BACKGROUND: In increasingly aging populations, awareness of outcomes of older patients treated with biologics is becoming more important. However, few studies to date have investigated the safety and durability of anti-tumor necrosis factor (TNF) therapy in this subgroup. METHODS: This was a retrospective single-center study with cases comprising all IBD patients who began anti-TNF treatment at age >60 years. Cases of Crohn's disease (CD) and ulcerative colitis (UC) were identified from medical record review. Our controls consisted of patients younger than age 60 years on anti-TNF treatment and patients >60 years on treatment with immunomodulators. Kaplan-Meier survival estimates were used to calculate the probability of remaining on anti-TNF therapy. RESULTS: We identified a total of 54 IBD patients who initiated anti-TNF therapy over the age of 60 years (mean 73, range 61-97 years). Among these, a total of 38 patients (70%) discontinued anti-TNF therapy after a mean of 24.1 months. At 12 months after initiation, 75% of patients older than age 60 years were still on anti-TNF agents compared to 93% among younger users and 82% among older AZA users (P < 0.05). Compared to older AZA users, older anti-TNF users remained more likely to require early therapy cessation (hazard ratio 2.21, 95% confidence interval 1.29-3.78). CONCLUSIONS: The IBD population older than age 60 at the time of initiation of anti-TNF therapy is at higher risk for discontinuation of therapy. They may also be particularly vulnerable to infectious complications requiring hospitalization, suggesting the need for careful monitoring during therapy.(Inflamm Bowel Dis 2012;).

OBJECTIVE To determine if patient weight is predictive of the degree of analgesic response to morphine in opioid naïve patients in the emergency department (ED). DESIGN Prospective observational study. SETTING Academic, tertiary ED, designated as a level 1 trauma center. PATIENTS Fifty opioid naive adult patients who were administered a single fixed intravenous dose of 4 mg morphine on initial presentation to the ED. INTERVENTIONS Pain was assessed at baseline and then repeated at 15- and 30-minute postdose using an 11-point (0-10) verbal numerical rating scale (NRS). MAIN OUTCOME MEASURES The primary outcome was maximum analgesic response, which is defined as the difference between initial pain score and lowest pain score achieved postdose at 15 or 30 minutes. Linear regression was used to analyze the relationship between maximum pain reduction and patient weight. RESULTS Mean patient weight was 85.4 kg (standard deviation =+/- 24.2; range 47.6-170). Median initial pain score was 8 (range 6-10) and median lowest pain score achieved postdose was 4 (range 0-10). In the linear regression analysis, patient weight did not predict the degree of pain reduction on the NRS (coefficient = 0.002 [95% confidence interval (CI)=-0.029-0.032], R2 < 0.001, p = 0.91). The only variable predictive of the degree of pain reduction was initial pain score (coefficient = 0.537/95% CI = 0.013-1.0611, R2 = 0.081,p = 0.045). CONCLUSIONS Patient weight was not significantly associated with the degree of analgesic response to morphine in opioid naive adults. Morphine dosing based on patient weight alone is not necessary in adults in the ED.

Severe left ventricular outflow obstruction often is associated with diastolic left ventricular myocardial dysfunction and tachycardia despite successful initial treatment. The authors have used esmolol to lower heart rate in this setting for successful weaning of patients from ventilation in postoperative recovery. Their limited experience supports the beneficial effect of continuous esmolol administration on infants with persistent tachycardia and severe left ventricular diastolic dysfunction in postoperative cardiac intensive care.

Aims: To investigate if two important epidemic viral encephalitis in children, Enterovirus 71 (EV71) encephalomyelitis and Japanese encephalitis (JE) whose clinical and pathological features may be non-specific and overlapping, could be distinguished. Methods: Tissue sections from the central nervous system of infected cases were examined by light microscopy, immunohistochemistry and in situ hybridization. Results: All 13 cases of EV71 encephalomyelitis collected from Asia and France invariably showed stereotyped distribution of inflammation in the spinal cord, brainstem, hypothalamus, cerebellar dentate nucleus, and to a lesser extent, cerebral cortex and meninges. Anterior pons, corpus striatum, thalamus, temporal lobe, hippocampus and cerebellar cortex were always uninflamed. In contrast, the 8 JE cases studied showed inflammation involving most neuronal areas of the central nervous system, including the areas that were uninflamed in EV71 encephalomyelitis. Lesions in both infections were non-specific, consisting of perivascular and parenchymal infiltration by inflammatory cells, oedematous/necrolytic areas, microglial nodules and neuronophagia. Viral inclusions were absent. Conclusions: Immunohistochemistry and in situ hybridization assays were useful to identify the causative virus, localising viral antigens and RNA, respectively, almost exclusively to neurons. The stereotyped distribution of inflammatory lesions in EV71 encephalomyelitis appears to be very useful to help distinguish it from JE. © 2012 The Authors. Neuropathology and Applied Neurobiology © 2012 British Neuropathological Society.

BACKGROUND Tattoo removal using Q-switched lasers is well established in the medical literature, but it is not clear how tattoos on mucosal membranes should be treated because of their infrequent presentation. OBJECTIVE To report successful cosmetic tattoo removal using Q-switched laser irradiation on the oral mucosal surface. MATERIALS AND METHODS Three men with cosmetic tattoos on the orolabial mucosa of the lower lip sought permanent removal. Each patient received treatments using a Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) laser to the desired endpoint. RESULTS Treatment of the affected area with the Nd:YAG laser resulted in clearing of the pigment without scarring. CONCLUSION Q-switched laser treatment is a safe and very effective means of removing cosmetic mucosal tattoos on the inner lip and should be considered the criterion standard treatment option.

BACKGROUND Ultraviolet radiation (UVR) contributes to the vast majority of nonmelanoma skin cancer (NMSC). As the incidence of NMSC continues to rise, topical therapies will be used with increasing frequency. Topical therapies may benefit high-risk surgical candidates as an alternative treatment modality and may improve overall cosmesis. The most commonly employed topical therapies are imiquimod, 5-fluorouracil (5-FU), and diclofenac. OBJECTIVE To review the detailed mechanism of action and side-effect profiles of each topical therapy used to treat NMSC and to explore newly discovered actions. Uncommon adverse events are also presented. MATERIALS AND METHODS An extensive literature search was performed to describe the pharmacologic actions of imiquimod, 5-FU, and diclofenac. CONCLUSION A keen understanding of the pharmacologic concepts of these topical therapies may aid the dermatologic surgeon in making sound choices before, during, and after surgery.

A country such as India abounds with diverse population groups with distinct anthropometric characteristics. Among these, numerous Nepalese population groups are present in different states of India comprising one of the most common immigrant races. The aim of the study is to compare two distinct races, Indians and Nepalese on the basis of facial height proportions, arch length and palatal rugae patterns and assess their significance in racial identification. A total of 120 subjects comprising of 60 Indians and 60 Nepalese were selected, with each group including 30 males and 30 females. Facial heights were measured using sliding digital calipers, arch lengths with the help of a brass wire and rugae patterns were traced on dental casts obtained with alginate impressions. Facial height measurements did not give significant results for racial or gender identification of given races. Differences between arch length parameters were found to be significant between the two population groups. Secondary and fragmentary palatal rugae forms were found to be more common in Nepalese than Indians. The Indian and Nepalese have similar anthropometric characteristics with regard to facial height. However, arch length and palatal rugae characteristics vary between the two races.

INTRODUCTION Skin sparing mastectomies (SSMs) represent a surgical approach that preserves the natural skin envelope of the breast and, when combined with immediate reconstruction, offers a good cosmetic outcome. The aim of this retrospective study was to compare the risk of local recurrence (LR) in this series with the known rate of recurrence following a conventional mastectomy. METHODS A total of 108 patients with breast cancer who underwent an SSM and immediate breast reconstruction over a 6-year period were reviewed. RESULTS A follow-up of more than eight years showed that three patients (2.78%) had developed LR. CONCLUSIONS The rate of LR is low with SSMs and is comparable to that seen with conventional mastectomies.