Report of a Patient With Heparin-induced Thrombocytopenia Type II Associated With IgA Antibodies Only

Heparin-induced thrombocytopenia type II (HIT II) is usually mediated by immunoglobulin G (IgG) antibodies that lead to platelet activation via the FcγIIA-receptor. Here we describe a patient who developed HIT II after aortocoronary bypass surgery. His serum contained an antibody that was detectable by the heparin-induced platelet activation assay (HIPA) and by the ID-HPF4 particle agglutination assay. The flow cytometric analysis showed that the antibody was of the IgA class.

Analysis of decision making at a multidisciplinary head and neck tumor board incorporating evidence-based National Cancer Comprehensive Network (NCCN) guidelines

PURPOSE

To evaluate incorporation of National Cancer Comprehensive Network (NCCN) guidelines in decision making at a head and neck cancer (HNC) multidisciplinary tumor board (MDT) at an urban academic medical center.

METHODS AND MATERIALS

A retrospective study of 176 HNC patients was performed. The extent to which MDT decisions and subsequent patient care incorporate NCCN guidelines was evaluated.

RESULTS

A total of 173 (98.3%) HNC patients received MDT recommendations according to NCCN guidelines. Of the 159 patients treated, 153 (96.2%) received treatment according to NCCN guidelines. The MDT recommended the highest available evidence-based NCCN category guideline in 78.0%. Subsequent treatment using the same or higher category MDT recommendation occurred in 87.0% of patients.

CONCLUSIONS

Evaluation of patients at an MDT using NCCN guidelines incorporates the highest level of evidence in approximately 80% of patients and translates well into subsequent care. Incorporation of the highest available NCCN guideline may be improved, although management should be individualized.

A case series of the effects of a novel composition of a traditional natural preparation for the treatment of psoriasis

The objective of this study was to assess the effectiveness of a specific composition of a traditional herbal preparation (DurrDerma) in adult patients with moderate to severe skin psoriasis. The preparation is a newly developed topical combination containing plant-based extracts traditionally used in skin disease as black cumin, olive oil, tea tree oil, cocoa butter completed by vitamin A and vitamin B12. We documented the effectiveness of the preparation in a first case series. A total of 12 patients (8 males and 4 females, 21–86 y) with manifest and treatment-resistant psoriasis were included and treated for 12 weeks. All patients were assigned to twice-daily treatment with the DurrDerma preparation. Treatment success as determined by the Psoriasis Area and Severity Index (PASI) score, the body surface area, and the dermatology life index was achieved (PASI reduction of >75%) in 10 of the 12 treated patients (83%). The remaining two patients showed a PASI reduction of ≤50%. In 5 of the patients PASI reduction was achieved <12 weeks (between week 3–11). The beneficial effect in responder patients might be explained by a synergistic anti-oxidative and anti inflammatory activity of all components present in DurrDerma. We conclude that the new preparation using a traditional approach seems to be a promising complementary treatment for psoriasis.

Predictors of mortality, hospital utilization, and the role of race in outcomes in head and neck trauma

OBJECTIVE

A retrospective cross-sectional analysis was undertaken to determine the impact of race and insurance status on trauma outcomes in patients admitted to a Level I trauma center following head and neck fractures.

STUDY DESIGN

Putative predictive factors, including injury mechanism, hemorrhagic shock, injury severity score (ISS), race, gender, and insurance status, were used in a multivariate outcome analysis to determine their influence on length of hospital stay, number of procedures performed, discharge status, and mortality; P < .05 was significant.

RESULTS

Proportionately more male patients (76.5%) sustained head and neck fractures compared with females (23.5%). Blacks and Hispanics sustained proportionately more gunshot wounds (GSWs) compared with Whites, 16:1 and 7:1, respectively. There were no significant differences in length of hospital stay and mortality based on race or insurance status. Mortality was related to age, GSW as a mechanism of injury, increasing ISS, and shock on admission.

CONCLUSIONS

Minority race and insurance status did not correlate with worse outcomes. Treatment biases in the acutely injured patient with head and neck injuries may be less prevalent than thought, if we consider mortality and utilization of care as primary outcome measures.

A finite volume approach to the problem of heat transfer in axisymmetric annulus geometry with internal heating element using local analytical solution techniques

In this paper we implement the local analytical solution technique to the problem of heat transfer in axisymmetric annulus geometry with internal heating element. This method has shown to be very accurate in estimating the temperature field for axisymmetric problems even for coarse mesh. It is shown that this method reduces to the analytical solution for unidirectional heat transfer in the radial direction in homogeneous media. The technique is based on finding an analytical expression for the temperature field in the radial direction within each grid cell. This means that the temperature field in each cell is allowed to change in a nonlinear fashion along the radial direction. We compare this technique with the traditional finite volume technique and show that; with only few cells in the radial direction, this technique arrives at the mesh-independent solution quite accurately whereas it required denser mesh to arrive closer to this solution using traditional techniques. This method is proposed to the 1D codes that are currently being used to simulate thermalhydraulic characteristics of reactor systems. Furthermore, we also implement the experimental temperature field algorithm in which the governing equations are approximated for each cell as it would without extra manipulation to the governing equations. This technique is very simple and separates the physics from the solving part.

The use of cervicofacial flap in maxillofacial reconstruction

One of the most useful reconstructive techniques in repairing cheek defects is the cervicofacial (CF) flap. The CF flap offers an excellent texture and color match with the recipient area. This flap can be used for defects of the cheek, temple, and orbit. The flap can be used alone or in combination with regional and free flaps depending on the extent of the defect. This article discusses the indications and anatomy of this flap and the surgical procedure for the use of this flap for maxilliofacial reconstruction.