Cavitary Pulmonary Nodules in an Immunocompromised Patient With Urothelial Carcinoma of the Bladder

A 59-year-old Moroccan man with a history of metastatic urothelial cell carcinoma presented in May 2016 with fever, shortness of breath, and chest pain. Noninvasive urothelial carcinoma had been diagnosed in 2012 and treated with mitomycin. In 2014, the patient had received intravesicular Mycobacterium bovis BCG therapy, but invasive bladder carcinoma subsequently developed, requiring 4 cycles of chemotherapy with methotrexate, vinblastine, doxorubicin, and cisplatin. Nine months before the current admission, the patient underwent a radical cystoprostatectomy with creation of a neobladder. Nonetheless, brain metastases developed, for which he received dexamethasone (4 mg orally, twice daily), and underwent neurosurgical resection 3 months before presentation, followed by whole-brain irradiation. He continued receiving intermittent dexamethasone therapy until his admission to our hospital.

In the Literature

News

Cover

The role of long‐wavelength ultraviolet A1 (UVA1) in acral vitiligo

Journal of Cosmetic Dermatology, EarlyView.

Combinatorial application of dissolving microneedle patch and cream for improvement of skin wrinkles, dermal density, elasticity, and hydration

Journal of Cosmetic Dermatology, EarlyView.

Differin® and depilation, a word of warning

Journal of Cosmetic Dermatology, EarlyView.

The Association Between Metabolic Syndrome and Serum Concentrations of Micronutrients, Inflammation, and Oxidative Stress Outside of the Clinical Reference Ranges: A Cross-Sectional Study

Metabolic Syndrome and Related Disorders, Ahead of Print.

Surgical Correction of Unicoronal Craniosynostosis with Frontal Bone Symmetrization and Staggered Osteotomies

Background. Craniosynostosis is the premature fusion of one or more cranial sutures that produce abnormal head shape. Plagiocephaly is a general term that describes unilateral flattening of the anterior or posterior quarter of the cranium. Anterior plagiocephaly is almost always due to unilateral coronal synostosis. Early surgical treatment is the best option for these patients. The aim of this study was to investigate the surgical correction results of unicoronal craniosynostosis with frontal bone symmetrization and staggered osteotomies. Methods. All unicoronal craniosynostosis cases treated surgically from 2013 to 2016 at our hospital, with frontal bone symmetrization and staggered osteotomies and fronto-orbital advancement, were reviewed. The following variables were analyzed: sex, age, weight, hospital stay time, ICU stay time, per os (PO) starting time, anesthetic time, estimated blood loss volume (ml), estimated blood loss as percentage of total volume, surgical complication, follow-up time, and Whitaker grade. All data were analyzed with SPSS. Results. The study consisted of 33 patients (19 females, 14 males). Average age was 10.24 months, average weight was 8.97 Kg, average hospital stay time was 7.84 days, average ICU stay time was 1.69 days, average PO starting time was 1.24 days after surgery, average anesthetic time was 397.72 minutes, average estimated blood loss was 213.78 ml, and estimated blood loss as percentage of total volume was 31.69%. One case (3.03%) needed reoperation and two cases had postoperative seizure. No mortality was seen. Conclusion. It is supposed that surgical correction of unicoronal craniosynostosis with frontal bone symmetrization and staggered osteotomies results in lower blood loss, lower complication rate and reoperation, and more durable results.

Epikutantest mit hausgemachten Testlösungen

Neuer Pfeil im Therapieköcher gegen Asthma von Kindern

Die Palette von Medikamenten für die Kontrolle von Asthma im Kindesalter hat Zuwachs bekommen: Der langwirksame Muskarinantagonist Tiotropium ergänzt die Optionen für die Add-on-Therapie.

Allergologie unter Druck

Personalisierte Prävention allergischer Erkrankungen

Asthma hat viele Gesichter

Unter dem Begriff Asthma werden heute eine Reihe unterschiedlicher Phänotypen der entzündlichen Atemwegserkrankung zusammengefasst. Den Grundstein für diese Entwicklung legte vor 100 Jahren der Mediziner Francis M. Rackemann.

„Für eine Welt ohne Allergien“

So weit, wie das ambitionierte Motto des 13. Deutschen Allergiekonkresses erahnen lassen könnte, ist es leider noch lange nicht. Doch wie man diesem bislang noch weit entfernten Ziel ein Stück näher kommen könnte, wurde Ende September in Dresden diskutiert. Behandelte Themen waren unter anderem die personalisierte Allergieprävention, Defizite in der Anapylaxietherapie und seltene allergische Erkrankungen.

13. Deutscher Allergiekongress — ein Rückblick in Bildern

Spezifische Immuntherapie: Warnung vor unbedachter Anwendung

Kombiniert oder einzeln — jetzt wieder erstattungsfähig!

Nicht verschreibungspflichtige nasale Glukokortikoide mit den Wirkstoffen Beclomethason, Fluticason und Mometason können inzwischen wieder auf Kassenrezept verordnet werden. Dies gilt auch für ein Kombinationspräparat aus nasalem Glukokortikoid und Antihistaminikum, wie der Ärzteverband Deutscher Allergologen klarstellt.

Arzneimittelallergie bei Kindern und Jugendlichen

Elektronische Abstracteinreichung Schritt für Schritt

Preisverleihungen 2018

Akupunktur bei allergischen Erkrankungen — wann ist sie sinnvoll?

Das Curriculum der deutschen Allergologie in einem Kurs

Basophilenaktivierungstest zur Diagnose von Sesamallergie

Für Menschen mit einer Allergie gegen Sesam können bereits Spuren von selbigem eine schwere anaphylaktische Reaktion auslösen. Doch bislang gibt es keine ideale Methode, mit der eine Sesamallergie zuverlässig und risikofrei diagnostiziert werden kann.

Allergie im Fokus: ASIT und Biologika — „State of the ART“

Seltene allergische Erkrankungen

Minorallergene bei Walnussallergie relevant

Untersucht man Walnussallergiker mit Walnuss-ImmunoCAP-Extrakt, reagieren nicht alle Seren. Ein Grund könnten fehlende Minorallergene wie das Jug r 4 sein. Eine Laborstudie ging der Frage nach.

Gezielte Exposition versus Allergenmeidung

Einladung zur DGAKI-Frühjahrstagung

Might hyperbaric oxygen therapy (HBOT) reduce renal injury in diabetic people with diabetes mellitus? From preclinical models to human metabolomics

Abstract

Diabetic kidney disease (DKD) is the leading cause of end-stage renal failure in the western world. Current treatment of diabetic kidney disease relies on nutritional management and drug therapies to achieve metabolic control. Here, we discuss the potential application of hyperbaric oxygen therapy (HBOT) for the treatment of diabetic kidney disease (DKD), a treatment which requires patients to breathe in 100% oxygen at elevated ambient pressures. HBOT has traditionally been used to diabetic foot ulcers (DFU) refractory to conventional medical treatments. Successful clinic responses seen in the DFU provide the underlying therapeutic rationale for testing HBOT in the setting of DKD. Both the DFU and DKD have microvascular endothelial disease as a common underlying pathologic feature. Supporting evidence for HBOT of DKD comes from previous animal studies and from our preliminary prospective clinical trial reported here. We report urinary metabolomic data obtained from patients undergoing HBOT for DFU, before and after exposure to 6 weeks of HBOT. The preliminary data support the concept that HBOT can reduce biomarkers of renal injury, oxidant stress, and mitochondrial dysfunction in patients receiving HBOT for DFU. Further studies are needed to confirm these initial findings and correlate them with simultaneous measures of renal function. HBOT is a safe and effective treatment for DFU and could also be for individuals with DKD.

Lipopolysaccharide induces human olfactory ensheathing glial apoptosis by promoting mitochondrial dysfunction and activating the JNK-Bnip3-Bax pathway

Abstract

Olfactory ensheathing glia (OEG) play an important role in regulating the regeneration of an injured nervous system. However, chronic inflammation damage reduces the viability of OEG via poorly understood mechanisms. We aimed to investigate the pathological responses of OEG in response to LPS-mediated inflammation stress in vitro. The results indicated that lipopolysaccharide (LPS) treatment significantly reduced the viability of OEG in a dose-dependent fashion. Mechanistically, LPS stimuli induced mitochondrial oxidative damage, mitochondrial fragmentation, mitochondrial metabolism disruption, and mitochondrial apoptosis activation. Furthermore, we verified that LPS modulated mitochondrial apoptosis by promoting Bax upregulation, and this process was regulated by the JNK-Bnip3 pathway. Inhibition of the JNK-Bnip3 pathway prevented LPS-mediated Bax activation, thus attenuating OEG apoptosis. Altogether, our data illustrated that LPS-mediated inflammation injury evoked mitochondrial abnormalities in OEG damage via the JNK-Bnip3-Bax pathway. This finding provides a potential target to protect OEG against chronic inflammation stress.

Protective effects of selenium against zearalenone-induced apoptosis in chicken spleen lymphocyte via an endoplasmic reticulum stress signaling pathway

Abstract

Selenium (Se), an antioxidant agent, provides significant protection from reactive oxygen species (ROS)-induced cell damage in vivo and in vitro. However, it is unclear whether Se can protect against zearalenone (ZEN)-induced apoptosis in chicken spleen lymphocyte. In this study, we investigated the underlying mechanism of the apoptosis induced by ZEN in chicken spleen lymphocyte and further evaluated the protective mechanism of Se on ZEN-induced apoptosis. The results show that ZEN induced an increase in ROS generation and lipid peroxidation, and a decrease in levels of superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GSH-Px), and glutathione (GSH). The results of apoptosis morphologically from acridine orange/ethidium bromide (AO/EB) fluorescent staining and flow cytometry analysis show apparent apoptosis in the ZEN-treated group, and was confirmed by the upregulation of caspase-3, -12 and downregulation of Bcl-2. Meanwhile, ZEN activated the endoplasmic reticulum (ER) stress by upregulating ER stress-related molecular sensors (GRP78, ATF6, ATF4, IRE). However, co-treatment with Se effectively blocked ROS generation, improved antioxdative capacity, and reversed apoptosis and ER stress-related genes and protein expression. Taken together, these data suggest that oxidative stress and ER stress play a vital role in ZEN-induced apoptosis, and Se had a significant preventive effect on ZEN-induced apoptosis in chicken spleen lymphocyte via ameliorating the ER stress signaling pathway.

Cell toxicity mechanism and biomarker

Cell toxicity may result in organ dysfunction and cause severe health problem. Recent studies revealed many toxicants may induced the over production of Nitric oxide, reactive oxygen species and the subsequent...

Actinic Lichen Planus Triggered by Drug Photosensitivity

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

Introduction: Special Issue—The Origins of Macrophages and Their Roles Beyond Immunology

In the context of ontogeny and phylogeny, macrophages emerge much earlier than other hematopoietic cells, including monocytes, implying that their roles extend beyond immunology. Phagocytosis, a representative function of macrophages, has been examined since the late 19th century and such studies were the basis of characterizing innate immunity. Macrophages also make a range of cytokines important in both innate and adaptive immunity. Recently, their non-immunological homeostatic roles in organ development, angiogenesis, tissue repair/regeneration and metabolism have also become clear. This involvement in so many responses in virtually all tissues requires them to be enormously flexible but their phenotypic and functional heterogeneity have made it difficult to delineate the origins of macrophages in specific sites under different circumstances.

21‐hydroxylase autoantibodies are more prevalent in Turner syndrome but without an association to the autoimmune polyendocrine syndrome type I

Clinical &Experimental Immunology, Volume 0, Issue ja, -Not available-.

Vom Messwert zum Bemessungsniederschlag – ein Service der Hydrographie Österreichs

Zusammenfassung

Für viele Planungen in der Wasserwirtschaft werden Niederschläge benötigt, denen eine Wiederkehrzeit zugeordnet ist – ein Bemessungsniederschlag.

Zur Berechnung dieser Bemessungsgrundlage verwendet der Hydrographische Dienst in Österreich seit 2009 drei Methoden: die Extremwertstatistik, maximierte Modellniederschläge und eine Kombination dieser beiden Methoden.

In diesem Artikel werden die Methoden beschrieben und es wird auf eine Aktualisierung der Auswertungen im Jahr 2019 hingewiesen.

Cost and effectiveness of prescribing emollient therapy for atopic eczema in UK primary care in children and adults: a large retrospective analysis of the Clinical Practice Research Datalink

Abstract

Background

The Clinical Practice Research Datalink (CPRD) was used to evaluate the overall costs to the National Health Service, including healthcare utilisation, of prescribing emollients in UK primary care for dry skin and atopic eczema (DS&E).

Methods

Primary care patients in the UK were identified using the CPRD and their records were interrogated for the 2 years following first diagnosis of DS&E. Data from patients with (n = 45,218) and without emollient prescriptions (n = 9780) were evaluated. Multivariate regression models were used to compare healthcare utilisation and cost in the two matched groups (age, sex, diagnosis). Two sub-analyses of the Emollient group were performed between matched groups receiving (1) a colloidal oatmeal emollient (Aveeno-First) versus non-colloidal oatmeal emollients (Aveeno-Never) and (2) Aveeno prescribed first-line (Aveeno-First) versus prescribed Aveeno later (Aveeno-Subsequently). Logistic regression models calculated the odds of prescription with either potent / very potent topical corticosteroids (TCS) or skin-related antimicrobials.

Results

Costs per patient were £125.80 in Emollient (n = 7846) versus £128.13 in Non-Emollient (n = 7846) matched groups (p = 0.08). The Emollient group had fewer visits/patient (2.44 vs. 2.66; p < 0.0001) and lower mean per-visit costs (£104.15 vs. £113.25; p < 0.0001), compared with the Non-Emollient group. Non-Emollient patients had 18% greater odds of being prescribed TCS and 13% greater odds of being prescribed an antimicrobial than Emollient patients. In the Aveeno-First (n = 1943) versus Aveeno-Never (n = 1943) sub-analysis, costs per patient were lower in the Aveeno-First compared with the Aveeno-Never groups (£133.46 vs. £141.11; p = 0.0069). The Aveeno-Never group had ≥21% greater odds of being prescribed TCS or antimicrobial than the Aveeno-First group. In the Aveeno-First (n = 1357) versus Aveeno-Subsequently (n = 1357) sub-analysis, total costs were lower in the Aveeno-First group (£140.35 vs. £206.43; p < 0.001). Patients in the Aveeno-Subsequently group had 91% greater odds of being prescribed TCS and 75% greater odds of being prescribed an antimicrobial than the Aveeno-First group.

Conclusions

Acknowledging limitations from unknown disease severity in the CRPD, the prescription of emollients to treat DS&E was associated with fewer primary care visits, reduced healthcare utilisation and reduced cost. Prescribing emollients, especially those containing colloidal oatmeal, was associated with fewer TCS and antimicrobial prescriptions.

Trial registration

The study is registered at http://isrctn.com/ISRCTN91126037.

A cohabiting bacterium alters the spectrum of short RNAs secreted by Escherichia coli

Abstract

Recently, it has been found that bacteria secrete short RNAs able to affect gene expression in eukaryotic cells, while certain mammalian microRNAs 'shape the gut microbiome' altering bacterial transcriptome. The involvement of bacterial RNAs in communication with other bacteria is also expected, but has not been documented yet. Here, we compared the fractions of extremely short (12–22 nucleotides) RNAs secreted by Escherichia coli grown in a pure culture and jointly with bacteria of the Paenibacillus genus. Besides fragments of rRNAs and tRNAs, abundant in all samples, secreted oligonucleotides (exoRNAs) predominantly contained GC-rich fragments of messenger and antisense RNAs processed from regions with stable secondary structures. They differed in composition from oligonucleotides of intracellular fraction, where fragments of small regulatory RNAs were prevalent. Both fractions contained RNAs capable to form complementary duplexes, while for exoRNA samples a higher percentage of 3'-end modified RNAs and different endonuclease cleavage were detected. The presence of a cohabiting bacterium altered the spectrum of E. coli exoRNAs indicating a population-dependent control over their composition. Possible mechanisms of this effect are discussed.

Regularities of free radical processes and involutional changes of face and neck skin in different age groups

Genomewide copy number alteration screening of circulating plasma DNA: potential for the detection of incipient tumors

Abstract

Background

Early cancer diagnosis might improve survival rates. As circulating tumor(ctDNA) carries cancer-specific modifications, it has great potential as a non-invasive biomarker for detection of incipient tumors.Patients and methods. We collected cfDNA samples of 1002 elderly without a prior malignancy, performed whole genome massive parallel sequencing and scrutinized the mapped sequences for the presence of (sub)chromosomal copy number alterations (CNAs) predictive for a malignancy. When imbalances were detected, 6-monthly clinical follow-up was performed.

Results

In 3% of participants chromosomal imbalances were detected. Follow-up analyses, including whole-body MRI screening, confirmed the presence of 5 hematological malignancies: 1 Hodgkin lymphoma, stage II; 3 non-Hodgkin lymphomas (type CLL, Rai I–Binet A; type SLL, stage III; type MALT, stage I) and 1 myelodysplastic syndrome with excess blasts, stage II. The CNAs detected in cfDNA were tumor-specific. Furthermore, 1 case was identified with monoclonal B-cell lymphocytosis, a potential precursor of B-cell malignancy. In 24 additional individuals CNAs were identified but no cancer diagnosis was made. For 9 of them, the aberrant cfDNA profile originated from peripheral blood cells. For 15 others the origin of aberrations in cfDNA remains undetermined.

Conclusion(s)

Genomewide profiling of cfDNA in apparently healthy individuals enables the detection of incipient hematological malignancies as well as clonal mosaicism with unknown clinical significance. CNA screening of cellular DNA of peripheral blood in elderly has established that clonal mosaicism for these chromosomal anomalies predicts a 5 to 10-fold enhanced risk of a subsequent cancer. We demonstrate that cfDNA screening detects CNAs, which are not only derived from peripheral blood, but even more from other tissues. Since the clinical relevance of clonal mosaics in other tissues remains unknown, long-term follow-up is warranted. Taken together, this study demonstrates that genomewide cfDNA analysis has potential as an unbiased screening approach for hematological malignancies and premalignant conditions.

An Algorithmic Approach to the Treatment of Frontal Fibrosing Alopecia-A Systematic Review

Publication date: Available online 28 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Yemisi Dina, Crystal Aguh

Present and future perspective of photodynamic therapy for cutaneous squamous cell carcinoma

Publication date: Available online 28 October 2018

Source: Journal of the American Academy of Dermatology

Author(s): Uma Keyal, Anil Kumar Bhatta, Guolong Zhang, Xiuli Wang

Abstract

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer. Surgery remains the main stay of treatment but, some patients are not eligible for surgery and more importantly, lesions at critical site need nonsurgical approach for tissue preservation. In this context, photodynamic therapy (PDT) has been extensively studied as noninvasive or minimally invasive treatment and studies have shown promising results in terms of safety, efficacy and cosmetic outcome. Also, studies have proposed different mechanism for its efficacy. However, human studies demonstrating its efficacy are limited in terms of sample size and tumor depth of invasion. Exciting results are mainly seen in case report in microinvasive SCC, which is defined as SCC limited to papillary dermis. This inadequacy is due to inadequate penetration of topically applied photosensitizers through keratinized tumor surface. To overcome these hurdles, pretreatment with lasers or microneedles and encapsulation of photosensitizers into nanoparticles have been tried. Hence, present paper will discuss studies that have demonstrated the efficacy and safety of PDT for cSCC, studies that have postulated the mechanism of action of PDT, agents that have been used as PDT enhancers and finally, the recent use of adjuvant therapy in combination with PDT.

Gastrointestinal parasites of zoonotic importance observed in the wild, urban, and captive populations of non‐human primates in Malaysia

Journal of Medical Primatology, EarlyView.

Mitteilungen DGKFO

Membrana basal: fundamentos moleculares en las enfermedades ampollosas

Publication date: Available online 28 October 2018

Source: Piel

Author(s): Andrea Ortiz Flórez, Raquel Eraso Bravo

Estudio retrospectivo del tratamiento sistémico de la dermatitis atópica grave con azatioprina. Eficacia y tolerancia en 11 pacientes pediátricos

Publication date: Available online 28 October 2018

Source: Actas Dermo-Sifiliográficas

Author(s): L. Noguera-Morel, N. Knöpfel, A. Torrelo, A. Hernández-Martín

Resumen

Antecedentes

La dermatitis atópica (DA) es una enfermedad inflamatoria crónica de la piel típicamente infantil cuyas formas graves pueden afectar intensamente la calidad de vida del paciente. Existen formas refractarias al tratamiento convencional en las que es preciso emplear inmunosupresores sistémicos como la azatioprina (AZA) para alcanzar un buen control de la enfermedad.

Objetivo

Evaluar la eficacia y la tolerancia de la AZA en niños con DA grave.

Pacientes y métodos

Se realizó una revisión retrospectiva de niños con DA grave tratados con AZA entre enero de 2007 y mayo de 2017.

Resultados

Se revisaron 11 pacientes (6 varones, 5 mujeres) con una edad promedio de 13 años (rango 8-18 años). La edad media ± DE al inicio del tratamiento fue de 10,9 ± 2,2 años (IC 95% 8,6-13,1). La media de la dosis inicial de AZA fue de 1,8 ± 0,2 mg/kg/d. Evaluamos la respuesta al tratamiento de nuestros pacientes a las 4 semanas, entre la semana 12 y la 16, y a partir de los 6 meses. La media del tratamiento fue de 10,8 ± 5,7 meses. Dos pacientes tuvieron que suspender el tratamiento por efectos adversos. Siete de los 9 pacientes restantes presentaron un aclaramiento completo o casi completo de la DA a los 6 meses de tratamiento.

Conclusión

En nuestra experiencia, la AZA es bien tolerada y puede ser considerada como una opción terapéutica en los niños con DA grave refractaria a tratamientos convencionales.

Abstract

Background

Atopic dermatitis (AD) is a chronic inflammatory skin disease that typically affects children. Severe forms may have a profound effect on patients' quality of life. Some forms are resistant to conventional treatment and require the use of systemic immunosuppressants such as azathioprine (AZA) to adequately manage the disease.

Objective

To evaluate the effectiveness and tolerance of AZA in children with severe AD.

Patients and methods

We performed a retrospective study of children with severe AD treated with AZA between January 2007 and May 2017.

Results

We reviewed the cases of 11 patients (6 boys and 5 girls) with a mean age of 13 years (range, 8-18 years). The mean (SD) age at start of treatment was 10.9 (2.2) years (95% CI 8.6-13.1). The mean initial dosage of AZA was 1.8 (0.2) mg/kg/d. We evaluated treatment response after 4 weeks, 12 to 16 weeks, and 6 months. Mean treatment duration was 10.8 (5.7) months. Treatment had to be suspended in 2 patients because of adverse effects. Seven of the 9 remaining patients presented complete or almost complete clearance of the AD after 6 months of treatment.

Conclusion

In our experience, AZA is well tolerated and may be considered as a treatment option in children with severe AD resistant to conventional treatment.

Características clínico-epidemiológicas del carcinoma de células de Merkel en una serie de 38 pacientes

Publication date: Available online 28 October 2018

Source: Actas Dermo-Sifiliográficas

Author(s): M. Dañino-García, J.J. Domínguez-Cruz, C. Pérez-Ruiz, J. Conejo-Mir, J.J. Pereyra-Rodríguez

Resumen

Introducción

El carcinoma de células de Merkel (CCM) es un tumor cutáneo muy agresivo y de mal pronóstico, aunque la incidencia es muy baja. Existen pocas series que analicen la experiencia en un mismo centro.

Metodología

Estudio observacional, descriptivo y retrospectivo de todos los pacientes diagnosticados en un hospital de tercer nivel entre 2002 y 2017. Se recogieron las características epidemiológicas, clínicas, histológicas, el tratamiento y la supervivencia, y se dividió la muestra en 2 períodos para el análisis (2002-2009 y 2010-2017). Se realizó un análisis de supervivencia mediante el modelo de Kaplan-Meier y un análisis multivariante mediante el modelo de riesgos proporcionales de Cox.

Resultados

Se incluyó a 38 pacientes, 24 hombres y 14 mujeres, con una edad media 77,76 años. El período medio de seguimiento fue de 30,11 meses. Se observó un aumento del 116% (12 vs. 26) entre los años 2002-2009 y 2010-2017, así como una edad media más avanzada (70,92 vs. 80,92; p < 0,05) y un incremento de lesiones en tronco y miembros inferiores (34,62% vs. 0%). Once pacientes fallecieron debido al CCM. La supervivencia global a los 12 meses en la serie fue del 78,2% y a los 24 meses del 69,3%. Los factores asociados a mortalidad fueron la edad mayor de 70 años y la afectación ganglionar, mientras que la localización en miembros superiores y la realización de ampliación de márgenes aumentó la supervivencia. Al realizar el análisis multivariante, solo la afectación de ganglios permaneció como factor pronóstico.

Conclusiones

Se ha observado un aumento de la frecuencia en los últimos años y un cambio en la forma de presentación a edades más avanzadas y en otras localizaciones diferentes a las clásicas.

Abstract

Background

Merkel cell carcinoma is a rare yet aggressive cutaneous tumor with a poor prognosis. Few studies have analyzed series of patients from the same hospital.

Methodology

We performed a retrospective, descriptive, observational study of all patients diagnosed with Merkel cell carcinoma at a tertiary care hospital between 2002 and 2017. We recorded epidemiological, clinical, and histologic data and information on treatments and survival. For analysis, the sample was divided into 2 groups from different periods: 2002-2009 and 2010-2017. We performed survival analysis using Kaplan-Meier curves and multivariate analysis using a Cox proportional hazards model.

Results

Thirty-eight patients (24 men and 14 women) with a mean age of 77.76 years were included. Mean follow-up time was 30.11 months. On comparing 2010-2017 with 2002-2009, we observed a 116% increase in the number of Merkel cell carcinoma cases (26 vs. 12), an older mean age at diagnosis (80.92 vs. 70.92 years, P<.05), and an increase in lesions located on the trunk and lower limbs (0% vs. 34.62%). Eleven patients died of Merkel cell carcinoma. Overall survival was 78.2% at 12 months and 69.3% at 24 months. In the univariate analysis, age over 70 years and lymph node involvement were associated with mortality, while tumor location on the upper extremities and wide surgical excision were associated with improved survival. Only lymph node involvement retained its prognostic significance in the multivariate analysis.

Conclusions

In this series, we observed that Merkel cell carcinoma has become more common in recent years and is now diagnosed at an older age and found in new anatomic locations.

Graphical abstract

46/w mit juckenden Hautveränderungen in den seborrhoischen Arealen

59/w mit Erosionen an Mund- und Nasenschleimhaut

Die AG JuDerm des BVDD

20/w mit plötzlich auftretendem, ausgeprägtem Haarausfall

40/m mit Fluor urethralis

85/m mit Blasen am gesamten Integument

77/w mit persistierenden rötlichen und schuppenden Plaques an den Extremitäten und am oberen Stamm

54/m mit rezidivierender Gesichtsdermatitis mit Papeln und Vesikeln an den Extremitäten

Mein Facharzttraining – ein Sonderheft nicht nur für Ärzte vor der Facharztprüfung

4/m mit Fieber, generalisierter Rötung und Blasen

57/m mit hyperkeratotischen Knoten am rechten Unterarm

67/w mit erythematös-schuppenden Plaques am Abdomen mit zentrifugaler Ausbreitung

46/m mit Pusteln an Hand- und Fußsohlen

31/w mit livid-erythematösen Papeln und Knoten

26/w mit beidseits tibialen druckempfindlichen und hochroten Knoten sowie bihilärer Lymphadenopathie

37/m mit konfluierenden Papeln und bogenförmig begrenzten erythematosquamösen Plaques am oberen Rumpf und an den Armen

Factors associated with variability in the prevention of pressure ulcers

Publication date: Available online 28 October 2018

Source: Journal of Tissue Viability

Author(s): Ana Belén Moya-Suárez, José Carlos Canca-Sánchez, Margarita Enríquez de Luna-Rodríguez, Marta Aranda-Gallardo, José Miguel Morales-Asencio

Evaluating the Risk Assessment Approach of the REACH Legislation: A Case Study

Abstract

Risk assessments based on occupational exposure to chemicals have increased since REACH (European regulation on Registration, Evaluation, Authorization, and restriction of Chemicals) came into force. The European Chemicals Agency (ECHA) recommends that chemical exposure could be calculated using exposure models and that parameters used to calculate the exposure scenario (ES) should be communicated in extended safety data sheets (e-SDS) as workplace instructions which downstream users are obligated to follow. We aimed to evaluate REACH's risk assessment approach using the Stoffenmanager^® 6.1, the Advanced REACH Tool 1.5 (ART), and the European Centre for Ecotoxicology and Toxicology of Chemicals' targeted risk assessment (ECETOC TRA 3.1) exposure models. We observed 239 scenarios in three companies handling chemicals using 45 e-SDS. Risk characterization ratios (RCRs) were calculated by dividing estimated exposures by derived no-effect levels (DNELs). Observed RCRs were much lower than registered RCRs, indicating lower exposures. However, about 12% of the observed ES still had RCRs > 1, after adjustment for control measures and personal protections described in the ES, when using Stoffenmanager^®. The ES with observed RCRs > 1 were the same by Stoffenmanager^® and ART, but not by ECETOC TRA. Stoffenmanager and ART identified 25 adjusted scenarios with RCR > 1, while ECETOC TRA gave RCR < 1 for the same scenarios. The ES with RCR > 1 were significantly associated to chemicals with higher vapour pressure and lower DNELs than ES with RCR < 1 by Stoffenmanager^®. The correlations between observed and registered RCRs were lower than those between RCRs calculated from the different models themselves; ECETOC TRA had the lowest correlation with the registered ES. These results put in question the generic ES recommended under the REACH legislation. Downstream users may get better estimates by assessing their own ES, especially for chemicals with low DNELs and high vapour pressure.

Skleromyxödem

Zusammenfassung

Das Skleromyxödem ist eine sehr seltene Erkrankung, die gewöhnlich in Verbindung mit einer monoklonalen Gammopathie auftritt und systemische Symptome aufweisen kann. Die Pathogenese des Skleromyxödems ist unbekannt. Der klinische Verlauf ist chronisch und progressiv und kann zu schwerer Morbidität bzw. zum Tod führen. Der Hautbefund besteht aus multiplen wachsartigen Papeln und verhärteten Plaques. Eine fortschreitende Hautbeteiligung kann zu einer verminderten Beweglichkeit von Mund und Gelenken führen. Extrakutane Manifestationen können im Nerven-, muskuloskeletalen oder kardiovaskulären System, im Gastrointestinal- oder Atemtrakt oder an den Nieren auftreten. Eine für das Skleromyxödem zugelassene oder evidenzbasierte Therapie gibt es nicht. Als Therapie der ersten Wahl gelten hoch dosierte Immunglobuline, gefolgt von Lenalidomid (bzw. Thalidomid) und systemischen Glukokortikosteroiden, bei schweren Verläufen auch eine autologe hämatopoetische Stammzelltransplantation. In der Regel treten nach Absetzen einer erfolgreichen Therapie Rezidive auf, sodass eine engmaschige interdisziplinäre Anbindung ratsam ist.

Aktuelle pathophysiologische Entwicklungen bei fibrosierenden Erkrankungen: Ansatzpunkte für neue Konzepte in der Therapie

Zusammenfassung

Die Fibrose ist ein häufiges Symptom zahlreicher Hauterkrankungen unterschiedlicher Genese. Die Pathogenese fibrosierender Veränderungen der Haut und anderer Organsysteme ist bisher nicht ausreichend verstanden, und die derzeitigen Therapiemöglichkeiten sind unzureichend. Fibrosierende Erkrankungen der Haut führen zu einer Gewebeverhärtung und zu einem Funktionsverlust, die in der Folge mit schwerwiegenden Einschränkungen der Lebensqualität, gesteigerter Morbidität und letztlich einer erhöhten Mortalität einhergehen können. Epidemiologische Studien weisen darauf hin, dass in den westlichen Industrienationen bis zu 45 % aller Todesursachen auf Erkrankungen zurückzuführen sind, die mit einer Gewebefibrose in unterschiedlichen Organen einhergehen. Aktuell stehen nur wenige spezifisch für fibrosierende Erkrankungen zugelassene Medikamente zur Verfügung. Die Entwicklung neuer, ursachenbasierter und damit effizienter Therapieansätze ist dringend erforderlich. Dies stellt einerseits eine große Herausforderung dar, eröffnet zugleich aber auch die Möglichkeit, einen besonderen Beitrag zur Aufklärung dieses medizinisch ungelösten Problems zu leisten. Im Folgenden sind ausgewählte Erkenntnisse der letzten Jahre mit Fokus auf der Rolle der Immunantwort in der Fibrogenese dargestellt.

Wenn Sonnenschutzprodukte nicht mehr helfen: Allergisches Kontaktekzem auf UV-Filter

Zusammenfassung

UV-Filtersubstanzen können sowohl allergische als auch häufiger photoallergische Kontaktekzeme auslösen. Deshalb sollte bei Verdacht auf eine Kontaktsensibilisierung gegenüber Lichtschutzmittel immer eine Photopatchtestung durchgeführt werden. Wir berichten über eine 65-jährige Frau mit seit 11 Jahren verstärkt nach Sonnenexposition auftretender Rötung der Haut im Gesichts- und Dekolletébereich trotz Anwendung eines Lichtschutzpräparates. Anhand der (Photo‑)Patchtestung konnte die Diagnose eines allergischen Kontaktekzems auf den UV-Filter 4-tert-Butyl-4'-methoxybenzoylmethan etabliert werden. Unter der Therapie mit einem topischen Glukokortikosteroid und Meidung der kausalen UV-Filtersubstanz kam es zur raschen Abheilung.

Panorama Dermatologische Praxis

Aktuelle Therapie der systemischen Sklerodermie

Zusammenfassung

Die systemische Sklerose (SSc, Sklerodermie) ist eine schwere chronisch entzündliche Bindegewebserkrankung der Haut, des muskuloskeletalen Systems und vieler innerer Organe. Der heterogene, langjährige Verlauf dieser Erkrankung mit dem Befall multipler Organe stellt eine besondere Herausforderung an den betreuenden Arzt dar. Die therapeutischen Möglichkeiten haben sich in den vergangenen Jahren in verschiedenen Bereichen entscheidend verbessert. Diese positiven Entwicklungen haben dazu geführt, dass in verschiedenen Arbeitsgruppen abgestimmte Empfehlungen zur Behandlung der SSc veröffentlicht wurden. Ziel dieser Übersicht ist es, die wesentlichen Empfehlungen vorzustellen und in ein Konzept einer modernen interdisziplinären Betreuung einzubetten.

Scleroedema adultorum

Zusammenfassung

Das Scleroedema adultorum (SA) ist eine seltene skleromuzinöse Erkrankung nicht geklärter Ätiologie, die charakteristischerweise zu brettharten Indurationen im Bereich des Nackens und oberen Rumpfes führt. Drei Typen des SA werden entsprechend ihrer Assoziation zu vorbestehenden bzw. zugrunde liegenden Erkrankungen unterschieden: SA bei Infektionen (v. a. Streptokokkeninfektionen der oberen Atemwege), SA bei monoklonaler Gammopathie und SA bei Diabetes mellitus. Die klinische Ausprägung, Schwere der Erkrankung und Verlauf variieren je nach Subtyp stark. Es existieren bisher keine evidenzbasierten Therapiestandards für das SA. Während spontane Remissionen häufig bei Infekt-assoziierten Formen des SA auftreten, kommt es beim SA im Rahmen von Diabetes mellitus oder monoklonaler Gammopathie in der Regel zu einem chronisch progredienten Verlauf. Zu den derzeitig empfohlenen Erstlinientherapien zählen Phototherapie und Methotrexat, eine klinische Besserung zeigt sich oftmals aber erst nach mehreren Monaten, und Therapieversagen ist häufig. Ergänzend sollte bei allen Formen des SA auch eine Physiotherapie zur Verbesserung der Beweglichkeit erfolgen.

Anaphylaxie auf Kamillentee

Zusammenfassung

Es wird über den Fall eines Patienten mit Typ-I-Allergie berichtet, die nach dem Genuss von Kamillentee auftrat. Etwa 30 min nach Konsum des Tees wurde der Patient mit Juckreiz der Handflächen, Schwellung der Augenlider, Oberlippe und der Nasenschleimhaut sowie Globusgefühl hospitalisiert. Ein hereditäres Angioödem konnte ausgeschlossen werden. Im Pricktest wurde die Diagnose einer Typ-I-Allergie auf Kamillentee bestätigt.

Fibrosierende Erkrankungen

Sandmückenfieber – eine „vernachlässigte“ Krankheit

Zusammenfassung

Eine 45-jährige Patientin stellte sich mit Fieber, Durchfall, Gliederschmerzen, allgemeinem Krankheitsgefühl und einem juckenden papulösen Exanthem in der Ambulanz eines tropenmedizinischen Zentrums zur weiteren Diagnostik vor. Sie hatte zuvor 11 Tage Urlaub mit ihrer Familie in einem Bergdorf in Nordzypern gemacht. Dort habe es sehr viele kleine, stechende Fliegen oder Mücken gegeben. Nach der Rückkehr erkrankten sie und ihre Familie. Die körperliche Untersuchung war bis auf das Exanthem an den Beugeseiten der Extremitäten unauffällig. In der Routineblutuntersuchung fielen eine deutliche Erhöhung der Transaminasen und ein nur geringfügig erhöhtes C‑reaktives Protein (CRP) auf. Unter Berücksichtigung des Reiselandes, des Hinweises auf die „stechenden Fliegen" und der Klinik wurde in die differenzialdiagnostischen Überlegungen zur Ursache der Hepatitis auch das sog. Sandmückenfieber einbezogen. Es konnten Antikörper gegen das sizilianische Sandmückenfiebervirus (SFSV) nachgewiesen werden, die im Verlauf eine typische Dynamik zeigten, sodass die Diagnose eines Pappataci-Fiebers gestellt wurde. Die Kasuistik und eine kurze Zusammenstellung von Informationen über den Erreger, den Vektor, die Epidemiologie, Klinik, Diagnostik und Therapiemöglichkeiten sollen dazu anregen, Phlebovirusinfektionen als mögliche Differenzialdiagnose zu berücksichtigen, wenn Reisende oder Flüchtlinge nach Aufenthalt im Mittelmeerraum an schweren fieberhaften Erkrankungen mit Hepatitis und Hauterscheinungen oder aseptischen viralen Meningitiden erkranken.

Unzureichender Tetanusimpfschutz bei Psoriasis und systemischer Immunsuppression

Zusammenfassung

Hintergrund

Psoriasis gehört mit einer Prävalenz von ca. 3 % weltweit zu den häufigsten entzündlichen Dermatosen. Patienten mit mittelschwerer bis schwerer Psoriasis werden leitliniengemäß mit immunmodulatorischen bzw. -suppressiven Substanzen behandelt. Aktuelle Leitlinien weisen darauf hin, dass auf den Impfstatus immunsupprimierter Patienten geachtet werden sollte.

Ziel der Arbeit (Fragestellung)

Das Ziel unserer Untersuchung war es, den Tetanusimpfstatus von systemisch therapierten Patienten mit moderater bis schwerer Psoriasis in Deutschland serologisch zu objektivieren.

Material und Methoden

Im Rahmen der vorliegenden retrospektiven Studie wurden die Konzentrationen von Immunglobulin(Ig)G-Antikörpern gegen Clostridium tetani bei 101 Psoriasispatienten mit überwiegend systemischer Immunsuppression bestimmt.

Ergebnisse

Bei insgesamt 27,7 % der Patienten (11 Männer, 17 Frauen) wurden unzureichende IgG-Antikörper-Konzentrationen nachgewiesen, was einem fehlendem Impfschutz bezüglich einer Infektion mit C. tetani entspricht. Subgruppenanalysen zeigten bei 50 % der Patienten im Alter ≥65 Jahre einen insuffizienten Tetanusschutz.

Schlussfolgerung

Die Daten stehen im Einklang mit den Impfschutzraten in der deutschen Gesamtbevölkerung. Die Ergebnisse unterstreichen, dass Psoriasispatienten auf ihren Tetanusschutz hin untersucht werden sollten und die erforderlichen Impfungen, wenn nötig, insbesondere bei Patienten mit systemischen immunmodulierenden bzw. -supprimierenden Therapien, aufgefrischt werden müssen.

Negative remnant 99m Tc-pertechnetate uptake predicts excellent response to radioactive iodine therapy in low- to intermediate-risk differentiated thyroid cancer patients who have undergone total thyroidectomy

Abstract

Objective

Negative ^99mTc-pertechnetate uptake of the thyroid bed indicates the absence or a small volume of remnant thyroid tissue (RTT) after total thyroidectomy (TT). The aim of this study is to evaluate the predictive value of negative ^99mTc-pertechnetate scintigraphy for excellent response (ER) to radioactive iodine therapy (RIT) in low- to intermediate-risk differentiated thyroid cancer (DTC) patients.

Patients

One-hundred and eighty-nine low- to intermediate-risk DTC patients who underwent TT, RIT with a single dose of 30 mCi and suppressive therapy with thyroid-stimulating hormone (TSH) from July 2015 to February 2016 in our hospital were retrospectively evaluated. ^99mTc-pertechnetate thyroid scintigraphy was performed just before RIT and images were reported dichotomously as negative or positive. The response of patients was assessed for 23.2 ± 3.8 months after RIT and dichotomized as excellent response (ER) or non-excellent response (NER). ^99mTc-pertechnetate uptake, age at diagnosis, gender, multifocality, T stage, N stage, preablative stimulated thyroglobulin (ps-Tg), and TSH were explored as potential predictors for ER.

Results

80.68% (71/88) of patients with negative ^99mTc-pertechnetate uptake achieved ER. When patients were evaluated according to different ps-Tg levels, we found that 94.83% (55/58) of patients with ps-Tg < 1 ng/ml and negative ^99mTc-pertechnetate uptake achieved ER. Multivariate Cox regression analysis revealed that ps-Tg (P = 0.0001) and ^99mTc-pertechnetate uptake (P = 0.0473) were independent predictors for ER.

Conclusions

In addition to ps-Tg, negative ^99mTc-pertechnetate uptake is also a significant independent predictor for an excellent response in low- to intermediate-risk patients. It may be possible to omit RIT in patients with ps-Tg < 1 ng/ml and concurrent negative ^99mTc-pertechnetate uptake.

Prevalence of contact allergy in the general population: A systematic review and meta‐analysis

Contact Dermatitis, EarlyView.

Patient Education in Atopic Dermatitis: Why It Is Needed and How to Improve It

Abstract

Purpose of Review

Demonstrate the need and objectives of patient education in atopic dermatitis (AD), provide an overview of the most recent studies regarding patient education, and propose new approaches to improve educational programs.

Recent Findings

Different models of patient education programs exist, and their structures depend on social and economic conditions. An active participation of patients is needed to improve new models of educational programs. Healthcare professionals who work with AD patients must have a comprehensive view of the many aspects involved in this disease, which includes psychological, environmental, social, financial, and cultural aspects.

Summary

AD is a complex disease and has a clear impact in patients' quality of life. Patients are often frustrated and confused by the information they receive. This information can often be conflicting and overwhelming. Education for patients with AD is now being proposed as an important step in major treatment guidelines. Most studies of patient education demonstrate a positive impact in patients' clinical outcomes, adherence, and quality of life.

The Objective and Subjective Sides of Human Moral Consciousness and Their Relation: Author’s Reply to Reviews of Kant’s Conception of Pedagogy

A randomized controlled trial protocol assessing the effectiveness, safety and cost‐effectiveness of methotrexate vs. ciclosporin in the treatment of severe atopic eczema in children: the TREatment of severe Atopic eczema Trial (TREAT)

British Journal of Dermatology, EarlyView.

Suprapubic catheterization is expedient for the surgical excision of female genital tumors

Dermatologic Therapy, EarlyView.

Cutaneous localization of angioimmunoblastic T‐cell lymphoma may masquerade as B cell lymphoma or classical Hodgkin lymphoma: a histologic diagnostic pitfall

Journal of Cutaneous Pathology, Volume 0, Issue ja, -Not available-.

Revisiting Prepectoral Breast Augmentation: Indications and Refinements

Abstract

Background

Prepectoral breast reconstruction is receiving renewed attention as a viable alternative to retropectoral reconstruction. Prepectoral breast augmentation needs to be reappraised, as patients increasingly demand safer and less invasive procedures with a shorter recovery period.

Objective

This study aimed to evaluate prepectoral breast augmentation combined with a microtextured prosthesis to determine whether it could be a useful alternative to retropectoral augmentation.

Methods

This study included 76 women (152 breasts) who were indicated for primary breast augmentation. The inclusion criterion was a pinch test result of more than 3 cm at the upper pole of the breast. A total subfascial dissection was performed with endoscopic assistance. Microtextured implants were placed through an axillary approach in the subfascial space.

Results

The mean follow-up period was 12 months (range, 6–23 months). The mean implant volume was 278.1 mL (range, 185–360 mL). Autologous fat grafts were applied in 12 patients. No patients developed seroma, capsular contracture or malposition during the follow-up period. Two patients expressed concerns of minor contour visibility, but no patients required revisional surgery.

Conclusions

The drawbacks of prepectoral implant placement were sought to be managed by fascial coverage and microtextured prostheses. Although the follow-up duration was short, major complications were not encountered with Motiva Ergonomix SilkSurface implants. Therefore, prepectoral augmentation with microtextured prostheses should be reconsidered as a potential alternative to retropectoral methods because of the recent advances in surgical techniques and device technology.

Is Histological Evaluation of Reduction Mammaplasty Specimens Worthwhile?

Abstract

Background

Reduction mammaplasty (RM) is one of the most common plastic surgery procedures. Despite its cost, the total number of RM procedures continues to increase every year.

Objectives

The purpose of this study is to review the prevalence of benign and malignant breast lesions among women who live in Aegean region of Turkey, based on our university hospital's records and to compare our results with those in the literature.

Methods

Seven hundred and thirty-three consecutive female patients who underwent RM between January 2003 and January 2017 in the Department of Plastic, Reconstructive, and Aesthetic Surgery were included in this study.

Results

One hundred and sixty-five patients (23.4%) had preoperative breast imaging results. Most of these patients had BI-RADS-2 and BIRADS-1 findings (41.21% and 40%, respectively). Fibrocystic changes were the most common lesions (81.3%). Sixty-eight patients (9.6%) had normal breast tissue on the right side and 34 patients (4.8%) had the same on the left side. Five patients (0.71%) had atypical ductal hyperplasia and no atypical lobular carcinoma. Four patients (0.56%) had occult breast cancer and one patient (0.14%) had benign phyllodes tumor.

Conclusion

RM is a good opportunity to detect proliferative lesions and occult breast cancer. While meeting the patient's aesthetic desires, the plastic surgeon should consider for histopathological evaluation. We suggest that every part of the breast tissue should be sent to pathological examination regardless of the weight of the specimen. Even if health insurance doesn't cover its cost, patients should be informed about the importance of this process.