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181. Safeness, subjective and objective changes after turbinate surgery in pediatric patients: A systematic review. (Abstract)

3.12% complication rates, being minor bleeding the most common (1.30%), followed by crust (0.49%) and pain (0.47%).There is a lack of high quality studies in children. Turbinate surgery in children is a safe technique with low complication rates. The available evidence suggests improvement in subjective outcomes after turbinate surgery in children. We cannot make a formal recommendation of a surgical technique in children given the lack of high quality studies, and since comparison between

2020 International Journal of Pediatric Otorhinolaryngology

182. Assessment of post-operative healing following endoscopic, transnasal, transsphenoidal pituitary surgery without formal sellar grafting. (Abstract)

was conducted for patients undergoing TSS without intraoperative CSF leaks between January 2014 and March 2017 at Rush University Medical Center. No formal sellar reconstruction was performed for the entire patient group. Follow-up endoscopic data and clinical notes were coded for time to mucosalization of the sella as well as degree of abnormal mucosal healing, epistaxis, crusting and scarring.83 patients were included in this study. Mean time to mucosalization was 119 days (range, 17 to 402 days (...) ). Incidence of abnormal mucosal healing, epistaxis, crusting and scarring increased from the first to the second postoperative visit but trended down by the third visit. Nasal crusting was the most common finding, followed by abnormal mucosal healing. Chi square analysis showed smoking to be associated with prolonged time to full mucosalization of the sella. Two patients (2.4%) had post-operative CSF leaks requiring lumbar drain placement.Adequate sellar healing is achievable in all cases without formal

2020 American Journal of Otolaryngology

183. Subjective and Objective Measurements of Sinonasal Manifestations in Patients With Autoimmune Disorders. (Abstract)

compared to randomly selected cohorts of noneosinophilic CRS without nasal polyps (neCRSsNP) and eosinophilic CRSsNP (eCRSsNP). Demographic data, along with the 22-item Sino-Nasal Outcome Test (SNOT-22), Lund-Kennedy (LK) endoscopy score, Lund-Mackay (LM) computed tomography (CT) score, nasal crusting, and epistaxis were reviewed at presentation.Fifty-three patients with an AD (26 with sarcoidosis, 14 with systemic lupus erythematosus, 10 with granulomatosis with polyangiitis [GPA], and three (...) difference in the CT score compared to both groups. Patients with an AD also scored significantly worse on all four SNOT-33 subdomains, nasal obstruction, nasal crusting, and epistaxis. Additionally, patients with GPA had the worst symptomatic and endoscopy scores.Patients with ADs presenting with sinonasal symptoms have a more severe subjective and objective presentation than patients with CRS without nasal polyps.4 Laryngoscope, 2020.© 2020 The American Laryngological, Rhinological and Otological

2020 Laryngoscope

184. The Effects of a Standardized Extract of <i>Centella asiatica</i> on Postlaser Resurfacing Wound Healing on the Face: A Split-Face, Double-Blind, Randomized, Placebo-Controlled Trial. (Abstract)

treated side exhibited significantly less erythema index over total follow-up by 0.03 U (coefficient = -0.03 [95% CI -0.06 to -0.0006]; p = 0.046). In keeping with the physicians' assessment that showed significantly higher improvements in skin erythema at days 2, 4, and 7 (p = 0.009, 0.0061, 0.012), crusting at days 2 (p = 0.02), and general wound appearance at days 2, 4, and 7 (p = 0.008, 0.001, 0.044), TI showed a trend toward better outcome in the ECa 233 group. Skin biophysics did not differ

2020 Journal of Alternative and Complementary Medicine

185. Evaluation of Recurrent Maxillary Sinusitis due to Middle Meatal Antrostomy Site Stenosis. (Abstract)

in the maxillary sinus on preoperative CT; intraoperative findings confirmed these conditions. In most patients, extensive trimming of the hypertrophied mucosa was performed intraoperatively through canine fossa trephination.MMA site stenosis is a rare condition after ESS. We hypothesized that rapid shrinkage and fibrosis of the sinus mucosa after extensive trimming thereof may be the main causes of stenosis. Residual mucosal inflammation, granulation formation, and persistent sinus crust and debris may also (...) be contributing factors. Therefore, conservative trimming, meticulous dressing, and removal of sinus crust and granulation tissue near the MMA site should be performed in patients with MMA site stenosis.

2020 Rhinology and Laryngology

187. Langerhans Cell Histiocytosis Treatment (PDQ®): Patient Version

: Flaking of the scalp that may look like dandruff. Raised, red or brown, crusted rash in the area, , back, or chest, that may be itchy or painful. Bumps or on the scalp. Ulcers behind the ears, under the , or in the groin area. Fingernails that fall off or have discolored grooves that run the across the nail. Mouth Signs or symptoms of LCH that affects the mouth may include: Swollen . Sores on the roof of the mouth, inside the cheeks, or on the tongue or lips. Teeth that become uneven or fall out. Bone

2018 PDQ - NCI's Comprehensive Cancer Database

188. Mycosis Fungoides (Including Sézary Syndrome) Treatment (PDQ®): Health Professional Version

significant elevation or induration. Presence/absence of hypo- or hyperpigmentation, scale, crusting, and/or poikiloderma should be noted. c For skin, plaque indicates any size skin lesion that is elevated or indurated. Presence/absence of scale, crusting, and/or poikiloderma should be noted. Histologic features such as folliculotropism, large cell transformation (>25% large cells) and CD30 positivity or negativity, as well as clinical features such as ulceration, are important to document. d For blood

2018 PDQ - NCI's Comprehensive Cancer Database

189. Skin Cancer Treatment (PDQ®): Patient Version

. A skin cancer lesion on the face that looks raised and crusty (left panel) and a skin cancer lesion on the leg that looks pink and raised (right panel). Squamous cell carcinoma occurs on areas of the skin that have been damaged by the sun, such as the ears, lower lip, and the back of the hands. Squamous cell carcinoma may also appear on areas of the skin that have been sunburned or exposed to or . Often this looks like a firm red bump. The may feel scaly, bleed, or form a crust. Squamous cell tumors

2018 PDQ - NCI's Comprehensive Cancer Database

190. Fungal skin infection - scalp

-Caribbean children. The clinical features of fungal scalp infection vary depending on the degree of inflammatory response, and include: Scaling and itch of the scalp, patches of hair loss. Skin erythema, pustules, crusting, and lymphadenopathy. Painful, pustular boggy masses, which may have a thick crust (kerion). Associated fungal infection at other sites. Assessment of suspected fungal scalp infection should include skin and hair sampling for fungal microscopy and culture, to confirm the diagnosis (...) and identify the underlying cause. Management of fungal scalp infection should include: Advice on self-care strategies including surface crust removal; discarding or disinfecting objects that can transmit infection; inspecting other family members or household pets for signs of infection. In adults, starting oral antifungal treatment before or after fungal microscopy and culture results are back, depending on clinical judgement. In children, starting oral antifungal treatment if there is a confirmed

2018 NICE Clinical Knowledge Summaries

191. Conjunctivitis - infective

? The clinical features of conjunctivitis include: Acute onset conjunctival erythema. Discomfort which may be described as ‘grittiness’, ‘foreign body’ or ‘burning’ sensation. Watering and discharge which may cause transient blurring of vision. It is difficult to differentiate viral and bacterial conjunctivitis clinically. Bacterial conjunctivitis may be associated with: Purulent or mucopurulent discharge with crusting of the lids which may be stuck together on waking. If discharge is mucopurulent

2018 NICE Clinical Knowledge Summaries

192. Shingles

, and, unlike other rashes, does not cross the midline of the body. The vesicles then burst, releasing varicella-zoster virus, and crust over within 7–10 days. Healing occurs over 2–4 weeks, and often results in scarring and permanent pigmentation in the affected area. The location of symptoms depends on the affected nerve: In immunocompetent people, the infection usually occurs on the thorax, with dermatomes T1 to L2 most commonly affected. In immunocompromised people, symptoms can be more widespread (...) — a superficial infection of the hair follicles, which develop into small inflammatory papules or pustules. Impetigo — presents with vesicles, which can rupture and crust. See the CKS topic on for more information. Insect bite or sting — there may be local symptoms (such as pain, swelling, and erythema) and symptoms that may indicate a systemic reaction (such as urticaria, rhinitis, wheezing, abdominal pain, vomiting, and dizziness). See the CKS topic on for more information. Scabies — an intensely itchy skin

2018 NICE Clinical Knowledge Summaries

193. Acne vulgaris

sunlight and solariums) — if sun exposure is unavoidable, an appropriate sunscreen or protective clothing should be used. Adverse effects Skin irritation including discomfort, blistering of skin, burning, crusting, dryness, peeling, erythema, oedema, pruritus, stinging, contact dermatitis and temporary changes of skin pigmentation. Eye irritation. Increased sensitivity to UV light — if sun exposure is unavoidable, an appropriate sunscreen or protective clothing should be used. Interactions Systemic

2018 NICE Clinical Knowledge Summaries

194. Pubic lice

, crusting and matting of eyelashes and conjunctivitis. Visible lice or nits in any area with coarse body hair (most often the pubic area, less commonly the axillae, chest, abdomen, perianal area, beard area, eyelashes and eyebrows). Rust-coloured flecks of faecal material may be seen. Skin lesions such as: Small blue macules (‘maculae cerulae’) or red papules — may be seen at feeding sites. Lichenification and hyperpigmentation of pruritic areas — may occur in chronic infestation. Basis (...) on . Dermatophyte infection — for more information, see the CKS topic on . Folliculitis. Seborrheic dermatitis — scales or crusts can be brushed off unlike nits. Conjunctivitis or blepharitis (if eyelashes are involved) — for more information, see the CKS topics on , and . Head or body lice — for more information on head lice see the CKS topic on . Basis for recommendation Basis for recommendation Information on the differential diagnosis of pubic lice is based on expert opinion from review articles

2018 NICE Clinical Knowledge Summaries

195. Eczema - atopic

of oral corticosteroids should be considered. If eczema is weeping, crusted, or there are pustules, with fever or malaise, secondary bacterial infection should be considered, and antibiotic treatment should be prescribed. Providing appropriate information on the nature of eczema and advice on the importance of adherence to skin care measures and avoidance of trigger factors (where possible) are essential for disease maintenence and management of flares. Immediate hospital admission should be arranged (...) activity may be continuous. The term 'atopic' is used to describe a group of conditions (eczema, asthma, hay-fever, and food allergy) that are linked by an increased activity of the allergy component of the immune system [ ]. The term 'eczema' comes from the Greek word 'to boil' and is used to describe itchy, red, dry skin which can sometimes become weeping, blistered, crusted, scaling, and thickened [ ]. [ ; ; ; ; ; ] Causes What causes it? There is no known single cause for atopic eczema

2018 NICE Clinical Knowledge Summaries

196. HIV infection and AIDS

causes rapid onset of severe dental pain. There may be an unpleasant taste in the mouth, fever, and malaise. See the CKS topic on for further information. Oral herpes simplex These are painful lesions that begin as vesicles, then ulcerate and crust. See the CKS topic on for further information. Gastrointestinal conditions HIV infection may cause: Oesophageal candidiasis Symptoms include retrosternal pain or dysphagia, and oral candidiasis is also likely to be present. Diarrhoea This is very common

2018 NICE Clinical Knowledge Summaries

197. Impetigo

release exudate forming a golden/brown crust. Non-bullous impetigo is usually asymptomatic but may be mildly itchy. The area around the mouth and nose is most commonly affected, although other areas of the face and the extremities may also be involved. Bullous impetigo most commonly affects infants, although older children and adults can also be affected. It presents with flaccid fluid filled vesicles and blisters (often with a diameter of 1-2cm) which can persist for 2-3 days. These blisters rupture (...) leaving a thin flat yellow/brown crust. Lesions most often occur on the flexures, face, trunk and limbs and can be particularly widespread in infants. Systemic features (such as fever and lymphadenopathy) may occur if large areas of skin are affected. Diagnosis of impetigo is usually clinical but swabs (of exudate from a moist lesion or de-roofed blister) for culture and sensitivities should be considered in cases which are persistent despite treatment, recurrent, or widespread; or when MRSA

2018 NICE Clinical Knowledge Summaries

198. Chickenpox

Chickenpox Chickenpox - NICE CKS Share Chickenpox: Summary Chickenpox is an acute disease, predominantly occurring in childhood. It is caused by varicella-zoster virus and is characterized by a vesicular rash, and often fever and malaise. Up to 90% of susceptible contacts develop the disease. Transmission is by personal contact or droplet spread, with an incubation of 1–3 weeks. Chickenpox is infectious from 1–2 days before the rash appears until the vesicles are dry or have crusted over (...) occur on the palms and soles, and mucous membranes, with painful and shallow oral or genital ulcers. Vesicles appear in crops. Crusting occurs usually within 5 days, and crusts fall off after 1–2 weeks. Laboratory tests are rarely required in primary care. For treatment of symptoms, the following can be considered: Paracetamol. Topical calamine lotion. Chlorphenamine (avoid in certain groups, for example pregnant and breastfeeding women, and children less than 1 year of age). If serious

2018 NICE Clinical Knowledge Summaries

199. Nappy rash

Often the nappy area is spared as this area is so well hydrated and not accessible to excoriation from scratching. A tendency to dry skin, a positive family history of atopic eczema, and rash affecting other skin areas such as the flexures may suggest the diagnosis. See the CKS topic on for more information. Eczema herpeticum Disseminated herpes simplex virus (HSV) infection presents with painful crops of uniform vesicles or blisters on an erythematous base which become pustular and crust over

2018 NICE Clinical Knowledge Summaries

200. Sinusitis

are not typical of sinusitis and the diagnosis is in doubt, referral to an ear, nose and throat specialist should be arranged to rule out an alternative diagnosis. Urgent referral for further investigation is required: For acute sinusitis — if symptoms suggest neoplasm (for example, unilateral polyp or mass, bloody nasal discharge). For chronic sinusitis — if there are unilateral symptoms, epistaxis, blood-stained discharge, crusting, orbital symptoms (such as diplopia or reduced visual acuity (...) , epistaxis, blood-stained discharge, crusting, orbital symptoms (such as diplopia or reduced visual acuity), or neurological symptoms or signs. Basis for recommendation Basis for recommendation Diagnosis Information on the diagnostic symptoms of chronic sinusitis is based on expert opinion published in the European position paper on rhinosinusitis and nasal polyps [ ]. The recommendations for adults also reflect a UK commissioning guide published by ENT UK and the Royal College of Surgeons

2018 NICE Clinical Knowledge Summaries

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