Updates in management of acute invasive fungal rhinosinusitis

Purpose of review Acute invasive fungal rhinosinusitis (AIFRS) is a rare and often fatal disease, that remains incompletely understood. Case series and literature reviews constitute most of the literature on AIFRS, and act as the standards by which we treat these extremely complex patients. This review discusses management of AIFRS, with focuses on optimal diagnostic and therapeutic strategies. Recent findings Mortality rates remain high, around 50% overall, though some recent studies have shown higher survival rates with early diagnosis and complete surgical resection. Some recent publications on AIFRS have focused on the utility of frozen section analysis both to diagnose and potentially guide the completeness of endoscopic surgical debridement. It was also recently shown that complete endoscopic resection of disease leads to higher survival than when disease was incompletely resected. Additionally, a new antifungal agent was recently approved by the FDA, which has a more favorable pharmacologic and side effect profile, though more studies are necessary to determine its utility. Summary Early diagnosis requires identification of sinusitis symptoms in immunocompromised patients, followed by intranasal biopsy and frozen section analysis. Early surgical debridement and antifungal therapy then remain the cornerstones of AIFRS management. Video abstract See Video, Supplemental Digital Content 1, http://bit.ly/2BKeblx. Correspondence to John R. Craig, MD, Department of Otolaryngology–Head and Neck Surgery, Henry Ford Health System, 2799 W. Grand Blvd, Detroit, MI 48202, USA. Tel: +1 313 971 9320; fax: +1 313 916 7263; e-mail: JCraig1@hfhs.org. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (http://bit.ly/2QPN9Uo). Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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Hepatic portal venous gas related to appendicitis

Abstract

Background: Hepatic portal venous gas (HPVG) is rare with high mortality. There are few reports on HPVG's association with appendicitis. Here we report a case of HPVG associated with appendicitis. Case presentation: A 79-year-old man presented with acute abdominal pain. Physical examination suggested peritoneal irritation. Blood tests indicated acute inflammation, metabolic acidosis, renal dysfunction and disseminated intravascular coagulation. Contrast-enhanced abdominal computed tomography revealed HPVG, a contrast defect in the small intestine, and minor ascites around the intestine. Urgent laparotomy was performed as intestinal ischemia was suspected. There were no findings of intestinal ischemia, but the appendix was discolored with wall thickening. We confirmed a clinical diagnosis of peritonitis caused by gangrenous appendicitis. We performed appendectomy and abdominal drainage. After surgery, the patient needed intensive care for septic shock. He left the ICU 7 days after the surgery and was discharged 10 days later. Conclusion: Thus, appendicitis may cause HPVG.

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The Melanocortin 1 receptor and its influence on naevi and melanoma in dark‐skinned phenotypes

Abstract

It is well appreciated that melanocortin 1 receptor variants can produce a fair skinned and red‐haired phenotype that has a strong association with increased melanoma risk. These patients are easily recognised and given appropriate attention. What may not be appreciated is that darker‐skinned individuals may also carry melanocortin 1 receptor variant alleles and that they can also be at increased risk of melanoma. Considering that melanocortin 1 receptor is crucial for melanocyte proliferation, regulation and differentiation do the naevi of these darker‐skinned individuals have specific features that help identify them as carrying one of these melanocortin 1 receptor variants and do melanomas that develop in dark‐skinned melanocortin 1 receptor variant carriers have particular characteristics?

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Dermatoscopic findings of penile intraepithelial neoplasia: Bowenoid papulosis, Bowen disease and erythroplasia of Queyrat

Abstract

Background/Objectives

The clinical diagnosis of penile intraepithelial neoplasia is challenging. No specific dermoscopic criteria for penile intraepithelial neoplasia have been described in the literature. This study aimed to describe and evaluate the dermoscopic features of penile intraepithelial neoplasia.

Methods

Clinical and dermoscopic images of 11 patients with histopathologically confirmed penile intraepithelial neoplasia were recorded and evaluated.

Results

The most frequent dermoscopic features were the presence of structureless areas (100%, structureless pink 72.7%) and vascular structures (81.8%), particularly dotted vessels (72.7%). Other findings included the absence of a pigment network (100%); scale (45.5%); scar‐like areas (45.5%); erosions (27.3%); and pigmentation consisting of brown‐grey dots and globules (27.3%).

Conclusions

The dermoscopic features that characterise penile intraepithelial neoplasia are structureless pink areas and a prominent vascular pattern (mainly clustered dotted vessels). Dermoscopy is a useful tool that can aid in the diagnosis and surveillance of penile intraepithelial neoplasia.

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Rhegmatogenous retinal detachment in a patient with choroidal melanoma simulating choroidal detachment: a case report

Ophthalmologists and retina specialists may consider choroidal detachment if patients with rhegmatogenous retinal detachment present with choroidal elevation. That misdiagnosis may lead to inappropriate treatm...

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Secondary extramedullary plasmacytoma of sigmoid colon in a patient with multiple myeloma: a case report

Extramedullary plasmacytoma is an uncommon tumor that most often involves the nasopharynx or upper respiratory tract. Extramedullary plasmacytoma is a type of plasma cell neoplasm that can present as a primary...

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Dysregulation of T cell immunoglobulin and mucin domain 3 (TIM-3) signaling in peripheral immune cells is associated with immune dysfunction in autistic children

Publication date: February 2019

Source: Molecular Immunology, Volume 106

Author(s): Sheikh F. Ahmad, Mushtaq A. Ansari, Ahmed Nadeem, Saleh A. Bakheet, Laila Y. AL-Ayadhi, Moureq R. Alotaibi, Ali R. Alhoshani, Musaad A. Alshammari, Sabry M. Attia

Abstract

Evidence suggests that immune dysregulation is associated with autism spectrum disorder (ASD). T cell immunoglobulin and mucin domain-3 (TIM-3) has a critical role in several inflammatory disorders; however, the role of TIM-3 signaling has not been demonstrated in ASD. In the present study, we assessed the role of TIM-3 signaling in children with ASD. We expected that increased numbers of TIM-3⁺ cells could alter immune function in children with ASD. We revealed production of TIM-3 on CD3⁺, CD4⁺, CD8⁺, CD11a⁺,b⁺, CD14⁺, CD62P⁺, and CXCR5⁺ PBMCs in children with ASD and typically developing (TD) controls using immunofluorescent staining. We further demonstrated the production of IL-1β, IFN-γ, IL-17 A, and Foxp3 in TIM-3⁺ PBMCs of TD controls and individuals with ASD. We also observed the mRNA expression levels of TIM-3, CD11a,b, CD14, IL-1β and IFN-γ using RT-PCR. We further assessed the protein levels of TIM-3, IL-1β, CXCR5, and IFN-γ using western blotting. The results showed that children with ASD had increased numbers of CD3⁺TIM-3⁺, CD4⁺TIM-3⁺, CD8⁺TIM-3⁺, CD11a,b⁺TIM-3⁺, CD14⁺TIM-3⁺, CD62P⁺TIM-3⁺ and CXCR5⁺TIM-3⁺ cells compared with TD controls. Our results further showed that children with ASD had increased IL-1β⁺TIM-3⁺, IFN-γ⁺TIM-3⁺, and IL-17⁺TIM-3⁺, and decreased Foxp3⁺TIM-3⁺ production compared with that in TD controls. Our results indicated that children with ASD significantly induced TIM-3, CD11a,b, CD14, CXCR5, IL-1β and IFN-γ mRNA and protein expression levels compared with TD controls. The results suggested that detection of TIM-3 signaling could contribute to the early diagnoses of ASD.

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