α. Immunohistochemical staining (anti-HIF-1α, anti- HIF-2α, and MIB-1) and hematoxylin and eosin staining revealed that positivity of HIF-1α and MIB-1, but not the HIF-2α, were associated with lower patient survival rates and increased MPNST cell growth. These histological results were validated by expression analysis in MPNST cell lines: nuclear expression of HIF-1α and HIF-1α-downstream genes (VEGFA and GLUT1) were enhanced under hypoxic conditions.
AKT signaling pathway: The AKT/mTOR pathway is activated in MPNST and is associated with increased HIF-1a protein levels [2,3].
To study the effects of reversing HIF-1α expression, small interfering RNAs against HIF-1α were used. The cell growth and viability assays revealed that HIF-1α-suppression reduces MPNST proliferation by decreasing the expression of downstream genes (VEGFA, GLUT1, and BNIP3). The team found that HIF-1α promoted MPNST cell growth in a cell-autonomous manner: nuclear HIF-1α expression was not correlated with microvessel density, indicating that tumor progression does not involve angiogenesis.
Next, the team used a screening kit (SCADS; Screening Committee of Anticancer Drugs, Japan) to find a small molecule that could potentially inhibit HIF-1α in MPNST. Only chetomin, a chemical that disrupts the binding of HIF-1α with p300/CBP complex, was found to dose-dependently reduce growth and induce apoptosis in MPNST cells. Interestingly, western blotting revealed an unaltered nuclear HIF-1α expression, indicating that chetomin inhibits only HIF-1α/p300 interaction, not the HIF-1α gene expression
Previously, studies on the role of HIF-1α in cancers had either focused on solid tumors [4,5] or used heterogenous populations containing bone and soft tissue sarcomas [6]. The research team in Japan overcame these problems by using cell lines and clinical specimens specific to MPNST. The study is also unique in combining clinical and experimental data to support the inhibition of HIF-1α signaling as a feasible strategy against MPNST.
Explore the interactive AKT pathway
Jamshed Arslan, Pharm D.
University of Alabama at Birmingham, School of Medicine
Dr. Arslan studies cell signaling in mitochondrial defects in C. elegans and transgenic mice.
References
- Fukushima, Suguru, et al. "Hypoxia-Inducible Factor 1 α is a Poor Prognostic Factor and Potential Therapeutic Target in Malignant Peripheral Nerve Sheath Tumor." PLoS One, vol. 12, no. 5, n. pag. http://ift.tt/2Ac7QgP
- Endo M, et al. Prognostic significance of AKT/ mTOR and MAPK pathways and antitumor effect of mTOR inhibitor in NF1-related and sporadic malignant peripheral nerve sheath tumors. Clinical Cancer Research: An Official Journal of the American Association for Cancer Research. 2013; 19(2):450–61. http://ift.tt/2l0x6nw
- Masoud, G. N., & Li, W. (2015). HIF-1α pathway: role, regulation and intervention for cancer therapy. Acta Pharmaceutica Sinica. B, 5(5), 378–389. http://ift.tt/2Ac7RkT
- Wang, Qian, et al. "Prognosis Value of HIF-1α Expression in Patients with Non-Small Cell Lung Cancer." Gene, vol. 541, no. 2, 2014, pp. 69–74. http://ift.tt/2l0x6Uy
- Fan, Yang, et al. "Prognostic Significance of Hypoxia-Inducible Factor Expression in Renal Cell Carcinoma: A PRISMA-compliant Systematic Review and Meta-Analysis." Medicine, vol. 94, no. 38, 2015, p. e1646. http://ift.tt/2AdedRa
- Li, Yongjiang, et al. "Prognosis Value of Hypoxia-Inducible Factor-1α Expression in Patients with Bone and Soft Tissue Sarcoma: A Meta-Analysis." SpringerPlus, vol. 5, no. 1, 2016, n. pag. http://ift.tt/2l0wFto
Dermatologists perform more reconstructive surgery in the Medicare population than any other specialist group: A cross-sectional individual-level analysis of Medicare volume and specialist type in cutaneous and reconstructive surgery
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Jonathan Kantor
Efficacy of topical diphenylcyclopropenone maintenance treatment for patients with alopecia areata: A retrospective study
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Sung Jay Choe, Solam Lee, Hanil Lee, Jaewoong Choi, Won-Soo Lee
Table of Contents
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Trends in US sunscreen formulations: Impact of increasing spray usage
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Rebeca W. Teplitz, Alex M. Glazer, Ryan M. Svoboda, Darrell S. Rigel
CME examination
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Information for Readers
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
A new evidence-based risk stratification system for cutaneous squamous cell carcinoma into low, intermediate, and high risk groups with implications for management
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Christian L. Baum, Adam C. Wright, Juan-Carlos Martinez, Christopher J. Arpey, Jerry D. Brewer, Randall K. Roenigk, Clark C. Otley
Most primary cutaneous squamous cell carcinomas are cured with surgery. A subset, however, may develop local and nodal metastasis that may eventuate in disease-specific; death. This subset has been variably termed high risk. Herein, we review; an emerging body of data on the risks of these outcomes and propose an evidence-based; risk stratification for low-, intermediate-, and high-risk tumors that takes into; account both tumor and patient characteristics. Finally, we discuss a framework for; management of these tumors on the basis of data, when available, and our; recommendations when data are sparse.
JAAD Case Reports article List
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Heterogeneous spectrum of acral melanoma: A clinicoprognostic study of 213 acral melanomas according to tumor site
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Hye Rim Moon, Hyun Ji Kang, Chong Hyun Won, Sung Eun Chang, Mi Woo Lee, Jee Ho Choi, Woo Jin Lee
Journal Based CME Instructions and Information
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Ivermectin versus permethrin in the treatment of scabies: A systematic review and meta-analysis of randomized controlled trials
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Ashar Dhana, Hsi Yen, Jean-Phillip Okhovat, Eunyoung Cho, NaNa Keum, Nonhlanhla P. Khumalo
Alopecia areata
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Lauren C. Strazzulla, Eddy Hsi Chun Wang, Lorena Avila, Kristen Lo Sicco, Nooshin Brinster, Angela M. Christiano, Jerry Shapiro
Alopecia areata (AA) is a common, inflammatory, nonscarring type of hair loss. Significant variations in the clinical presentation of AA have been observed, ranging from small, well-circumscribed patches of hair loss to a complete absence of body and scalp hair. Patients affected by AA encompass all age groups, sexes, and ethnicities, and may experience frustration with the unpredictable nature of their disease for which there is currently no definitive treatment. The cause of AA remains incompletely understood, though it is believed to result—at least in part—from a loss of immune privilege in the hair follicle, autoimmune-mediated hair follicle destruction, and the upregulation of inflammatory pathways. Patients with AA frequently experience marked impairment in psychological well-being, self-esteem, and may be more likely to suffer from psychiatric comorbidities. Part one of this two-part continuing medical education series describes the epidemiology, clinical evaluation, prognosis, and recent advancements in the understanding of the pathogenesis of AA.
Editorial Board
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
CME examination
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Evidence-based update on rosacea comorbidities and their common physiologic pathways
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Anna D. Holmes, Julia Spoendlin, Anna L. Chien, Hilary Baldwin, Anne Lynn S. Chang
Rosacea is a common chronic inflammatory disease affecting the facial skin whose etiology and pathophysiology are the subject of much investigation. Risk factors include genetic and environmental elements that may predispose individuals to localized inflammation and abnormal neurovascular responses to stimuli. Recent studies have introduced an array of systemic rosacea comorbidities, such as inflammatory bowel disease and neurologic conditions, that can be challenging to synthesize. We critically review the current data behind reported rosacea comorbidities and identify and highlight underrecognized physiologic mediators shared among rosacea and associated comorbidities. This information may be helpful in addressing patient questions about potential systemic implications of rosacea and can serve as a candidate platform for future research to understand rosacea and improve treatments.
Answers to CME examination
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Alopecia areata
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Lauren C. Strazzulla, Eddy Hsi Chun Wang, Lorena Avila, Kristen Lo Sicco, Nooshin Brinster, Angela M. Christiano, Jerry Shapiro
Many therapies are available for the treatment of alopecia areata, including topical, systemic, and injectable modalities. However, these treatment methods produce variable clinical outcomes and there are no currently available treatments that induce and sustain remission. When making management decisions, clinicians must first stratify patients into pediatric versus adult populations. Disease severity should then be determined (limited vs extensive) before deciding the final course of therapy. The second article in this continuing medical education series describes the evidence supporting new treatment methods, among them Janus kinase inhibitors. We evaluate the evidence concerning the efficacy, side effects, and durability of these medications. An overview of conventional therapy is also provided with new insights gleaned from recent studies. Finally, future promising therapeutic options that have not yet been fully evaluated will also be presented.
Metastatic melanoma after solid organ transplantation: An interdisciplinary, institution-based review of management with systemic and targeted therapies
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Shivani V. Tripathi, Caroline R. Morris, Tarek Alhamad, Ryan C. Fields, Gerald P. Linette, Lynn A. Cornelius
A novel treatment for limited mouth opening due to facial fibrosis: A case series
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Author(s): Kara Hoverson, Tracy Love, Thomas K. Lam, Jason D. Marquart
Answers to CME examination
Publication date: January 2018
Source:Journal of the American Academy of Dermatology, Volume 78, Issue 1
Erosive pustular dermatosis of the scalp: reappraisal of an underrecognized entity
Summary
Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis of unknown etiology. Herein, we present a review of the disease and report our own clinical and histopathological experience in eleven patients. EPDS tends to spontaneously affect bald areas of the scalp in elderly individuals. A history of previous surgery at the same site – as observed in four of our patients – is common. Coronary artery disease, cerebrovascular insult, arterial hypertension, diabetes mellitus, and severe cases of cancer were frequent comorbidities. Most patients show an undulating clinical course despite topical anti-inflammatory treatment; in some individuals, the lesions heal with scarring. Histopathology reveals scaly crusts or erosions and granulation tissue-like changes in the dermis, evolving into a scar in more advanced stages. Apart from actinic/local damage, impaired immunity and microcirculation may be predisposing factors of the disease. Similar to pyoderma gangrenosum, EPDS must be considered in the context of nonhealing wounds in the elderly after the differential diagnoses mimicking EPDS have been ruled out. Given that previous or concomitant adjacent basal cell or squamous cell carcinoma is a common finding and that infiltrative variants extending beyond the clinically visible tumor may occur, histological mapping of the surrounding skin may be advisable in doubtful cases.
Enzooty of non-Hodgkin's malignant lymphoma of Papio hamadryas in Sukhumi monkey colony. Clinical and morphological signs of pre-lymphoma
Abstract
Inoculation of hamadryas baboons with blood of leukemia ill people-induced malignant non-Hodgkin's lymphoma in experimental animals for a very considerable latency period. At close contact of inoculated baboons with healthy non-inoculated animals, the lymphoma spread between them. The epidemiological analysis, postmortem examination, histological analysis, tissue culturing, and PCR were used for the diagnostics of lymphoma and pre-lymphoma, purification, identification of STLV-1, and HVP viruses. Characteristic clinical and morphological signs designated by us as pre-lymphoma often precede the lymphoma development. In some cases, pre-lymphoma does not develop in lymphoma because animals die from various diseases and do not reach the point of the lymphoma development. The horizontal transmission of lymphoma arising with the participation of T-lymphotropic retrovirus STLV-1 is shown.
Medikamentöse Therapie der Acne inversa
Zusammenfassung
Acne inversa ist eine chronisch entzündliche, destruierende Hauterkrankung, die ca. 1 % der Bevölkerung betrifft. Die Therapie der Erkrankung erfolgt personalisiert und umfasst chirurgische und konservative Maßnahmen. Antibiotika kommen topisch und systemisch zum Einsatz. Sehr effektiv ist eine Kombinationstherapie bestehend aus Clindamycin und Rifampicin über 10 bis 12 Wochen. Außerdem zeigen TNF (Tumor-Nekrose-Faktor)-α-Inhibitoren eine gute Wirksamkeit und werden empfohlen. Adalimumab ist zurzeit das einzige für die Therapie von Acne inversa zugelassene Systemtherapeutikum. Die Wirksamkeit von Retinoiden ist sehr unterschiedlich. Isotretinoin wird für die Therapie von Acne inversa nicht empfohlen, jedoch zeigt Acitretin einen besseren Effekt. Immunmodulierende Substanzen, wie z. B. Dapson, Cyclosporin A, Methotrexat, Colchicin oder Kortikosteroide können für die Therapie erwogen werden, allerdings ist die Studienlage für eine Empfehlung nicht ausreichend. Hormonpräparate können den Verlauf der Erkrankung beeinflussen. Antiseptika werden stadienunabhängig unterstützend angewendet. Patienten sollten über Triggerfaktoren der Erkrankung aufgeklärt werden.
The science behind skin care: Cleansers
Summary
Two of the most important skin care categories with profound dermatologic implications are cleansers and moisturizers. Cleansers are composed of alkaline soaps or the less barrier-damaging synthetic detergents, known as syndets. The lower skin irritation and dryness found with syndets are related to their reduced tendency to cause protein denaturation due to the charge density of protein-bound micelle-like surfactant aggregates. Many cleansing formulations are available for purchase to meet hygiene needs varying by sex, age, ethnicity, occupation, environment, personal preferences, and the presence or absence of skin disease. This discussion covers the science of skin cleansing.
Female pattern hair loss: a pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone
Abstract
Background
Minoxidil and spironolactone are oral antihypertensives known to stimulate hair growth.
Objective
To report on a case series of women with pattern hair loss (PHL) treated with once daily minoxidil 0.25 mg and spironolactone 25 mg.
Methods
Women newly diagnosed with a Sinclair stage 2–5 PHL were scored for hair shedding and hair density before and after 12 months of treatment with oral minoxidil 0.25 mg and spironolactone 25 mg.
Results
A total of 100 women were included in this observational pilot study. Mean age was 48.44 years (range 18–80). Mean hair loss severity at baseline was Sinclair 2.79 (range 2–5). Mean hair shedding score at baseline was 4.82. Mean duration of diagnosis was 6.5 years (range 0.5–30). Mean reduction in hair loss severity score was 0.85 at 6 months and 1.3 at 12 months. Mean reduction in hair shedding score was 2.3 at 6 months and 2.6 at 12 months. Mean change in blood pressure was −4.52 mmHg systolic and −6.48 mmHg diastolic. Side effects were seen in eight women but were generally mild. No patients developed hyperkalemia or any other blood test abnormality. Six of these women continued treatment, and two women who developed urticaria discontinued treatment.
Limitations
Prospective, uncontrolled, open-label observational study.
Discussion
Once daily capsules containing minoxidil 0.25 mg and spironolactone 25 mg appear to be safe and effective in the treatment of FPHL. Placebo-controlled studies to investigate this further are warranted.
SLURP-1 is mutated in Mal de Meleda, a potential molecular signature for melanoma and a putative squamous lineage tumor suppressor gene
Abstract
Background
Mal de Meleda (MDM) is a rare inherited autosomal recessive genodermatosis characterized by palmoplantar keratoderma (PPK) with transgrediens and caused by mutations in the SLURP1 gene. Uncommonly, cutaneous tumors have been found at PPK sites in MDM patients.
Objective
To study a Middle Eastern family with MDM with both PPK and skin tumors.
Methods
We studied a Middle Eastern (Palestinian) family with clinical features of MDM and cutaneous tumors. Histopathological analysis was performed on biopsies from skin lesions found in the affected individuals. Direct sequencing of SLURP1 was performed in MDM affected members. In silico analysis of publicly available datasets was used to survey SLURP1 mRNA levels in normal and malignant tissues. Statistical analysis was performed in the R statistical language.
Results
Affected members from the Middle Eastern family displayed severe forms of PPK consistent with MDM. Histopathological analysis of the skin lesions revealed that the examined affected members exhibited skin squamous cell carcinomas (SCCs) and melanoma. Sequence analysis revealed homozygous SLURP1 mutations (c.82delT) in the affected members. Following analysis of various publicly available expression datasets, SLURP1 mRNA levels were found to be markedly elevated in tissues of epithelial lineage, relative to tissues of other lineages, and significantly suppressed in malignant tumors of epithelial lineage relative to normal or their premalignant counterparts. There was significant decrease in SLURP-1 expression in melanomas versus melanocytic nevi as well as a highly significant decrease in SLURP-1 expression in metastatic melanomas as compared to primary melanoma.
Conclusion
Our study underscores cases of Middle Eastern MDM with SLURP1 mutations and skin malignancies at PPK sites. Our findings also highlight a plausible epithelial lineage-specific tumor suppressor role for the SLURP1 gene, as well as a role in the development and metastasis of melanoma and thus a potential molecular signature for melanoma.
Population-based incidence and melanoma-specific survival of cutaneous malignant melanoma in a Colombian population 2000–2009
Abstract
Background
Demographic, clinical, and morphological characteristics of cutaneous melanoma are unknown for the Colombian population. We aim to provide these characteristics as well as population-based incidence and survival data.
Methods
All patients with an invasive cutaneous melanoma diagnosed in the period 2000–2009 registered in the population-based cancer registry of the metropolitan area of Bucaramanga were included for analysis (n = 169). Age-standardized incidence rates were calculated and melanoma-specific and overall survival estimated with follow-up until June 9, 2016, using Kaplan–Meier methodology, stratifying for gender, anatomical localization, and type of affiliation to the social security system.
Results
The age-standardized melanoma incidence rate was 1.7 per 100,000, with lower limbs being the most affected body sites (42.6% of all melanomas). A high proportion of melanomas presented on the plants or palms (16%) and under the nails (7.1%); at least 24.3% of melanomas were ulcerated, and 21.1% had a Breslow thickness more than 2 mm. Melanoma-specific 5-year survival was 79.3%, with worst survival for melanomas localized on the plants (64.6%) and subungual areas (55.6%). Affiliation to the subsidized type of affiliation to the social security system was statistically significantly (P = 0.003) associated with poorer survival (68.8%) compared to the special regimes (95.8%).
Conclusions
Melanoma is a relatively rare cancer in Colombia with mainly the acral sites, high proportion of thick and ulcerated melanomas, and relatively poor survival being distinct features, indicating the need for tailor-made primary and secondary prevention strategies. Better training of pathologists in the difficult field of melanoma would improve precision of available data.
Internal venous anomalies in patients with a genital venous malformation
Abstract
Background
Cutaneous venous malformation (VM) can be associated with internal vascular anomalies. Our objective was to investigate the frequency of internal vascular anomalies in patients with an isolated genital venous malformation to assess the utility of screening for internal findings.
Methods
We retrospectively reviewed our Vascular Anomalies Center database for patients with a focal genital venous malformation presenting between 1999 and 2016. Abdominal and pelvic imaging reports were reviewed for internal vascular anomalies. Endoscopy reports were also reviewed when available.
Results
A focal genital venous malformation was found in 22 patients (14 female, 8 male). Ten (45%) had a venous malformation of at least one internal structure, most commonly the pelvic floor (n = 6), colon (n = 5), urethra (n = 4), and/or bladder (n = 3). Eight experienced hematuria, hematochezia, and/or rectorrhagia secondary to their internal venous malformation. In patients with internal venous malformations, the mean age of symptom presentation was 7.3 years (range 1-22 years). Two patients had malformed inferior mesenteric and portal veins visible using ultrasonography and magnetic resonance imaging. They required surgical intervention to prevent thrombosis and decrease urogenital and gastrointestinal bleeding.
Conclusion
Nearly half of our patients with a focal genital venous malformation had internal venous anomalies. Physicians should suspect urogenital or gastrointestinal venous malformations in patients with a focal genital venous malformation, especially if they develop hematuria, hematochezia, or rectorrhagia. Significant mesenteric venous trunk anomalies can also occur. Because these require surgical intervention, early recognition is important. We recommend that all patients with a focal genital venous malformation undergo abdominal and pelvic ultrasound to evaluate for internal venous anomalies.
Lichen planus pigmentosus inversus in children: Case report and updated review of the literature
Abstract
Lichen planus pigmentosus inversus (LPPI) is a rare variant of lichen planus characterized by slate grey to dark black-brown macules, papules, or patches occurring in the skin folds. We present a case of LPPI in an 11-year-old girl, the second-youngest case and only the third pediatric case. This article also reviews the differential diagnosis and treatment of LPPI.
Pernio as the presenting sign of blast crisis in acute lymphoblastic leukemia
Abstract
A previously healthy 5-year-old girl presented with acute onset of blue toes and red spots on the nose and fingers. The striking nature of these lesions, along with the finding of submandibular lymphadenopathy, prompted further evaluation. Laboratory findings were remarkable for anemia, high transaminase levels, and high blast count. Histopathologic findings were consistent with early pernio. Further examination revealed acute B-cell lymphoblastic leukemia. Treatment of the leukemia led to resolution of the pernio.
A case of keratosis circumscripta in a Chinese boy
Abstract
Keratosis circumscripta is a rare dermatosis occurring in children and adolescents that has been reported in the English literature only in Africans and their descendants. We report here a case of keratosis circumscripta in a 13-year-old Chinese boy who presented with pruritic follicular keratotic rashes below both knees. This case indicates that keratosis circumscripta may not occur only in individuals of African descent.
Circadian rhythm in atopic dermatitis—Pathophysiology and implications for chronotherapy
Abstract
Circadian rhythm is a biological clock that controls a wide range of physiological functions throughout the body, including various skin functions. A 24-h diurnal cycle, governed by an endogenous clock in the brain, largely controls cutaneous diurnal rhythm, which external factors, including temperature, humidity, diet, and stress, also modulate locally. Circadian rhythm influences cutaneous blood flow and properties of skin barrier function, such as transepidermal water loss and capacitance, and has important implications in atopic dermatitis (AD). This review explores how aberrations in circadian rhythm may play a role in the pathogenesis of AD and proposes implementation of chronotherapy to improve treatment outcomes in patients with AD.
Characteristics of pediatric recurrent erythema multiforme
Abstract
Background
Erythema multiforme (EM) is an acute condition characterized by distinctive target lesions of the skin often accompanied by mucosal ulcers. A subset of individuals experience frequent episodes of recurrent EM, which is rare and poorly understood, especially in children.
Objective
To characterize clinical features, laboratory findings, and treatment responses of pediatric recurrent EM.
Methods
A retrospective chart review was conducted at the Children's Hospital of Wisconsin in Milwaukee, Wisconsin (2000-2015) and the Mayo Clinic in Rochester, Minnesota (1990-2015). Inclusion criterion was a diagnosis before age 18 years with recurrent EM, defined as a symmetrically distributed, fixed eruption, including target lesions, with or without mucous membrane involvement, occurring on at least three occasions. A literature review was conducted to include individuals who met the inclusion criterion.
Results
Twenty-six patients were included, of whom 16 (62%) were male. The median age of onset was 9.1 years (range 0-15.7 years). Nine patients (35%) required hospitalization. Herpes simplex virus testing was positive in 9 of 17 (65%) patients. Remission was achieved in 5 of 16 (31%) patients while taking suppressive antivirals. Eight patients received continuous anti-inflammatory treatment, two (25%) of whom experienced remission.
Conclusion
This study of pediatric recurrent EM found a greater male predominance, more hospitalizations, fewer cases caused by herpes simplex virus, and a lower response to immunosuppression in children than in the general population.
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Publication date: Available online 28 September 2017 Source: Actas Dermo-Sifiliográficas Author(s): F.J. Navarro-Triviño
