Medicine by Alexandros G.Sfakianakis,Anapafseos 5 Agios Nikolaos,Crete 72100,Greece,tel :00302841026182 & 00306932607174
Haematological cancer: Cancer risks persist after Hodgkin lymphoma.
Nat Rev Clin Oncol. 2016 Jan 20;
Authors: Sidaway P
PMID: 26787280 [PubMed - as supplied by publisher]
Lung cancer: Anti-PD-L1 therapy: patient selection is important.
Nat Rev Clin Oncol. 2016 Jan 20;
Authors: Sidaway P
PMID: 26787279 [PubMed - as supplied by publisher]
Patient-reported outcomes in the evaluation of toxicity of anticancer treatments.
Nat Rev Clin Oncol. 2016 Jan 20;
Authors: Di Maio M, Basch E, Bryce J, Perrone F
Abstract
Symptomatic toxicities associated with anticancer treatments, such as nausea and vomiting, are frequently underreported by clinicians, even when data are prospectively collected within clinical trials. Such underreporting can result in an underestimation of the absolute rate of toxicity, which is highly relevant information for patients and their physicians in clinical practice, and for regulatory authorities. Systematic collection of patient-reported outcomes (PROs) has been demonstrated to be a valid, reliable, feasible and precise approach to tabulating symptomatic toxicities and enables symptoms that are missed by clinicians to be detected. In this Perspectives, the barriers and challenges that should be addressed when considering broad integration of PRO toxicity monitoring in oncology clinical trials are discussed, including challenges related to data collection logistics, analytical approaches, and resource utilization. Instruments conceived to enable description of treatment-related adverse effects, from the patient perspective, bring the potential to improve risk-versus-benefit analyses in clinical research, and to provide patients with accurate information, on the basis of previous experiences of their peers.
PMID: 26787278 [PubMed - as supplied by publisher]
CNS cancer: Breaking boundaries - IDH mutations in glioma.
Nat Rev Clin Oncol. 2016 Jan 20;
Authors: Killock D
PMID: 26787277 [PubMed - as supplied by publisher]
Preablative stimulated thyroglobulin correlates to new therapy response system in differentiated thyroid cancer.
J Clin Endocrinol Metab. 2016 Jan 20;:jc20154016
Authors: Yang X, Liang J, Li T, Zhao T, Lin Y
Abstract
CONTEXT: Studies suggested a potential value of preablative stimulated Tg (ps-Tg) on predicting the recurrent and persistent diseases of differentiated thyroid cancer (DTC), whereas its correlations with therapeutic response remain uncertain.
OBJECTIVE: To establish the correlation between ps-Tg and therapeutic response proposed in 2015 American Thyroid Association (ATA) guidelines, and calculate a cut-off ps-Tg threshold for predicting a poor response.
DESIGN/SETTING: Patients who underwent total thyroidectomy and radioactive iodine (RAI) therapy in a University hospital participated in this retrospective study.
PATIENTS: Totally, 452 DTC patients were followed for a median of 38 months and were divided into three groups in terms of ps-Tg level: Group1:<1ng/ml (n=82), Group2: 1-10ng/ml (n=173), Group3:≥10ng/ml (n=197).
MAIN OUTCOME MEASURE: Clinical outcomes were assessed based on response to therapy re-staging system, dividing response into excellent (ER), indeterminate (IDR), biomedical incomplete (BIR), and structural incomplete (SIR).
RESULTS: Therapeutic responses could be obviously distinguished by different ps-Tg strata. SIR was identified in none of Group 1, 1.73% of Group 2, and 42.74% of Group 3, respectively ((2)=123.037, p<0.001). A cut-off value of ps-Tg at 26.75 ng/ml was obtained by receiver operating characteristic (ROC) curve for differentiating SIR from either ER, IDR, or BIR. The area under curve (AUC) was 0.947 and negative predictive value (NPV) was 96.99%. Ps-Tg was an independent predictive variable of SIR (OR: 42.312, p<0.001).
CONCLUSIONS: Ps-Tg has a great performance in predicting therapeutic response and providing incremental value for decision making of RAI therapy, especially for patients with high ps-Tg level.
PMID: 26789779 [PubMed - as supplied by publisher]
Follicular thyroid carcinoma with NRAS Q61K and GNAS R201H mutations that had a good (131)I treatment response.
Endocrinol Diabetes Metab Case Rep. 2016;2016:150067
Authors: Lu JY, Hung PJ, Chen PL, Yen RF, Kuo KT, Yang TL, Wang CY, Chang TC, Huang TS, Chang CC
Abstract
UNLABELLED: We report a case of follicular thyroid carcinoma with concomitant NRAS p.Q61K and GNAS p.R201H mutations, which manifested as a 13.5 cm thyroid mass with lung, humerus and T9 spine metastases, and exhibited good response to radioactive iodine treatment.
LEARNING POINTS: GNAS p.R201H somatic mutation is an activating or gain-of-function mutation resulting in constitutively activated Gs-alpha protein and downstream cAMP cascade, independent of TSH signaling, causing autonomously functioning thyroid nodules. NRAS p.Q61K mutations with GNAS p.R201H mutations are known for a good radioactive iodine treatment response.Further exploration of the GNAS-activating pathway may provide therapeutic insights into the treatment of metastatic follicular carcinoma.
PMID: 26788326 [PubMed]
(Secondary) solid tumors in thyroid cancer patients treated with the multi-kinase inhibitor sorafenib may present diagnostic challenges.
BMC Cancer. 2016;16(1):31
Authors: Schneider TC, Kapiteijn E, van Wezel T, Smit JW, van der Hoeven JJ, Morreau H
Abstract
BACKGROUND: Sorafenib is an orally active multikinase tyrosine kinase inhibitor (TKI) that targets B-type Raf kinase (BRAF), vascular endothelial growth factor receptors (VEGFR) 1 and 2, and rearranged during transfection (RET), inducing anti-angiogenic and pro-apoptotic actions in a wide range of solid tumors. A side effect of sorafenib is the occurrence of cutaneous squamous tumors.
CASE PRESENTATION: Here we describe three patients with a history of sorafenib treatment for advanced radioactive iodine refractory papillary thyroid cancer (two with a BRAF c.1799 T > A and one carrying a rare c.1799-1801het_delTGA mutation) who presented with secondary non-cutaneous lesions. The first patient was diagnosed with a squamous cell carcinoma (SCC) of the tongue, the second patient with a primary adenocarcinoma of the lung, and the third with a SCC originating from the cricoid. Secondary analysis was required to show that the latter two presentations were in fact recurrent thyroid cancer.
CONCLUSION: These findings suggest that drugs such as sorafenib may induce metaplasia/clonal divergence of metastatic thyroid cancer and thus cause diagnostic misclassification. Furthermore, sorafenib is potentially involved in the tumorigenesis of secondary non-cutaneous SCC. These observations should now be confirmed in larger series of patients treated with drugs such as sorafenib.
PMID: 26786320 [PubMed - in process]
Osteomyelitis is a common occurrence in orthopaedic surgery, which is caused by different bacteria. Treatment of osteomyelitis patients aims to eradicate infection by debridement surgery and local and systemic antibiotic therapy. Local treatment increases success rates and can be performed with different antimicrobial bone graft substitutes. This review is performed to assess the level of evidence of synthetic bone graft substitutes in osteomyelitis treatment. According to the PRISMA statement for reporting systematic reviews, different types of clinical studies concerning treatment of osteomyelitis with bone graft substitutes are included. These studies are assessed on their methodological quality as level of evidence and bias and their clinical outcomes as eradication of infection. In the fifteen included studies, the levels of evidence were weak and in ten out of the fifteen studies there was a moderate to high risk of bias. However, first results of the eradication of infection in these studies showed promising results with their relatively high success rates and low complication rates. Due to the low levels of evidence and high risks of bias of the included studies, these results are inconclusive and no conclusions regarding the performed clinical studies of osteomyelitis treatment with antimicrobial bone graft substitutes can be drawn.
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Giant Cutaneous Leiomyosarcoma Originating From the Abdominal Wall: A Case Report.
Am J Case Rep. 2016;17:35-8
Authors: Eken H, Karagul S, Topgül K, Yoruker S, Ozen N, Gun S, Balci MG, Somuncu E, Cimen O, Soyturk M, Karavas E
Abstract
BACKGROUND Leiomyosarcoma, a rare type of tumor, accounts for 5-10% of all soft tissue tumors. CASE REPORT A 44-year-old male patient was admitted to the emergency service of our medical faculty with the complaints of fatigue and abdominal mass. CONCLUSIONS The pathology result was leiomyosarcoma. Leiomyosarcoma of the skin is rare and our case is the largest such lesion reported in the literature.
PMID: 26787636 [PubMed - in process]
Patient-specific biomechanical models have been advocated as a tool for predicting deformations of soft body organs/tissue for medical image registration (aligning two sets of images) when differences between the images are large. However, complex and irregular geometry of the body organs makes generation of patient-specific biomechanical models very time consuming. Meshless discretisation has been proposed to solve this challenge. However, applications so far have been limited to 2-D models and computing single organ deformations. In this study, 3-D comprehensive patient-specific non-linear biomechanical models implemented using Meshless Total Lagrangian Explicit Dynamics (MTLED) algorithms are applied to predict a 3-D deformation field for whole-body image registration. Unlike a conventional approach which requires dividing (segmenting) the image into non-overlapping constituents representing different organs/tissues, the mechanical properties are assigned using the Fuzzy C-Means (FCM) algorithm without the image segmentation. Verification indicates that the deformations predicted using the proposed meshless approach are for practical purposes the same as those obtained using the previously validated finite element models. To quantitatively evaluate the accuracy of the predicted deformations, we determined the spatial misalignment between the registered (i.e. source images warped using the predicted deformations) and target images by computing the edge-based Hausdorff distance. The Hausdorff distance-based evaluation determines that our meshless models led to successful registration of the vast majority of the image features.
Adrenal adenocarcinoma with Kartagener's syndrome: A case report.
Oncol Lett. 2015 Dec;10(6):3635-3638
Authors: Hu W, Cheng L, Cheng B, Zhang P, Xiao HE, Wu W, Wang X
Abstract
The present study reports the case of a 44-year-old woman with an adrenal tumor, complicated by Kartagener's syndrome (KS). The patient was admitted to Zhongnan Hospital (Wuhan, China), and presented with an 8-week history of vertigo and extended history of a recurrent cough, accompanied by sputum and a congested nose. Computed tomography indicated a mass on the right adrenal gland and situs inversus. A right adrenal tumor combined with KS was diagnosed, and resection of the tumor was performed following relief of respiratory symptoms and control of blood pressure. During six months of follow up the patient recovered well from surgery and blood pressure remained stable. This case revealed that patients exhibiting KS may suffer from serious respiratory infections as a result of impaired defense mechanisms against microbes in the airway. Therefore, comprehensive management of infection, safe anesthesia and appropriate surgical procedures for the avoidance of inflammation and trauma are the most significant factors required for the success of the treatment.
PMID: 26788182 [PubMed - as supplied by publisher]
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Editorial: proton pump inhibitor-responsive oesophageal eosinophilia - two different phenotypes? - Author's reply.
Aliment Pharmacol Ther. 2015 Aug;42(4):487-8
Authors: Moawad FJ
PMID: 26179763 [PubMed - indexed for MEDLINE]
| Related Articles |
Editorial: proton pump inhibitor-responsive oesophageal eosinophilia - two different phenotypes?
Aliment Pharmacol Ther. 2015 Aug;42(4):485-7
Authors: Molina-Infante J, Katzka DA
PMID: 26179762 [PubMed - indexed for MEDLINE]
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[Determination of hyperregeneratory esophagopathy in dogs with clinical signs attributable to esophageal disease].
Tierarztl Prax Ausg K Kleintiere Heimtiere. 2015;43(3):147-55
Authors: Münster M, Kook P, Araujo R, Hörauf A, Vieth M
Abstract
OBJECTIVE: It was hypothesized that typical characteristics of hyperregeneratory esophagopathy (HRE) in humans such as basal cell hyperplasia and elongation of stromal papillae are also histologically detectable in canine esophageal epithelium, and that these changes are associated with clinical signs and endoscopic findings suggesting gastroesophageal reflux (GER).
MATERIAL AND METHODS: Sixty-five adult dogs with clinical signs attributable to esophageal disease underwent esophagoscopy and biopsy. Clinical signs suggesting GER (regurgitation, ptyalism, painful discomfort) were prospectively evaluated through a questionnaire. Endoscopic mucosal alterations suggesting GER such as minimal endoscopic changes and obvious mucosal defects were assessed via video endoscopy. Biopsy specimens obtained from the esophageal squamous epithelium were evaluated histologically. The squamous epithelium's substructures of esophageal biopsies were quantitatively assessed through microscopic morphometry.
RESULTS: Esophageal squamous epithelium was considered normal in 48 dogs, and HRE was detected histologically in 17 dogs; both pathognomonic changes (basal cell hyperplasia, elongation of stromal papillae) were consistently present. Morphometrically assessed stromal papillary length and basal cell layer thickness was significantly (each, p < 0.0001) higher in the 17 dogs with HRE than in the 48 dogs without HRE, respectively. Overall, clinical signs suggesting GER were significantly (p = 0.02) more frequently encountered and regurgitation was significantly (p = 0.009) more common in the 17 dogs with HRE than in the 48 dogs without HRE. Similarly, endoscopic changes were significantly (p = 0.002) more frequently observed and minimal endoscopic changes suggesting GER were significantly (p = 0.004) more common in 17 dogs with HRE than in the 48 dogs without HRE.
CONCLUSION AND CLINICAL RELEVANCE: Typical characteristics of hyperregeneratory esophagopathy in humans are also histologically detectable in canine esophageal epithelium. Histological changes are associated with clinical signs and endoscopic findings suggesting GER.
PMID: 25993916 [PubMed - indexed for MEDLINE]
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Scintigraphy in laryngopharyngeal and gastroesophageal reflux disease: a definitive diagnostic test?
World J Gastroenterol. 2015 Mar 28;21(12):3619-27
Authors: Falk GL, Beattie J, Ing A, Falk SE, Magee M, Burton L, Van der Wall H
Abstract
AIM: To investigate the utility of scintigraphic studies in predicting response to laparoscopic fundoplication (LF) for chronic laryngopharyngeal reflux symptoms.
METHODS: Patients with upper aero-digestive symptoms that remained undiagnosed after a period of 2 mo were studied with conventional pH and manometric studies. Patients mainly complained of cough, sore throat, dysphonia and globus. These patients were imaged after ingestion of 99m-technetium diethylene triamine pentaacetic acid. Studies were quantified with time activity curves over the pharynx, upper and lower oesophagus and background. Late studies of the lungs were obtained for aspiration. Patients underwent LF with post-operative review at 3 mo after surgery.
RESULTS: Thirty four patients (20 F, 14 M) with an average age of 57 years and average duration of symptoms of 4.8 years were studied. Twenty four hour pH and manometry studies were abnormal in all patients. On scintigraphy, 27/34 patients demonstrated pharyngeal contamination and a rising or flat pharyngeal curve. Lung aspiration was evident in 50% of patients. There was evidence of pulmonary aspiration in 17 of 34 patients in the delayed study (50%). Pharyngeal contamination was found in 27 patients. All patients with aspiration showed pharyngeal contamination. In the 17 patients with aspiration, graphical time activity curve showed rising activity in the pharynx in 9 patients and a flat curve in 8 patients. In those 17 patients without pulmonary aspiration, 29% (5 patients) had either a rising or flat pharyngeal graph. A rising or flat curve predicted aspiration with a positive predictive value of 77% and a negative predictive value of 100%. Over 90% of patients reported a satisfactory symptomatic response to LF with an acceptable side-effect profile.
CONCLUSION: Scintigraphic reflux studies offer a good screening tool for pharyngeal contamination and aspiration in patients with gastroesophageal reflux disease.
PMID: 25834329 [PubMed - indexed for MEDLINE]
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Randomized comparison of the i-gel(TM) with the LMA Supreme (TM) in anesthetized adult patients.
Anaesthesist. 2015 Apr;64(4):271-6
Authors: Beleña JM, Núñez M, Vidal A, Gasco C, Alcojor A, Lee P, Pérez JL
Abstract
BACKGROUND: The LMA Supreme(TM) (LMA-S) and i-gel(TM) are two of the most commonly used supraglottic airway devices (SADs) with an inbuilt drain channel. These devices are particularly indicated for performing certain procedures accompanied by high peak airway pressure, such as laparoscopy. This study compared the devices regarding efficacy, safety, ease of use and incidence of adverse events, focusing on the postoperative rate of sore throat, dysphagia or dysphonia and development with time, in patients undergoing laparoscopic cholecystectomy procedures under general anesthesia.
METHODS: This was a prospective, randomized, controlled clinical study including 140 patients randomized into 2 groups undergoing elective laparoscopic cholecystectomy to use either i-gel or LMA-S. After the general anesthesia procedure, the speed of insertion, success rates, ease of insertion of the drain tube, leak pressure and tidal volume achieved by the devices were evaluated. The postoperative oropharyngeal discomfort (POPD) during the period of stay of the patients in the recovery room was also recorded.
RESULTS: The mean leak pressure was comparable between the two groups (i-gel 28.18 ± 3.90 cmH2O and LMA-S 27.50 ± 4 cmH2O, p = 0.09), as well as maximum expiratory tidal volume provided (i-gel 559.60 ± 45.25 ml and LMA-S 548.95 ± 56.18 ml, p = 0.12). Insertion times were lower for the i-gel (10 ± 1.62 s) compared with the LMA-S (11.31 ± 2.85 s, p = 0.008). Insertion success rate at the first attempt was higher for the LMA-S (95 % compared with i-gel 79 %, p = 0.007). Drain tubes were easier to insert in the LMA-S group (p < 0.001). No differences were found between groups relating to intraoperative complications. Frequency of coughing and visible blood on removal of the device were low and comparable in both groups (p = 0.860 and p = 0.623, respectively). There were no differences relating to the incidence of sore throat, dysphagia or hoarseness at 10 min postoperatively between groups (p = 0.088). The i-gel group complained about a higher sore throat score at 2 h postoperatively (p = 0.009), specifically patients receiving i-gel suffered more from sore throats with 0.24 more points on the visual analog scale (VAS) than patients from the LMA-S group. The i-gel group also reported a lower POPD drop during the first 2 h (p < 0.001).
CONCLUSION: No differences were found between i-gel and LMA-S regarding leak pressure in the groups of anesthetized patients undergoing laparoscopic cholecystectomy. The LMA-S was easier to insert than the i-gel (based on its better first time success rate) and this device showed better ease of drain tube insertion, although the i-gel was quicker to insert than the LMA-S. The i-gel resulted in higher sore throat scores at 2 h postoperatively and lower POPD reduction during the 2 h period studied in the recovery room was reported.
PMID: 25801488 [PubMed - indexed for MEDLINE]
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Assessment of feeding and swallowing in children: validity and reliability of the Ability for Basic Feeding and Swallowing Scale for Children (ABFS-C).
Brain Dev. 2015 May;37(5):508-14
Authors: Kamide A, Hashimoto K, Miyamura K, Honda M
Abstract
OBJECTIVE: The purpose was to devise a dysphagia scale for disabled children that could be applied by various medical professionals, family members, and personnel in treatment and education institutions and facilities for disabled children and to assess the validity and reliability of that scale, "Ability for Basic Feeding and Swallowing Scale for Children" (ABFS-C).
METHODS: Subjects were 54 children (aged 2months to 14years and 7months, median 14months) who visited the National Center for Child Health and Development from January 2012 to December 2013. They were examined using the Fujishima's Grade of Feeding and Swallowing Ability (Fujishima's Grade), the Functional Independence Measure for Children (WeeFIM) and the ABFS-C composed of 5 items (wakefulness, head control, hypersensitivity, oral motor and saliva control). Validity was evaluated according to correlations of the ABFS-C with Fujishima's Grade or WeeFIM. To assess interrater reliability, 17 children were assessed by a doctor and occupational therapist independently.
RESULTS: The ABFS-C scores and Fujishima's Grade were correlated using Spearman rank correlation coefficients. Fujishima's Grade was significantly correlated with saliva control (R=0.470) and the total ABFS-C scores (R=0.322) but not with wakefulness (R=-0.014), head control (R=0.122), hypersensitivity (R=-0.009), or oral motor (R=0.139). In addition, the total ABFS-C scores had a significant correlation with the total score of the WeeFIM (R=0.562), motor WeeFIM (R=0.451), cognitive WeeFIM (R=0,478), and the eating subscore of the WeeFIM (R=0.460). Interrater reliability was demonstrated for all items except hypersensitivity.
CONCLUSIONS: There were significant correlations between the total ABFS-C scores and Fujishima's Grade and WeeFIM, which suggested the need for comprehensive assessments rather than assessments of individual feeding and swallowing functions. To improve the reliability for hypersensitivity, the assessment process for hypersensitivity should be reviewed.
PMID: 25183471 [PubMed - indexed for MEDLINE]
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Profiles of orofacial dysfunction in different diagnostic groups using the Nordic Orofacial Test (NOT-S)--a review.
Acta Odontol Scand. 2014 Nov;72(8):578-84
Authors: Bergendal B, Bakke M, McAllister A, Sjögreen L, Åsten P
Abstract
OBJECTIVE: The Nordic Orofacial Test-Screening (NOT-S) was developed as a comprehensive method to assess orofacial function. Results from the screening protocol have been presented in 11 international publications to date. This study reviewed these publications in order to compile NOT-S screening data and create profiles of orofacial dysfunction that characterize various age groups and disorders.
MATERIALS AND METHODS: NOT-S results of nine reports meeting the inclusion criteria were reviewed. Seven of these studies not only provided data on the mean and range of total NOT-S scores, but also on the most common domains of orofacial dysfunction (highest rate of individuals with dysfunction scores), allowing the construction of orofacial dysfunction profiles based on the prevalence of dysfunction in each domain of NOT-S.
RESULTS: The compiled data comprised 669 individuals, which included healthy control subjects (n = 333) and various patient groups (n = 336). All studies reported differences between individuals with diagnosed disorders and healthy control subjects. The NOT-S data could measure treatment effects and provided dysfunction profiles characterizing the patterns of orofacial dysfunction in various diagnoses.
CONCLUSIONS: This review corroborates previous results that the NOT-S differentiates well between patients and healthy controls and can also show changes in individuals after treatment. NOT-S could be used as a standard instrument to assess orofacial dysfunction, evaluate the outcomes of oral habilitation and rehabilitation and improve comparability in clinical practice and research.
PMID: 25155559 [PubMed - indexed for MEDLINE]
Recent Progress in the Research of Eosinophilic Esophagitis and Gastroenteritis.
Digestion. 2016 Jan 14;93(1):7-12
Authors: Kinoshita Y, Ishimura N, Oshima N, Mikami H, Okimoto E, Jiao DJ, Ishihara S
Abstract
Eosinophilic esophagitis (EoE) and gastroenteritis are allergic gastrointestinal diseases mainly caused by food allergens. The number of patients with EoE is rapidly increasing in both Western and Asian countries. Basic knowledge of these diseases has mainly come from studies of EoE and Th2 type allergic reactions, including IL-5, IL-13, and IL-15, thymic stromal protein, and eotaxin 3, which are considered to have important roles. For a diagnosis of EoE, endoscopic abnormalities and histological confirmation of dense eosinophile infiltration in the esophageal epithelial layer are important, in addition to identifying dysphagia symptoms. As for eosinophilic gastroenteritis, blood test findings are more useful and the role of an endoscopic examination is reduced. For both diseases, the infection rate of Helicobacter pylori is lower than in healthy controls. Glucocorticoid administration is standard treatment for these diseases, while proton pump inhibitors are frequently effective for EoE.
PMID: 26789117 [PubMed - as supplied by publisher]
Primary Small Cell Carcinoma of the Esophagus (PSCEC) Associated with Paraneoplastic Sweating Syndrome: A Case Report and Literature Review.
Iran J Otorhinolaryngol. 2015 Nov;27(83):463-7
Authors: Fattahi Masoum SH, Sharifi N, Taraz Jamshidi S, Sharifian A, Rezaee R
Abstract
INTRODUCTION: Primary small cell carcinoma of the esophagus (PSCEC) associated with paraneoplastic sweating syndrome is a rare disease characterized with rapid growth rate, metastasis at the time of diagnosis, and poor prognosis. The lung is the most common site for small cell carcinoma but this malignancy includes 0.1% to 1% of all gastrointestinal and 0.8% to 2.7% of esophageal malignancies. So far more than 200 cases of PSCEC have been reported in literature.
CASE REPORT: The patient is a 54-year-old female from the Golestan province who presented with dysphagia, 19 kg-weight loss (from 105 kgs to 86 kgs), and excessive sweating. She was admitted in the thoracic surgery ward, at Ghaem Hospital, in the Mashhad University of Medical Sciences, with a pathological diagnosis of small cell carcinoma. She underwent transhiatal total esophagectomy. Excessive sweating was eradicated after surgery and she was discharged after 13 days without any complication. She received chemotherapy and at her 5-year follow up, she showed no recurrence or metastasis.
CONCLUSION: PSCEC usually requires chemotherapy with or without surgery. A favorable outcome, with total resection of the lesion combined with chemotherapy, was obtained. However, due to the rarity of the disease there is no definitive choice of treatment.
PMID: 26788492 [PubMed]
[Collet-Sicard Syndrome due to Occipital Condyle Fracture. Case Report].
Acta Chir Orthop Traumatol Cech. 2015;82(6):440-2
Authors: Barna M, Štulík J, Kryl J, Vyskočil T, Nesnídal P
Abstract
UNLABELLED: The case of a 63-year-old man diagnosed with Collet-Sicard syndrome due to a fracture of the right occipital condyle is presented. The cause of injury was falling off a bicycle. Dysphonia and dysphagia were present from the moment of injury, with the gradual development of light atrophy of the tongue muscles and right trapezius muscle. The diagnosis was based on examination by CT and MRI methods, the act of swallowing and physical examination by an otorhinolaryngology specialist and a neurologist who confirmed the diagnosis of injury to cranial nerves IX, X and XI on the right side. The patient was treated conservatively with application of a Philadelphia collar. Dysphagia required PEG tube insertion. Skull fracture healing was evident on a CT scan at 3-month follow-up. However, dysphonia with dysphagia and muscle atrophy remained persistent.
KEY WORDS: Collet-Sicard syndrome, occipital condyle fracture, dysphagia, dysphonia, cranial nerves.
PMID: 26787186 [PubMed - in process]
Laryngeal Manifestations of Neurofibromatosis.
Otolaryngol Head Neck Surg. 2016 Jan 19;
Authors: Naunheim MR, Plotkin SR, Franco RA, Song PC
Abstract
OBJECTIVES: To describe the range of findings in patients with neurofibromatosis (NF) presenting to a laryngology clinic and to analyze the etiologic factors of vocal fold dysfunction in this cohort.
STUDY DESIGN: Case series with chart review.
SETTING: Tertiary laryngology practice.
SUBJECTS AND METHODS: All cases of NF presenting to an academic laryngology practice were retrospectively reviewed (August 2005 to May 2014), with a total of 34 cases. Demographic data, symptoms, and endoscopic examination findings were reviewed. Etiologic factors of laryngeal complaints were analyzed with reference to NF-associated pathologies and surgical history.
RESULTS: Thirty-four patients with NF-1 or NF-2 were evaluated, and 28 of these patients (6 NF-1 and 22 NF-2) had laryngeal pathology. The most common presenting symptoms were vocal weakness (n = 21), dysphagia (n = 5), and globus (n = 4). Three patients had NF-related vocal fold masses on examination, including 2 neurofibromas and 1 schwannoma. Unilateral vocal cord paralysis was seen in 17 patients; bilateral paralysis was observed in 5 patients. Of patients with unilateral or bilateral paralysis, 20 had intracranial masses (vestibular schwannoma, meningioma, or skull base tumors), and 16 had previously undergone surgery for these lesions. Of the patients with NF-associated intracranial tumors, 87.0% presented with vocal cord paralysis, whereas only 40.0% of those without intracranial masses had paralysis (P = .0560). Seven patients underwent medialization procedures.
CONCLUSION: Neurofibromatosis patients may present to laryngology clinic with primary laryngeal tumors or, more commonly, unilateral or bilateral paralysis. Otolaryngologists should be keenly aware of vocal fold paralysis caused by the NF-associated tumors, with particular attention to bilateral paralysis in NF-2.
PMID: 26786267 [PubMed - as supplied by publisher]
Primary esophageal melanoma: Report of a case.
Rev Esp Enferm Dig. 2016 Jan 20;108
Authors: Granel Villach L, Moya Sanz MA, Fortea Sanchis C, Escrig Sos VJ, Fortea Sanchís C, Martínez Lahuerta C, Tornador Gaya N, Salvador Sanchís JL
Abstract
INTRODUCTION: Primary malignant melanoma of the esophagus is a rare tumor representing only 0.1-0.2% of esophageal malignancies. The goal of the study was to report on the management of a new case diagnosed and treated in our site.
CASE REPORT: A 67-year-old patient presented with dysphagia to solids with no other remarkable history or associated skin lesions. He underwent gastroscopy, which revealed a polypoid mass suggestive of neoplasm in the distal third of the esophagus. Biopsy indicated melanoma with positive immunohistochemical markers S100 and HMB45, and negative cytokeratins and CEA. Computerized tomography (CT) and positron-emission tomography (PET) scans showed no local infiltration or distant metastases. An Ivor-Lewis esophagectomy procedure was performed with regional lymphadenectomy. Postoperative stay lasted for three weeks, and no remarkable postsurgical complications arose. The pathological study of the specimen confirmed the diagnosis of primary esophageal melanoma.
DISCUSSION: Primary malignant melanoma of the esophagus has an unfortunate prognosis as it is an aggressive tumor usually diagnosed at an advanced stage, with local invasion and metastatic disease. Currently, surgery is the treatment of choice, with the remaining adjuvant therapies obtaining limited results.
PMID: 26785716 [PubMed - as supplied by publisher]
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Editorial: proton pump inhibitor-responsive oesophageal eosinophilia - two different phenotypes? - Author's reply.
Aliment Pharmacol Ther. 2015 Aug;42(4):487-8
Authors: Moawad FJ
PMID: 26179763 [PubMed - indexed for MEDLINE]
| Related Articles |
Editorial: proton pump inhibitor-responsive oesophageal eosinophilia - two different phenotypes?
Aliment Pharmacol Ther. 2015 Aug;42(4):485-7
Authors: Molina-Infante J, Katzka DA
PMID: 26179762 [PubMed - indexed for MEDLINE]
| Related Articles |
[Determination of hyperregeneratory esophagopathy in dogs with clinical signs attributable to esophageal disease].
Tierarztl Prax Ausg K Kleintiere Heimtiere. 2015;43(3):147-55
Authors: Münster M, Kook P, Araujo R, Hörauf A, Vieth M
Abstract
OBJECTIVE: It was hypothesized that typical characteristics of hyperregeneratory esophagopathy (HRE) in humans such as basal cell hyperplasia and elongation of stromal papillae are also histologically detectable in canine esophageal epithelium, and that these changes are associated with clinical signs and endoscopic findings suggesting gastroesophageal reflux (GER).
MATERIAL AND METHODS: Sixty-five adult dogs with clinical signs attributable to esophageal disease underwent esophagoscopy and biopsy. Clinical signs suggesting GER (regurgitation, ptyalism, painful discomfort) were prospectively evaluated through a questionnaire. Endoscopic mucosal alterations suggesting GER such as minimal endoscopic changes and obvious mucosal defects were assessed via video endoscopy. Biopsy specimens obtained from the esophageal squamous epithelium were evaluated histologically. The squamous epithelium's substructures of esophageal biopsies were quantitatively assessed through microscopic morphometry.
RESULTS: Esophageal squamous epithelium was considered normal in 48 dogs, and HRE was detected histologically in 17 dogs; both pathognomonic changes (basal cell hyperplasia, elongation of stromal papillae) were consistently present. Morphometrically assessed stromal papillary length and basal cell layer thickness was significantly (each, p < 0.0001) higher in the 17 dogs with HRE than in the 48 dogs without HRE, respectively. Overall, clinical signs suggesting GER were significantly (p = 0.02) more frequently encountered and regurgitation was significantly (p = 0.009) more common in the 17 dogs with HRE than in the 48 dogs without HRE. Similarly, endoscopic changes were significantly (p = 0.002) more frequently observed and minimal endoscopic changes suggesting GER were significantly (p = 0.004) more common in 17 dogs with HRE than in the 48 dogs without HRE.
CONCLUSION AND CLINICAL RELEVANCE: Typical characteristics of hyperregeneratory esophagopathy in humans are also histologically detectable in canine esophageal epithelium. Histological changes are associated with clinical signs and endoscopic findings suggesting GER.
PMID: 25993916 [PubMed - indexed for MEDLINE]
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Scintigraphy in laryngopharyngeal and gastroesophageal reflux disease: a definitive diagnostic test?
World J Gastroenterol. 2015 Mar 28;21(12):3619-27
Authors: Falk GL, Beattie J, Ing A, Falk SE, Magee M, Burton L, Van der Wall H
Abstract
AIM: To investigate the utility of scintigraphic studies in predicting response to laparoscopic fundoplication (LF) for chronic laryngopharyngeal reflux symptoms.
METHODS: Patients with upper aero-digestive symptoms that remained undiagnosed after a period of 2 mo were studied with conventional pH and manometric studies. Patients mainly complained of cough, sore throat, dysphonia and globus. These patients were imaged after ingestion of 99m-technetium diethylene triamine pentaacetic acid. Studies were quantified with time activity curves over the pharynx, upper and lower oesophagus and background. Late studies of the lungs were obtained for aspiration. Patients underwent LF with post-operative review at 3 mo after surgery.
RESULTS: Thirty four patients (20 F, 14 M) with an average age of 57 years and average duration of symptoms of 4.8 years were studied. Twenty four hour pH and manometry studies were abnormal in all patients. On scintigraphy, 27/34 patients demonstrated pharyngeal contamination and a rising or flat pharyngeal curve. Lung aspiration was evident in 50% of patients. There was evidence of pulmonary aspiration in 17 of 34 patients in the delayed study (50%). Pharyngeal contamination was found in 27 patients. All patients with aspiration showed pharyngeal contamination. In the 17 patients with aspiration, graphical time activity curve showed rising activity in the pharynx in 9 patients and a flat curve in 8 patients. In those 17 patients without pulmonary aspiration, 29% (5 patients) had either a rising or flat pharyngeal graph. A rising or flat curve predicted aspiration with a positive predictive value of 77% and a negative predictive value of 100%. Over 90% of patients reported a satisfactory symptomatic response to LF with an acceptable side-effect profile.
CONCLUSION: Scintigraphic reflux studies offer a good screening tool for pharyngeal contamination and aspiration in patients with gastroesophageal reflux disease.
PMID: 25834329 [PubMed - indexed for MEDLINE]
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Profiles of orofacial dysfunction in different diagnostic groups using the Nordic Orofacial Test (NOT-S)--a review.
Acta Odontol Scand. 2014 Nov;72(8):578-84
Authors: Bergendal B, Bakke M, McAllister A, Sjögreen L, Åsten P
Abstract
OBJECTIVE: The Nordic Orofacial Test-Screening (NOT-S) was developed as a comprehensive method to assess orofacial function. Results from the screening protocol have been presented in 11 international publications to date. This study reviewed these publications in order to compile NOT-S screening data and create profiles of orofacial dysfunction that characterize various age groups and disorders.
MATERIALS AND METHODS: NOT-S results of nine reports meeting the inclusion criteria were reviewed. Seven of these studies not only provided data on the mean and range of total NOT-S scores, but also on the most common domains of orofacial dysfunction (highest rate of individuals with dysfunction scores), allowing the construction of orofacial dysfunction profiles based on the prevalence of dysfunction in each domain of NOT-S.
RESULTS: The compiled data comprised 669 individuals, which included healthy control subjects (n = 333) and various patient groups (n = 336). All studies reported differences between individuals with diagnosed disorders and healthy control subjects. The NOT-S data could measure treatment effects and provided dysfunction profiles characterizing the patterns of orofacial dysfunction in various diagnoses.
CONCLUSIONS: This review corroborates previous results that the NOT-S differentiates well between patients and healthy controls and can also show changes in individuals after treatment. NOT-S could be used as a standard instrument to assess orofacial dysfunction, evaluate the outcomes of oral habilitation and rehabilitation and improve comparability in clinical practice and research.
PMID: 25155559 [PubMed - indexed for MEDLINE]
Most patient education involves passive learning. To improve patient education regarding surgery, an active learning workshop-based teaching method is proposed. The objective of this study was to assess level of patient surgical knowledge, achievement of workshop learning objectives, patient apprehension about future surgery, and participant workshop satisfaction after completing a surgical training workshop. A four-station workshop (surgical scrub, surgical suture, laparoscopic surgery, and robotic surgery) was developed to teach four important components of the surgical process. Healthy, surgery-naive adolescents were enrolled to attend this 1-h workshop-based training program. Training received by participants was technically and procedurally identical to training received by actual surgeons. Pre- and post-workshop questionnaires were used to assess learning outcomes. There were 1312 participants, with a mean age 15.9 ± 1.1 years and a gender breakdown of 303 males and 1009 females. For surgical knowledge, mean pre-workshop and post-workshop scores were 6.1 ± 1.5 and 7.5 ± 1.5 (out of 10 points), respectively (p < 0.001). Out of 5 possible points, achievement of learning objectives, decreased apprehension about future surgery, and overall workshop satisfaction scores were all higher than 4.5. Active, hands-on patient education is an effective way to improve understanding of surgery-related processes. This teaching method may also decrease apprehension that patients or potential patients harbor regarding a future surgical procedure.
The present study assessed perceptions of effective sun-protection strategies among the general public and whether these perceptions have changed in recent years. During five summers from 2007/2008 to 2011/2012, 4217 adolescents and adults living in a region with very high levels of solar UV radiation participated in annual, cross-sectional telephone surveys. Respondents' perceptions of the most effective sun-protection strategy were measured with a single open-ended question. In all survey years, sunscreen was the by far most frequently nominated sun-protection strategy, with an average mention rate of 71.0 %. The tendency to nominate sunscreen increased significantly over the 5-year study period and on average, was more common among adolescents compared to adults (81.6 vs 60.0 %) and females compared to males (73.6 vs 68.3 %). Despite respondents' increasing tendency to nominate sunscreen as the most effective sun-protection strategy, health experts have voiced concerns about flawed application practices. Current sun-protection hierarchies indicate that protective clothing and shade are better options.
Stem cells are classified into embryonic stem cells and adult stem cells. An evolving alternative to conventional stem cell therapies is induced pluripotent stem cells (iPSCs), which have a multi-lineage potential comparable to conventionally acquired embryonic stem cells with the additional benefits of being less immunoreactive and avoiding many of the ethical concerns raised with the use of embryonic material. The ability to generate iPSCs from somatic cells provides tremendous promise for regenerative medicine. The breakthrough of iPSCs has raised the possibility that patient-specific iPSCs can provide autologous cells for cell therapy without the concern for immune rejection. iPSCs are also relevant tools for modeling human diseases and drugs screening. However, there are still several hurdles to overcome before iPSCs can be used for translational purposes. Here, we review the recent advances in somatic reprogramming and the challenges that must be overcome to move this strategy closer to clinical application.
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