Cutaneous atypical papular CD8+ lymphoproliferative disorder at acral sites in a renal transplant patient

Summary

A 20-year-old woman presented with a 2-month history of an acute symmetrical eruption, manifesting as asymptomatic ill-defined erythematous macules and hyperkeratotic papules on the palms. The patient was a renal transplant recipient, and the lesions had developed 2 months post-transplantation. Histologically, the eruption shared features of a reactive inflammatory condition called papular eruption of atypical CD8+ lymphocytes as well as primary cutaneous acral CD8+ T-cell lymphoma (a provisional indolent entity in the new World Health Organisation classification of lymphoid neoplasms, 2016). The latter disorder has been described to occur at acral sites in immunocompetent patients, whereas the former has previously been described only in patients infected with human immunodeficiency virus. The lesions in our patient healed after topical treatment with corticosteroids and alteration of immunosuppressive therapy, supporting the role of immunosuppression in this case. We classified our patient's condition as lying in the spectrum of the aforementioned two conditions, but the relationship between both diseases remains to be clarified. Awareness of these unusual conditions may prevent the use of unnecessary aggressive therapies in similar patients.

A new endoscopic technique to close big nasal septal perforations: prospective evaluation of the double meat hook technique in 19 consecutive cases

Abstract

Despite the variety of surgical techniques available to close big symptomatic septum perforations, closure rates of 30 to 70% indicate the difficulty of obtaining a good end result.

The double meat hook technique is a new endoscopically assisted technique that delivers excellent visualization and control of mucosal flap elevation, extension and suturing.

Mucosa from the nasal floor, lateral nasal wall and inferior turbinate bone are valuable donor site extensions.

There is no need for additional incisions into the nasal septal mucosa in order to perform a tension-free closure. Preservation of the structural integrity and blood supply of the mucosal flaps, possibly contributes to a high closure rate and delivers a physiological result.

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Current Use of Baseline Medical Treatment in Chronic Rhinosinusitis: Data from the National Chronic Rhinosinusitis Epidemiology Study (CRES)

Abstract

Objectives

According to clinical and comissioning guidelines for chronic rhinosinusitis (CRS), patients being referred to secondary care should have failed primary medical treatment with nasal douching (ND) and intranasal corticosteroids (INCS). The study objectives were to identify the rate of specific medical therapy in CRS patients and establish any differences in medication use, for both CRS and associated medical conditions, between CRS phenotypes.

Design and setting

Case-control study in a secondary care setting.

Methods

Participant-reported study-specific questionnaire capturing free text data on current medication use at the time of study entry. Qualitative interviews with 21 participants also explored their experience of CRS and its management.

Particpants

Patients with both without (CRSsNPs) and with polyps (CRSwNPs).

Main outcome measures

Reported use of CRS-related and non-related medications.

Results

Within a total of 1243 CRS participants, current INCS usage was low (18% in CRSwNPs, 12% in CRSsNPs); ND was being performed by only 1% of all participants. Bronchodilators and inhaled corticosteroids use was significantly higher in CRSwNPs participants (p < 0.0001). Antidepressants use was significantly higher in CRSsNPs (14% versus 7%, p < 0.0002). There were no significant regional variations in rates of INCS use, nor any significant influence of social deprivation.

Conclusions

The current use of baseline medical therapy in CRS appears to be very low, representing a combination of poor patient compliance, possible ineffectiveness of treatment and a lack of familiarity with current guidelines amongst general practitioners and some ENT specialists. Work is needed to disseminate guidelines to all practitioners involved and reduce unnecessary burden on existing healthcare resources for this common condition by ensuring timely referral and definitive management.

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Lenalidomide-Associated Thyroid-Related Eyelid Retraction.

Several antineoplastic treatments have been responsible for thyroid dysfunction and thyroid eye disease. Min, Vaidya, and Becker (2011) reported a case of euthyroid Graves orbitopathy after treatment with ipilimumab with the patient displaying proptosis and myositis in the setting of normal thyroid function tests and elevated thyroid antibodies. The authors report a case of a 76-year-old woman who developed right upper lid retraction and proptosis after 2.5 years of treatment with lenalidomide for multiple myeloma. Thyroid function tests were normal: thyroid-stimulating hormone 0.808 mIU/mL, total T3 102 ng/dL, free T4 1.48 ng/dL. Thyroid antibodies were elevated: thyrotropin receptor antibody 2.26 IU/L, thyroglobulin antibody 1043.1 IU/mL, and thyroid peroxidase antibody 38 IU/mL. A nuclear medicine thyroid scan was normal. Given the possible thyroid effects from lenalidomide, patients who receive this medication should be periodically evaluated for thyroid dysfunction and thyroid eye disease. (C) 2017 by The American Society of Ophthalmic Plastic and Reconstructive Surgery, Inc., All rights reserved.

Investigación clínica en dermatología y venereología de centros e instituciones españolas, 2005-2014. Resultados del estudio MaINDH

Publication date: Available online 20 October 2017
Source:Actas Dermo-Sifiliográficas
Author(s): A. Molina-Leyva, M.A. Descalzo, I. García-Doval
Antecedentes y objetivoLos artículos de investigación clínica publicados en revistas científicas y los indicadores bibliométricos que de ellos derivan son un método útil para medir la cantidad y la calidad de la investigación clínica realizada. El objetivo de este estudio es conocer la cantidad, calidad y temática de la producción científica de centros e instituciones de dermatología españoles.Material y métodoEstudio bibliométrico de los artículos de investigación clínica con fecha definitiva de publicación entre el año 2005 al 2014, ambos inclusive, en las bases de datos Medline o Embase, en cuya dirección de autor de correspondencia figure un centro o institución de dermatología española y que cumplan los criterios de investigación clínica en dermatología.ResultadosDe los 8.617 artículos encontrados, 1.104 (12,81%) cumplieron los criterios de inclusión. El principal criterio de exclusión —67,37% de los artículos— fue tener un nivel de evidencia científico mayor de 4. La revista en la que se publicaron más artículos fue Actas Dermosifiliográficas con 326 artículos (29,53%). La enfermedad con un mayor número de artículos fue el melanoma, con 134artículos (12,13%).LimitacionesEl criterio para atribuir una publicación científica a una institución dermatológica española en función de la dirección del autor de la correspondencia hace que estudios en los que participan dermatólogos que trabajan en estudios dirigidos por instituciones no dermatológicas no sean incluidos.ConclusionesSolo una pequeña proporción de los artículos que publican las instituciones de dermatología españolas pueden ser considerados investigación clínica. El principal motivo es el bajo nivel de evidencia científica. La mayoría de las publicaciones son reportes de casos clínicos.Background and objectiveBibliometric indicators provide a useful measure of the number of clinical research articles published in scientific journals and their quality. This study aimed to assess the amount and quality of research carried out in Spanish dermatology centers and to describe the research topics.Material and methodBibliometric study of clinical research articles that met the inclusion criteria and had a definitive publication date between 2005 and 2014 in MEDLINE or Embase in which the corresponding author's affiliation was a Spanish hospital dermatology department or other center.ResultsOf 8,617 articles found, 1,104 (12.81%) met the inclusion criteria. The main reason for excluding articles was that they did not have an evidence level of 4 or better. The main vehicle for reporting was the journal Actas Dermosifiliográficas, which published 326 articles (29.53%). Melanoma, the disease the researchers studied most often, accounted for 134 articles (12.13%).LimitationsA limitation to bear in mind when interpreting the results is that we relied on the corresponding author's affiliation to identify articles reflecting research from a Spanish dermatology center. Thus, studies in which dermatologists participated would not be recognized if they were directed by other specialists.ConclusionOnly a small portion of articles published from Spanish dermatology centers can be considered clinical research, mainly because many publications provide a low level of scientific evidence. Most publications are case reports.

Graphical abstract

A Technique for Reduction of Edentulous Fractures Using Dentures and SMARTLock Hybrid Fixation System

Summary: Establishing anatomic reduction of an edentulous mandible fracture is a frequently acknowledged challenge in craniomaxillofacial trauma surgery. In this study, we report a novel method for the reduction of the edentulous mandible fracture, via fabrication of modified Gunning splints using existing dentures and SMARTLock hybrid arch bars. This technique dramatically simplifies the application of an arch bar to dentures, obviates the need for the fabrication of impressions and custom splints, and eliminates the lag time associated with the creation of splints. Furthermore, this method may be used with or without adjunctive rigid internal fixation. The technique described herein of creating Gunning splints with SMARTLock hybrid arch bars provides surgeons with a simple, rapid, single-stage solution for reduction of mandibular fractures in the edentulous patient.

Immediate Nipple-Areolar Complex Reconstruction for Patients Undergoing Implant-Based Reconstruction or Therapeutic Mammoplasty

Background: We report a technique of immediate nipple-areolar complex (NAC) reconstruction for patients undergoing skin-sparing mastectomy and implant-based breast reconstruction or therapeutic mammoplasty with central excision. Methods: Immediate nipple reconstruction is performed using a modified C-V flap planned along the edge of the incision. The areola is reconstructed using a full-thickness skin graft taken from skin usually discarded during the procedure. Immediate NAC reconstruction using this technique was performed on 32 breasts in 21 patients. This included 19 risk-reducing mastectomies, 9 therapeutic mastectomies, and 2 major revisions to existing implant reconstruction. Reconstruction was direct to implant in 29 breasts and by expander in 1 breast. The device was placed in a pre- or post-pectoral plane utilizing dermal sling and/or acellular dermal matrix as determined on a case-by-case basis. Immediate NAC reconstruction was also performed on 2 patients undergoing therapeutic mammoplasty with central excision. Results: Mean follow-up is 12 months (5–27 months), and cosmetic results have been good. There have been no significant complications, and no revisional surgery has been required. Conclusion: The application of simple techniques for NAC reconstruction in the primary procedure allows reconstruction of the whole breast in a single stage. There is an immediate focal point to the reconstruction to improve cosmesis, patient satisfaction, and psychosocial function without delay.

Characterization of Melanosomes and Melanin in Japanese Patients with Hermansky-Pudlak Syndrome Types 1, 4, 6 and 9

Abstract

Hermansky-Pudlak syndrome (HPS) is an autosomal recessive disorder characterized by oculocutaneous albinism (OCA), a bleeding tendency and ceroid deposition. Most of the causative genes for HPS encode subunits of the biogenesis of lysosome-related organelles complex (BLOC). In this study, we identified one patient each with HPS4, HPS6 and HPS9 by whole-exome sequencing. Next, we analyzed hair samples from the three patients and representative patients with HPS1 and controls using electron microscopy and chemical methods. All HPS patients had fewer, smaller and more immature melanosomes than healthy controls. Further, all patients showed reduced total melanin content and increased levels of benzothiazine-type pheomelanin. The results of this study demonstrate the impact of the dysfunctions of BLOCs on the maturation of melanosomes and melanin levels and composition through analysis of their hair samples.

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Nuances in component nasal hump reduction

Nasal hump reduction is a frequent manoeuver in rhinoplasty. Over the last years, composite hump reduction has been advocated in favour of component hump reduction. The latter allows a more controlled and stepwise approach in reducing the nasal dorsum by deprojecting the cartilaginous dorsum separately from the bony dorsum. This approach also preserves the upper lateral cartilages (ULCs) and their mucosa.

Anthropometric growth study of the ear in a chinese population

A large number of anthropometric studies of the auricle have been reported in different nations, but little data are available in the Chinese population. The aim of this study was to analyze growth changes in the ear by measuring the width and length of ears in a Chinese population.

Mammaplasty in patients with large areola: reducing the nipple-areola complex using intra-areolar incisions

Minimal incision breast reduction techniques resulting in periareolar scars are widely used. However, this technique is less suitable for patients with large areola diameters and relatively small breasts, requiring a modest reduction or lift only. As a result of the large nipple-areola-complex larger amounts of skin must be removed in order to resect the complete peripheral areola, increasing the risk of high-riding nipples, breast flattening and incomplete areola resection resulting in a rest on the vertical scar.

Post-operative care of VRAM flaps for perineal reconstruction: results of a UK practice survey and literature review

The trans-pelvic vertical rectus abdominis myocutaneous (VRAM) flap has shown considerable utility in the reconstruction of pelvic defects following abdomino-perineal excision (APE) or total pelvic exenteration (TPE) for pelvic malignancy. These patients are often nursed post-operatively on colorectal wards, or even in outlying hospitals in those Plastics units operating on a hub-and-spoke basis. Protocols for the post-operative care of free flap reconstruction patients are well established and have been shown to reduce major complications1,2.

The scrotal free flap: first successful clinical application of a free Super-Thin External Pudendal Artery (STEPA) flap for reconstruction of a foot defect

Dear Editor,

External validation of a cancer risk prediction model for suspected head and neck cancer referrals

Abstract

Head and neck cancer (HNC) affects more than 9000 new patients every year in England and Wales with an additional 1200 in Scotland. ^1,2 Patients are urgently referred to head and neck clinics for further assessment when a suspicion of cancer is raised in the primary care setting. In England, the referral criteria are based on the NICE recommendations for symptoms associated with HNC. ² A different combination of symptoms is described in the Scottish cancer referral guidelines. ³ There is currently no unified referral proforma across the different UK cancer networks.

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A review of periorbital cellulitis guidelines in Fifty-One Acute Admitting Units in the United Kingdom

Abstract

Periorbital cellulitis is an acute infection of the periorbital soft tissues with potential sight and life threatening complications that most commonly occurs in children^[1]. Post-septal abscess formation can cause loss of sight; furthermore, posterior spread of infection may progress to cavernous sinus thrombosis and intracranial infection^{[1, 2]}. In England April 2014-March 2015, 3687 patients attended hospital with periorbital cellulitis costing the National Health Service over £9.5 million per annum before considering the cost of treating its complications^[3].

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Post-operative corticosteroid irrigation for chronic rhinosinusitis after endoscopic sinus surgery: a meta-analysis

Abstract

Background

Recently, topical steroid therapy delivery using high-volume sinonasal irrigations has been used more frequently, following endoscopic sinus surgery (ESS), to improve drug delivery into the paranasal sinuses.

Objective

The goal of this study was to perform a systematic review with meta-analysis of the efficacy of steroid nasal irrigation on postoperative management of CRS following ESS.

Methods

Five databases (PubMed, SCOPUS, Embase, Web of Science, and the Cochrane database) from inception to March 2017 were independently reviewed by two researchers. Studies that scored CRS endoscopic findings and CRS-related quality of life postoperatively before and after steroid nasal irrigation, and that compared the effects of steroid nasal irrigation (treatment groups) with saline alone irrigation (control group) were included in the analysis.

Results

Twelve studies (n=360) met inclusion criteria. Steroid nasal irrigation significantly reduced the endoscopic score compared with pretreatment values and also improved quality of life. Adverse effects following steroid nasal irrigation such as increased intraocular pressure and hypothalamus-pituitary-adrenal axis disturbance were not significant. However, compared with saline alone irrigation, the additional effects of steroid irrigation were not significant in the view of the endoscopic score and disease-specific quality of life.

Conclusion

Although steroid nasal irrigation would not induce adverse effects related to systemic steroid absorption, the beneficial effects of additional steroids in saline irrigation were ambiguous in regards to endoscopic score and CRS-related quality of life improvement compared with saline alone irrigation. However, further clinical trials with robust research methodologies should be conducted to confirm the results of this study.

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Influence of Backside Loading on the Floating Mass Transducer: an in vitro experimental study

Abstract

Hypothesis

The vibration of the floating mass transducer (FMT) of a single active middle-ear implant (AMEI) is distinctly influenced by the properties of the material coupled to its back side.

Background

In round window vibroplasty, the FMT needs to be padded against the surrounding bone opposite from the round window membrane. This represents one factor influencing its performance as a round window driver. Therefore, we examined the effects of different materials linked to the back side of an FMT on its vibration range.

Methods

The back side of an FMT was glued to a silicone cylinder 1.0 mm in diameter and 1.0 mm – 1.5 mm in length and of 40A, 50A or 70A Shore hardness; to cartilage of equivalent size; or to a round window soft coupler (RWSC), all firmly fixed on a steel plate. The vibrations were determined by a laser Doppler vibrometer (LDV) measuring the velocity of the centre point on the front side of the FMT.

Results

The materials on the back side of the FMT significantly influenced the vibration range of the FMT. The RWSC and silicone of 40A Shore hardness allowed for the highest detected velocities, while cartilage led to a distinct reduction similarly to 70A silicone.

Conclusion

The coupling on the back side of an FMT distinctly affects its vibration range. In this regard, the RWSC and silicone of 40A Shore hardness yield the least impairment of vibration. Thus, the RWSC may be a feasible option in round window vibroplasty when additionally connected to the FMT opposite from the round window membrane.

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Efficacy of Laryngectomy alone for Treatment of Locally Advanced Laryngeal Cancer: A Stage and Subsite Specific Survival Analysis

Abstract

Objective

Total laryngectomy is a well-established treatment for locally advanced laryngeal cancer. Evidence for the benefit of post-operative radiotherapy after laryngectomy in patients with locally advanced primaries and N0 or N1 nodal disease is limited. This study aims to determine whether total laryngectomy alone is adequate therapy for certain patient subgroups with locally advanced laryngeal cancer.

Design

We performed a retrospective survival analysis of patients in the surveillance epidemiology and end results (SEER) database with locally advanced laryngeal cancer between 2004-2012.

Outcome Measures

Primary outcome measure was overall survival.

Results

For all patients with T3-4aN0-1 tumors, overall survival was worse for those treated with laryngectomy only when compared using the Kaplan-Meier with a Log-Rank test and when accounting for demographic and tumor data using a Cox multivariate regression. Other independent predictors of poor survival included age > 65 years old, Medicaid or uninsured payor status, supraglottic primary and N1 nodal disease. Stage and subsite specific analysis revealed that patients with T4a primary tumors, N1 nodal disease and supraglottic subsite had worse overall survival when treated with laryngectomy alone. Alternatively, patients with T3 primary tumors, N0 nodal disease, glottic subsite had equivalent overall survival and disease specific survival when treated with laryngectomy alone versus laryngectomy with post-operative radiotherapy.

Conclusion

Locally advanced laryngeal cancer patients with T3 primaries, no nodal disease or primaries of the glottis may not benefit from post operative radiotherapy when treated with primary total laryngectomy.

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Age of Diagnosis, Incidence and Prevalence of Recurrent Respiratory Papillomatosis – A South African Perspective

Abstract

Objectives

To determine the distribution of the age of onset of recurrent respiratory papillomatosis (RRP) and to determine the incidence and prevalence of RRP in both adults and children in the Free State province of South Africa in order to provide data from a population in sub-Saharan African.

Design

Retrospective record review.

Participants

All patients with recurrent respiratory papillomatosis in the Free State province of South Africa between 2011 and 2015.

Main outcome measures

Distribution of the age of diagnosis of RRP and incidence and prevalence of RRP.

Results

The best fitting mixture distribution for the age of diagnosis of RRP was a two-component mixture of log-normal distributions. Within the first component (JoRRP), the age of diagnosis was significantly lower in patients with HPV11 disease (median 3.2 year) than those with HPV6 disease (median 5.6 years) (p=0.021), while in the second component (AoRRP), there was no significant difference in the age of diagnosis between HPV11 disease (30.7 year) and HPV6 disease (median 44.0 years) (p=0.0696).

The incidence and prevalence of JoRRP were 1.34/100000 population/year and 3.88/100000 population, respectively, while the incidence and prevalence of AoRRP were 0.18/100000 population/year and 0.38/100000 population, respectively.

Conclusion

RRP in the Free State province of South Africa is a disease with a predominantly juvenile onset, with AoRRP having a lower prevalence than in Europe. This is probably reflective of the situation in sub-Saharan Africa.

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Cryotherapy plus oral zinc sulfate versus cryotherapy plus placebo to treat common warts: A double blind, randomized, placebo-controlled trial

Cutaneous warts are caused by a small group of specific types of human papillomaviruses. Cryotherapy is a highly effective treatment for patients with viral warts; however, it is a painful method and usually requires several treatment sessions. Zinc is a trace element with many proven effects on the immune system.