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  • Anterolateral Thigh Myocutaneous Flap for Reconstruction of a Large Anterior Neck Sinus Caused by Tuberculous Lymphadenitis: a Case Report
    SN Compr. Clin. Med. Pub Date : 2020-01-15
    Hu Jiao, Liqiang Liu, Cheng Gan, Jincai Fan, Tiran Zhang, Li Liu

    Abstract Tuberculosis remains a major global health problem and persistent lymphadenitis or incorrect treatment may result in sinus formation. We present a case of a large anterior neck sinus caused by tuberculous lymphadenitis. We designed an anterolateral thigh myocutaneous flap with 6 × 5 cm of skin and 10 × 7 cm of muscle for the reconstruction of the large sinus. The descending branch of the lateral circumflex femoral artery and 2 venae comitantes were anastomosed with superior thyroid arteries and two anterior neck veins. The patient experienced complete survival of the flap and did not complain of any discomfort. The donor site healed well, and weakness of the lower limb was absent. In conclusion, an anterolateral thigh myocutaneous flap is a good choice for the reconstruction of a neck sinus caused by tuberculous lymphadenitis.

    更新日期:2020-01-15
  • High Energy Spine Injury Alternate Multiple Fractures Observational Retrospective Study
    SN Compr. Clin. Med. Pub Date : 2020-01-08
    Aníbal José Sarotto, Jorge Paulus Astiasarán, Alejandro Steverlynck, Roberto Muscia, Roberto Castelli, Luis M. Melo, Ricardo Baldassarre, Diego Gandara, José Rosado Pardo, Diego Ponte, Leandro Ambrosini, Dino Dinelli, Diego Sobrero, Nicolás Scheverin, Edward Romero, Fernando Tillet, Micaela Besse

    Multiple alternate fractures are those that present injuries at several levels of the spine separated by at least one healthy vertebral body. A posttraumatic prevalence of up to 23% is reported.3–5 There are no reports in Argentina. The purpose of this study is to report the prevalence of multiple alternate spine fractures in five hospitals of the City of Buenos Aires, Argentina, and evaluate its connection to other relevant characteristics. Inclusion criteria involve acute fractures of the spine. Classifications used were the following: cervical subaxial8 and thoracolumbar9 AO, Anderson for odontoids,15, 16 Effendi Laurin17 and Geweiler,18, 19 ASIA,20, 21 and Frankel.22 Statistical analysis consists of two groups: “Alternate” and “Contiguous.” Sample distribution, Shapiro-Wilk or Kolmogorov Smirnov test, was used. In comparison of continuous variables, “Student’s t-test or the Mann-Whitney U test” was used. To compare the categorical variables, Chi2 test or Fisher’s exact test was used. In data analysis, IBM SPSS Macintosh software, version 24.0 (IBM Corp., Armonk, NY, USA), was used. From the five hospitals of Buenos Aires, 514 medical records were reviewed, and 120 patients included, from April 2007 to April 2017. Of the total of spine fractures, 56 (46.7%) were simple, 35 (29.2%) were multiple contiguous, and 29 (24.1%) were multiple alternate. Fifty-four (45%) patients were women, average age of the sample: 40 years old. Within the group of multiple alternate fractures, the cervical area was the most affected in 16 (55.1%) patients. Fractures of nine (31%) patients of the Alternate group were related to a labor accident (9.9% contiguous, significant p = 0.02). Fourteen (48.3%) patients of the Alternate group presented an associated injury (23 patients [25.3%] of the contiguous fractures, with significance p = 0.02). As regards the International Publications, the prevalence of multiple alternate fractures was 24.1% (17 or 19%)4, 5, 23, 24 with similar production mechanism, male predominance, and an average of 40 years old.3, 5, 23 The location was similar: cervico-thoracic 24.1%. One in four patients admitted in our centers, with a spine fracture, had at least other vertebrae fractured at a distance. These were associated with neurological alterations, extra-spinal injuries, and labor accidents.

    更新日期:2020-01-08
  • Pulmonary Nodular Lymphoid Hyperplasia in the Eye of Radial Endobronchial Ultrasound
    SN Compr. Clin. Med. Pub Date : 2020-01-06
    Larry Ellee Anak Nyanti, Sze Shyang Kho, Pak Inn Teoh, Siew Teck Tie

    Abstract Pulmonary nodular lymphoid hyperplasia (PNLH) is a rare, benign lymphoproliferative disorder often manifesting as a solitary pulmonary nodule (SPN). Once a malignant cause of SPN is ruled out, it presents a diagnostic dilemma to clinicians due to histopathological overlap with diseases like mucosa-associated lymphoid tissue (MALT) lymphoma and IgG4-related sclerosing disease. We report an adult patient who presented with incidental finding of a SPN, and was subsequently diagnosed with PNLH via a combined technique of radial-endobronchial ultrasound (R-EBUS), virtual bronchoscopic navigation (VBN), and cryobiopsy. We discuss the sonographic appearance and histopathological morphology of PNLH, and the merits of bronchoscopic techniques in averting surgical intervention of SPN. This is the first reported sonographic appearance of PNLH under radial-endobronchial ultrasound (R-EBUS).

    更新日期:2020-01-06
  • T-Cell Lymphoma: Clinical Presentation and Therapeutic Outcome from a Tertiary Care Hospital in Eastern India
    SN Compr. Clin. Med. Pub Date : 2020-01-03
    Ankita Sen, Rajib De, Prakas Kumar Mandal, Shyamali Dutta, Shuvra Neel Baul, Tuphan Kanti Dolai, Prantar Chakrabarti

    T-cell non-Hodgkin’s lymphoma (T-NHL) is rare and heterogeneous disease. There is a marked difference in biology, clinical presentation and therapeutic outcomes worldwide. This is a retrospective study from May 2014 to May 2018. Patients with established T-NHL after diagnosis were included, and their clinical presentation and therapeutic outcomes were analysed in detail. In the above-mentioned period, a total of 248 NHL patients were evaluated out of which 32(12.9%) had T-NHL. The median age of presentation was 37 years (range 7–69 years), with a male predominance 26 (81.2%). Most common presentation was painless lymphadenopathy 18 (56.2%). B symptoms were found in 8 (25%). In the Ann Arbor staging system, most T-NHL presented with either Stage III or IV with 12 (37.5%) patients respectively. Among the T-NHL subtypes, peripheral T-cell lymphoma, not otherwise specified (PTCL, NOS), 20 (62.5%); anaplastic large-cell lymphoma (ALCL), 7 (21.9%); angioimmunoblastic T-cell lymphoma (AITL), 3 (9.4%); cutaneous T-cell lymphoma (CTCL), 2 (6.2%); and prolymphocytic leukaemia (PLL), 1 (3.1%) were diagnosed. Therapeutic options for T-NHL used were cyclophosphamide, doxorubicin, vincristine, prednisolone and etoposide (CHOEP) based. Response assessment after 6 cycles showed complete response (CR) and partial response (PR), 13 (40.6%) and 16 (50%), respectively. Three patients died during therapy. The progression-free survival (PFS) at 18 months was 57.34%. In our study, 12.9% patients had T- NHL among all patients of lymphoma. Lymphadenopathy and advanced stage disease were most common presentations. Chemotherapy outcomes showed CR in 40.6% of patients and PFS at 18 months was 57.34%.

    更新日期:2020-01-04
  • Boering’s Arthrosis of the Temporomandibular Joint in a 9-Year-Old Girl; a Case Report
    SN Compr. Clin. Med. Pub Date : 2020-01-03
    Jahanzeb Chaudhry, Haidi Omar, Eleftherios Kaklamanos, Sharmeen J. Chaudhry

    Abstract Boering’s arthrosis is a rare disorder of the temporomandibular joints that usually occurs in the second decade and seldom after age 20. It was first described by G. Boering in 1966. It is more common in females and can be unilateral or bilateral. The disease results in resorption of the condyle with elongation of the articular surface resulting in the characteristics toadstool appearance observed on panoramic images. Condylar changes are often accompanied by anterior displacement of the disc and remodeling of the glenoid fossa. Facial asymmetry is almost always present. We present a case of a 9-year-old female with Boering’s arthrosis. She presented with facial asymmetry and bite abnormality but did not report symptoms typically associated with temporomandibular disorders.

    更新日期:2020-01-04
  • Laparoscopic Fenestration for a Giant Pseudocyst Complicated from TEP
    SN Compr. Clin. Med. Pub Date : 2020-01-03
    Zi Qin Ng, Hannes Basson

    Abstract Laparoscopic inguinal hernia repair is the preferred approach in most centers. One of the most common complications encountered is seroma. Majority are asymptomatic and resolve with time. Very rarely, the seroma can lead to the formation of a giant pseudocyst. Hereby, we described a case of recurrent seroma leading to a giant pseudocyst post-laparoscopic inguinal hernia repair that failed conservative management requiring laparoscopic fenestration of the pseudocyst.

    更新日期:2020-01-04
  • Usefulness of Preoperative Trans-Abdominal Ultrasound Prior to Bariatric Surgery
    SN Compr. Clin. Med. Pub Date : 2020-01-03
    Bhagyam Nagarajan, Karan Gupta, Amrit Nasta, Autkar Gayatri, Ramen Goel

    An enlarged left lobe of liver can complicate bariatric surgery. Preoperative ultrasound of the abdomen is routinely performed in bariatric patients to measure the liver, particularly the left lobe, as well as to record any ancillary findings such as gallstones. Our study aims to evaluate the reliability of ultrasound in evaluating the craniocaudal length of the left lobe of the liver vis-a-vis intraoperative measurements. It also aims to assess the impact of ancillary findings detected on ultrasound, on the pre-surgical preparation and follow-up of such patients. Forty patients who were to undergo bariatric surgery in our hospital between June 2018 and May 2019 were included in this study. All of these patients underwent preoperative ultrasound. The measurements of the left lobe of liver evaluated on ultrasound were compared with the intraoperative measurements. Mean preoperative BMI for the forty patients was 41.47 kg/m2. On applying the paired t test, the left liver lobe measurements calculated by our ultrasound technique correlated with intraoperative measurements. The left liver lobe length measured less than 15 cm in all 40 patients. Ultrasound detected ancillary findings in 8 (20%) patients. Ultrasound showed fatty infiltration of liver in approximately 80% of the patients with a trend towards increasing incidence of fatty change with increasing BMI. Our study showed that left liver lobe measurements calculated by preoperative ultrasound correlate with intraoperative measurements. Ancillary ultrasound findings helped the surgeon in preparing for the bariatric surgery and may modify the follow-up protocol in such patients.

    更新日期:2020-01-04
  • Estimating Residual Kidney Function: Present and Future Challenge
    SN Compr. Clin. Med. Pub Date : 2020-01-03
    Inês Castro, Anabela Rodrigues

    Residual kidney function is a major prognosis factor in patients with end-stage renal disease under hemodialysis or peritoneal dialysis. Advances in later years promoted residual kidney function protection as an adequacy target and the advocacy of incremental dialysis, utilizing its assessment as a parameter of individualized dialysis schedules. Glomerular filtration rate measurement is only a dimension of kidney function neglecting the share of tubular function, with several dialytic limitations. The need for interdialytic urine collections to quantify residual kidney function, by the mean of urea and creatinine clearances, is cumbersome and prone to errors in dialysis patients. This review will approach residual kidney function estimation without urine collection, mainly with biomarkers such as cystatin C, beta-2 microglobulin, and beta-trace protein, as well as the behavior of these molecules on various dialysis modalities, their non-renal determinants, and its potential use for patient risk stratification. Multi-frequency bioimpedance analysis is also described as a promising approach to estimate residual kidney function, being an opportunity to highlight the relevant link between volume balance and diuresis. We conclude that standard glomerular filtration rate estimation formulas are not sufficiently accurate for residual kidney function assessment. There is a need for innovative tools that consider glomerular and interstitial function to be implement in clinical practice, therefore the new equations already developed and approached in this review should be validated in larger cohorts.

    更新日期:2020-01-04
  • The Use of Haemostatic Agents in Percutaneous Nephrolithotomy: A Systematic Review
    SN Compr. Clin. Med. Pub Date : 2020-01-02
    Varun Misra, Agapios Gkentzis

    Percutaneous nephrolithotomy (PCNL) is the gold standard treatment for large renal and ureteric stones. A nephrostomy tube is often inserted post-operatively to reduce complications such as tract haemorrhage and infection. However, nephrostomy tubes cause significant discomfort, increasing both analgesic requirements and length of inpatient stay. Whilst tubeless PCNL has been shown to be safe in low-risk patients, the risk of above complications remains. To address these concerns, clinicians have trialled applying haemostatic agents (HA) to the tract, with varied results. We aim to determine if HA are safe and clinically beneficial in PCNL. Systematic review of literature yielded 97 original research articles. Seventeen papers were deemed suitable after abstract screening and eligibility criteria application. These 17 research studies compared either tubeless PCNL vs PCNL with HA or PCNL with nephrostomy tube vs PCNL with HA. Within these studies a wide range of HA with differing mechanisms were used. Outcomes compared, where available, included bleeding (as determined by Hb drop or transfusion rates), pain scores, analgesic requirements, length of hospital stay and complication rates. We conclude that low-risk patients undergoing tubeless PCNL are unlikely to benefit from HA. However, potential remains in using HA to complement or replace nephrostomy tube in patients with significant intraoperative bleeding. Further studies are required to determine the optimal patient demographic who may benefit from HA, with a focus on cost-benefit analysis. Whilst HA were found to be safe, concerns remain regarding inadvertent collecting system injection and long-term effects, as well as increased cost.

    更新日期:2020-01-04
  • Immune Checkpoint Inhibitor-Induced Colitis Successfully Followed up by Ultrasonography
    SN Compr. Clin. Med. Pub Date : 2020-01-02
    Satomi Omotehara, Mutsumi Nishida, Kazunori Nagashima, Takehiko Katsurada, Tetsuhito Muranaka, Yoshito Komatsu, Tomoko Mitsuhashi, Hitoshi Shibuya, Takashige Abe, Ryuji Matsumoto, Nobuo Shinohara, Junichi Sugita, Takanori Teshima

    Abstract Nivolumab is an immune checkpoint inhibitor (ICI), which is used for treatment of advanced malignancies. Diarrhea is a typical adverse effect of ICIs. Several endoscopic features of ICI-related colitis have been reported. Herein, we reported a case of ICI-related colitis, with successful follow-up using ultrasonography (US). A 54-year-old woman, diagnosed with renal cell carcinoma, underwent radical nephrectomy. Multiple liver and bone metastases appeared 6 months after surgery. She was prescribed sunitinib, which was discontinued, because of severe diarrhea. She was prescribed nivolumab after 1 week. However, she was hospitalized 9 days later, due to fever and diarrhea. US showed diffuse wall thickening from the cecum to the rectum. The wall layer structures were preserved, and thickening was observed mainly in the submucosa, but not in the mucosa, without a decrease in the echo level. Subsequently, sigmoidoscopy was performed. Severe edema was observed in the mucosa, without any erosion and granularity. She was clinically diagnosed with ICI-related colitis, and steroid therapy was administered. One week after steroid therapy, the diarrhea improved, and the earlier findings showed marked improvement on US. After another week of reduced steroid dose, US revealed further improvement, and she was discharged.

    更新日期:2020-01-04
  • The Complete Blood Count in Children and Adolescents with Tuberculosis: Utility and Prevalence of Anaemia, Lymphopenia and Neutrophilia
    SN Compr. Clin. Med. Pub Date : 2020-01-02
    Ajibola Alabi, Faisal Kordy, Ray Lam, Melanie Kirby-Allen, Ian Kitai

    Abstract There are very few reports about complete-blood-count (CBC) findings in paediatric tuberculosis. We assessed the prevalence and predictors of haematologic abnormalities and the utility of a routine CBC in initial management of paediatric TB. We reviewed records and results of investigations of all children and adolescents (ages 0–18) treated for TB disease at the Hospital for Sick Children, Toronto, Canada from January 2002 to December 2012. Anaemia was found in 52/138 (42%) patients, was often microcytic, more prevalent in adolescent females (Odds Ratio (OR) 3.7 [95% confidence intervals (CI) 1.27–10.6]) and those with disseminated disease (OR 3.60 [95% CI 1.12–11.53]), and often resolved with anti-tuberculous treatment. Only 4 children received iron therapy. White cell abnormalities that occurred often suggested diagnoses other than TB: lymphopenia occurred in 30/124 patients (24%) (all HIV negative) and neutrophilia in 20/124 (16%) patients, 9 of whom had pulmonary airspace disease. An initial routine CBC seldom changed patient management and had limited utility.

    更新日期:2020-01-04
  • Age at Menarche and Oxidative Stress Markers in Women with Endometriosis
    SN Compr. Clin. Med. Pub Date : 2020-01-02
    Areti Augoulea, A. Kindis, E. Karopoulou, N. Tsoltos, G. Kaparos, E. Tsakonas, K. Panoulis

    Endometriosis is one of the most frequent gynecological disorders defined as the existence and growth of endometrial tissue outside the uterine cavity. Aim of this study was to evaluate the level of six oxidative stress markers in the serum of patients with and without endometriosis. This study included 46 women who were undergoing laparoscopy. The participants were divided into two groups based on their laparoscopic results. Thirty-one women had visually and histopathologically confirmed endometriosis, whereas 15 did not. The serum level of ADMA (asymmetric dimethylarginine), MCP1 (monocyte chemoattractant protein 1), MMP2 (matrix metalloproteinases 2), MMP9 (matrix metalloproteinases 9), RANTES (regulated upon activation, normal T cell expressed and presumably secreted), and VEGF-A (vascular endothelial growth factor) as oxidative stress markers were measured and compared between the two groups. No significant difference in the ADMA, MCP1, MMP2, MMP9, RANTES, and VEGF-A serum levels was detected between the entometriosis patients and controls. The disease stage did not affect any of the markers’ level either. Women with endometriosis had menarche at an earlier age compared to controls [11.7 (SD 1.09) vs 12.6 (SD 1.4), p = 0.04)]. These results suggest that there is no association between endometriosis and increased oxidative stress. The elevation and possible role of oxidative stress markers in the diagnosis and pathogenesis of endometriosis should be evaluated in more extended studies.

    更新日期:2020-01-04
  • First Autochthonous Case of Cryptococcal Meningitis in an Immunocompetent Host Due to Cryptococcus gattii VGIin Northern Italy
    SN Compr. Clin. Med. Pub Date : 2019-12-18
    Marco Passera, Virginio Bonito, Laura Comi, Elisa Calvi, Ornella Manara, Claudio Farina, Massimo Cogliati

    Abstract We describe a case of cryptococcal meningitis diagnosed in an immunocompetent patient, with no apparent predisposing conditions, living in Northern Italy. The patient was initially admitted for visual disturbs with nausea and cervical pain, but magnetic resonance imaging of the brain showed a diencephalic lesion. Colonies of Cryptococcus gattii species complex were isolated from cerebrospinal fluid. Antifungal therapy was started and conditions of the patient improved in 2 months. The fungal isolate was identified as C. gattii molecular type VGI, mating type αB, and genotype ST156. This is the most common C. gattii species complex genotype circulating in Europe and in Italy suggesting that the infection was probably acquired in Italy since the patient did not report any recent travel abroad.

    更新日期:2020-01-04
  • Hyperuricemia and Cardiovascular Diseases in Very Elderly Patients with Coronary Artery Disease
    SN Compr. Clin. Med. Pub Date : 2019-12-18
    S. V. Topolyanskaya, O. N. Vakulenko, A. E. Semashkova, L. M. Kupina, L. I. Dvoretskiy

    Abstract There are few data available on the prevalence of hyperuricemia and its possible association with cardiovascular diseases among the very elderly population. The main part of this study enrolled 320 very elderly hospitalized patients (aged 86.4 ± 5.0 years; females, 78.1%; males, 21.9%) with coronary artery disease (CAD) and arterial hypertension (AH). The second part of the study involved 48 patients younger than 60 years, who were hospitalized with CAD diagnosis for coronary angiography study. Patients with gout were excluded from analysis. Hyperuricemia was defined as serum uric acid (SUA) more than 340 μmol/l in women and 420 μmol/l in men. Elevated serum uric acid (SUA) levels were detected in 37.4% of 320 elderly patients. Hyperuricemia was significantly more common in women (in 41.5% of cases) than in men (in 25%) (p = 0.02). In the group of very elderly patients, there was a clear correlation between hyperuricemia and clinically significant chronic heart failure (OR = 5.0; 95% CI = 2.4–10.7; p < 0.0001), as well as with stroke in history (OR = 1.9; 95% CI = 1.0–3.4; p = 0.03). Hyperuricemia remained significant risk factor of heart failure in the multiple regression analysis (p < 0.001). Atrial fibrillation was significantly more frequently diagnosed in patients with hyperuricemia compared with patients with normal levels of uric acid (OR = 2.2; 95% CI = 1.3–3.6; p = 0.001). A pronounced positive correlation was found between the SUA levels and the diameter of the left atrium (r = 0.3; p = 0.000003). In the group of 48 CAD patients under 60 years of age, hyperuricemia was significantly associated with myocardial infarction (OR = 8.8; 95% CI = 2.0–38.9; p = 0.002) and chronic heart failure (OR = 6.9; 95% CI = 1.8–26.3; p = 0.003). In general, the obtained results indicate a significant prevalence of hyperuricemia in people with CAD. A significant relationship between the increased SUA levels and the development of some cardiovascular diseases was found.

    更新日期:2020-01-04
  • Prevalence of Anemia Among Adults at Capital Governorate in Kuwait
    SN Compr. Clin. Med. Pub Date : 2019-12-17
    Salma M. AlDallal, Maryam Al-Hilal

    Abstract Anemia, defined by low hemoglobin level, is recognized as a major public health problem that has a significant impact on lifelong health. In 2014, the Kuwait Nutrition Surveillance System stated that the prevalence of anemia was 9.7% in adult males and 32.7% in adult females. This study aimed to establish the prevalence and classification of anemia among adult patients attending the Capital Governorate hospital of Kuwait. It is a retrospective record-based study. The study included patients (aged 18–60 years) attending Amiri Hospital OPD and primary care centers affiliated from January 2014 to December 2018. Hemoglobin levels were taken from the Laboratory Information System (LIS) and were classified as mild, moderate, and severe based on WHO classification. This study showed that anemia was more prevalent among the Kuwaiti population than non-Kuwaitis. The maximum percentage of anemic people belonged to the moderate and mild range of anemia; a very low percentage was found in the severe range. The incidence of anemia was significantly higher among females compared to males (16–17% of females and 4–5% of males in the moderate range; 16–18% of females and 10–11% of males in the mild range; 2–3.3% of females and 0.8–1.1% of males in the severe range). Age-wise comparison of data showed that anemia was more common among the older age groups. Prevalence of anemia is quite high in Kuwait; therefore, more studies and interventions are needed for certain vulnerable groups—specifically for women and people from older age groups—to reduce the risk of anemia.

    更新日期:2020-01-04
  • Paraoxonase Activity in Patients with Obstructive Sleep Apnea: a Systematic Review and Meta-analysis
    SN Compr. Clin. Med. Pub Date : 2019-12-16
    Reza Fadaei, Roya Safari-Faramani, Mohammad Rezaei, Reza Ahmadi, Masoumeh Rostampour, Nariman Moradi, Habibolah Khazaie

    Obstructive sleep apnea (OSA) is a common sleep disorder affecting high proportion of the population. This disorder is associated with an increase in the oxidative stress and cardiovascular disease. Paraoxonase (PON) is a lipolactonase enzyme removing toxic lipids and decreasing lipoprotein oxidation. The present study was conducted to reassess possible alternation of PON activities in OSA patients. Studies measured PON activities in OSA were searched in PubMed, Scopus, EMBASE, Web of Science databases, and Cochrane Library from January 1990 to February 2019. Screening of the studies was performed by two authors independently according to title, abstract, and full text. Quality of studies was assessed by Newcastle-Ottawa Quality Assessment Scale, and random-effect model was used for evaluating the effect of OSA on PON activities. A total of 97 records were found in searching, 39 duplicated records were removed, and 5 studies for PON activity and 2 studies for aryl-esterase (ARE) activity were included in the meta-analysis. Pooled analysis showed no significant difference in terms of PON activity between OSA and control groups (p = 0.434). Similarly, ARE demonstrated no significant difference between OSA and control groups (p = 0.515). Subgroup meta-analysis according to age, BMI, AHI, and diagnosis criteria demonstrated no significant difference between two groups. The results of this study indicated no association between OSA and PON activities as an antioxidant enzyme. However, a relatively low number of studies limited us to conclude a definite conclusion; therefore, more studies are needed in this regard.

    更新日期:2020-01-04
  • Vitamin B 12 Deficient Megaloblastic Anemia Mimicking Thrombotic Thrombocytopenic Purpura
    SN Compr. Clin. Med. Pub Date : 2019-12-14
    Yutaka Shimazu, Takeya Edagawa, Masaharu Nohgawa

    Megaloblastic anemia is a benign disorder characterized by ineffective hematopoiesis due to lack of vitamin B12 or folate. Megaloblastic anemia could be easily treated with either vitamin B12 or folate. However, a megaloblastic anemia patient may show schizocyte and hemolytic anemia with thrombocytopenia, necessitating to exclude urgent diseases like thrombotic thrombocytopenic purpura. We have experienced the vitamin B12–deficient megaloblastic anemia patient mimicking thrombotic thrombocytopenic purpura. We should know the rare coexistence of hemolytic anemia with megaloblastic anemia in severe cases.

    更新日期:2020-01-04
  • Bilateral and Unilateral Partially Thrombosed Orbital Varices – Report of Two Cases and Literature Review
    SN Compr. Clin. Med. Pub Date : 2019-12-14
    Niharika Shahi, David Kisselgoff, Anatoly Shuster

    Orbital varices represent a rare type of venous malformation composed of a single or multiple abnormally enlarged veins communicating to the systemic venous system. Clinical presentation is often nonspecific. Potential complications including intraorbital bleed and venous thrombosis may lead to a permanent visual loss. Multimodality imaging is important for proper interpretation and accurate diagnosis as well as timely management of the lesion. We report two acute cases of bilateral and unilateral partially thrombosed orbital varices in which the correct diagnosis was made based on an integrated imaging approach.

    更新日期:2020-01-04
  • An Update on Corneal Imaging Techniques: from Macroscale to Nanostructure
    SN Compr. Clin. Med. Pub Date : 2019-12-14
    Francisco J. Ávila, Jorge Ares, Mª Victoria Collados, Mª Concepción Marcellán, Laura Remón

    The structural integrity of the cornea and transparency are critical for normal vision. Corneal evaluation in ophthalmology and clinical research requires fast and user-friendly techniques allowing accurate diagnoses and follow-up of pathologies, injuries or surgery. Macroscopic irregularities in the anterior corneal surface are the main cause of irregular refractive vision problems. The microscopic and nanoscopic irregularities within the three-dimensional architecture of cornea are the cause of loss of optical transparency and scattering. In this review, the state of the art of the different corneal imaging techniques with three-dimensional capabilities will be detailed and discussed according to the descriptive level of analysis: macroscopic, microscopic and nanoscopic scales.

    更新日期:2020-01-04
  • Effects of Thyroid Hormones on Risk of Intraventricular Hemorrhage in Preterm Infants
    SN Compr. Clin. Med. Pub Date : 2019-12-12
    Nastaran Khosravi, Farhad Abolhasan Chobdar, Ali Mazouri, Nasrin Khalesi, Zahra Vahedi, Alireza Karimi

    Abstract Intraventricular hemorrhage (IVH) often occurs in preterm infants and is an important cause of brain damage in the infants. Although its incidence has decreased, IVH remains a significant complication in the survival of preterm infants. One of the predisposing factors is thyroid function. The aim of the present study was to evaluate the effects of thyroid hormones T4 and thyroid-stimulating hormone (TSH) on risk of IVH in Iranian preterm infants. We designed a cross-sectional study, and the population includes fifty preterm infants admitted in the neonatal intensive care unit (NICU) ward of Ali Asghar Hospital, Tehran, Iran, during the period of 2017 to 2018. Cranial sonography at the 5th and 30th day after birth was performed to evaluate the IVH and thyroid function tests were conducted on blood samples using radioimmunoassay. Results of IVH prevalence and grading indicated that 5th day IVH occurs in 38% and 30th day IVH occurs in 28% of infants. There is no statistically significant correlation between T4 and TSH with 5th day IVH but there is a significant statistical relationship between T4 and TSH levels and IVH on the 30th day after birth. Thyroid function hormones could be used as markers to predict the risk of IVH in preterm infants. Larger sample size can help to obtain more validated results.

    更新日期:2020-01-04
  • Accuracy of Intracavitary Applicator Reconstruction for Cervix Cancer Brachytherapy
    SN Compr. Clin. Med. Pub Date : 2019-12-11
    Hussein ALMasri, Yasumasa Kakinohana, Takafumi Toita, Takuro Ariga, Goro Kasuya, Sadayuki Murayama

    The accuracy of intracavitary applicator reconstruction for cervical cancer was assessed. A homemade phantom that mimics clinical applicator placement and reference points was used. Three stainless steel (15°, 30°, and 45°) tandems, x-ray markers, and three reference points were used to compare radiography- and CT-based systems. For CT reconstructions, two Fletcher CT compatible (15° and 30°) tandems, two ovoids, and two reference points, with and without inserted x-ray markers, were used. A 2.5-mm CT slice thickness was used. To check for inter- and intra-operator variations in CT, only a 30° tandem without x-ray markers and 1.25-mm CT slice thickness were used. Applicators were reconstructed three times for each image set to verify the operator reproducibility. A 6 Gy dose was prescribed and normalized at AL-point. Source dwell times were compared to check for dose variation at A-point. Maximum standard deviations SD (σ) for radiography and CT reconstructions were 0.35 and 0.83 mm, respectively. Analysis of variance for the means of 15° and 30° tandems showed no significant difference. Levene’s test proved insignificant difference for 15° tandem (p value = 0.131), whereas it showed a significant difference for 30° tandem (p value = 0.011). This phantom study showed that the variance of dwell times between the two methods for 30° tandem was statistically significant due to increased applicator curvature. CT proves superiority to radiography. X-ray marker method was more accurate but has less image quality. Inter- and intra-oncologist variations showed good agreement.

    更新日期:2020-01-04
  • A Case of Generalized Crystal Storage Histiocytosis Presenting as Soft Tissue Sarcoma: Diagnostic Dilemma
    SN Compr. Clin. Med. Pub Date : 2019-12-10
    Manasi C. Mundada, Faiq Ahmed, Sudha Murthy, Senthil Rajappa

    Crystal storage histiocytosis (CSH) is a rare clinical entity. It comprises of benign histiocytes showing accumulation of refractile generally immunoglobulin crystals in the cytoplasm. Accumulation of non-immunoglobulin substances is also described, common being clofazimine, charcot-leyden, and cystine. Here, we present a case of generalized CSH presenting as a chest wall mass in a 62-year-old gentleman. X-ray showed a chest wall mass with destruction of the right sixth rib. Histopathological examination revealed plasmacytoma with the presence of histiocytes showing abundant pink cytoplasm. Bone marrow examination revealed the presence of plasma cells with dense azurophilic granules. The patient was started on chemotherapy for multiple myeloma. It is clinically important to identify these cases as part of published literature since it annotates poor prognosis to the generalised form of CSH compared to localized one. The unusual location, presence of morphologically distinct plasma cells in marrow, made the diagnosis challenging. The case also highlights the role played by immunohistochemistry to arrive at the right diagnosis.

    更新日期:2020-01-04
  • Cryptococcal Osteomyelitis in an Immune-Competent Host: a Case Report
    SN Compr. Clin. Med. Pub Date : 2019-12-10
    Thomas Gehring, H. Kim, S. Schlabe, C. Prangenberg, A. Hoerauf, V. Rickerts, C. Buechler

    We report a rare case of osteomyelitis due to Cryptococcus neoformans var. grubii in a non-immunosuppressed patient. The epidemiology, symptoms, diagnostics and treatment are discussed. The case illustrates the complexity of differential diagnosis of osteomyelitis.

    更新日期:2020-01-04
  • The association between gout and cardiovascular disease in patients with atrial fibrillation.
    SN Compr. Clin. Med. Pub Date : 2019-08-10
    Per Wändell,Axel C Carlsson,Jan Sundquist,Kristina Sundquist

    Objective Gout is a sign of a disturbed metabolism and associated with atrial fibrillation (AF) and other cardio-vascular diseases. Our aim was to study associations between gout and cardiovascular co-morbidities in patients with AF. Methods The study population included all adults (n=12,283) ≥45 years diagnosed with AF visiting 75 primary care centers in Sweden 2001-2007. Logistic regression was used to calculate odds ratios with 95% confidence intervals (CIs) for the associations between prevalent gout and cardiovascular co-morbidities. In subsamples we studied incident congestive heart failure (CHF) and ischemic stroke (IS), excluding patients with earlier registered specific diagnosis, using Cox regression (to estimate hazard ratios (HR) with 95% CIs). Results Gout was significantly and positively associated with CHF, obesity and diabetes among men and women, and among men also with hypertension and coronary heart disease. Prevalent gout was negatively associated with incident IS (HR and 95% CI: 0.64, 0.49-0.82; 0.50, 0.39-0.64) in both full model (adjusted for sex, age, socio-economic factors and comorbidities) and CHA2DS2-VASc model (adjusted for CHA2DS2-VASc, sex and age). Adding gout to full model increased Harrell's C by 1% in CHA2DS2-VASc model. Conclusions In this clinical setting we found gout to be associated with most cardiometabolic diseases except cerebrovascular diseases, and with decreased risk of IS, with gout adding significantly to the predictive value compared to CHA2DS2-VASc without gout included.

    更新日期:2019-11-01
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