Percutaneous gastrostomy in a child

A 2-year-old girl with cyanotic congenital heart disease needed to undergo gastrostomy. To avoid the use of general anesthesia, a percutaneous gastrostomy was performed as an interventional radiologic procedure with the patient under sedation and with the use of local anesthesia. The placement of a nasogastrocutaneous guide wire under fluoroscopic guidance provided a stable tract for placement of the gastrostomy tube.     

A new paradigm of eosinophil granulocytes: neuroimmune interactions

Abstract:  Eosinophil granulocytes have long been regarded as potent effector cells with the potential to release an array of inflammatory mediators involved in cytotoxicity to helminths and tissue destruction in chronic inflammatory diseases such as asthma. However, it has become evident that eosinophils are also involved in regulatory mechanisms modulating local tissue immune responses. Eosinophils take part in remodelling and repair mechanisms and contribute to the localized innate and acquired immune response as well as systemic adaptive immunity. In addition, eosinophils are involved in neuroimmune interactions modulating the functional activity of peripheral nerves. Neuromediators can also modulate the functional activity of eosinophils, revealing bidirectional interactions between the two cell types. Eosinophils are tissue-resident cells and have been found in close vicinity of peripheral nerves. This review describes neuroimmune interactions between eosinophil granulocytes and peripheral nerves and highlights why eosinophils are important in allergic diseases such as asthma.     

Human papillomavirus molecular biology and pathogenesis

Human papillomavirus (HPV) infection is the most common sexually transmitted disease in the world and accounts for an estimated 11% of the global cancer incidence in women. HPV-16 is the most prevalent type detected in cervical cancer and along with types 18, 31, 33 and 45 has been classified as a class I carcinogen. In addition to cervical cancer, HPVs are also associated with the malignant transformation of other mucosal and skin cancers. Thus, the combination of the malignant potential of HPV and its high prevalence of infection confers to it an importance of generalized clinical and virological significance. The natural history of HPV infection with or without treatment varies from spontaneous regression to persistence. The most important mechanism for wart regression appears to be cell-mediated immunity. Cytokines released by keratinocytes or cells of the immune system may play a part in the induction of an effective immune response against HPV infection and the subsequent regression of lesions. This review discusses the molecular biology, pathogenesis and immunology of HPV infections.     

Urticaria

Urticaria is a very common skin disease which was already described in the ancient world. Questions still remain about its pathogenesis and management remain open. Compared to other common skin diseases, the published evidence is rather low. The clinical symptoms with pruritic transient wheals and/or angioedema are caused by mediators (particularly histamine) released by activated mast cells and basophils. The mechanism of target cell activation has not been clarified in detail for most urticaria subtypes. Different urticaria subtypes should be distinguished. Spontaneous forms are more common than inducible forms. Chronic urticaria and urticaria in certain age groups (children, pregnancy) can be difficult to manage. Therefore, international consensus resulting in the regular update of urticaria guidelines can be very helpful. Currently, these updated guidelines include a three‐step treatment algorithm for chronic spontaneous urticaria. Only the first step of this algorithm, second generation H1‐antihistamine in standard dose, utilized approved drugs. However after omalizumab was established as a third line choice in the guideline algorithm, it has approved in many countries for chronic spontaneous urticaria without response to H1‐antihistamines. The exact mechanism of action of omalizumab in urticaria has not been fully elucidated. Unrevealing this mechanism might result in a deeper understanding of urticaria pathogenesis and the development of further therapeutic strategies.     

Kontaktallergie auf Dentalmaterialien

The oral mucosa is constantly exposed to a large number of potentially irritating and sensitizing dental materials. Dental materials used for fillings and fixed or removable replacements must have a good biocompatibility. Metals including palladium are used in alloys for the production of the core of crowns, onto which porcelain is bonded for the generation of an artificial tooth to which the patient can develop an allergic contact dermatitis. The clinical manifestations of contact allergy to dental materials are not uniform. Objective symptoms of a contact allergy include a stomatitis and lichenoid reactions. However, patients may present with more subjective affections of the oral mucosa including burning, pain and dryness which need to be differentiated from a real contact allergic reaction. In this article we focus on the management of contact allergy to dental materials.