Luteolin suppresses inflammation through inhibiting cAMP-phosphodiesterases activity and expression of adhesion molecules in microvascular endothelial cells

Abstract

Luteolin, an anti-inflammatory ingredient found in the Chinese herb Folium perillae, can inhibit not only the cyclic adenosine monophosphate (cAMP)-phosphodiesterases (PDEs) activity of neutrophils, but also the expression of lymphocyte function-associated antigen-1 in neutrophils, both of which result in a decrease in the adhesion between neutrophils and microvascular endothelial cells. However, the effect of luteolin on the cAMP-PDEs activity and expression of adhesion molecules in endothelial cells are not clear. In the present study, primary rat pulmonary microvascular endothelial cells and a lipopolysaccharide-induced rat acute pneumonia model were used to explore the role of luteolin on cAMP-PDEs activity, expression of adhesion molecules, and leukocyte infiltration. We demonstrate that rat pulmonary microvascular endothelial cells expressed high levels of cAMP-PDEs, specifically PDE4, and further luteolin exhibited dose-dependent inhibition on the activity of cAMP-PDEs or PDE4 in endothelial cells. Luteolin also had a significant inhibitory effect on the expression of vascular cell adhesion molecule (VCAM)-1, but not intracellular cell adhesion molecule (ICAM)-1 in microvascular endothelial cells. Further, we show that luteolin decreased the levels of soluble ICAM-1 (sICAM-1), but not soluble E-selectin in the serum of rats subjected to acute pneumonia. We also show that luteolin treatment decreased the wet/dry weight ratio of lung tissue and reduced the total number of serum leukocytes in a dose-dependent manner in a rat acute pneumonia model. In conclusion, these results demonstrate that luteolin suppresses inflammation, at least in part, through inhibiting both cAMP-PDEs or PDE4 activity and the expression of VCAM-1 (in vitro) and sICAM-1 (in vivo) in endothelial cells.

Erratum zu: Monolokuläres Erythema elevatum et diutinum am Handrücken

Erratum zu:

Hautarzt 2018, Suppl 1

https://ift.tt/2xPnvDQ

Sehr geehrte Leserin, sehr geehrter Leser,

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Therapeutic effects of simultaneous Photobiomodulation therapy (PBMT) and Meloxicam administration on experimental acute spinal cord injury: Rat animal model

Publication date: Available online 29 September 2018

Source: Journal of Photochemistry and Photobiology B: Biology

Author(s): Mir Sepehr Pedram, Mohammad Mehdi Dehghan, Maryam Shojaee, Reza Fekrazad, Davood Sharifi, Arash Farzan, Setareh Ghasemi, Katayoun AliMohammad Kalhori

Abstract

Study design

Application of Photobiomodulation therapy (PBMT) and meloxicam in acute spinal cord injury, functional recovery and histological evaluation.

Objective

Evaluation of the effect of simultaneous PBMT and meloxicam on treatment of acute experimental spinal cord injury and comparing it with the effect of application of each of them separately.

Setting

The study was conducted at the Department of Surgery & Radiology and Biomedical Research Center, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran.

Methods

24 rats were used in this study. A compression injury was induced to the T8-T9 segment of the spinal cord of rats using a Fogarty embolectomy catheter. Rats were randomly divided into 4 groups including: Control group, PBMT (810 nm-200 mw-8 s-2 weeks) group, Meloxicam (1 mg/kg) group, and PBMT and Meloxicam (mixed) group. After inducing injury, hind limb performance of the rats was evaluated, using BBB test and then treatment intervention was performed and continued for 2 weeks.

Results

4 weeks after injury induction, BBB test results were significantly higher in all treatment groups in comparison to control group, however, there were no significant differences among the treatment groups. In addition, histological findings revealed no significant difference between all 4 study groups.

Conclusion

According to the results of this study we can conclude that simultaneous and separate application of PBMT and Meloxicam play an effective role in treatment of acute spinal cord injuries.

Frequency of occurrence of polymorphic light eruption in patients treated with photohardening and patients treated with phototherapy for other diseases

Photodermatology, Photoimmunology &Photomedicine, Volume 0, Issue ja, -Not available-.

The impact of positive antinuclear antibody on narrowband ultraviolet B phototherapy in patients with vitiligo: a retrospective chart review

Photodermatology, Photoimmunology &Photomedicine, Volume 0, Issue ja, -Not available-.

Micafungin may be safely administered as outpatient parenteral antimicrobial therapy for chronic pulmonary aspergillosis

Mycoses, Volume 0, Issue ja, -Not available-.

Rhodotorula species infections in humans: a systematic review

Mycoses, Volume 0, Issue ja, -Not available-.

Coexisting cutaneous macroglobulinosis and scleredema of Buschke in a patient with a Waldenström Macroglobulinemia

Journal of the European Academy of Dermatology and Venereology, Volume 0, Issue ja, -Not available-.

Combination of Natural Extracts and Photobiomodulation in Keratinocytes Subjected to UVA Radiation

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

Design and Synthesis of Coumarin–Imidazole Hybrid Chromophores: Solvatochromism, Acidochromism, and Non‐Linear Optical Properties

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

Tranexamic Acid Ameliorates Non‐melanoma Skin Cancer Induced by Long‐term Ultraviolet A Irradiation

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

3D Bioprinting with UVA1 Radiation and Photoinitiator Irgacure 2959: Can the ASTM Standard L929 Cells Predict Human Stem Cell Cytotoxicity?

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

Photodynamic Therapy Mediated by 5‐aminolevulinic Acid Promotes the Upregulation and Modifies the Intracellular Expression of Surveillance Proteins in Oral Squamous Cell Carcinoma

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

Solar Ultraviolet Radiation Exposure Proxy‐estimated by Sky View Fish‐eye Photography – Potentials and Limitations from an Exploratory Correlation Study

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

The PROCLIPI international registry of early stage Mycosis Fungoides identifies substantial diagnostic delay in most patients

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

Tranexamic Acid Ameliorates Non‐melanoma Skin Cancer Induced by Long‐term Ultraviolet A Irradiation

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

3D Bioprinting with UVA1 Radiation and Photoinitiator Irgacure 2959: Can the ASTM Standard L929 Cells Predict Human Stem Cell Cytotoxicity?

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

Photodynamic Therapy Mediated by 5‐aminolevulinic Acid Promotes the Upregulation and Modifies the Intracellular Expression of Surveillance Proteins in Oral Squamous Cell Carcinoma

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

Solar Ultraviolet Radiation Exposure Proxy‐estimated by Sky View Fish‐eye Photography – Potentials and Limitations from an Exploratory Correlation Study

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

The PROCLIPI international registry of early stage Mycosis Fungoides identifies substantial diagnostic delay in most patients

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

Alternative and complementary therapies for vulvovaginal candidiasis

Abstract

When it comes to women's health, treating vaginal infections makes up a high proportion of the gynecological services. Among the forms of vaginitis, vulvovaginal candidiasis (VVC) is considered the second most common. Demand for new treatment alternatives is increasingly relevant, especially for therapies with fewer side effects, better tolerability, and lower cost, while still offering improved quality of life in terms of disease prevention. This study intended to investigate the alternative therapies described for the adjuvant treatment of vulvovaginitis caused by Candida species, including alternative and complementary treatment methods used by women. This literature review is based on articles written in English and Portuguese in the PubMed, Google Scholar, and SciELO databases. This study was conducted for the most part using the Brazilian Government's Capes Periodicals Portal, which directs to Google Scholar and PubMed. Since the 1980s, there has been growing interest in alternative therapies in Brazil, a trend which also began in other Western countries in the second half of the twentieth century. Some alternative treatments include substances with antifungal activity, some substances help restore the balance of the vaginal microbiota, while others have an inhibitory activity on microbial virulence factors. The proper use of therapeutic alternatives can effectively contribute to the treatment of VVC, but it should be remembered that some chemical products, such as boric acid or vinegar, and even natural products such as propolis, garlic, and tea tree may have undesirable side effects, having not been tested by well-designed clinical studies. Even so, alternative therapies in the treatment of VVC do have support in the scientific literature.

Assessing the Efficacy of Deoxycholic Acid for the Treatment of Submental Fat: A Three-Dimensional Study

Abstract

Background

Deoxycholic acid is used for the treatment of excess submental fat, offering a potential alternative to more invasive surgical procedures. However, there is currently an absence of high-level evidence in the literature outside of Phase 3 clinical trials.

Objectives

The aim of this study was to evaluate the efficacy of deoxycholic acid for the treatment of submental adiposity by correlating objective 3-dimensional (3D) data with subjective patient assessment scores.

Methods

Thirteen patients were prospectively enrolled into the study. 3D images were obtained prior to initial treatment, at 4-week intervals, and in the acute recovery period. Volumetric changes were calculated using Vectra software. Corresponding subjective surveys using the FACE-Q tool evaluated the perceived treatment results and side effects.

Results

Objectively, there was a significant reduction in submental volume following treatment (P = 0.004), with total rounds of treatment averaging 3.4 (SD: 1.19). During the immediate recovery period, there was a statistically significant increase in submental volume, with an average increase of 8.68% (P = 0.0003). Subjectively, patient satisfaction scores improved significantly for both the aesthetics of the area under the chin and jawline (P < 0.005). Self-resolving paresthesia following treatment occurred in all study participants. There were no major complications. Participant scores of early treatment recovery also improved significantly with subsequent treatments (P < 0.005).

Conclusions

This study validates the use of deoxycholic acid for reducing supraplatysmal adiposity in the submental area. Objective volume changes showed positive correlation with subjective improvements in patient satisfaction scores. Recovery and side effect profiles were also described and may aid in future patient education and management.Level of Evidence: 4

Filler Rhinoplasty: Evidence, Outcomes, and Complications

Rhinoplasty is one of the most popular facial aesthetic procedures but also one of the most technically challenging, with revision rates after surgical rhinoplasty ranging from 5% to 20%.¹ The popularity of nonsurgical alternatives has been steadily increasing, especially that of injectable filler rhinoplasty using hyaluronic acid (HA), which offers reduced financial and anaesthetic impact, immediate aesthetic results, and rapid recovery.² This is often demonstrated on video posts on social media platforms, which show immediate postprocedure results but often no further follow-up.³ Although fillers are predominantly used for aesthetic rhinoplasty, the technique has also been utilized to address functional issues including internal valve collapse.⁴

Commentary on: Outcomes of Acellular Dermal Matrix for Immediate Tissue Expander Reconstruction with Radiotherapy: A Retrospective Cohort Study

In this retrospective cohort study of women who underwent immediate tissue expander reconstruction at a major cancer center, the authors evaluated the effects of acellular dermal matrix (ADM) on patient outcomes in the setting of postmastectomy radiation therapy (PMRT).¹ Currently, 2-stage tissue expander/implant breast reconstruction is the most common type of reconstruction performed in the United States.² Meanwhile, increasing use of PMRT over the past decade has significantly impacted the clinical, aesthetic, and patient-reported outcomes of these procedures.^3-8 Despite the widespread adoption of ADM in implant-based breast reconstruction, there have been few well-designed studies assessing the benefits and risks of this material, particularly among women receiving PMRT. This study by Craig et al represents an important step forward in addressing this gap in our knowledge.

Acknowlegment to reviewers

Editor’s note

Let us utilize breast contrast-enhanced ultrasound more

The effect of halogen light stimulation on duration of ultrasound parameters of biophysical profile: a randomized clinical trial

Abstract

Introduction

The objective is to assess if fetal halogen light stimulation can reduce the time needed to obtain a normal biophysical profile (BPP).

Methods

Patients scheduled for a BPP and who satisfied the inclusion criteria were prospectively randomized to halogen light stimulation and no stimulation groups. The study group was exposed to handheld halogen light for 10 s whenever fetal breathing, movement, or tone was absent through the first 5 min of BPP. The time required to achieve complete BPP score was recorded. In patients with complete BPP score who had delivery within 1 week after the test, perinatal morbidity was examined.

Results

A total of 598 patients were randomized (light = 302, no light = 296). There was no difference between the two groups in terms of gestational age, maternal age, body mass index, and indication for BPP except for preterm labor (light: 9%, no light: 4%, p = 0.03). Among the patients who had a normal BPP score (n = 507), the mean (light: 7.1 ± 6 min, no light: 12.3 ± 8 min, p < 0.0001) and median (light: 4.3, no light: 8, p = 0.004) time needed to complete the BPP score was significantly less in the light stimulation group than the no stimulation group. Perinatal outcomes were not different between groups who had delivery during the first week after BPP.

Conclusion

Fetal halogen light stimulation can be utilized to reduce the time needed to complete a BPP. However, further studies should be conducted in order to determine the effect of this method on decreasing non-reassuring test results.

Clinical Trial Registration

The study was submitted to the Registry of Clinical Trials on 04/20/2017 (IRCT2017041633470N1). After IRCT registration on 06/07/2017, we recruited patients from 06/08/2017 till 10/15/2017.

Flexor pollicis longus tendon rupture by sandwiched underlying volar locking plate and distal radius

Abstract

Flexor pollicis longus (FPL) tendon rupture is a major complication of volar locking plate fixation for distal radius fractures. The tendon rupture is usually caused by friction between the distal edge of the plate and the FPL tendon, and has been well detected recently with ultrasonography. Rarely, the volar locking plate itself entraps the FPL tendon, leading to its rupture. A 63-year-old man was consistently unable to flex his right thumb after previous surgery for a distal radius fracture at another hospital. Ultrasonography demonstrated loss of tendon gliding and unusual patterns of the FPL tendon. The tendon was sandwiched between the plate and the distal radius, and was penetrated by the distal locking screw, which was comparable to intraoperative findings of complete entrapment and rupture of the FPL tendon from the underlying plate. The tendon defects were repaired using a palmaris longus tendon graft after removing the screws and plate. Finally, he could flex his thumb actively with satisfaction. Unusual patterns of FPL tendon rupture buried under inadequate plate positioning must be recognized, as in this case. Ultrasonographic assessment is routinely recommended to visibly determine any FPL tendon damage after volar locking plate fixation for distal radius fractures.

Contrast-enhanced ultrasonography of post-interventional hematoma: the bleeding mushroom is growing inside

Abstract

Catheter ablation is an effective treatment in patients with symptomatic atrial fibrillation. Complications are infrequent and usually resolve with minimal or no intervention, but active bleeding due to arterial injury during the vascular access can sometimes represent a life-threatening complication. Contrast-enhanced computed tomography is the standard technique to detect active bleeding, but it may not be immediately available. We report a case of iatrogenic hemorrhage after catheter ablation, in which contrast-enhanced ultrasonography played a decisive role in the recognition of active arterial bleeding due to injury to the right common femoral artery.

Three-step procedure for safe internal jugular vein catheterization under ultrasound guidance

Abstract

Real-time ultrasound guidance for central venous catheterization has become a standard technique. This technique has been reported to yield high success rates and fewer complications compared with landmark techniques. However, it can be risky when the practitioner does not possess proper knowledge and skills. Lose sight of the needle tip can lead to severe complications such as arterial puncture or pneumothorax. Also, posterior wall penetration of the target vessels must be avoided. Misplacement of the catheter to other vessels can sometimes occur, and may only be discovered after the catheterization procedure. To avoid these complications, we perform a three-step procedure to place an internal jugular vein catheter under ultrasound guidance. The three steps are: (a) advance the needle tip to the internal jugular vein with a short-axis image with an out-of-plane technique, (b) rupture the anterior wall by using a long-axis image with an in-plane technique, and (c) confirm the guidewire position from the internal jugular vein to the brachiocephalic vein using a short-axis image, and a coronal image from the supraclavicular fossa. For safe needle advancement and penetration of the anterior wall of the vein, combined use of short-axis and long-axis images is helpful, and guidewire placement should be confirmed by scanning with the short-axis image and the coronal image.

Reproducibility of acquiring ultrasonographic infant hip images by the Graf method after an infant hip ultrasound training course

Abstract

Purpose

The objective screening of infant hips using ultrasonography (Graf method) is gaining favor in the diagnosis of developmental dysplasia of the hip in Japan. However, the accuracy of the Graf method is dependent on the examiner's experience and technique. The purpose of this study was to investigate the reproducibility of acquiring ultrasonic hip images and their evaluation after examiners attended an infant hip ultrasound training course.

Materials and methods

Ultrasonic images of 70 hips of 35 newborns who were screened by ultrasonography using the Graf method, were evaluated. The images were acquired by two inexperienced examiners who attended the training course. The inter- and intra-examiner measurement errors as well as reproducibility were calculated based on the images obtained.

Results

The intra-examiner measurement error in the acquired images of the same hip was minor. The inter-examiner measurement error was also small. The intra- and inter-examiner agreements of the Graf classification were high. The intra-examiner reproducibility of the acquired ultrasonic images was substantial, and the inter-examiner reproducibility was almost perfect.

Conclusions

Our results demonstrated that inexperienced examiners could obtain ultrasonic infant hip joint images with minor differences and high reproducibility after the training course. Our findings raise the possibility of extending the infant hip ultrasound course in Japan.

A case of stage IA pancreatic ductal adenocarcinoma accompanied with focal pancreatitis demonstrated by contrast-enhanced ultrasonography

Abstract

A patient with slight dilatation of the main pancreatic duct was followed-up with ultrasonography every 6 months as a high-risk case of pancreatic cancer. Twelve years later, a faint hypoechoic area 13 mm in diameter was first detected on the body of the pancreas. Contrast-enhanced ultrasonography revealed a well-demarcated hypoenhanced area 8 mm in diameter and a hyperenhanced area with an unclear margin. The former was suspected to be a small pancreatic cancer lesion, and the latter to be focal pancreatitis accompanying cancer. However, contrast-enhanced dynamic CT did not suggest any tumor, diagnosis of adenocarcinoma was confirmed with pancreatic juice cytology through endoscopic retrograde pancreatography. Surgical resection was performed, and the lesion was pathologically diagnosed as invasive ductal carcinoma as follows: pTS1 (1.0 cm), infiltrative type (pT1), stage IA. When comparing the images from contrast-enhanced ultrasonography with the pathological findings, the hypoenhanced area corresponded to ductal adenocarcinoma, and the hyperenhanced area to focal pancreatitis. Contrast-enhanced ultrasonography was able to reveal detailed information on the focal lesion in the pancreas, and it was effective for the early diagnosis of pancreatic cancer.

A novel ultrasonic method for evaluation of blood clotting parameters

Abstract

Purpose

For long time, blood clot retraction was measured only by thromboelastographic or platelet contractile force measurement techniques. The purpose of the present study was development of a novel ultrasonic method based on simultaneous monitoring of variations in the ultrasound velocity and the frequency spectrum of the signal propagating in clotting blood and its application for automatic evaluation of blood clotting parameters.

Methods

Simultaneous measurement of ultrasound velocity and variations in the frequency spectrum of wideband ultrasonic signals in clotting blood samples was performed. All measurements were performed in pulse-echo mode. Standard clinical data were obtained using routine clinical laboratory methods.

Results

The amplitudes of ultrasonic signals during native blood coagulation varied up to ten times for different frequencies. The measurement results of the start and duration of blood clot retraction differed between patient samples: different components of the blood coagulation system had significant impact on the blood clot retraction process.

Conclusions

Our results showed that during blood clotting, the ultrasound velocity and variations in frequency spectrum should be used simultaneously to determine the beginning and duration of blood clot retraction. Our results also showed that blood clot retraction is controlled by the activity of factor XIII.

Atypically presenting kaposiform hemangioendothelioma of the knee: ultrasound findings

Abstract

Kaposiform hemangioendothelioma (KHE) is a rare vascular tumor of early childhood and infancy. Kasabach–Merritt phenomenon, a common complication of KHE, is characterized by life-threatening thrombocytopenia, hemolytic anemia, and consumption coagulopathy. There may be atypical cases that do not present with Kasabach–Merritt phenomenon and do have atypical imaging findings. Knowledge of atypical imaging features may assist radiologists in identifying KHE. In this report, we present a 4-year-old case of KHE with atypical ultrasound findings.

Assessment of the renal collecting system using a pocket-sized ultrasound device

Abstract

Purpose

To assess the performance of a pocket-sized ultrasound device (PUD) for evaluating dilatation of the renal collecting system with high-end ultrasound devices (HUDs) as a reference standard.

Methods

One sonographer examined both kidneys using a PUD to evaluate dilatation of the collecting system. The grading of the dilatation ranged from 0 to 4. Immediately after the examination, another sonographer blinded to the previous results performed a formal examination with a HUD.

Results

Two hundred kidneys in 100 patients were included in the analysis. The agreement of grades between the PUD and HUDs was excellent (weighted kappa = 0.83; P < 0.001). When hydronephrosis was defined as grade 1 or higher, the test characteristics of the PUD were as follows: sensitivity 91% (95% confidence interval (CI) 79–97%), positive predictive value 73% (95% CI 60–83%), and negative predictive value 96% (95% CI 92–99%). When hydronephrosis was defined as grade 2 or higher, the test characteristics were as follows: sensitivity 88% (95% CI 73–97%), positive predictive value 75% (95% CI 59–87%), and negative predictive value 98% (95% CI 94–99%).

Conclusion

Ultrasound using a PUD is useful for evaluating dilatation of the collecting system, especially for ruling out its presence.

Prenatal diagnosis of mediastinal neurenteric cyst: a case report and review of the literature

Abstract

Neurenteric cyst is a very rare developmental anomaly. Prenatal diagnosis of mediastinal neurenteric cysts has been reported rarely. We present a case of neurenteric cyst associated with vertebral anomalies diagnosed by prenatal ultrasonography at 31 weeks of gestation, which was treated successfully in the early neonatal period. In addition, we searched the English literature for all cases of mediastinal neurenteric cyst diagnosed in the prenatal period reported to date. We found that only 17 cases were reported previously. We reviewed the reports of these 17 patients along with our case, and we investigated the prenatal and postnatal diagnosis and treatment approaches and the factors influencing the prognosis. Fetuses with mediastinal neurenteric cysts should be monitored regularly by ultrasonography. Fetuses with no signs of hydrops are more likely to survive with proper neonatal center transfer, regular follow-up, and appropriate postnatal approach. Fetuses with hydrops findings have a high risk of fetal and neonatal death.

Elderly Fitz-Hugh–Curtis syndrome observed with superb microvascular imaging system

Abstract

Fitz-Hugh–Curtis syndrome (FHCS) is defined as inflammation on the surface of the liver following sexually transmitted chlamydia infection. We successfully observed the microvascular structure of the inflamed portion between the abdominal wall and surface of the liver in an elderly patient with FHCS using a superb microvascular imaging (SMI) system, a new technology developed for observing minute vascular flow. An 80-year-old Japanese female with right dorsal to lateral abdominal pain and fever came to our hospital. Anti-chlamydia antibodies were positive. SMI revealed signals suggesting small vessels passing from the liver surface to the hypoechoic space.

Evaluation of carotid artery elasticity in patients with uremia by echo tracking

Abstract

Purpose

The purpose of this study was to compare the carotid artery wall elasticity between patients with uremia and controls using echo tracking (ET).

Methods

Ninety-three patients with uremia and 35 control subjects (Group A) were enrolled in this study. In the ET mode, the carotid artery elasticity parameters including stiffness index (β), pressure–strain elasticity modulus (EP), arterial compliance (AC), and one-point pulse wave velocity (PWVβ) were measured, and carotid intima–media thickness (IMT) was measured with B-mode ultrasonography. The patients were classified into three groups: Group B (normal IMT), Group C (thickened IMT), and Group D (one single atheroma plaque).

Results

β, EP, and PWVβ were significantly higher in Group B, C, and D (especially in group D) than those of the control group (P < 0.05), and there were significant differences between Group A and Group B, while AC was lower than in controls, but there were no statistically significant differences among the four groups.

Conclusions

ET is a noninvasive method that can demonstrate a loss in carotid artery elasticity in uremia patients with normal IMT.

Ultrasonographic images of the hand in a case with early eosinophilic fasciitis

Abstract

Eosinophilic fasciitis (EF), a rare rheumatic disease, usually affects the limbs symmetrically and generally spares the hands and feet. Cases of unilateral hand involvement are rarely reported. Here, we report such a rare case. Ultrasonography demonstrated thickening of the overlying skin and subcutaneous tissue, peripheral deep fascia, myositis of lumbrical muscles and adductor pollicis muscle, and edema surrounding flexor digitorum tendons. It reminds us that EF should be considered in the differential diagnosis of unilateral painful hand swelling despite being uncommon. Ultrasonography can be used to aid the diagnosis and monitor therapeutic response in patients with EF.

Renal shear wave elastography for the assessment of nephron hypertrophy: a cross-sectional study in chronic kidney disease

Abstract

Purpose

To investigate the association of renal elasticity to microscopic findings of nephron hypertrophy and nephrosclerosis.

Methods

Patients who underwent renal biopsy were enrolled. Renal elasticity was measured by acoustic radiation force impulse, and nephron size (glomerular volume, non-sclerotic glomerular density, and mean profile tubular area) and nephrosclerosis (globally sclerotic glomeruli and interstitial fibrosis) were estimated. Nephron hypertrophy was indicated by larger glomerular volume, larger tubular area, and lower non-sclerotic glomerular density. Nephrosclerosis was indicated by a higher percentage of globally sclerotic glomeruli and higher severity of fibrosis.

Results

Renal elasticity was negatively correlated with glomerular volume (r = − 0.480, P = 0.024) and mean tubular area (r = − 0.469, P = 0.028), but it was not correlated with non-sclerotic glomerular density (r = 0.205, P = 0.359), percentage of globally sclerotic glomeruli (r = 0.057, P = 0.800), and severity of fibrosis (r = 0.014, P = 0.950). In a multiple linear regression analysis, glomerular volume and mean tubular area were independently associated with renal elasticity (std β = − 0.454, P = 0.015 and std β = − 0.577, P = 0.007, respectively).

Conclusion

Renal elasticity was correlated with microstructural findings of nephron hypertrophy. Measuring renal elasticity could help in detecting kidney disease.

There is a significant relationship between morning blood pressure surge and increased abdominal aortic intima–media thickness in hypertensive patients

Abstract

Purpose

There are limited data about increased aortic intima–media thickness (A-IMT) in the presence of subclinical target organ damage in hypertensive (HT) patients. In this study, we aimed to determine the frequency of increased A-IMT, the parameters determining increased A-IMT, and the relationship between increased A-IMT and other vascular IMT measurements.

Materials and methods

We prospectively included 265 patients (mean age 54.1 ± 10.6 years, male/female 91/174) with essential HT. Physical examination of all patients was performed. Laboratory data and antihypertensive treatments were recorded. Twenty-four-hour ambulatory blood pressure monitoring (ABPM) was performed. Bilateral carotid, brachial, and femoral artery and abdominal A-IMT values were measured by B-mode ultrasonography (USG). Patients were categorized into two main groups: patients with increased A-IMT (≥ 3 mm) or normal A-IMT (< 3 mm).

Results

Increased A-IMT was detected in 55 patients (20.8%). There was a close relationship between increased A-IMT and advanced age, presence of coronary artery disease, high morning blood pressure surge (MBPS), and bilateral carotid and femoral IMT. Parameters associated with increased A-IMT in univariate analysis were assessed by regression analysis. Left femoral IMT and MBPS were independently associated with increased A-IMT. In the regression model, each 5-mmHg elevation in MBPS increased the risk of increased A-IMT by 34.2%. The cutoff value of MBPS obtained by the ROC curve analysis was 32 mmHg for the prediction of increased A-IMT (sensitivity 76.3%, specificity 63.5%). The area under the curve was 0.784 (95% CI 0.720–0.847, p < 0.001).

Conclusion

Abdominal A-IMT increased at a significant rate in patients with HT. An independent association was found between MBPS and A-IMT, which can both be easily detected by ABPM and B-mode USG. The high MBPS level was considered to be a simple and inexpensive method for detecting subclinical target organ damage. A-IMT measurement should also be a part of abdominal USG, which is a routine examination in HT patients.

Validation trial for efficacy of ultrasonographic measurement method to predict ascitic volume using virtual ultrasonography

Abstract

Purpose

The aim of this study was to clarify whether ultrasound quantitative methods were positively correlated with volume of ascites evaluated by whole abdominopelvic CT.

Methods

Sixty-eight patients with cirrhotic ascites were retrospectively analyzed. First, to confirm that virtual ultrasonography (VUS) is an alternative method to conventional ultrasound, 22 patients underwent both conventional ultrasonography and VUS. Second, the efficacy of US quantitative methods (3-point method, 4-point method, 5-point method, and Matsumoto's method) was confirmed by VUS in 68 patients. We assessed whether the ascites volume predicted by VUS corresponded with that calculated by 3D-CT. Of the 68 patients, 23 patients were analyzed before and after administration of tolvaptan.

Results

The predictive volumes calculated by VUS were remarkably relative to those yielded by conventional US. Correlations between exact volume and those measured by VUS were significantly high (3-point method: r = 0.882, p < 0.001; 4-point method: r = 0.797, p < 0.001; 5-point method: r = 0.836, p < 0.001; Matsumoto's method: r = 0.453, p < 0.001). Correlations between decreasing volume on 3D-CT and that measured by VUS were also significantly high in patients with administration of tolvaptan.

Conclusion

Ascites volume measured by ultrasound was effective, especially the 3-point and 5-point methods. It was useful to assess the efficacy of diuretics in cirrhotic patients.

A refractory hypertensive patient with fibromuscular dysplasia and multicystic dysplastic kidney

Abstract

The case of a 16-year-old male patient with left renal artery stenosis due to fibromuscular dysplasia (FMD) and an atrophic kidney due to a right multicystic dysplastic kidney (MCDK) who presented with refractory hypertension is reported. On continuous Doppler imaging, the peak systolic velocity (PSV) at the stenotic site of the left renal artery was 404 cm/s. The FMD formed a "string-of-beads" appearance on computed tomographic angiography (CTA) and renal artery angiography. Percutaneous transluminal renal angioplasty (PTRA) with a balloon catheter was performed, after which the left renal artery returned to near normal, and his blood pressure decreased to within the normal range. In this case, the main cause of refractory hypertension was considered to have been renal artery stenosis due to left FMD.

Increased nitroglycerin-mediated vasodilation in migraineurs without aura in the interictal period

Abstract

Purpose

Migraine is associated with vascular disorders, but the underlying mechanism is unknown. Nitric oxide (NO) sensitivity is believed to play a major role in migraine pathophysiology. We investigated flow-mediated vasodilatation (FMD) and nitroglycerin-mediated vasodilatation (NMD) of the brachial artery by means of a key molecular mediator, NO, in patients with migraine without aura in the interictal period whether the abnormality is found.

Methods

A total of 12 patients with migraine without aura and 12 matched healthy controls were enrolled in this study. FMD and NMD were measured in all patients and controls using brachial artery ultrasonography.

Results

There was no significant difference in brachial artery diameter between migraineurs and nonmigraineurs (3.39 ± 0.68 vs 3.89 ± 0.67 mm, respectively; p = 0.083). A significant difference in FMD was not found between migraineurs and nonmigraineurs (6.94 ± 5.72 vs 6.08 ± 2.98%, respectively; p = 0.651). However, NMD in migraineurs was significant higher than that in nonmigraineurs (21.56 ± 7.36 vs 14.23 ± 7.41%, respectively; p = 0.024).

Conclusion

We think that patients with migraine without aura in the interictal period have selective sensitivity in dilator response to nitroglycerin and may have systemic NO sensitivity.

Liver abscess due to Fusobacterium species detected on ultrasonography: a case report

Abstract

An oral infection harboring Fusobacterium species can gain entrance to the liver via hematogenous spread in the form of septic embolus, and can thereby cause abscesses. Such spread, described as Lemierre syndrome, is life threatening. We present such a case history of a man in his mid-40s, who presented with infection and Fusobacterium liver abscess with an acute fulminant disease course. The initial diagnosis was arrived at by ultrasound imaging and blood investigations. He was treated with antibiotics, ultrasound-guided liver abscess drainage, and extraction of the infected molar tooth. He was discharged 6 weeks after admission. To date, there have been no reports describing the ultrasound images of a Fusobacterium liver abscess in detail. Hence, we herein present the ultrasound images of a Fusobacterium liver abscess.

Prenatal diagnosis of funisitis: two case reports

Abstract

Acute funisitis is characterized by the infiltration of fetal neutrophils from the umbilical vessels into Wharton's jelly and presents as fetal inflammation. However, no reports about its prenatal diagnosis using ultrasonography have been published. We encountered one case of oligohydramnios at 26 weeks and another case of threatened premature delivery at 27 weeks of gestation with ultrasonographic findings of non-uniform thickening of Wharton's jelly, a heterogeneous internal echo, and a high echoic line of the umbilical vessel wall. Acute funisitis was diagnosed, and the postpartum histopathological examination revealed severe funisitis in both cases. To our knowledge, this is the first case report of prenatal diagnosis of funisitis determined using ultrasonography. When we find such ultrasonographic features under the circumstances of intrauterine infection, severe funisitis should be included in the differential diagnosis.

Only Imagine? Not Necessarily

In her recent book, Only Imagine, Kathleen Stock promotes extreme intentionalism with respect to fictional content.1¹ She writes, 'the fictional content of a particular text is equivalent to exactly what the author of the text intended the reader to imagine' (1). There are at least three separate points here: (i) the author's intentions determine the fictional content; (ii) the fictional content is (or should be) identical with the content of what the reader imagines; (iii) reading fiction necessarily entails imagining. The first two points are normative; they are concerned with truth in fiction. The third point takes for granted that fiction necessarily involves imagining on the part of the reader; the main debates here focus on the kind of imagining that is involved in reading fiction. In the following discussion, I leave aside the normative issues marked by the first two points and concentrate on the third point—namely, the relation between fiction and imagining.

Exploring the diagnosis and profile of cannabis allergy

Publication date: Available online 29 September 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Ine Ilona Decuyper, Athina Ludovica Van Gasse, Margaretha A. Faber, Jessy Elst, Christel Mertens, Hans-Peter Rihs, Margo M. Hagendorens, Vito Sabato, Hilde Lapeere, Chris H. Bridts, Luc S. De Clerck, Didier Gaston Ebo

ABSTRACT

Background

Cannabis allergy (CA) has mainly been attributed to Can s 3, the nsLTP (non-specific lipid transfer proten) of Cannabis sativa. Nevertheless, standardized diagnostic tests are lacking and research on CA is scarce.

Objective

To explore the performance of five cannabis diagnostic tests and the phenotypic profile of CA.

Methods

120 CA patients were included and stratified according to the nature of their cannabis-related symptoms, 62 healthy and 189 atopic controls were included. Specific (s)IgE hemp, sIgE and BAT rCan s 3, BAT with a crude cannabis extract and a skin prick test (SPT) with a nCan s 3-rich cannabis extract were performed. Clinical information was based on patient-history and a standardized questionnaire.

Results

Firstly, up to 72% of CA reporting likely-anaphylaxis (CA-A) are Can s 3 sensitized. Actually, the Can s 3-based diagnostic tests show the best combination of positive and negative predictive values; 80% and 60%, respectively. sIgE hemp displays 82% sensitivity but only 32% specificity. Secondly, Can s 3+CA reported significantly more cofactor mediated reactions and displayed significantly more sensitizations to other nsLTPs than Can s 3-CA. Finally, the highest prevalence of systemic reactions to plant-derived foods was seen in CA-A, namely 72%.

Conclusions

The most effective and practical tests to confirm CA are the SPT with a nCan s 3-rich extract and the sIgE rCan s 3. Can s 3 entails a risk of systemic reactions to plant-derived foods and cofactor-mediated reactions. However, as Can s 3 sensitization is not absolute, other cannabis allergens probably play a role.

OCCURRENCE AND PERSISTENCE OF BIOFILMS ON CARED CHRONIC WOUNDS: A large multicentric clinical study: Short title: biofilm and chronic wounds

Publication date: Available online 29 September 2018

Source: Wound Medicine

Author(s): Fromantin Isabelle, Seyer Damien, Florence Rollot, Sylvie Meaume, Chauty Annick, Alhassane Diallo, Marie Christine Escande, Luc Teot, Garde Véronique Larreta

CDKN2A germline mutations are not associated with poor survival in an Italian cohort of melanoma patients

Publication date: Available online 28 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Bruna Dalmasso, Lorenza Pastorino, Giulia Ciccarese, Virginia Andreotti, Federica Grillo, Luca Mastracci, Francesco Spagnolo, Alberto Ballestrero, Paola Queirolo, William Bruno, Paola Ghiorzo

Background

Cyclin dependent kinase inhibitor 2A gene (CDKN2A) germline mutations have recently been associated with poor survival in patients with melanoma. Despite the high mutation rate in our cohort (up to 10% in patients with apparently sporadic melanoma), information on the impact of CDKN2A on survival in this cohort is lacking.

Objective

To investigate whether poor survival associated with CDKN2A germline mutations was confirmed in a high mutation–prevalence cohort of Italian patients with melanoma undergoing a mutation-based follow-up.

Methods

A total of 1239 patients with cutaneous melanoma were tested for CDKN2A mutational status and then assigned to a follow-up scheme according not only to family history but also to CDKN2A mutational status, as follow-up intervals were more frequent for CDKN2A germline mutation–positive (MUT⁺) patients. From this cohort, we selected 106 MUT⁺ patients (with familial melanoma or apparently sporadic melanoma) and 199 CDKN2A germline mutation–negative (MUT^–) patients with sporadic melanoma who were matched by age and sex and had a similar tumor stage distribution.

Results

We found no difference in overall survival (hazard ratio, 0.85; 95% confidence interval, 0.48-1.52; P = .592,) or melanoma-specific survival (hazard ratio, 0.86; 95% confidence interval, 0.38-1.95; P = .718,) between MUT⁺ and MUT^– patients. MUT⁺ patients were more likely to develop multiple melanomas and to undergo surgical excision of dysplastic nevi than were MUT^– patients.

Limitations

Retrospective study.

Conclusion

CDKN2A mutations were not associated with survival in our cohort.

Chirurgie oncoplastique du sein

Publication date: Available online 28 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): A. Baratte, C. Mathelin, L. Ruffenach, C. Bruant-Rodier, C. Dissaux

Résumé

La chirurgie oncoplastique est la chirurgie plastique appliquée aux exérèses des tumeurs mammaires. Les traitements conservateurs des cancers du sein sont souvent suffisants et moins traumatisants psychologiquement que les mastectomies totales. Mais les mastectomies partielles peuvent déformer le sein, source de problèmes d'acceptation du corps et à l'origine de réinterventions. La chirurgie oncoplastique vise la conservation d'une forme de sein acceptable, et va du simple remodelage glandulaire à des procédés plus complexes modifiant la base mammaire. Selon le quadrant atteint (supéro-interne, supéro-externe, inféro-interne, inféro-externe, union de quadrants, tumeurs de la plaque aréolo-mamelonnaire ou tumeurs du sillon sous-mammaire), mais aussi selon la proximité de la lésion par rapport à l'aréole, et selon le rapport entre la taille du sein et la taille tumorale, différents procédés sont proposés. Les retouches à distance sont peu nombreuses. La symétrisation peut s'envisager d'emblée ou secondairement.

Summary

Oncoplastic surgery is to treat breast tumors with the help of plastic surgery. Efficiency of breast-conserving treatments (BCT) compared to mastectomies is equivalent. BCT is better accepted but can cause breast deformity, thus further operations. Oncoplastic surgery aims at conserving an acceptable shape to the breast. It ranges from simple remodeling to more complex techniques modifying the width of the breast. According to the quadrant to treat (inner upper, outer upper, inner lower, outer lower, union of quadrants, tumors of the nipple-areola complex, tumors of the inframammary fold), according to the proximity of the tumor to the nipple, and to the size of the breast and tumor, various techniques are displayed. Few touch ups are necessary. Symmetry is managed during the initial operation or after.

Spontaneous Regeneration of Bone in Segmental Mandibular Defect

Abstract

Aim

To highlight the spontaneous regeneration of mandibular segmental defects in young and pediatric cases and to review the literature of this unusual and rare phenomenon.

Methodology

Two case reports of a 17-year old male and a 8-month-old infant has been presented who underwent resection of mandible for benign tumors. These two cases have been compared with the existing literature of 61 cases published till date.

Inference

Spontaneous regeneration of mandible as a viable reconstructive option is not practically feasible. The consistency and predictability of the phenomenon is questionable. Bone grafting should probably be done immediately in all cases, even in young patients if a delay would interfere with quality of life. In infants and small children though, we propose that immediate reconstruction may be avoided to allow some regeneration at the defect site. If it does not occur, secondary reconstruction may then be considered.

MC1R CpG island regulates MC1R expression and is methylated in a subset of melanoma tumours

Pigment Cell &Melanoma Research, Volume 0, Issue ja, -Not available-.

Increased expression of interleukin‐9 in patients with allergic contact dermatitis caused by p‐phenylenediamine

Contact Dermatitis, EarlyView.

Allergic contact dermatitis caused by medical devices for diabetes patients: A review

Contact Dermatitis, EarlyView.

“Crossed” allergic contact dermatitis caused by oxidized vitamin K1 in a patient previously sensitized to non‐oxidized vitamin K1

Contact Dermatitis, EarlyView.

The Protective Effect of Violaxanthin from Nannochloropsis oceanica against Ultraviolet B‐Induced Damage in Normal Human Dermal Fibroblasts

Photochemistry and Photobiology, Volume 0, Issue ja, -Not available-.

Enlarging plaque on the sole

Clinical and Experimental Dermatology, EarlyView.

Bullous pemphigoid in a 3‐month‐old infant after vaccination

Clinical and Experimental Dermatology, EarlyView.

Neutrophilic dermatosis associated with an NFKB2 mutation

Clinical and Experimental Dermatology, EarlyView.

Cutaneous features of Zika virus infection: a clinicopathological overview

Clinical and Experimental Dermatology, EarlyView.

First reported case of dermatofibrosarcoma in siblings

Clinical and Experimental Dermatology, EarlyView.

Description of a new pigmentary demarcation line (Type I)

Clinical and Experimental Dermatology, EarlyView.

Quality of Life in Hand Eczema Questionnaire: Validation of the Japanese version of a disease‐specific measure of quality of life for hand eczema patients

The Journal of Dermatology, EarlyView.

Epidemiology and bone‐related comorbidities of ingrown nail: A nationwide population‐based study

The Journal of Dermatology, EarlyView.

Psoriasiform keratosis shows abnormal keratinization and increased number of T‐helper 17 cells in psoriasiform keratosis implying a pathogenic link to psoriasis

The Journal of Dermatology, EarlyView.

Malassezia infections with systemic involvement: Figures and facts

The Journal of Dermatology, EarlyView.

Familial or sporadic porokeratosis as an autoinflammatory keratinization disease

The Journal of Dermatology, EarlyView.

Anterolateral leg alopecia: unknown entity or yet underreported?

International Journal of Dermatology, EarlyView.

Factors impairing cell proliferation in the granulation tissue of pressure ulcers: impact of bacterial burden

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Cervical lymphadenopathy from PRP treatment with microneedling therapy

Journal of Cosmetic Dermatology, EarlyView.

Should we provide anti‐HPV vaccination for patients with genital hidradenitis suppurativa?

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

Novel therapeutic approaches to xeroderma pigmentosum

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

Current Therapeutic Approaches to DCIS

Abstract

Treatment for ductal carcinoma in-situ (DCIS) has historically been extrapolated from studies of invasive breast cancer. Accepted local therapy approaches range from small local excisions, with or without radiation, to bilateral mastectomies. Systemic treatment with endocrine therapy is often recommended for hormone positive patients. With improvements in imaging, pathologic review, and treatment techniques in the modern era, combined with new information regarding tumor biology, the management of DCIS is rapidly evolving. A multidisciplinary approach to treatment is now more important than ever, with a shift towards de-escalating therapy to reduce treatment related toxicity. This review focuses on nuances of clinical management of DCIS in the modern era, highlighting key differences between DCIS as compared to invasive breast cancer. The American Cancer Society (ACS) currently recommends beginning screening with annual mammograms for women age 45, with the option to start at age 40. As treatment of DCIS has not been shown to impact survival, the USPSTF has more conservative screening recommendations of biennial mammograms from age 50–74. Unlike invasive breast cancer, DCIS is almost exclusively diagnosed by mammographic detection, and lymph node evaluation is not recommended. Pathologic review of biopsy specimens should follow the guidelines of the College of American Pathologists. Surgical management options include breast conservation, mastectomy, or possibly nipple sparing mastectomy, with upfront sentinel lymph node evaluation in the case of mastectomy. Radiation therapy is generally recommended as a component of breast conserving therapy for patients with DCIS, though in some low risk patients, there is trial data to suggest that adjuvant radiation may be omitted. Techniques for minimizing radiation toxicity should always be emphasized. Endocrine therapy is offered to women with hormone positive DCIS who have undergone lumpectomy for risk reduction, and has the benefit of decreasing incidence of events in both the ipsilateral and contralateral breast. More recent studies have explored use of targeted treatments such as trastuzumab in DCIS for HER2 overexpression. Future directions include tailoring therapy based on patient characteristics and tumor biology. With so many different options for treatment, it is also critical to engage in a discussion with the patient to arrive at a treatment decision that balances patient preferences for disease control versus treatment toxicity, financial toxicity, cosmesis, and quality of life.

Current Therapeutic Approaches to DCIS

Abstract

Treatment for ductal carcinoma in-situ (DCIS) has historically been extrapolated from studies of invasive breast cancer. Accepted local therapy approaches range from small local excisions, with or without radiation, to bilateral mastectomies. Systemic treatment with endocrine therapy is often recommended for hormone positive patients. With improvements in imaging, pathologic review, and treatment techniques in the modern era, combined with new information regarding tumor biology, the management of DCIS is rapidly evolving. A multidisciplinary approach to treatment is now more important than ever, with a shift towards de-escalating therapy to reduce treatment related toxicity. This review focuses on nuances of clinical management of DCIS in the modern era, highlighting key differences between DCIS as compared to invasive breast cancer. The American Cancer Society (ACS) currently recommends beginning screening with annual mammograms for women age 45, with the option to start at age 40. As treatment of DCIS has not been shown to impact survival, the USPSTF has more conservative screening recommendations of biennial mammograms from age 50–74. Unlike invasive breast cancer, DCIS is almost exclusively diagnosed by mammographic detection, and lymph node evaluation is not recommended. Pathologic review of biopsy specimens should follow the guidelines of the College of American Pathologists. Surgical management options include breast conservation, mastectomy, or possibly nipple sparing mastectomy, with upfront sentinel lymph node evaluation in the case of mastectomy. Radiation therapy is generally recommended as a component of breast conserving therapy for patients with DCIS, though in some low risk patients, there is trial data to suggest that adjuvant radiation may be omitted. Techniques for minimizing radiation toxicity should always be emphasized. Endocrine therapy is offered to women with hormone positive DCIS who have undergone lumpectomy for risk reduction, and has the benefit of decreasing incidence of events in both the ipsilateral and contralateral breast. More recent studies have explored use of targeted treatments such as trastuzumab in DCIS for HER2 overexpression. Future directions include tailoring therapy based on patient characteristics and tumor biology. With so many different options for treatment, it is also critical to engage in a discussion with the patient to arrive at a treatment decision that balances patient preferences for disease control versus treatment toxicity, financial toxicity, cosmesis, and quality of life.

FDA Approves Cemiplimab, First Drug for Advanced CSCC

The US Food and Drug Administration today approved cemiplimab for the treatment of patients with metastatic cutaneous squamous cell carcinoma (CSCC) or locally advanced, unresectable CSCC.
FDA Approvals

Trichothiodystrophy: A rare association of brittle hair, ichthyosis, and epilepsy

GS Asha, Tapasya S Kini, KS Chandan, P Mahanthesh

Indian Journal of Paediatric Dermatology 2018 19(4):357-359

Trichothiodystrophy (TTD) is a rare autosomal recessive genetic disorder characterized by abnormal synthesis of sulfur-containing keratins and consequently hair dysplasia, associated with numerous symptoms affecting mainly organs derived from the neuroectoderm. The deficiency of cysteine and methionine explains the fragility and the regular undulation of the hair shaft of patients with TTD, appreciated as the characteristic tiger tail appearance on polarized microscopy. We report a case of TTD with a rare association of brittle hair, ichthyosis, and epilepsy, classified as Tay syndrome based on clinical features and complementary examinations.

Seeing beyond, mimicker of genital lesions and a personal view

Ebtisam Elghblawi

Indian Journal of Paediatric Dermatology 2018 19(4):382-383

Allergic contact dermatitis in atopic dermatitis

Sandipan Dhar, Sahana M Srinivas, Ashok K Bajaj

Indian Journal of Paediatric Dermatology 2018 19(4):304-307

Atopic dermatitis (AD) coexisting with allergic contact dermatitis (ACD) is not uncommon. There has been lot of controversies regarding this concept as the prevalence of ACD in AD is similar to that seen in nonatopics. There is increased susceptibility to ACD in AD as AD modulates the exposure to allergens. There is an impaired barrier function that predisposes to the development of ACD in AD. Patch testing is a standard test for detecting allergens in AD.

Eczema herpeticum in a patient with atopic dermatitis, coxsackie B virus, and staphylococcal infection: A double skin damage

Andrea D Pratico, Valentina Fatuzzo, Maria Elena Cucuzza, Flavia M C La Mendola

Indian Journal of Paediatric Dermatology 2018 19(4):369-370

Eczema herpeticum is a rare viral skin scattered infection whose main etiologic agents are HSV1–2 and coxsackievirus, but its association with atopic dermatitis suggests that different factors may play a role in this complex phenotype. When not promptly treated, it can spread to other organs, causing severe complications such as keratoconjunctivitis, encephalitis, and meningitis. We describe the case of a patient with atopic dermatitis who came to our observation presenting with diffuse purulent vesicular lesions, whose bacterial culture was positive for Staphylococcus aureus and whose serologic examinations showed IgM positivity for coxsackie B virus.

Childhood psoriasis: What is new and what is news

Sunil Dogra, Anuradha Bishnoi

Indian Journal of Paediatric Dermatology 2018 19(4):308-314

Psoriasis is a chronic inflammatory disorder that affects around 2%–4% of the general population, and the prevalence can be higher in selected populations. About one-third of the people affected with psoriasis have the onset of their disease in the first and second decades of life. Of the pediatric population, about 0.5%–2% is affected. Infants are affected rarely. The incidence increases with age and is reported to be ~0.55% in the age group of 0–9 years and 1.37% in the age group of 10–19 years. Flexures, face, periauricular area and medial aspect of the upper eyelid are commonly involved in children. In infants, there is predilection for diaper area. Overall, plaque psoriasis is the most common type, followed by guttate and pustular psoriasis. Lesions are more pruritic, but thinner, less erythematous, and less scaly. Follicular lesions are common. Treating psoriatic erythroderma can pose difficulties, especially in pediatric population. Some cases achieve rapid control of disease activity, while others develop chronic erythroderma with frequent disease flares. The impact of disease on psychosocial parameters is significant in this subgroup of psoriasis and affects patients and parents alike with significantly high rates of absenteeism from school. Pediatric psoriasis therefore needs to be managed effectively. However, effective treatment also poses the risk of producing adverse effects, more so in pediatric age group. A delicate balance therefore should be maintained and overzealous treatment should be avoided.

Infantile hemangiomas: An update on pathogenesis, associations, and management

Karina L Vivar, Anthony J Mancini

Indian Journal of Paediatric Dermatology 2018 19(4):293-303

Infantile hemangiomas (IH) are the most common vascular neoplasm in infants. The typical clinical course of IH follows a pattern of growth (proliferation) followed by spontaneous involution. The majority of IH are isolated to the skin; however, some cutaneous IH can be associated with internal organ involvement or anomalies. IH which are functionally impairing, ulcerated or potentially disfiguring require therapy. Treatment options include systemic or topical beta-blockers, systemic or intralesional corticosteroids, pulsed dye laser therapy, or surgical excision. In this article, we review the updated understanding of IH pathogenesis, clinical presentations and associations, and approaches to management.

Does color really matter? Reliability of transcutaneous bilirubinometry in different skin-colored babies

Pearl Mary Varughese, Lalitha Krishnan, Ravichandran

Indian Journal of Paediatric Dermatology 2018 19(4):315-320

Background: Transcutaneous bilirubinometry, in keeping with rapid technological advances, has come a long way as an effective tool for assessing bilirubin levels in newborns. Though the early devices showed changes due to melanin concentration, the new generation devices were based on micro-spectrometry. Color coded scales were rarely used for the comparison. Hence the primary outcome is that TcBI is more reliable in lighter skin color babies than darker skin color babies.Objective: To study the reliability of TcB in different skin color babies. Materials and Methods: The study was conducted in a tertiary newborn center from November 2014 to June 2016. The inclusion criteria included all babies above 34 weeks gestation and exclusion criteria included babies with established direct hyperbilirubinemia, neonatal septicemia, major congenital/ gastrointestinal malformations and those on phototherapy. 396 babies were recruited. At 24 hours, babies were categorized based on Fitzpatrick skin color chart. Statistical analysis was done using the ROC curves Bland Altman charts. Results: Mean TcB was found to be uniformly higher than TSB for all variables like sex, birth weight, gestational age and growth of the baby with an excellent correlation (r = 0.698-0.932). 335 babies (74.4%) were falling in the color code 3. 113 babies (25.1%) were in the color code 4 and 2 babies (0.4%) were in the color code 5. TcB correlates better in light skin tone babies (color code 3) than dark skin tone babies (color code 4) with r= 0.874 and r= 0.856 respectively. Conclusion: Though TcB overestimates; it correlates well with TSB in lighter skin tone babies than babies with darker skin tone.

Klippel–Trenaunay syndrome affecting an uncommon site

Ibrahim Aliyu, Godpower Chinedu Michael

Indian Journal of Paediatric Dermatology 2018 19(4):363-365

Klippel–Trenaunay syndrome (KTS) is characterized by the triad of varicosity of cutaneous veins, port wine stains, and soft tissue/bone overgrowth. It was first described by French physicians Klippel and Trenaunay in 1900. There is often overlap between KTS and Parkes Weber syndrome. The lower extremities are mostly affected and it is usually asymmetric; other sites involved are the upper limbs, trunk, and rarely, the head and face region. Therefore, the case of a 5-year-old girl who presented with KTS symmetrically involving the trunk and lower limbs is reported.

A hospital-based clinical study of childhood psoriasis in a tertiary care center of Northeast India

Seujee Das, Pankaj Adhicari

Indian Journal of Paediatric Dermatology 2018 19(4):321-325

Background: Childhood psoriasis has been reported to differ from that among adults. There are a limited number of studies on childhood psoriasis and none from the north-eastern part of India. A detailed clinical study will help to understand better the disease profile in children, thereby assisting in better diagnosis and treatment. Objective: The objective of this study was the clinical profile of childhood psoriasis. Materials and Methods: The present observational study was conducted in the Dermatology Outpatient Department of Assam Medical College and Hospital, Dibrugarh, during 12 months from June 2014 to May 2015. All children up to 13 years presenting with psoriasis during 1 year were taken as study participants after obtaining the written consent from the sole guardian. A detailed examination and relevant investigations were done, whenever necessary. The findings were recorded in a pro forma for the analysis and interpretation of data. Results: A total of 26 cases of childhood psoriasis were recorded during the study. The prevalence of childhood psoriasis in our outpatient pediatric population was 1.24%. Female cases (19; 73.08%) outnumbered male cases (7; 26.92%). A maximum number of cases were noted in 9–13 years of age group. The lower extremities (11; 42.31%) were the most common site of onset. Plaque type (14; 53.85%) was found to be the most common type. About 7.69% cases had a positive family history. Conclusion: Frequent involvement of soles was noted in childhood psoriasis similar to other parts of India but unlike other parts of the world. Pediatric patients had significantly more involvement of the trunk, face, and groin than did adult patients.

Hot topics in pediatric dermatology

Vishal Thakur, Dipankar De

Indian Journal of Paediatric Dermatology 2018 19(4):375-379

Clinicomycological study of dermatophytoses in children: Presenting at a tertiary care center

Nitin Mishra, Madhur Kant Rastogi, Pratik Gahalaut, Sandhya Yadav, Neeraj Srivastava, Anuj Aggarwal

Indian Journal of Paediatric Dermatology 2018 19(4):326-330

Background: Superficial tinea infections are some of the most common dermatological conditions in children. Recently, few studies done showed abrupt increase in dermatophytic infection in adults; however, similar recent studies describing clinicoepidemiological pattern in pediatric population are lacking. Aims and Objectives: The aims and objectives of this study are to identify the epidemiological profile of the dermatophytoses among pediatric population. Materials and Methods: Pediatric patients with suspected tinea infections presenting in the Department of Dermatology at a tertiary care medical college hospital in Northern India from April 2016 to 2017 were evaluated for inclusion in this study. Samples were collected in two parts; if first part was found to be potassium hydroxide (KOH) positive for septate hyphae, the second part was sent for fungal culture subsequently. Statistical Analysis Used: SPSS version 20 was used for statistical analysis. Results: Out of 235 patients, 152 were male and 83 were female. Only 200/235 (85.1%) KOH positive enrolled patients yielded positive fungal culture. Most common species identified on culture was Trichophyton mentagrophytes, followed by Trichophyton rubrum, and Trichophyton violaceum. Trunk was the most common site affected in 29.4% patients, palms and soles were least affected. Conclusion: More number of patients applied topical steroid for a longer period of time in patients with extensive disease as compared to limited disease. The present study provides evidence that dermatophytosis in pediatric patients is following the pattern of adult dermatophytosis clinically and microbiologically now.

An unusual presentation of congenital melanocytic nevus

Ibrahim Aliyu

Indian Journal of Paediatric Dermatology 2018 19(4):385-386

Epidemiology of pediculosis capitis among schoolchildren in Damascus, Syria

Mohammad Taher Ismail, Mohammad Maher Kabakibi, Abeer Al-Kafri

Indian Journal of Paediatric Dermatology 2018 19(4):331-334

Background: Pediculosis is a common ectoparasitic infection in schoolchildren, causing a public health problem, which is neglected in Syria. Objective: This study aimed to determine the prevalence of infestation with head lice among primary schoolchildren in Damascus, Syria, and explore the predisposing factors of head lice infestation in public schools. Materials and Methods: The present study was to determine the head lice infestation (pediculosis) levels in primary schoolchildren, from March to July 2017. A total of 8689 (females: 4392, males 4297) schoolchildren aged 6–12 years from 18 selected primary school of Damascus city and countryside were examined for head lice. Pediculosis was defined as the presence of at least on living adult, nymph, or viable egg. Results: The overall head lice infestation rate was 14. 3% (1243/8689) and infestation rate was higher in girls (23.72%, 1042/4392) than in boys (4.67%, 201/4297). The infestation rate among schoolchildren varied from 1.4% to 60.7% and depended on the age group is 18.10% (6–8 years), 12.22% (9–10 years), and 13.30% (11–12 years). The infestation rate among girls varied from 22.2% (10–12-year-old group) to 42.8% (6–8-year-old group). Conclusions: Pediculosis is a common public health problem affecting primary schoolchildren in Damascus area, and the levels of infestation are of an endemic significance.

Lymphoplasmacytic plaque in children: An emerging new clinical entity

Sadhika Ganni, Sasi Kiran Attili, Raghurama Rao Gandikota, Kollipara Haritha

Indian Journal of Paediatric Dermatology 2018 19(4):354-356

Pretibial lymphoplasmacytic plaque in children is a rare emerging clinicopathological entity characterized by asymptomatic benign solitary plaque. Most of the cases are reported in healthy females. The treatment of choice is topical steroids.

Reticulate dyschromia, congenital atrichia and speech delay in a child: A diagnostic dilemma

Tasleem Arif, Mohammad Adil, Syed Suhail Amin

Indian Journal of Paediatric Dermatology 2018 19(4):335-338

Disorders of reticulate dyschromia can be diagnosed on the basis of the distribution and type of pigmentation in association with coexisting abnormalities. We describe a 4-year-old male child with reticulate dyschromia of the dorsal aspects of hands and feet and over the axillae, buttocks, and groins. The child had near complete absence of hair over body since birth. Skin-colored firm papules were present over dorsal aspects of hands and feet, and milestones were delayed for speech. We discuss the probable differentials in this article and why it fits none of the existing differentials.

Restrictive dermopathy: Report of two cases

Anisha K Janardhanan, Sarita Sasidharanpillai, Aparna S Vidya, Babu Francis, Mohandas Nair Karippoth

Indian Journal of Paediatric Dermatology 2018 19(4):360-362

Restrictive dermopathy is a rare entity that is fatal in the neonatal period itself. The rigidity of the skin leads to erosions, contractures, and restriction of respiratory movements. Diagnosis is often made clinically with classical features such as low-set ears, micrognathia, small, and persistently open fixed "o"-shaped mouth, translucent, shiny, rigid skin with prominent superficial blood vessels, and pseudocontractures of limb joints. We report two cases of restrictive dermopathy observed in our center within 2 years period and suggest that this condition may not be as rare as believed.

Bleomycin-induced flagellate dermatosis in a 7-Year-Old child: A case report with review of literature

Preeti Sharma, Rajesh Sinha, Dhiraj Kumar, Amit Kumar

Indian Journal of Paediatric Dermatology 2018 19(4):339-341

A 7-year-old female known case of nonseminomatous germ cell tumor was on treatment with bleomycin, etoposide, and cisplatin (BEP) regimen. After completing two cycles of BEP regimen, she developed linear hyperpigmented lesions in flagellate-like pattern on the trunk, neck, arms, and legs. After cessation of bleomycin, the patient started to improve.

Idiopathic localized involutional lipoatrophy in a child with spontaneous resolution

Reena Kumari Sharma, Mudita Gupta, Anuj Sharma

Indian Journal of Paediatric Dermatology 2018 19(4):366-368

Idiopathic localized involutional lipoatrophy (ILIL) is focal loss of subcutaneous tissue without any clinical or histopathological inflammation. Histopathology of ILIL characteristically shows diminutive fat lobules composed of small adipocyte resembling embryonic fat tissue. Immunohistochemical examination reveals a number of CD-68 positive macrophages in the fat lobules. Most reported cases of ILIL were unilateral in young women; we are reporting a case of 4-year-old child with bilateral involvement showing quick spontaneous resolution.

Dermoscopy of branchial fistula

Subrata Malakar, Priya Diwaker, Pratibha Pradhan

Indian Journal of Paediatric Dermatology 2018 19(4):342-343

Branchial fistula is a congenital anomaly resulting from failure of closure of one of the four branchial clefts. It is usually a clinical diagnosis, but dermoscopy helps in highlighting its features, thereby avoiding the need of imaging studies and other invasive diagnostic procedures. Here, we report a case of 3-year-old female patient who presented with asymptomatic tiny papule on the neck since early childhood. Dermoscopy was done to describe the features of branchial fistula and cleft.

Hutchinson's signs in dermatology

Manjyot Gautam, Palak Sheth

Indian Journal of Paediatric Dermatology 2018 19(4):371-374

Japan Singapore Skin Conference 2019

The Editor's Choice

Editorial board

Confucius and Kierkegaard: A Compatibilist Account of Social Ontology, Acquired Selfhood, and the Sources of Normativity

Abstract

Nearly all of the scant comparative work on Søren Kierkegaard and Confucius places the two starkly at odds with each other. Kierkegaard is pictured as the paradigmatic exemplar of the Western self: a discrete rights-bearing and volitional atom who is quite alone in the world, while Confucius, by contrast, is the paradigmatic exemplar of the Eastern self: a complex and irreducibly embedded communitarian bundle of relations and rich social roles. In this article, I challenge this oppositional approach, since it is both erroneous and obscures fruitful dialogue between the two on conceptually commensurate problems. I argue (1) that Kierkegaard offers a relational ontology of the self which moves in a Confucian direction, (2) that subjectivity and relational reciprocity are not fundamentally at odds in the two thinkers, (3) that both thinkers value a life of harmonious integration that entails right relation to others, and finally (4) that Confucius' appeal to Heaven as a source of normativity allows for salutary social critique of prevailing ethical norms and practices, in a way that provides important comparative insights with Kierkegaardian theism.

Wang, Daiyu, The First Islamic Classic in Chinese: W ANG Daiyu’s Real Commentary on the True Teaching

Wittgenstein and the Xunzi on the Clarification of Language

Abstract

Broadly speaking, language is part of a social activity in both Wittgenstein and Xunzi 荀子, and for both clarification of language is central to their philosophical projects; the goal of this article is to explore the extent of resonance and discord that may be found when comparing these two philosophers. While for Xunzi, the rectification of names (zhengming 正名) is anchored in a regard for establishing, propagating, and/or restoring a harmonious social system, perspicuity is for Wittgenstein represented as a philosophical end in itself. The article ventures study in particular the themes of perspicuity and aspect-perception in Wittgenstein together with the topics of correcting names and the cultivation of the heart-mind (xin 心) in the Xunzi. The aspiration of this project is to gain an overview of the role(s) of clarification projects in different philosophical traditions, all while not overlooking the different historical contexts and philosophical ends of these two philosophers.

On the Interpreter’s Choices: Making Hermeneutic Relativity Explicit

Abstract

In this essay, we explore the various aspects of hermeneutic relativity that have rarely been explicitly discussed. Our notion of "hermeneutic relativity" can be seen as an extension, with significant revisions, of Gadamer's notion of Vorurteil. It refers to various choices and constraints of the interpreter, including beliefs concerning the best way of doing philosophy, what criteria are to be used to evaluate competing interpretations, and so on. The interpreter cannot completely eliminate the guidance and constraint originating from his/her "background." However, in principle the interpreter can "choose" to be guided by other constraints. Hence, we speak of "choices" or "commitments." Hermeneutic relativity is the major cause for the variation of competing interpretations.

Is the Question “Who Does the Sounding?” Meaningful?

Anscombe’s “I,” Zhuangzi’s Pipings of Heaven, and The Self That Plays the Ten Thousand Things: Remarks on Thomas Ming’s “Who Does the Sounding?”

Antiviral potentials of Lactobacillus plantarum , Lactobacillus amylovorus , and Enterococcus hirae against selected Enterovirus

Abstract

Enteroviruses have been associated with a host of clinical presentations including acute flaccid paralysis (AFP). The site of primary replication for most enteroviruses is the gastrointestinal tract (GIT) and lactic acid bacteria (LAB) may confer protection in the GIT against them. This study therefore investigates the antiviral potential of some selected lactic acid bacteria against enterovirus isolates recovered from AFP cases. The antiviral activities of Lactobacillus plantarum, Lactobacillus amylovorus, and Enterococcus hirae in broth culture, their cell-free supernatant (CFS), and bacterial cell pellets were assayed against Echovirus 7 (E7), E13, and E19 in a pre- and post-treatment approach using cytopathic effect (CPE) and cell viability (MTT) assay. The tested Lactobacillus plantarum, Lactobacillus amylovorus, and Enterococcus hirae strains have good antiviral properties against E7 and E19 but not against E13. Lactobacillus amylovorus AA099 shows the highest activity against E19. The pre-treatment approach displays better antiviral activities compared to post-treatment approach. The LAB in broth suspension have better antiviral activities than their corresponding CFS and bacterial pellet. Lactic acid bacteria used in this study have the potential as antiviral agents.

NEDD4 is involved in inflammation development during keloid formation

Keloids mark a chronic inflammatory disease characterized by a fibroproliferative disorder of the skin. A genome-wide association study (GWAS) has revealed that single nucleotide polymorphism (SNP) rs8032158 in the neural precursor cell expressed, developmentally down-regulated 4 (NEDD4) gene, which has six protein-coding transcript variants (TV), is genetically linked with keloid. Here we show a high frequency of the risk allele C in rs8032158 in keloid patients is associated with a selectively higher expression of TV3 of NEDD4 to activate the NFκB pathway.

Notch-signaling activity determines uptake and biological effect of imatinib in systemic sclerosis dermal fibroblasts.

Tyrosine kinase inhibitors (TKI) have emerged as therapeutic option for rheumatic diseases such as systemic sclerosis (SSc). Since TKs like c-Abl kinase are important for fibroblast activation and fibrosis development in SSc, the c-Abl inhibitor imatinib was proposed for SSc treatment. Transporters for organic cations have become increasingly recognized as an important determinant for uptake and efficacy of TKI. Therefore, we investigated the role of organic cation transporters in the uptake of imatinib.

Imaging of salivary gland pathology

The major salivary glands can be affected by a variety of acute or chronic, systemic, and neoplastic conditions. Several modalities can be used for salivary gland imaging, each with its own advantages and limitations. The article reviews the optimal imaging modality for different clinical scenarios, the typical imaging appearance of commonly encountered pathologies, and seeks to provide a framework for generating an appropriate differential diagnosis. Additionally, with regard to neoplastic conditions, the goals of the review are to highlight features suggestive of benign or low-grade lesions verses high grade malignancy, while recognizing the limitations of imaging in making specific histologic diagnoses.

CDKN2A germline mutations are not associated with poor survival in an Italian cohort of melanoma patients

Cyclin dependent kinase inhibitor 2A gene (CDKN2A) germline mutations have recently been associated with poor survival in patients with melanoma. Despite the high mutation rate in our cohort (up to 10% in patients with apparently sporadic melanoma), information on the impact of CDKN2A on survival in this cohort is lacking.

Exchanging for Reasons, Right and Wrong

Constructivism and the Problem of Normative Indeterminacy

Mechanisms, resources, and background conditions

Abstract

Distinguishing mechanistic components from mere causally relevant background conditions remains a difficulty for mechanistic accounts of explanation. By distinguishing resources from mechanical parts, I argue that we can more effectively draw this boundary. Further, the distinction makes obvious that there are distinctive resource explanations which are not captured by a traditional part-based mechanistic account. While this suggests a straightforward extension of the mechanistic model, I argue that incorporating resources and resource explanations requires moving beyond the purely local account of levels that some mechanists advocate.

Histiocitosis de células de Langerhans cutánea de presentación en el adulto

Publication date: Available online 27 September 2018

Source: Actas Dermo-Sifiliográficas

Author(s): M.A. Flores-Terry, J.L. Sanz-Trenado, M. García-Arpa, M.P. Cortina-de la Calle

Placa hiperqueratósica asintomática en glande en un varón de mediana edad

Publication date: Available online 27 September 2018

Source: Actas Dermo-Sifiliográficas

Author(s): P. Aguayo-Carreras, F.J. Navarro-Triviño, R. Ruiz-Villaverde, S. Saenz-Guirado

The anatomy of the superficial temporal artery in patients with unilateral microtia.

Publication date: Available online 28 September 2018

Source: Journal of Plastic, Reconstructive & Aesthetic Surgery

Author(s): Clara M. Olcott, Patrick E. Simon, Thomas Romo, William Louie

Summary

Background

This is a retrospective study that evaluated the anatomical distribution of the superficial temporal artery (STA) in supply of the temporoparietal fascial (TPF) flap for use in unilateral microtia patients undergoing reconstruction. We aimed to determine if embryologic arrest of pharyngeal arch development would lead to aberrant STA which impedes reliable harvest of the TPF flap in patients requiring microtia repair.

Methods

CT angiograms (CTA) and 3-D reconstruction of the face and neck of 41 microtia patients, aged 6 to 21 years, were examined. The number of STA branches, branching pattern, vessel diameter, and the presence or absence of the external auditory canal atresia were documented.

Results

The superficial temporal artery crosses the zygoma on average 4mm more anterior to the porion (anterior-inferior lip of the tympanic part of temporal bone) on the side with microtia compared to the non-microtia side. There were no statistically significant differences between vessel caliber or STA branches between the two sides.

Conclusion

The STA is anatomically reliable for inclusion in TPF flaps being used in auricular reconstruction for microtia patients. A TPF flap can be safely harvested with routine technique, though surgeons should be cognizant of the STA coursing more anteriorly on the microtia ear.

Lipoidoproteinosis o enfermedad de Urbach-Wiethe: presentación de un caso y revisión de la literatura

Publication date: Available online 27 September 2018

Source: Piel

Author(s): Raquel Ávila, Valmore Bermúdez, Maricarmen Chacín González, Eylineth Vílchez, Ismael Contreras

Histiocitoma fibroso maligno y sarcoma pleomórfico indiferenciado, ¿son la misma entidad?

Publication date: Available online 27 September 2018

Source: Piel

Author(s): Camilo E. Alarcón Pérez, Ana M. Álvarez Mantilla, Óscar Mora Hernández, Juan Carlos Hiromi López Takegami, Fernando Palma Escobar, Patricia de Castro Lotero

Postoperative complications of male to female sex reassignment surgery: A 10-year French retrospective study

Publication date: Available online 27 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): S. Cristofari, B. Bertrand, S. Leuzzi, K. Rem, J. Rausky, M. Revol, M. Atlan, A. Stivala

Summary

In primary male to female (MTF) sex reassignment surgery (SRS), the most frequent postoperative functional complications using the penoscrotal skin technique remain neovaginal stenosis, urinary meatal stenosis and secondary revision surgery. We aimed to retrospectively analyze postoperative functional and anatomical complications, as well as secondary procedures required after MTF SRS by penile skin inversion. All patients operated on for MTF SRS, using the inverted technique, from June 2006 to July 2016, were retrospectively reviewed. The minimum follow-up was one year (five-years maximum follow-up). Soft postoperative dilationprotocol was prescribed until complete healing of the vagina. We did not prescribe long-term hard dilation systematically. Possible short-depth neovaginas were primarily treated with further temporary dilation using a hard bougie. Among the 189 included patients, we reported a 2.6% of rectovaginal wall perforations. In 37% of patients we had repeated compressive dressings and 15% of them required blood transfusions. Eighteen percent of patients presented with hematoma and 27% with early infectious complications. Delayed short-depth neovagina occurred in 21% of patients, requiring additional hard dilatation, with a 95.5% success rate. Total secondary vaginoplasty rate was 6.3% (4.7% skin graft and 3.7% bowel plasty). Secondary functional meatoplasty occurred in 1% of cases. Other secondary cosmetic surgery rates ranged between 3 to 20%. A low rate of secondary functional meatoplasty was showed after MTF SRS by penile skin inversion. Hard dilation was prescribed in case of healed short-depth vagina, with good efficiency in most of cases. Secondary vaginoplasty was required in cases of neovagina stenosis or persisting short-depth neovagina after failure of hard dilation protocol.

Résumé

Dans la chirurgie de réattribution sexuelle (SRS) primaire masculine à féminine, les complications fonctionnelles postopératoires les plus fréquentes utilisant la technique de la peau pénoscrotale restent la sténose néovaginale, la sténose urinaire et la reprise secondaire. Nous avons cherché à analyser rétrospectivement les complications fonctionnelles et anatomiques postopératoires, ainsi que les procédures secondaires requises après un SRS MTF par inversion de la peau du pénis. Tous les patients opérés pour le SRS MTF, en utilisant la technique inversée, de juin 2006 à juillet 2016, ont été revus rétrospectivement. Le suivi minimum était d'un an et le maximum était de cinq ans. Un protocole de dilatation postopératoire souple a été prescrit jusqu'à guérison complète du vagin. Nous n'avons pas prescrit une dilatation dure à long terme systématiquement. Les néovagins de faible profondeur possible ont été traités principalement avec une dilatation temporaire supplémentaire en utilisant une bougie dure. Parmi les 189 patients inclus, nous avons rapporté 2,6 % des perforations de la paroi rectovaginale. Chez 37 % des patients, nous avions des pansements compressifs répétés et 15 % d'entre eux nécessitaient des transfusions sanguines. Dix-huit pour cent des patients présentaient un hématome et 27 % présentaient des complications infectieuses précoces. Vingt et un pour cent des patients ont présenté un court néovagin en différée, nécessitant une dilatation dure supplémentaire, avec un taux de réussite de 95,5 %. Le taux de vaginoplastie secondaire totale était de 6,3 % (4,7 % de greffe de peau et 3,7 % de plastie intestinale). Une veinoplastie fonctionnelle secondaire est survenue dans 1 % des cas. Les autres taux de chirurgie esthétique secondaire se situaient entre 3 et 20 %. Un faible taux de meatoplastie fonctionnelle secondaire a été montré après MTF SRS par inversion de la peau du pénis. Une dilatation dure a été prescrite en cas de vagin guéri à faible profondeur, avec une bonne efficacité dans la plupart des cas. Une vaginoplastie secondaire a été nécessaire en cas de sténose à néovagin ou de néovagin à faible profondeur persistante après l'échec du protocole de dilatation dure.

Prélever un SIEP à la place d’un DIEP en reconstruction mammaire : note technique

Publication date: Available online 27 September 2018

Source: Annales de Chirurgie Plastique Esthétique

Author(s): Q. Bettex, C. Jaloux, M. Abellan Lopez, D. Casanova, B. Bertrand, C. Philandrianos

Résumé

La reconstruction mammaire par lambeau abdominal a évolué vers une diminution des séquelles du site donneur depuis la description du lambeau perforant de DIEP (pour Deep Inferior Epigastrique Perforator). De même épaisseur et de même surface, le lambeau de SIEA (pour Superficial Inferior Epigstrique Artery) ne nécessite pas, pour son prélèvement, d'ouverture de la gaine abdominale ni de dissection au travers des muscles grands droits, minimisant encore les séquelles. Cependant, il est peu utilisé en raison de la variabilité de sa vascularisation et d'un taux d'échec plus élevé que le DIEP dans la littérature. Nous pensons qu'il est tout de même raisonnable, dans certains cas, de prélever un SIEA à la place d'un DIEP. Nous présentons une note technique expliquant notre stratégie opératoire permettant de prélever un SIEA de façon fiable lorsque le calibre des vaisseaux le permet.

Summary

Breast reconstruction by abdominal flap has evolved to ensure minimal donor-site morbidity with the description of Deep Inferior Epigastric artery Perforator flap (DIEP flap). Being of the same thickness and the same surface, the Superficial Inferior Epigastric Artery flap (SIEA flap) does not require, for it harvesting, to open the abdominal fascia or to dissect through the muscles minimizing again donor-site sequelae. However, it is little used because of the variability of its vascularization and a higher failure rate than the DIEP in the literature. We believe that it is reasonable, in some cases, to harvest a SIEA flap instead of DIEP flap in mammary reconstruction. We present a technical note explaining our operative strategy for reliably taking a SIEA when the caliber of the vessels allows.

Psychiatric Dermatology: Management

Publication date: Available online 27 September 2018

Source: Clinics in Dermatology

Author(s): Madhulika A. Gupta

Case of bilateral elastofibroma on the tensor fasciae latae

The Journal of Dermatology, EarlyView.

Is Monogamy Morally Permissible?

More on the MORE Life Experience Model: What We Have Learned (So Far)

Breast Lipofilling Does Not Pose Evidence of Chronic Inflammation in Rats

Abstract

Background

Fat grafting to the breast has a questionable oncologic risk according to laboratory reports on adipose tissue. One possible reason for this is the theoretical chronic inflammation due to adipokynes released by the grafted white adipose tissue (WAT).

Objectives

Analyze inflammatory activity in lipofilled breast through proinflammatory markers.

Methods

Fifty-four paired-breasts of female rats were divided into four groups (control, sham, breasts grafted with autologous WAT of subcutaneous - SC, and of omentum - OM). The WAT was prepared through centrifugation and the grafting was performed via 0.9mm blunt tip cannula. The rats were euthanized at 8 weeks postoperatively, and their breasts were harvested for immunohistochemical staining for CD68-expressing macrophages, gene expression (real-time PCR) for Mcp-1, F4/80, Cox-2 and IL-6.

Results

The rats' weight differs between groups that underwent a procedure and the unmanipulated control (p<0.01). The macrophage counting of CD68 was different only between breasts lipofilled with OM and control (p<0.01). Mcp-1, F4/80 and Cox-2 were similarly expressed among the groups (respectively p=0.422, p=0.143 and p=0.209). The expression of IL-6 was different between samples of breast grafted with WAT of omentum and subcutaneous (p=0.015), but not between samples of control and omentum (p=0.752), and control and subcutaneous (p=0.056).

Conclusions

No inflammation activity was identified in the microenvironment of lipofilled breasts. This illustrates that chronic inflammation does not seem to be trigged by the breast lipofilling procedure.

Surgical Lip Remodeling After Injection of Permanent Filler

Abstract

Background

A major concern regarding permanent lip fillers is difficulty with revision, if warranted. Currently, the only way to treat lip sequelae is by surgical remodeling.

Objectives

Based on the senior author's 6-year experience, the authors collectively suggest a surgical method to correct lip deformity in such situations.

Methods

The records of 38 patients with lip deformity who underwent surgery between 2011 and 2017 after receiving permanent filler injections were analyzed retrospectively. A total of 38 consecutive patients, 69 lips, with an average age of 38.8 years (range, 28-52 years) were treated surgically.

Results

All patients experienced postoperative swelling (average duration, 15 days), and no infections were recorded. In 3 cases, a 1-cm dehiscence was documented, which healed by second intention. In 1 case, a hematoma noted several days after surgery resolved spontaneously within 3 weeks. In 2 upper lips, a minor touchup procedure (with the patient under local anesthesia) was performed 9 months after the initial surgery. Overall, patients noted that it took at least 6 to 9 months to achieve natural lip movement. The average time until softening of the lip tissue was 4 months.

Conclusions

This study emphasizes the importance of informing patients that complete removal of permanent filler is not always possible. However, most of the authors' patients were pleased with the results. This study also highlights the importance of paying strict attention when approaching the area adjacent to the oral commissures in order to avoid potential reductions in mouth opening that can occur from postoperative scarring.

Tofacitinib for the treatment of lichen planopilaris: A case series

Dermatologic Therapy, EarlyView.

Seltene Komplikation nach bilateralem MS2-TRAM-Flap

Zusammenfassung

Vorstellig wurde eine 49 Jahre alte Patientin mit Beschwerden, bei der 2 Jahre zuvor auswärts eine prophylaktische Mastektomie beidseits und ein Simultanaufbau beidseits durchgeführt worden waren. Als Grund für die geschilderten Beschwerden stellte sich ein in situ belassener Wundspreizer heraus. Dies macht deutlich, dass Beschwerden des Patienten ernst zu nehmen sind und bei Persistieren einer unklaren Problematik eine erweiterte Diagnostik erfolgen sollte.

Treatment of Vocal Cord Paralysis by Autologous Fat Injection: Our Experience with 41 Patients

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

A 20 year observational cohort of a 5 million patient population – tonsillectomy rates in the context of two national policy changes

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

Our Experience of Long Term Result of Tympanoplasty Using Areolar Tissue in 359 patients

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

Snoring sound energy as a potential biomarker for disease severity and surgical response in childhood obstructive sleep apnea: a pilot study

Clinical Otolaryngology, Volume 0, Issue ja, -Not available-.

Histone modifications associated with biological drug response in moderate‐to‐severe psoriasis

Experimental Dermatology, Volume 0, Issue ja, -Not available-.

Effects of extracorporeal photopheresis on serum levels of vitamin D: Preliminary Data from a Pilot Study

Photodermatology, Photoimmunology &Photomedicine, Volume 0, Issue ja, -Not available-.

Topical nicotinic receptor activation improves wound bacterial infection outcomes and TLR2‐mediated inflammation in diabetic mouse wounds

Wound Repair and Regeneration, Volume 0, Issue ja, -Not available-.

Use of cold atmospheric pressure plasma to treat warts: a potential therapeutic option

Clinical and Experimental Dermatology, EarlyView.

A painful vegetating finger

Clinical and Experimental Dermatology, EarlyView.

Loricrin palmoplantar keratoderma: full‐thickness skin grafting for pseudoainhum

Clinical and Experimental Dermatology, EarlyView.

Impact of a combined dermatology–rheumatology clinic on management of autoimmune connective tissue disorders

Clinical and Experimental Dermatology, EarlyView.

Melanocytic soluble adenylyl cyclase protein expression around lentigo maligna and in contralateral control skin

Clinical and Experimental Dermatology, EarlyView.

Erythematous lesion with peripheral purpura on the face

Clinical and Experimental Dermatology, EarlyView.

Grover disease and bullous pemphigoid: a clinicopathological study of six cases

Clinical and Experimental Dermatology, EarlyView.

Morse code‐like hairs in tinea capitis disappear after successful treatment

International Journal of Dermatology, EarlyView.

Fibroepithelioma of Pinkus in a 6‐year‐old boy: a case report

International Journal of Dermatology, EarlyView.

Pitfalls in diagnosing primary cutaneous aggressive epidermotropic CD8+ T‐cell lymphoma

British Journal of Dermatology, Volume 0, Issue ja, -Not available-.

Outcomes following SRS for small- to medium-sized brain metastases are exceptionally dependent upon tumor size and prescribed dose

Abstract

Background

At our institution, we have historically treated brain metastasis (BM) ≤2cm in eloquent brain with a radiosurgery (SRS) lower prescription dose (PD) to reduce the risk of radionecrosis (RN). We sought to evaluate the impact of this practice on outcomes.

Methods

We analyzed a prospective registry of BM patients treated with SRS between 2008 and 2017. Incidences of local failure (LF) and RN were determined and Cox regression was performed for univariate and multivariable analyses (MVA).

Results

1,533 BM ≤2cm were evaluated. Median radiographic follow-up post SRS was 12.7 months (1.4-100). Overall, the 2year incidence of LF was lower for BM treated with PD≥21Gy (9.3%) compared with PD≤15Gy (19.5%);(subHR 2.3; 95CI 1.4-3.7;p=0.0006). The 2-year incidence of RN was not significantly higher for the group treated with PD ≥21Gy (9.5%) compared to the PD ≤15Gy group (7.5%) (p=0.16). MVA demonstrated that PD (≤15 Gy) and tumor size (>1cm) were significantly correlated (p<0.05) with higher rates of LF, and RN, respectively. For tumors ≤1 cm, when comparing PD ≤15Gy to ≥21Gy, the risks of LF and RN are equivalent. However, for lesions >1cm, PD ≥21Gy is associated with a lower incidence of LF without significantly increasing the risk of RN.

Conclusion

Our results indicate that rates of LF or RN following SRS for BM are strongly correlated to size and PD. Based on our results, we now, depending upon the clinical context, consider increasing PD to 21 Gy for BM in eloquent brain, excluding the brain stem.

Sex difference of mutation clonality in diffuse glioma evolution

Abstract

Background

x differences in glioma incidence and outcome have been previously reported but remain poorly understood. Many sex differencesthat affect the cancer risk were thought to be associated with cancer evolution.

Material/Methods

In this study, we used an integrated framework to infer the timing and clonal status of mutations in ~600 diffuse gliomas from The Cancer Genome Atlas including glioblastomas (GBM) and low grade gliomas (LGG), and investigated the sex difference of mutation clonality.

Results

We observed higher overall and subclonal mutation burden in female patients with different grades of gliomas, which could be largely explained by the mutations of X-chromosome. Some well-established drivers were identified showing sex-biased clonality, such as CDH18 and ATRX. Focusing on glioma subtypes, we further found a higher subclonal mutation burden in females than males in the majority of glioma subtypes, and observed opposite clonal tendency of several drivers between male and female patients in a specific subtype. Moreover, analysis of clinically actionable genes revealed that mutations in genes of mitogen-activated protein kinase (MAPK) signaling pathway were more likely to be clonal in female patients with GBM, whereas mutations in genes involved in receptor tyrosine kinase (RTK) signaling pathway were more likely to be clonal in male patients with LGG.

Conclusions

The patients with diffuse glioma showed sex-biased mutation clonality (e.g. different subclonal mutation number and different clonal tendency of cancer genes), highlighting the need to consider sex as an important variable for improving glioma therapy and clinical care.

Books received

A Man With Tonsillitis and Hepatitis

A previously well Australian-born 28-year-old gentleman was diagnosed with a stage 1 non-seminomatous testicular cancer, for which he underwent a left radical orchidectomy, followed by a single cycle of adjuvant chemotherapy with bleomycin, etoposide and cisplatin. One week later, he presented to hospital with a one-day history of fevers, rigors and severe sore throat. There was no recent travel or animal contact, nor was there any risk factor for blood-borne viruses. He had recently entered into a new relationship with a female partner. On physical examination he was noted to have bilateral swollen, erythematous tonsils with exudates, associated with bilateral tender cervical lymphadenopathy. No visible mucocutaneous vesicles or ulcers were found. Initial investigation results showed neutrophilia of 13.4 × 10^9/L (2.0–8.0) but lymphopenia of 0.4 × 10^9/L (1.0–4.0), and a normal liver function test. Blood film demonstrated toxic changes of leukocytes with occasional reactive lymphocytes. Heterophile antibody test for infectious mononucleosis was negative. He was given penicillin following which he developed a widespread blanching macular rash two days later. He was then discharged home.

In the Literature

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43rd National AOMSI Conference

Immunology of Wound Healing

Abstract

Purpose of Review

Chronic wounds are a tremendous burden on the healthcare system and lead to significant patient morbidity and mortality. Normal cutaneous wound healing occurs through an intricate and delicate interplay between the immune system, keratinocytes, and dermal cells. Each cell type contributes signals that drive the normal phases of wound healing: hemostasis, inflammation, proliferation, and remodeling. This paper reviews how various immunological cell types and signaling molecules influence the way wounds develop, persist, and heal.

Recent Findings

Concurrent with the achievement of hemostasis, neutrophils are the first cells to migrate to the wound bed, brought in by pro-inflammatory signals including IL-8. Their apoptosis and engulfment by macrophages (efferocytosis) provides a key signal to the local immune milieu, including macrophages, to transition to an anti-inflammatory, pro-repair state, where angiogenesis occurs and granulation tissue is laid down. Myofibroblasts, activated through contractile forces and signaling molecules, then drive remodeling, where granulation tissue becomes scar. Unchecked inflammation at this stage can result in abnormal scar formation.

Summary

Although the derangement of immune signals at any stage can result in impaired wound healing, recent research has shown that the key transition point lies between the inflammatory and the proliferative phases. This review summarizes the events that facilitate this transition and discusses how this process can be disrupted, leading to chronic, non-healing wounds.