Torus mandibularis affects the severity and position‐dependent sleep apnea in non‐obese patients

Abstract

Objective

Various anatomical structures of upper airway and physical differences are known to be risk factors for obstructive sleep apnea (OSA). Torus mandibularis is a structure that can appear on the inside of the mandible. Therefore, it is possible for tori to influence airway volume by occupying the space for tongue, and cause sleep apnea. The purpose of this study is to investigate the effect of torus mandibularis on the severity of OSA as one of the craniofacial risk factors.

Design

Retrospective case‐control study.

Setting

University‐based tertiary medical center.

Participants

Adult patients over 19‐years‐old who visited out‐patient clinics with complaints of sleep‐disordered breathing symptoms between January 2010 and December 2017 were investigated.

Main outcome measures

The presence of torus mandibularis in oral cavity was confirmed by physical examination or CT image. We analyzed demographic findings including age, sex, medical history, previous operation history, physical findings of upper airway, and result of polysomnography. To evaluate the effect of torus mandibularis on OSA, polysomnography data of the two groups according to presence or absence of torus mandibularis were compared and analyzed.

Results

232 OSA patients with BMI less than 25 were divided into two groups, according to either the presence or absence of torus mandibularis. We analyzed 138 patients of control group and 94 of torus mandibularis group. AHI was 18.8 ± 14.9 in control group and 25.1 ± 18.4 in torus mandibularis group (p=0.006). RDI was 23.1 ± 14.7 in control group and 27.9 ± 18.4 in torus mandibularis group (p=0.035). Supine AHI showed 26.6 ± 20.3 in control group and 32.5 ± 22.6 in torus mandibularis group (p=0.039). Patients with torus mandibularis had a trend of increase in proportion according to the severity of sleep apnea, such as AHI (p=0.007) or RDI (p=0.034).

Conclusions

We newly found that the presence of torus mandibularis affects not only severity of OSA and also position dependent OSA. These results support the necessity of torus mandibularis evaluation in OSA patients, and further study is also required to investigate its consequence in the surgical outcome.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2MghDcs

Our Experience with a Novel CSF Leak Repair Material in 14 Patients Following Anterior Skull Base Surgery

Abstract

Hemopatch (HE) advanced hemostatic pad composed of collagen and a synthetic, protein‐reactive monomer which polymerises on contact with protein containing body fluids such as blood and CSF to seal tissues.

HE is readily available which shortens the operating time, and may be manipulated intra‐nasally to reconstruct defects of the anterior skull base.

Reconstruction using HE reduces the morbidity compared with traditional facia lata graft harvesting techniques.

Length of stay and operative times might be decreased due to lower morbidity from donor site complications.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2stVL4j

Daily outpatient intravenous antibiotic therapy for the management of pediatric periorbital cellulitis, a retrospective case series of sixty‐six patients

Abstract

Objective

To evaluate whether outpatient treatment of periorbital cellulitis with daily administration of intravenous antibiotics and physician evaluation is an effective and safe alternative to admission.

Design

A retrospective chart review study of pediatric patients treated on an outpatient basis for periorbital cellulitis at a tertiary children's hospital between 2013‐2015 was performed. Children were assessed day by a pediatrician to monitor for resolution of symptoms or complications.

Setting

The Montreal Children's hospital, a tertiary care center.

Participants

Children diagnosed with an uncomplicated periorbital cellulitis secondary to an acute sinusitis or upper respiratory tract infection.

Main outcome measures

The number of days of intravenous antibiotics, complications or need for subsequent admission. Complications were defined as formation of an abscess or phlegmon confirmed on computerized tomography scan, worsening or recurrent persistent cellulitis, failure to improve on intravenous antibiotics, and intracranial complications.

Results

Sixty‐six children with a diagnosis of uncomplicated periorbital cellulitis secondary to sinusitis who received intravenous antibiotics via medical day hospital and who fit the inclusion criteria were identified. The mean duration of intravenous antibiotic therapy was 4.1 days. All children received ceftriaxone, with one patient also receiving cefuroxime. Two of 66 patients developed complications; one patient required admission for failure to improve/subperiosteal phlegmon and later underwent functional endoscopic sinus surgery, and one patient developed an eyelid abscess that did not require admission. No patients developed severe neurological or visual deficits.

Conclusions

Outpatient intravenous therapy with daily reassessment by a physician may be a safe alternative to admission in select cases of periorbital cellulitis without systemic signs of illness.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2SPsyww

ΒΟΗΘΗΜΑΤΑ ΑΚΟΗΣ,ΑΚΟΥΣΤΙΚΑ ΒΑΡΗΚΟΙΑΣ,ΕΝΙΣΧΥΤΕΣ ΑΚΟΗΣ

Οπισθωτιαία
Εφαρμόζονται πίσω από το αυτί και συνδέονται με το κατάλληλο εκμαγείο

Ενδοκαναλικά
Αθέατα,Είναι μικρότερα σε μέγεθος και εφαρμόζονται μέσα στον ακουστικό πόρο.

Καθαρή και διαυγή μετάδοση της φωνής των συνομιλούντων
Έξυπνη φραγή των θορύβων

Άριστη ποιοτική ενίσχυση και απόδοση του ήχου,εύκολα στη χρήση,άνετα στην εφαρμογή,όμορφα για καλύτερη αισθητική όσο αφορά το μέγεθος και την εξωτερική εμφάνιση,χωρίς καμμία ιδιαίτερη συντήρηση.

Ενδοωτιαίο Ακουστικό Βοήθημα με ελεγχόμενη ένταση,
Ενδοωτιαίο Ακουστικό Βοήθημα Υψηλής Πιστότητας,
Ενδοωτιαίο Ακουστικό Βοήθημα Δώρο Χαράς Σε Όσους Αγαπάτε και Φροντίζετε,
Ενδοωτιαίο Ακουστικό Βοήθημα με πιστοποίηση γνησιότητας και ποιότητας,
Ενδοωτιαίο Ακουστικό Βοήθημα υποαλλεργικά άριστης εφαρμογής,
Ενδοωτιαίο Ακουστικό Βοήθημα όμορφα μικρά αόρατα με άριστες αποδόσεις,
Ενδοωτιαίο Ακουστικό Βοήθημα όμορφα μικρά αόρατα με άριστες αποδόσεις για μεσαίες εως υψηλές βαρηκοΐες,
Ενδοωτιαίο Ακουστικό Βοήθημα Οδηγίες Χρήσης,

https://akoustika-ellas.blogspot.com/,
12 ή 14 άτοκες δόσεις
Δωρεάν μεταφορικά

Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με μπαταρία μακράς διάρκειας,

https://akoustika-ellas-2.blogspot.com/,
12 ή 14 άτοκες δόσεις
Δωρεάν μεταφορικά

Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με μπαταρία μακράς διάρκειας,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC Extra Low Noise,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC sound processing technology,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC Extra Low Noise με μπαταρία μακράς διάρκειας και γρήγορης φόρτισης,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με μπαταρία μακράς διάρκειας 12 εως 18 ωρών φόρτιση σε θύρα USB,
Οπισθοωτιαίο Ακουστικό Βαρηκοίας υψηλής ποιότητας επαναφορτιζόμενο με έξυπνη φραγή όλων των θορύβων με επεξεργαστή IC Extra Low Noise με μπαταρία μακράς διάρκειας και γρήγορης φόρτισης 5γρ εύκολη χρήση,

https://akoustika-ellas1.blogspot.com/,
12 ή 14 άτοκες δόσεις
Δωρεάν μεταφορικά  

“Change over time in the treatment of pemphigus vulgaris between 2004 and 2016 in Iran”: A multiple cross‐sectional study

from A via a.sfakia on Inoreader http://bit.ly/2FEPvQb

Low dose thalidomide monotherapy for the treatment of recalcitrant erosive lichen planus

from A via a.sfakia on Inoreader http://bit.ly/2TQ1TzO

Use of potassium iodide in deep mycosis

from A via a.sfakia on Inoreader http://bit.ly/2HexPw7

A Case of Pityriasis Lichenoides et Varioliformis Acuta Pemphigoides Successfully Treated with Methotrexate and Corticosteroids

Abstract

Pityriasis lichenoides et varioliformis acuta(PLEVA) pemphigoides is an uncommon skin disease, which is characterized by the appearance of blistering skin lesions in patients with PLEVA. We present a 3‐year‐old boy, who was diagnosed PLEVA pemphigoides. Combined treatment of oral methotrexate and corticosteroids was more effective than corticosteroids alone on this patient.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2FCHBXb

Impressive response of CD30‐negative, treatment‐refractory mycosis fungoides to brentuximab vedotin

Abstract

Brentuximab vedotin is a CD30‐antibody/drug conjugate which has demonstrated excellent response in treating CD30‐positive mycosis fungoides (MF) and anaplastic large cell lymphoma (ALCL). In this report, we present a patient with CD30‐negative MF refractory to multiple other lines of therapy who demonstrated a dramatic response to brentuximab. This paradoxical response may be due to inadequate detection of CD30 expression by immunohistochemical techniques. From this case we see that even in the setting of apparent CD30 negativity, brentuximab may be a viable treatment option for patients who require bridging to stem cell transplant or seek successful palliation. This case highlights the point that rigid inclusion criteria for MF trials without use of more sensitive techniques to confirm lack of CD30 expression may inappropriate.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2FJ9DQ9

Acitretin Combined with NB‐UVB in the Treatment of Cutaneous CD30‐positive Anaplastic Large Cell Lymphoma

Abstract

Cutaneous CD30⁺ lymphoproliferative disorders represent a spectrum of skin lymphatic reticular proliferative diseases, including lymphomatoid papulosis (LYP), primary cutaneous anaplastic large cell lymphoma (PC‐ALCL), and borderline lesions between them. Although they all express CD30 as a phenotypic marker and share overlapping immunophenotypic features, they differ in clinical manifestations, pathological features, treatment, and prognosis. LYP is a kind of benign disease characterized by recurrent papules and nodules and may spontaneously regress. PC‐ALCL presents with solitary tumor or local grouped nodules characterized by large T‐cells and may completely or partially resolve in fewer than half of cases. We reported a case of patient with clinical manifestation and pathologic features consistent with LYP in its early stages, which later turned into PC‐ALCL. This patient was treated with acitretin combined with NB‐UVB and had an obvious response.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2FCHyKZ

Rapid remission of Stevens‐Johnson syndrome by combination therapy using etanercept and intravenous immunoglobulin and a review of the literature

Abstract

SJS/TEN are spectrum of rare, acute and life‐threatening delayed‐type drug hypersensitivity reactions that are associated with high mortality rates. However, no therapeutic standard has been proposed for SJS/TEN. Here, we report a case of a patient diagnosed with Stevens‐Johnson syndrome whose disease progression was halted by a single dose of etanercept and was treated successfully. In addition, we reviewed the literature reporting patients with SJS/TEN treated with similar regimens.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2FPr2a7

“Intramatricial Platelet Rich Plasma Therapy: A Novel Treatment Modality in Refractory Nail Disorders”

Abstract

Background

Platelet rich plasma (PRP) is essentially an increased concentration of autologous platelets (growth factors) suspended in small amount of plasma. These factors have a proliferative and regenerative effect on a number of tissues in body and have been extensively used in dermatology, surgery, orthopedics and dentistry.

Case report

Two patients, one with nail lichen striatus and second with idiopathic trachyonychia were treated with intramatriceal injections of platelet rich plasma. 0.1ml of the plasma solution was injected into the matrix of the involved nails at 3 weekly intervals. Follow up was done at each sitting and thereafter at 16 and 20 weeks. Assessment was done both photographically and by dermoscopy. Case 1 showed marked improvement within 3 weeks and case 2 showed improvement within 6 weeks. No relapses were seen at 16weeks and 20 weeks of follow up.

Conclusion

Intramatricial PRP is a safe and effective therapeutic modality in nail lichen striatus and idiopathic trachyonychia refractory to other treatment options. Further studies with larger sample size and controls are required to validate the results.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2FEPDz9

Successful treatment of porocarcinoma with maxacalcitol and imiquimod

from A via a.sfakia on Inoreader http://bit.ly/2FKURIG

Omalizumab as an alternative therapeutic tool in the treatment of Bullous Pemphigoid: a case report

from A via a.sfakia on Inoreader http://bit.ly/2FEPA6r

Scalp basal cell carcinoma: a different entity?

Abstract

Basal cell carcinoma is the most frequent malignant neoplasm in white‐skinned individuals. It develops in different body areas, including in the scalp, which is a unique anatomical region due to the high number of pilosebaceous follicles; the scalp is protected from UV exposure, a main risk factor for basal cell carcinoma development. Moreover, scalp basal cell carcinoma has been described as more aggressive and difficult to treat than other forms of basal cell carcinoma. In this study, we reviewed the clinical and pathological characteristics, risk factors, genetics, and treatment options for scalp basal cell carcinoma to better understand this special type of cancer. Even though it is not yet clear whether scalp basal cell carcinomas represent a different entity, it seems important to give them special attention due to their potential aggressiveness, invasion capacities, tendency to relapse, and treatment difficulties.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2FIQeig

Kaposi varicelliform eruption induced by methotrexate in an adult atopic dermatitis patient

from A via a.sfakia on Inoreader http://bit.ly/2FHVti6

A case of erythrodermic psoriasis successfully treated with ixekizumab

Abstract

Erythrodermic psoriasis (EP) is the most severe form of psoriasis, resulting in significant morbidity and mortality. International guidelines on EP treatment are lacking, with most of the biologic drugs being used basing on case reports or small case series. Ixekizumab, a fully human anti‐interleukin (IL)‐17A monoclonal antibody, is approved for moderate to severe plaque psoriasis while its use in EP is off label. However, two studies conducted on 8 Japanese EP patients have showed ixekizumab as an efficacious and well tolerated therapy up to 24 and 52 weeks, respectively. To date, no case reports on Caucasian patients have been described. We report the case of a 66‐year‐old Caucasian female with EP successfully treated with ixekizumab, reaching PASI 100 after only 6 weeks of therapy and still maintaining this response at week 24. Our case report suggest ixekizumab as a highly efficacious treatment in EP, presenting also a very rapid action which leads to complete resolution of the disease after 6 weeks. Further studies are warrant to confirm our data, with controlled trials specifically dedicated to EP being strictly needed in order to verify the role and efficacy of the new biologics in EP.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2AZQO8n

Pentoxyfilline as a Treatment for Subcorneal Pustular Dermatosis

Abstract

Subcorneal pustular dermatosis (SPD) is a rare pustular neutrophilic dermatosis in which groups of sterile pustules appear in the superficial (subcorneal) skin. This chronic condition can be associated with significant morbidity and decreased quality of life. Dapsone is the first‐line therapy for subcorneal pustular dermatosis, but some patients fail to respond or cannot tolerate it. In these instances, patients may be treated with second‐line therapies such as phototherapy, topical corticosteroids, or systemic agents including glucocorticoids, acitretin, immunosuppressive or biologic medications. These therapies may not always be efficacious and can be associated with intolerable adverse effects. Here, we report a case of a patient who sustained long‐term remission and no side effects with the novel use of pentoxifylline, a tumor necrosis factor – alpha (TNF‐α) inhibitor, as monotherapy. Pentoxifylline should be considered as a possible therapy in patients with subcorneal pustular dermatosis intolerant to dapsone.

This article is protected by copyright. All rights reserved.

from A via a.sfakia on Inoreader http://bit.ly/2RNxZ1F

Mucocutaneous ulcers as forerunners of methotrexate toxicity

from A via a.sfakia on Inoreader http://bit.ly/2Dapvtb

Relative efficacy of 5‐fluorouracil compared with other treatments among patients with actinic keratosis: A network meta‐analysis

from A via a.sfakia on Inoreader http://bit.ly/2TQx7GK