Epigallocatechin-3-gallate exhibits anti-inflammatory effects in a human interface dermatitis model-implications for therapy.

BACKGROUND: Epigallocatechin-3-gallate (EGCG) has been proven effective in treating viral warts. Since anticarcinogenic as well as anti-inflammatory properties are ascribed to the substance, its use has been evaluated in the context of different dermatoses. The effect of EGCG on interface dermatitis (ID), however, has not yet been explored. OBJECTIVES: In this study, we investigated the effect of EGCG on an epidermal human in vitro model of ID. METHODS: Via immunohistochemistry, lesional skin of lichen planus patients and healthy skin were analysed concerning the intensity of interferon-associated mediators, CXCL10 and MxA. Epidermal equivalents were stained analogously upon ID-like stimulation and EGCG treatment. Monolayer keratinocytes were treated likewise and supernatants were analysed via ELISA while cells were processed for vitality assay or transcriptomic analysis. RESULTS: CXCL10 and MxA are strongly expressed in lichen planus lesions and induced in keratinocytes upon ID-like stimulation. EGCG reduces CXCL10 and MxA staining intensity in epidermis equivalents and CXCL10 secretion by keratinocytes upon stimulation. It furthermore minimizes the cytotoxic effect of the stimulus and downregulates a magnitude of typical pro-inflammatory cytokines that are crucial for the perpetuation of ID. CONCLUSIONS: We provide evidence concerning anti-inflammatory effects of EGCG within a human in vitro model of ID. The capacity to suppress mediators that are centrally involved in disease perpetuation suggests EGCG as a potential topical therapeutic in lichen planus and other autoimmune skin diseases associated with ID.

Computerized axial tomography versus complex motion as a predictor of surgical findings in middle ear and mastoid cholesteatoma.

In order to evaluate the efficacy of polytomography and computerized tomography in the prediction of surgical findings in cases of suspected cholesteatoma of the middle ear and mastoid, we evaluated preoperatively 52 ears by both radiographic methods. We utilized a check list of 14 radiological signs or surgical findings to generate measures of sensitivity and specificity. The strengths of each radiographic method are outlined and the considerable weaknesses in predictive value are discussed.

Primary small cell (oat cell) carcinoma of the larynx associated with an IgD multiple myeloma.

Primary small cell (oat cell) carcinoma of the larynx is a rare condition. We report a case of primary oat cell carcinoma of the subglottic larynx associated with a synchronous IgD multiple myeloma (an unreported association). An increased incidence of carcinoma associated with plasma cell disorders has been reported, and the theories of this association are discussed. In a review of the reported cases, the most successful management of oat cell carcinoma of the larynx appears to incorporate a combination of radiotherapy and chemotherapy. Our case was treated with a combination of protocols used for oat cell carcinoma of the larynx and multiple myeloma. At 24 months after diagnosis, the patient is free of oat cell carcinoma, and the multiple myeloma is under control.

Vestibular schwannoma presenting with sudden facial paralysis.

Facial paralysis is an unusual manifestation of vestibular schwannoma, and generally signifies an advanced stage of tumor growth. We describe a case of eighth-nerve schwannoma that presented initially with rapid-onset complete unilateral facial paralysis. At the time of operation the nerve was found to be electrically intact despite marked compression by tumor. The facial nerve was preserved and facial motion has partially recovered postoperatively. All unexplained persistent facial paralysis should be evaluated by magnetic resonance imaging with paramagnetic contrast enhancement.

Extradural spinal meningioma presenting as a neck mass. Diagnosis by aspiration cytology.

A case of a 36-year-old woman with an extradural spinal meningioma presenting as a neck mass is documented. Fine-needle aspiration biopsy was used as an initial diagnostic procedure and provided the diagnosis. Fine-needle aspiration biopsies are an excellent, cost-effective, diagnostic approach with low morbidity. Although these are underused, we recommend their use in the management of patients with neck masses. The entity of extradural spinal meningioma is briefly discussed.

[Monitoring somatosensory evoked potentials during carotid endarterectomy]. / Szomatoszenzoros kiváltott válasz monitorozás carotis endarterectomia alatt.

The tromboembolic and ischemic events during carotid endarterectomy can be avoided or detected with appropriate monitoring. Median nerve somatosensory evoked potentials recorded from the parietal cortex correlate with the blood flow in the middle cerebral artery. The good evoked responses after cross-clamping of the carotid artery indicate a sufficient collateral circulation, enabling a surgery without shunt, thus minimizing the risk of embolisation. Insufficient collateral circulation after cross-camping results in an amplitude reduction of the parietal N20-P25 complex of more than 50%. In this case an ischemic event can be prevented by shunting. As a total 83 carotid endarterectomies were done. In 65 cases (78.3%) the evoked potentials showed no significant alteration, and no postoperative neurological deficit occurred. Seven patients (8.45%) needed to be operated with a shunt, because of cross-clamping ischaemia. One of them presented a transient postoperative hemiparesis, which was predicted by the long-term loss of the SEP-s, and which resolved within 4 hours. Seven further patients (8.45%)--operated primarily with shunt, and 4 patients (4.8%)--monitored with transcranial Doppler sonography, showed no postoperative neurological deficit. We found that median nerve somatosensory evoked potential monitoring during carotid endarterectomy is a simple, sensitive and reliable method.

Nasogastric tube perforation of the nasopharynx.

We have presented two unusual cases of nasogastric tube perforation of the posterior nasopharynx. Complications included subcutaneous emphysema, pneumomediastinum, and pleural effusion. Both patients recovered. Recommendations to improve nasogastric tube safety include gentle placement using lubricant and an appropriately sized tube, confirmation of tube placement before any infusion, and awareness of patients at increased risk of mucosal injury.

Intracranial complications of sinusitis.

Sinusitis is a common problem that is routinely diagnosed and treated by most primary care physicians. Although most cases usually respond to appropriate therapy, some occasionally progress to the development of intracranial complications, including meningitis, osteomyelitis, epidural and subdural empyema, intracranial mucocele or polyps, and frank brain abscess. It is important to develop a rational approach to the diagnosis and treatment of these conditions. A high clinical index of suspicion must always be maintained, since symptoms are often masked by previous antibiotic therapy. Radiologic evaluation must always include computerized tomography (CT) for accurate diagnosis and surgical planning. Therapy includes surgical drainage and high doses of appropriate intravenous antibiotics. Cefuroxime and metronidazole provide excellent broad spectrum antibacterial coverage. Only early recognition and appropriate therapy can reduce the potential morbidity and mortality associated with these life-threatening complications.