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-.