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Clinical pearls

Sarah F M Pilati, Bianca C Bianco, Daniella S C Vieira, Filipe Modolo
OBJECTIVE: This study aimed to determine the histopathological findings in actinic cheilitis (AC) and lip squamous cell carcinomas (LSCC) diagnosed at Federal University of Santa Catarina in order to attempt to predict the evolution from AC to LSCC based on the comparison of two dysplasia classification systems. METHODS: Histopathological features were evaluated according to the World Health Organization classification of dysplasia and binary system of classification...
October 19, 2016: Oral Diseases
Luis Sala-Icardo, Amalia Lamana, Ana María Ortiz, Elena García Lorenzo, Pablo Moreno Fresneda, Rosario García-Vicuña, Isidoro González-Álvaro
OBJECTIVE: To analyze the effect of single nucleotide polymorphisms (SNPs) with well-known functional impact of methylenetetrahydrofolatereductase (MTHFR; rs1801131 and rs1801133), the membrane transporter ABCB1 (rs1045642), the AICAR transformylase/IMP cyclohydrolase (ATIC; rs2372536) and folyl-polyglutamatesynthetase (FPGS; rs1544105), on liver and bone marrow toxicity of methotrexate (MTX). PATIENTS AND METHODS: We analyzed 1415 visits from 350 patients of the PEARL (Princesa Early Arthritis Register Longitudinal) study: (732 with MTX, 683 without MTX)...
October 14, 2016: Reumatología Clinica
Ganggang Zhang, Alice Brion, Anne-Sophie Willemin, Marie-Hélène Piet, Vanessa Moby, Arnaud Bianchi, Didier Mainard, Laurent Galois, Pierre Gillet, Marthe Rousseau
During the past two decades, with a huge and rapidly increasing clinical need for bone regeneration and repair, bone substitutes are more and more seen as a potential solution. Major innovation efforts are being made to develop such substitutes, some having advanced even to clinical practice. It is now time to turn to natural biomaterials. Nacre, or mother-of-pearl, is an organic matrix-calcium carbonate coupled shell structure produced by molluscs. In vivo and in vitro studies have revealed that nacre is osteoinductive, osteoconductive, biocompatible and biodegradable...
October 17, 2016: Journal of Biomedical Materials Research. Part A
Hendrik A Zuiderbaan, Jelle P van der List, Pauline Appelboom, Nanne P Kort, Andrew D Pearle, Maarten V Rademakers
In this review, we evaluate the modern indications, subjective outcome scores, and survivorship results of unicompartmental knee arthroplasty (UKA) and high tibial osteotomy (HTO) in the treatment of isolated medial compartment degeneration of the knee. In addition, in a thorough review of the literature, we evaluate global trends in the use of both methods. In our evaluation of articles, we note that inclusion criteria are relatively broader for UKA than for HTO, where age and body mass index should be considered before HTO surgery in order to optimize clinical outcome and survivorship results...
September 2016: American Journal of Orthopedics
Alessandra Haskin, Shawn G Kwatra, Crystal Aguh
Acquired trichorrhexis nodosa is a common cause of hair loss for patients of all ethnicities. It is especially prevalent in black patients with tightly curled hair types and can present unique diagnostic and therapeutic challenges due to structural differences in these hair types and the combination of various hair care and styling practices that contribute to hair damage. While scalp biopsies can help rule out other etiologies of hair loss, there is a paucity of histologic findings in acquired trichorrhexis nodosa, making this primarily a clinical diagnosis...
October 10, 2016: Journal of Dermatological Treatment
Jeffrey M Ellenbogen
Sleep medicine can be a particularly rewarding clinical area for neurologists. After all, the driving organ of sleep is the brain. Many of the sleep disorders are primary brain disorders, whereas other sleep disorders (and their medications) influence brain function. But without an organized approach, even the engaged and motivated neurologist can easily become frustrated when dealing with patients whose concerns center on an undesirable degree of sleepiness. Lost in the thicket of information provided during the patient-doctor encounter, many physicians are unable to direct the history toward particular diagnostic hypotheses...
October 2016: Seminars in Neurology
Brett M Morrison
Neuromuscular diseases are a broadly defined group of disorders that all involve injury or dysfunction of peripheral nerves or muscle. The site of injury can be in the cell bodies (i.e., amyotrophic lateral sclerosis [ALS] or sensory ganglionopathies), axons (i.e., axonal peripheral neuropathies or brachial plexopathies), Schwann cells (i.e., chronic inflammatory demyelinating polyradiculoneuropathy), neuromuscular junction (i.e., myasthenia gravis or Lambert-Eaton myasthenic syndrome), muscle (i.e., inflammatory myopathy or muscular dystrophy), or any combination of these sites...
October 2016: Seminars in Neurology
Mary K Mulcahey, Brian R Waterman
In its brief 10-year existence, the Arthroscopy Association of North America Advanced Arthroscopy Traveling Fellowship has quickly established itself as the paramount educational experience for aspiring young surgeons in sports medicine and arthroscopy. The Traveling Fellowship is structured as a 10-day experience with visits to 3 host sites and culminates at the AANA Annual Meeting. With 4 selected fellows and an honorary "Godfather," the Traveling Fellowship affords a unique and invaluable opportunity to forge enduring friendships and rare mentorships with established leaders in the field of Arthroscopy...
October 2016: Arthroscopy: the Journal of Arthroscopic & related Surgery
Giovanni Amodeo, Chiara Candiracci, Ilaria Capecci, Sergio De Filippis, Sonia Giuliani, Giorgio Guerani, Carmine Tomasetti, Vincenzo Villari, Andrea Fagiolini
INTRODUCTION: Aripiprazole long acting once-monthly (AOM) is approved for the treatment of schizophrenia in adults. Despite recent evidence of AOM efficacy in the acute treatment of schizophrenia, it is recommended that AOM should be started once the acute symptoms are controlled and patients are stabilized. However, there currently are no definitive guidelines exactly describing when a patient is to be considered stabilized enough to start AOM and which the patients are for whom an early AOM start is to be preferred...
October 3, 2016: Expert Opinion on Pharmacotherapy
Deanna E Johnson
BACKGROUND: The skin of extremely preterm infants is underdeveloped and has poor barrier function. Skin maintenance interventions initiated in the neonatal intensive care unit (NICU) have immediate and lifelong implications when the potential for infection, allergen sensitization, and altered aesthetic outcomes are considered. In addition, the high-level medical needs of extremely preterm infants demand skin-level medical interventions that too often result in unintended skin harm. PURPOSE: We describe the use of a harm prevention, or consequence-centered, approach to skin care, which facilitates safer practice for extremely premature infants...
October 2016: Advances in Neonatal Care: Official Journal of the National Association of Neonatal Nurses
Jouni Havulinna, Jarkko Jokihaara, Pasi Paavilainen, Olli V Leppänen
Coronal plane fracture of lunate in Kienböck disease is a challenging problem with no proven treatment. We present a technique for the treatment. A vascularized bone graft from the distal radius employing the fourth and fifth extracompartmental artery pedicles is used as a mechanical support in order to enable fracture union. The technical pearls and pitfalls are described and a clinical case is presented.
September 20, 2016: Journal of Hand Surgery
Andrew B Mick
No abstract text is available yet for this article.
October 2016: Optometry and Vision Science: Official Publication of the American Academy of Optometry
Hasan Rehman, Ann W Silk, Michael P Kane, Howard L Kaufman
With the recent regulatory approval of Talimogene laherparepvec (T-VEC) for the treatment of advanced of melanoma in the United States, Europe and Australia, oncolytic virus immunotherapy has earned its place in the clinic. However, the adoption of T-VEC by the U.S. oncology community has been slow, and so far has been largely limited to specialized cancer centers. Limiting factors include the intratumoral route of administration, which is unfamiliar to medical oncologists, biosafety concerns related to the use of a live virus in the clinic, and the explosion of other therapeutic strategies now available for the treatment of advanced melanoma...
2016: Journal for Immunotherapy of Cancer
Joseph A R Englert, Jennifer A Davis, Selim R Krim
BACKGROUND: Heart transplantation remains the definitive therapy for patients with advanced heart failure; however, owing to limited donor organ availability and long wait times, continuous-flow left ventricular assist devices (LVADs) have become standard therapy. METHODS: This review summarizes the history, progression, function, and basic management of LVADs. Additionally, we provide some clinical pearls and important caveats for managing this unique patient population...
2016: Ochsner Journal
Pearl K Jones, Brett H Shaw, Satish R Raj
Postural tachycardia syndrome (POTS) is a multifactorial clinical syndrome defined by an increase in heart rate of ≥30 bpm on standing from supine position (or ≥40 bpm in children). It is associated with symptoms of cerebral hypoperfusion that are worse when upright and improve when in supine position. Patients often have additional symptoms including severe fatigue and difficulty concentrating. There are several possible pathophysiologic mechanisms including hypovolaemia, small-fibre peripheral neuropathy and hyperadrenergic states...
September 22, 2016: Practical Neurology
Andrew C Faust, Pearl Rajan, Lyndsay A Sheperd, Carlos A Alvarez, Phyllis McCorstin, Rebecca L Doebele
BACKGROUND: Recent attention to adverse effects of intensive care unit (ICU) sedation has led to the use of strategies that target a "lighter" depth of sedation. Among these strategies are "analgosedation" protocols, which prioritize pain management and preferentially use IV opioids before administration of continuously infused sedatives such as propofol or midazolam. We hypothesized that using an analgosedation protocol would result in a shorter duration of mechanical ventilation than a protocol with greater emphasis on IV sedatives METHODS: : We conducted a retrospective study comparing the duration of mechanical ventilation before and after implementation of an analgosedation protocol in a 24-bed medical ICU...
October 2016: Anesthesia and Analgesia
Peter A Ljubenkov, Michael D Geschwind
Dementia often is defined as a progressive cognitive disturbance leading to a loss of independent function. Most clinicians are familiar with the typical pattern of amnestic Alzheimer's disease, the most common neurodegenerative presentation of dementia. Atypical dementia presentations, including atypical Alzheimer's variants, however, may pose a diagnostic challenge for even experienced clinicians. In this article the authors discuss clinical "pearls" for the diagnosis of various neurodegenerative dementia syndromes...
August 2016: Seminars in Neurology
Mackenzie C Cervenka, Peter W Kaplan
The accurate diagnosis and classification of seizures is critical in informing prognosis and determining appropriate antiseizure treatments for patients with epilepsy. The electroencephalogram is the gold standard for diagnosis. Obtaining a thorough history, performing a careful physical examination, and selecting appropriate diagnostic studies are also essential in determining the underlying seizure etiology. The authors provide clinical pearls and pitfalls in the diagnosis and management of epilepsy.
August 2016: Seminars in Neurology
Howard D Weiss
Hyperkinetic movements, such as tremor, myoclonus, chorea, and dystonia, occur in many neurologic and medical conditions. Accurate clinical evaluation is the important first step for the proper diagnosis and treatment of patients with abnormal movements.
August 2016: Seminars in Neurology
Fareen Zaver, Michael Hansen, Evan Leibner, Andrew Little, Michelle Lin
INTRODUCTION: By critically appraising open access, educational blogs and podcasts in emergency medicine (EM) using an objective scoring instrument, this installment of the ALiEM (Academic Life in Emergency Medicine) Blog and Podcast Watch series curated and scored relevant posts in the specific areas of pediatric EM. METHODS: The Approved Instructional Resources - Professional (AIR-Pro) series is a continuously building curriculum covering a new subject area every two months...
September 2016: Western Journal of Emergency Medicine
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