These guidelines were developed jointly by the American Society of Health-System Pharmacists (ASHP), the Infectious Diseases Society of America (IDSA), the Surgical Infection Society (SIS), and the Society for Healthcare Epidemiology of America (SHEA). This work represents an update to the

/pdf/clinical-practice-guidelines-for-antimicrobial-prophylaxis-1gq1adk8ux.pdf

Clinical practice guidelines for antimicrobial prophylaxis in surgery

Current medical imaging technologies allow visualization of tissue anatomy in the human body at resolutions ranging from 100 micrometers to 1 millimeter. These technologies are generally not sensitive enough to detect early-stage tissue abnormalities associated with diseases such as cancer and atherosclerosis, which require micrometer-scale resolution. Here, optical coherence tomography was adapted to allow high-speed visualization of tissue in a living animal with a catheter-endoscope 1 millimeter in diameter. This method, referred to as "optical biopsy," was used to obtain cross-sectional images of the rabbit gastrointestinal and respiratory tracts at 10-micrometer resolution.

In Vivo Endoscopic Optical Biopsy with Optical Coherence Tomography

Far from being simple degradative enzymes, proteases are now seen as key signalling molecules and desirable drug targets in several diseases. Turk discusses our success so far at targeting proteases and how these enzymes might be exploited therapeutically in the future. Until fairly recently, proteases were considered primarily to be protein-degrading enzymes. However, this view has dramatically changed and proteases are now seen as extremely important signalling molecules that are involved in numerous vital processes. Protease signalling pathways are strictly regulated, and the dysregulation of protease activity can lead to pathologies such as cardiovascular and inflammatory diseases, cancer, osteoporosis and neurological disorders. Several small-molecule drugs targeting proteases are already on the market and many more are in development. The status of human protease research and prospects for future protease-targeted drugs are reviewed here, with reference to some key examples where protease drugs have succeeded or failed.

Targeting proteases: successes, failures and future prospects.

/pdf/clinical-practice-guidelines-for-antimicrobial-prophylaxis-yxd0y9e4ks.pdf

Clinical practice guidelines for antimicrobial prophylaxis in surgery.

Carotenoids constitute a ubiquitous group of isoprenoid pigments. They are very efficient physical quenchers of singlet oxygen and scavengers of other reactive oxygen species. Carotenoids can also act as chemical quenchers undergoing irreversible oxygenation. The molecular mechanisms underlying these reactions are still not fully understood, especially in the context of the anti- and pro-oxidant activity of carotenoids, which, although not synthesized by humans and animals, are also present in their blood and tissues, contributing to a number of biochemical processes. The antioxidant potential of carotenoids is of particular significance to human health, due to the fact that losing antioxidant-reactive oxygen species balance results in “oxidative stress”, a critical factor of the pathogenic processes of various chronic disorders. Data coming from epidemiological studies and clinical trials strongly support the observation that adequate carotenoid supplementation may significantly reduce the risk of several disorders mediated by reactive oxygen species. Here, we would like to highlight the beneficial (protective) effects of dietary carotenoid intake in exemplary widespread modern civilization diseases, i.e., cancer, cardiovascular or photosensitivity disorders, in the context of carotenoids’ unique antioxidative properties.

https://www.mdpi.com/2072-6643/6/2/466/pdf

Potential role of carotenoids as antioxidants in human health and disease.

Background Although relatively rare, eccrine porocarcinoma (EP) is widely recognized in the literature as the most common of the sweat gland adenocarcinoma types. EP is an adenocarcinoma of the eccrine sweat gland with a propensity to recur locally and metastasize to regional lymph nodes. This paper presents the second case of fine needle aspiration (FNA) cytology of an EP along with histopathology and mmnitiohiftochemistry. Case A 64-year-old Filipino woman had a history of EP of the right eyebrow and presented with a right preauricular mass. The cytopathologic features of the case included: (1) clusters and sheets of polyhedral epithelial tumor cells with abundant, cyanophilic, variolated cytoplasm; round to oval, hyperchromatic nuclei; and occasional prominent mucleoli; (2) multinucleated tumor cells; (3) singly dispersed and relatively large aggregates of parakeratotic squainous cells; and (4) a background of necrotic debris. Conclusion Given the critical importance of local control of tumor growth to prognosis, the accurate preoperative diagnosis of EP is crucial to developing an effective (curative) surgical plan. FNA cytology potentially provides a convenient, safe and effective approach to solving a challenging differential diagnosis. The constellation ofcvtoloeic findines probably is distinctive and, in the proper clinical setting, may be diagnostic. History is important in making an accurate diagnosis.

Eccrine porocarcinoma: Report of a case with fine needle aspiration cytology, histopathology and immunohistochemistry.

Objective: To evaluate a new radiographic imaging technique: computed tomography virtual endoscopy (CTVE) for head and neck tumors. Study Design: Twenty-one patients presenting with head and neck masses who underwent axial computed tomography (CT) scan with contrast were evaluated by CTVE. Comparisons were made with video-recorded images and operative records to evaluate the potential utility of this new imaging technique. Methods: Twenty-one patients with aerodigestive head and neck tumors were evaluated by CTVE. One patient had a nasal cylindrical cell papilloma; the remainder, squamous cell carcinomas distributed throughout the upper aerodigestive tract. Patients underwent complete head and neck examination, flexible laryngoscopy, axial CT with contrast, CTVE, and in most cases, operative endoscopy. Available clinical and radiographic evaluations were compared and correlated to CTVE findings. Results: CTVE accurately demonstrated abnormalities caused by intraluminal tumor, but where there was apposition of normal tissue against tumor, inaccurate depictions of surface contour occurred. Contour resolution was limited, and mucosal irregularity could not be defined. There was very good overall correlation between virtual images, flexible laryngoscopic findings, rigid endoscopy, and operative evaluation in cases where oncological resections were performed. CTVE appears to be most accurate in evaluation of subglottic and nasopharyngeal anatomy in our series of patients. Conclusion: CTVE is a new radiographic technique that provides surface-contour details. The technique is undergoing rapid technical evolution, and although the image quality is limited in situations where there is apposition of tissue folds, there are a number of potential applications for this new imaging technique.

Head and neck computed tomography virtual endoscopy: evaluation of a new imaging technique.

Hemorrhage relatively frequent event. Most cases are mild, causing only pain and discomfort, and rarely cause significant neck swelling. Even more rarely, however, massive hemorrhage into a thyroid nodule can result in a rapidly expanding hematoma with airway compromise. We report a case of a rapidly expanding thyroid hematoma that occurred after minor trauma and resulted in airway compromise in a patient with no clinical or surgical evidence of thyroid disease. We also present a review of the literature. (Arch Otolaryngol Head Neck Surg. 1994;120:427-430)

Acute airway compromise secondary to traumatic thyroid hemorrhage.

The capsule endoscope has revolutionized small-bowel inspection, which before was limited to indirect studies, such as barium radiography, scintigraphy, and angiography, or to direct but invasive push enteroscopy. It provides a direct, yet minimally invasive, visualization of the small bowel. Capsule endoscopy is approved by the FDA for detection of small-bowel mucosal abnormalities. To date its major application has been evaluation of occult gastrointestinal (GI) bleeding. The device has been used in 340,000 patients worldwide, with 105,000 procedures in the US within the last year. As its applications increase to include evaluation of conditions such as Crohn’s disease, small-bowel polyps, and abnormal small-bowel radiographic studies, its utilization will increase (sales increased by 18% over the last year), and clinicians should be aware of its complications. Three cases of capsule endoscope aspiration have been reported in gastroenterology literature to date. This is the first report in otolaryngology literature. Although rare, this complication is potentially fatal and should be considered an emergency. A 67-year-old man with history of anemia was referred for capsule endoscopy to evaluate for occult GI hemorrhage. Due to a past medical history of hypertension, diabetes mellitus, cerebrovascular accident, and intermittent dysphagia, endoscopic placement of a capsule endoscope (M2A, Given Imaging, Ltd, Duluth, GA) was recommended. However, the patient declined and chose to swallow the capsule, immediately after which he began to cough and exhibit dysphonia, which resolved. There was no respiratory distress, but he developed a persistent cough. Within 3 minutes the patient became tachypneic and tachycardic, but his oxygen saturation remained above 95%. There were ronchi, but no stridor. The physician recognized the possibility of interrogating the capsule endoscope to determine its location. Images from the capsule endoscope were downloaded and analyzed within 5 minutes and definitively revealed that the device was aspirated promptly after it was swallowed (Fig 1). This process took less time than obtaining plain radiographs. The patient was taken to the operating room for retrieval

Aspiration of a capsule endoscope and description of a unique retrieval technique

Optical coherence tomography (OCT) is an emerging imaging modality that combines a low-coherence light source and an interferometer to produce cross-sectional high-resolution images of living tissues.1 OCT works analogously to ultrasonography but instead of sound uses near-infrared light to discern variation in tissue optical properties. Clinical OCT devices have an axial resolution of approximately 10 µm and a maximum depth penetration of 2 to 3 mm, although 1 to 2 mm is more typical because most biologic tissues are turbid.2 This technology has been widely used in ophthalmology for examination of the retina, cornea, and macula3–5 and as a guide in cataract surgery.6 OCT has been evaluated in other specialties, including dermatology, cardiology, pulmonology, gastroenterology, urology, and neurology, although primarily using research OCT systems designed and constructed by specialists in photonic technologies at academic medical centres.7–12

In the head, neck, and upper aerodigestive tract, clinical OCT has focused on examination of the larynx, with one goal: to distinguish benign from microinvasive cancer that has violated the integrity of the basement membrane (BM).2,13–18 Some work has focused on using OCT to perform image-guided therapy of the larynx, although the results have been mixed.19 It has also been used coupled to a surgical microscope, allowing hands-free OCT simultaneously with microscopic visualization of the vocal cords.20 More recently, we pioneered the use of OCT to image both the neonatal and the pediatric airway with the aim of examining changes in the subglottis following prolonged intubation.21,22 OCT has also been used to image the middle ear and thyroid gland.23–26 The oral cavity has been studied comprehensively using OCT and is reviewed elsewhere.24,25,27–33

Outside of ophthalmology, most clinical OCT studies have involved the use of systems designed and built by research groups focused on enhancing the resolution, image acquisition rates, and functionality of this nascent imaging modality. Until recently, there has not been a commercially available turnkey OCT system for use in the head and neck, and most studies to date have used research devices designed and constructed in university optics laboratories.

At University of California Irvine, we have had an active OCT research program at the Beckman Laser Institute and Medical Clinic for over 15 years, with over 7 years of clinical experience on OCT imaging in the head and neck in human subjects. Our investigations to date have used only OCT systems designed and constructed in our laboratories. The objective of this study was to present our experience with using the first commercially available OCT device designed to image the larynx among other applications and to compare its use with our previous experience in over 200 patients using research OCT systems.

/pdf/optical-coherence-tomography-of-the-larynx-using-the-niris-1km5l5od7n.pdf

William B. Armstrong

Papers

Eccrine porocarcinoma: Report of a case with fine needle aspiration cytology, histopathology and immunohistochemistry.

Head and neck computed tomography virtual endoscopy: evaluation of a new imaging technique.

Acute airway compromise secondary to traumatic thyroid hemorrhage.

Aspiration of a capsule endoscope and description of a unique retrieval technique

Optical coherence tomography of the larynx using the Niris system.