Anatomical basis and design of the distally based lateral dorsal cutaneous neuro-lateral plantar venofasciocutaneous flap pedicled with the lateral plantar artery perforator of the fifth metatarsal bone: a cadaveric dissection.

Related Articles

Anatomical basis and design of the distally based lateral dorsal cutaneous neuro-lateral plantar venofasciocutaneous flap pedicled with the lateral plantar artery perforator of the fifth metatarsal bone: a cadaveric dissection.

Surg Radiol Anat. 2016 Jun 13;

Authors: Wang T, Lin J, Song D, Zheng H, Hou C, Li L, Wu Z

Abstract
BACKGROUND: Detailed investigation of the vasculature of the lateral aspect of the foot has rarely been presented. However, harvesting the flap in this area to cover defects of the foot and hand is highly important. Repair of soft-tissue defects at the forefoot remains a challenge in reconstructive surgery. This study explores the characteristics of the distal-based lateral dorsal cutaneous neuro-lateral plantar venofasciocutaneous flap pedicled with the lateral plantar artery perforator of the fifth metatarsal bone to establish a repair procedure for ulcers or defects in the forefoot region.
METHODS: This study is divided into two parts: anatomical study and simulated operation. Thirty cadavers were utilized in the anatomical study after arterial injection. The tuberosity of the fifth metatarsal bone was used as the anatomical landmark. The lateral plantar artery perforator of the fifth metatarsal bone was identified through dissection. The perforators were dissected under a microscope. The details of the lateral plantar artery perforators, the distribution of the lateral dorsal cutaneous nerve and lateral plantar vein, the anastomosis in the lateral plantar artery perforator of the fifth metatarsal bone, the nutrient vessels of the lateral dorsal cutaneous nerve and lateral plantar vein, and other arteries of the lateral foot were recorded. The flap-raising procedure was performed on three fresh cadavers.
RESULTS: The lateral dorsal cutaneous nerve originated from sural nerve, traveled obliquely downward along the anterior lateral margin of the foot, and accompanied by the lateral plantar vein after bifurcation, and was eventually distributed on the lateral aspect of the foot. The nutrifying arteries to the lateral dorsal cutaneous nerve and lateral plantar vein were present segmentally and mainly originated from the lateral plantar artery perforator of the fifth metatarsal bone. These nitrifying arteries constantly originated from the lateral plantar artery in the area of tuberosity of the fifth metatarsal, ran along the medial side of the fifth metatarsal, traveled between the fifth metatarsal bone and the lateral muscle group (the flexor digitorum brevis and the abductor digiti minimi muscles), pierced the aponeurosis, vascularized the skin of the anterior lateral plantar region, and resulted in many minute branches, which anastomosed with the lateral tarsal artery and fourth dorsal metatarsal artery. The anatomical study showed that (1) the vasculature pattern can roughly be classified into three types and (2) constant anastomoses occurred between the above-mentioned arteries in the lateral-dorsum region of the foot.
CONCLUSION: A reliable large- or medium-sized neuro-venocutaneous flap with lateral dorsal cutaneous nerve, lateral plantar vein, and nutrient vessels can be raised using only the perforator of the lateral plantar artery of the fifth metatarsal bone, which is thin, is in the immediate vicinity of the forefoot, and has a reliable retrograde blood supply. This flap can be considered an alternative means to reconstruct soft-tissue defects of the forefoot.

PMID: 27294973 [PubMed - as supplied by publisher]

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Bicipital tuberosity bone characteristics in surgical reattachment of the distal biceps: anatomical and radiological study.

Related Articles

Bicipital tuberosity bone characteristics in surgical reattachment of the distal biceps: anatomical and radiological study.

Surg Radiol Anat. 2016 Jun 13;

Authors: Lázaro-Amorós A, Tomás-Batlle X, Ballesteros-Betancourt J, Guillermo JR, Gómez-Bonsfills X, de la Vall XC, Llusà-Pérez M

Abstract
PURPOSE: The aim of this study was to measure the cortical thickness and bone density of the different parts of the bicipital tuberosity, to evaluate the importance of these variables on resistance to pulling out of distal biceps tendon reinsertion implants.
METHODS: Sixteen cadaveric arms were used for this study. A multiple detector computed tomography was performed in each proximal radius. Bone thickness and density of anterior, posterior cortex and anterior trabecular bone were measured in proximal, medial and distal parts of the bicipital tuberosity. Statistical and concordance analyses of results were performed.
RESULTS: In our specimens, the medial and distal parts of the anterior cortex and the anterior trabecular bone were thicker, mean 11.3 mm SD 2.72 and 11.17 mm SD 3.05, with a significant difference when compared to the proximal part; mean 10.3 mm SD 2.35, of radial tuberosity. The three posterior segments where all thicker compared to the anterior cortex (proximal 3.15 SD 1.31; medial 3.33 SD 1.5; distal 3.34 SD 1.43 mm), but without statistical differences between them. The measured bone density was equivalent in the three portions of the anterior cortex and trabecular bone [proximal 1924.63 SD 547.22; medial 1848.19 SD 538.59; distal 2100.47 SD 396.32 Hounsfield units (HU)]. The posterior cortex was denser compared to the anterior cortex and the anterior trabecular bone in all the segments (proximal 1962.63 SD 223.57; medial 1907.16 SD 232.08; distal 1987.06 SD 189.12 HU), but without statistical differences between the three parts.
CONCLUSIONS: Based on the results of this anatomic study which have demonstrated that anterior cortex and anterior trabecular bone of the medial and distal regions of the bicipital tuberosity are thicker than proximal part, we postulate that these segments could give better pulling out resistance to monocortical implants. Our findings suggest that the strongest parts of the bicipital tuberosity are the proximal and medial parts of the posterior cortex. We can afford them drilling across the radius using a bicortical implant in the proximal and medial section of the radial tuberosity. Furthermore, we suggest that an increased margin of safety could be achieved to prevent injury to the posterior interosseous nerve, drilling the cortical hole in the proximal part of the radial tuberosity without losing resistance properties.

PMID: 27294837 [PubMed - as supplied by publisher]

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Psychosocial morbidity in women with abnormal cervical cytology managed by cytological surveillance or initial colposcopy: longitudinal analysis from the TOMBOLA randomised trial

Abstract

Objective

To compare psychosocial outcomes (follow-up related worries and satisfaction with follow-up related information and support) over 30 months of two alternative management policies for women with low-grade abnormal cervical cytology.

Methods

Women aged 20–59 years with low-grade cytological abnormalities detected in the National Health Service Cervical Screening Programme were randomised to cytological surveillance or initial colposcopy. A total of 3399 women who completed psychosocial questionnaires at recruitment were invited to complete questionnaires at 12, 18, 24 and 30 months. Linear mixed models were used to investigate differences between arms in the two psychosocial outcomes. Each outcome had a maximum score of 100, and higher scores represented higher psychosocial morbidity.

Results

On average, over 30 months, women randomised to colposcopy scored 2.5 points (95%CI −3.6 to −1.3) lower for follow-up related worries than women randomised to cytological surveillance. Women in the colposcopy arm also scored significantly lower for follow-up related satisfaction with information and support (−2.4; −3.3 to −1.4) over 30 months. For both outcomes, the average difference between arms was greatest at 12th- and 18th-month time points. These differences remained when the analysis was stratified by post-school education.

Conclusions

Women with low-grade cytology, irrespective of their management, have substantial initial psychosocial morbidity that reduces over time. Implementation of newer screening strategies, which include surveillance, such as primary HPV screening, need to consider the information and support provided to women. © 2016 The Authors. Psycho-Oncology published by John Wiley & Sons Ltd.

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Anatomy Pathology Unread

Presence of repeating hyperostotic bones in dorsal pterygiophores of the oarfish, Regalecus russellii

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎2 hours ago | E. W. Misty Paig-Tran, Andrew S. Barrios, Lara A. Ferry

Abstract

Hyperostosis, excessive bone growth along bone that stems from bone, periosteum or articular or epiphyseal cartilage, occurs in at least 22 families of fishes most of which are tropical or subtropical marine species. While the presence of hyperostosis is well documented in fishes, the mechanism driving the development of the excessive bone growth is unclear. This study documented hyperostosis along the dorsal pterygiophores in both sexes of oarfish, Regalecus russellii; however, it was not present in all specimens examined. This is the second lampridiform fish with hyperostoses and the first case documented in a deeper-water, epi-mesopelagic fish. In oarfish, the majority of the dorsal pterygiophores tissues are poorly mineralized, anosteocytic bones with some fish displaying localized stiffened, hyperostotic growths near the distal edge. Oarfish lack a swim bladder so they must continuously beat their bi-directional dorsal fin to maintain position within the water column while engaged in locomotory behavior. These fishes have areas of localized, hyperostotic skeletal elements along the dorsal pterygiophores that, presumably, function as a stiffened lever system to support fin undulation. It was noted that hyperossification was not present in all fish examined and was only documented in fish with total lengths greater than 3 m.

Recurrent mutations in genes involved in nuclear factor kappa B signalling in nodal marginal zone lymphoma – diagnostic and therapeutic implications

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎5 hours ago | Michiel van den Brand, Jos Rijntjes, Konnie M Hebeda, Laura Menting, Carolyn V Bregitha, Wendy BC Stevens, Walter JFM van der Velden, Bastiaan BJ Tops, J Han JM van Krieken, Patricia JTA Groenen

Abstract

Aim

To investigate the spectrum of mutations in 20 genes involved in B-cell receptor and/or Toll-like receptor signalling resulting in activation of nuclear factor kappa B (NF-kappaB) in 20 nodal marginal zone lymphomas (NMZLs), 20 follicular lymphomas (FLs), and 11 cases of B-cell lymphoma, unclassifiable (BCL-u).

Methods and results

NMZLs were diagnosed with strict criteria including expression of at least one putative marginal zone marker (MNDA and/or IRTA1). Cases that showed features of NMZL but did not fulfil all criteria were included as BCL-u. All FLs were required to have a BCL2 rearrangement.

Mutations were found in 9 NMZLs, with recurrent mutations in TNFAIP3 and CD79B. In FL, mutations were found in 12 cases, with recurrent mutations in TNFRSF14, TNFAIP3, and CARD11. In BCL-u, mutations were found in 5 cases with recurrent mutations in TNFRSF14. TNFRSF14 mutations were present in FL and BCL-u, but not in any of the NMZLs. In the group of BCL-u, TNFRSF14 mutations clustered with a FL immunophenotype.

Conclusions

These results suggest that TNFRSF14 mutations point towards a diagnosis of FL and can be used in the sometimes difficult distinction between NMZL and FL, but to apply this in diagnostics would require confirmation in an independent cohort. In addition, the presence or absence of specific mutations in pathways converging on NF-kappaB could be important for decisions regarding targeted treatment.

This article is protected by copyright. All rights reserved.

Announcements

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎7 hours ago

Issue Information

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎7 hours ago

Issue Information

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎7 hours ago

Anatomical basis and design of the distally based lateral dorsal cutaneous neuro-lateral plantar venofasciocutaneous flap pedicled with the lateral plantar artery perforator of the fifth metatarsal bone: a cadaveric dissection

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎12 hours ago

Abstract

Background

Detailed investigation of the vasculature of the lateral aspect of the foot has rarely been presented. However, harvesting the flap in this area to cover defects of the foot and hand is highly important. Repair of soft-tissue defects at the forefoot remains a challenge in reconstructive surgery. This study explores the characteristics of the distal-based lateral dorsal cutaneous neuro-lateral plantar venofasciocutaneous flap pedicled with the lateral plantar artery perforator of the fifth metatarsal bone to establish a repair procedure for ulcers or defects in the forefoot region.

Methods

This study is divided into two parts: anatomical study and simulated operation. Thirty cadavers were utilized in the anatomical study after arterial injection. The tuberosity of the fifth metatarsal bone was used as the anatomical landmark. The lateral plantar artery perforator of the fifth metatarsal bone was identified through dissection. The perforators were dissected under a microscope. The details of the lateral plantar artery perforators, the distribution of the lateral dorsal cutaneous nerve and lateral plantar vein, the anastomosis in the lateral plantar artery perforator of the fifth metatarsal bone, the nutrient vessels of the lateral dorsal cutaneous nerve and lateral plantar vein, and other arteries of the lateral foot were recorded. The flap-raising procedure was performed on three fresh cadavers.

Results

The lateral dorsal cutaneous nerve originated from sural nerve, traveled obliquely downward along the anterior lateral margin of the foot, and accompanied by the lateral plantar vein after bifurcation, and was eventually distributed on the lateral aspect of the foot. The nutrifying arteries to the lateral dorsal cutaneous nerve and lateral plantar vein were present segmentally and mainly originated from the lateral plantar artery perforator of the fifth metatarsal bone. These nitrifying arteries constantly originated from the lateral plantar artery in the area of tuberosity of the fifth metatarsal, ran along the medial side of the fifth metatarsal, traveled between the fifth metatarsal bone and the lateral muscle group (the flexor digitorum brevis and the abductor digiti minimi muscles), pierced the aponeurosis, vascularized the skin of the anterior lateral plantar region, and resulted in many minute branches, which anastomosed with the lateral tarsal artery and fourth dorsal metatarsal artery. The anatomical study showed that (1) the vasculature pattern can roughly be classified into three types and (2) constant anastomoses occurred between the above-mentioned arteries in the lateral-dorsum region of the foot.

Conclusion

A reliable large- or medium-sized neuro-venocutaneous flap with lateral dorsal cutaneous nerve, lateral plantar vein, and nutrient vessels can be raised using only the perforator of the lateral plantar artery of the fifth metatarsal bone, which is thin, is in the immediate vicinity of the forefoot, and has a reliable retrograde blood supply. This flap can be considered an alternative means to reconstruct soft-tissue defects of the forefoot.

Bicipital tuberosity bone characteristics in surgical reattachment of the distal biceps: anatomical and radiological study

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎12 hours ago

Abstract

Purpose

The aim of this study was to measure the cortical thickness and bone density of the different parts of the bicipital tuberosity, to evaluate the importance of these variables on resistance to pulling out of distal biceps tendon reinsertion implants.

Methods

Sixteen cadaveric arms were used for this study. A multiple detector computed tomography was performed in each proximal radius. Bone thickness and density of anterior, posterior cortex and anterior trabecular bone were measured in proximal, medial and distal parts of the bicipital tuberosity. Statistical and concordance analyses of results were performed.

Results

In our specimens, the medial and distal parts of the anterior cortex and the anterior trabecular bone were thicker, mean 11.3 mm SD 2.72 and 11.17 mm SD 3.05, with a significant difference when compared to the proximal part; mean 10.3 mm SD 2.35, of radial tuberosity. The three posterior segments where all thicker compared to the anterior cortex (proximal 3.15 SD 1.31; medial 3.33 SD 1.5; distal 3.34 SD 1.43 mm), but without statistical differences between them. The measured bone density was equivalent in the three portions of the anterior cortex and trabecular bone [proximal 1924.63 SD 547.22; medial 1848.19 SD 538.59; distal 2100.47 SD 396.32 Hounsfield units (HU)]. The posterior cortex was denser compared to the anterior cortex and the anterior trabecular bone in all the segments (proximal 1962.63 SD 223.57; medial 1907.16 SD 232.08; distal 1987.06 SD 189.12 HU), but without statistical differences between the three parts.

Conclusions

Based on the results of this anatomic study which have demonstrated that anterior cortex and anterior trabecular bone of the medial and distal regions of the bicipital tuberosity are thicker than proximal part, we postulate that these segments could give better pulling out resistance to monocortical implants. Our findings suggest that the strongest parts of the bicipital tuberosity are the proximal and medial parts of the posterior cortex. We can afford them drilling across the radius using a bicortical implant in the proximal and medial section of the radial tuberosity. Furthermore, we suggest that an increased margin of safety could be achieved to prevent injury to the posterior interosseous nerve, drilling the cortical hole in the proximal part of the radial tuberosity without losing resistance properties.

Two cases of histiocytic sarcoma with BCL2 translocations and occult or subsequent follicular lymphoma

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎8:18:06 μμ

Publication date: September 2016
Source:Human Pathology, Volume 55
Author(s): Sebastian Fernandez-Pol, Charles D. Bangs, Athena Cherry, Daniel A. Arber, Dita Gratzinger
Histiocytic sarcoma is rare and difficult to distinguish from histologic mimics such as myeloid sarcoma due to its relatively nonspecific immunoprofile. A subset of histiocytic sarcomas are clonally related to synchronous or metachronous follicular lymphomas. Interestingly, the histiocytic tumor component has been shown to harbor BCL2 gene translocations that are identical to those found in the lymphoma. We present one case of histiocytic sarcoma and initially occult follicular lymphoma in which detection of a BCL2 gene translocation helped support the diagnosis. We also provide follow-up regarding a previously published case of histiocytic sarcoma with IGH/BCL2 fusion gene in which the patient subsequently developed follicular lymphoma and, later, diffuse large B-cell lymphoma. Our findings suggest that BCL2 gene translocations are a recurrent feature of a distinct subset of histiocytic sarcomas that are associated with follicular lymphoma; the follicular lymphoma component may be clinically occult at the time of diagnosis. Testing for an IGH/BCL2 translocation should be considered in the diagnostic workup of difficult-to-characterize neoplasms with histiocytic/monocytic morphology and immunoprofile.

Cover Image

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎6:26:53 μμ

Two decades of lung cancer through the pages of Cancer Cytopathology

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎4:40:50 μμ | Gladwyn Leiman

Issue Information

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎4:40:50 μμ

Gladwyn Leiman: An appreciation

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎4:40:50 μμ | Celeste N. Powers

Caging the pack

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎4:40:50 μμ | Bryn Nelson

2016 publication schedule

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎4:40:50 μμ

Correlation between liver cell necrosis and circulating alanine aminotransferase after ischaemia/reperfusion injuries in the rat liver

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎11:12:24 πμ | Anders R. Knudsen, Kasper J. Andersen, Stephen Hamilton-Dutoit, Jens R. Nyengaard, Frank V. Mortensen

Summary

Circulating liver enzymes such as alanine transaminase are often used as markers of hepatocellular damage. Ischaemia/reperfusion (I/R) injury is an inevitable consequence of prolonged liver ischaemia. The aim of this study was to examine the correlation between liver enzymes and volume of liver cell necrosis after ischaemia/reperfusion injuries, using design-unbiased stereological methods. Forty-seven male Wistar rats were subjected to 1 h of partial liver ischaemia, followed by either 4 or 24 h of reperfusion. Within each group, one-third of animals were subjected to ischaemic preconditioning and one-third to ischaemic postconditioning. At the end of reperfusion, blood and liver samples were collected for analysis. The volume of necrotic liver tissue was subsequently correlated to circulating markers of I/R injury. Correlation between histological findings and circulating markers was performed using Pearson's correlation coefficient. Alanine transferase peaked after 4 h of reperfusion; however, at this time-point, only mild necrosis was observed, with a Pearson's correlation coefficient of 0.663 (P = 0.001). After 24 h of reperfusion, alanine aminotransferase was found to be highly correlated to the degree of hepatocellular necrosis R = 0.836 (P = 0.000). Furthermore, alkaline phosphatase (R = 0.806) and α-2-macroglobulin (R = 0.655) levels were also correlated with the degree of necrosis. We show for the first time that there is a close correlation between the volume of hepatocellular necrosis and alanine aminotransferase levels in a model of I/R injury. This is especially apparent after 24 h of reperfusion. Similarly, increased levels of alkaline phosphatase and α-2-macroglobulin are correlated to the volume of liver necrosis.

Loss of p53 expression is accompanied by upregulation of beta-catenin in meningiomas: a concomitant reciprocal expression

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎8:07:46 πμ | Nives Pećina-Šlaus, Anja Kafka, Tomislav Vladušić, Davor Tomas, Monika Logara, Josip Skoko, Reno Hrašćan

Summary

Crosstalk between Wnt and p53 signalling pathways in cancer has long been suggested. Therefore in this study we have investigated the involvement of these pathways in meningiomas by analysing their main effector molecules, beta-catenin and p53. Cellular expression of p53 and beta-catenin proteins and genetic changes in TP53 were analysed by immunohistochemistry, PCR/RFLP and direct sequencing of TP53 exon 4. All the findings were analysed statistically. Our analysis showed that 47.5% of the 59 meningiomas demonstrated loss of expression of p53 protein. Moderate and strong p53 expression in the nuclei was observed in 8.5% and 6.8% of meningiomas respectively. Gross deletion of TP53 gene was observed in one meningioma, but nucleotide alterations were observed in 35.7% of meningiomas. In contrast, beta-catenin, the main Wnt signalling molecule, was upregulated in 71.2%, while strong expression was observed in 28.8% of meningiomas. The concomitant expressions of p53 and beta-catenin were investigated in the same patients. In the analysed meningiomas, the levels of the two proteins were significantly negatively correlated (P = 0.002). This indicates that meningiomas with lost p53 upregulate beta-catenin and activate Wnt signalling. Besides showing the reciprocal relationship between proteins, we also showed that the expression of p53 was significantly (P = 0.021) associated with higher meningioma grades (II and III), while beta-catenin upregulation was not associated with malignancy grades. Additionally, women exhibited significantly higher values of p53 loss when compared to males (P = 0.005). Our findings provide novel information about p53 involvement in meningeal brain tumours and reveal the complex relationship between Wnt and p53 signalling, they suggest an important role for beta-catenin in these tumours.

Functional roles of CSPG4/NG2 in chondrosarcoma

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎8:07:46 πμ | Nuor S. M. Jamil, Asim Azfer, Harrison Worrel, Donald M. Salter

Summary

CSPG4/NG2 is a multifunctional transmembrane protein with limited distribution in adult tissues including articular cartilage. The purpose of this study was to investigate the possible roles of CSPG4/NG2 in chondrosarcomas and to establish whether this molecule may have potential for targeted therapy. Stable knock-down of CSPG4/NG2 in the JJ012 chondrosarcoma cell line by shRNA resulted in decreased cell proliferation and migration as well as a decrease in gene expression of the MMP (matrix metalloproteinase) 3 protease and ADAMTS4 (aggrecanase). Chondrosarcoma cells in which CSPG4/NG2 was knocked down were more sensitive to doxorubicin than wild-type cells. The results indicate that CSPG4/NG2 has roles in regulating chondrosarcoma cell function in relation to growth, spread and resistance to chemotherapy and that anti-CSPG4/NG2 therapies may have potential in the treatment of surgically unresectable chondrosarcoma.

Chondroma arising from the spinal dura mater at the thoracic level: a case report with molecular analysis

‎Κυριακή, ‎12 ‎Ιουνίου ‎2016, ‏‎12:46:02 μμ

Publication date: Available online 11 June 2016
Source:Pathology - Research and Practice
Author(s): Masaya Miyazaki, Keita Yashiro, Mishie Tanino, Shinya Tanaka, Yasunori Fujioka
Chondromas are benign tumors that can be found at several sites in the body, while those arising from the dura mater are extremely rare. Among them, although chondromas arising from the cranial dura mater have been reported, those arising from the spinal dura mater have not been reported in the literature to date.A 66-year-old woman presented with right-sided continuous backache which she had developed recently. After detailed examinations, an epidural tumor at the thoracic level was detected. The patient underwent surgery and a total en-bloc resection was accomplished. From the clinical and pathological findings, the tumor was revealed as chondroma arising from the spinal dura mater.A recent comprehensive study has identified the isocitrate dehydrogenase 1 (IDH1) and IDH2 mutations in conventional central and periosteal cartilaginous tumors, and it has subsequently been analyzed in intracranial chondrosarcoma and chondroma, including chondroma of the convexity dura mater. Herein, we describe a novel case of chondroma arising from the spinal dura mater, with mutation analysis of IDH1 and IDH2 both of which revealed wild-type.

Activity of cyclin B1 in HL-60 cells treated with etoposide

‎Κυριακή, ‎12 ‎Ιουνίου ‎2016, ‏‎12:41:32 πμ

Publication date: Available online 11 June 2016
Source:Acta Histochemica
Author(s): Agnieszka Żuryń, Adrian Krajewski, Dawid Szulc, Anna Litwiniec, Alina Grzanka
Cyclin B1 triggers G2/M phase transition phosphorylating with its catalytical partner − Cdc2 many of the molecular targets essential for cell cycle progression. Human leukemia cell line HL-60 were treated with increasing doses of etoposide (ETP) (0.5; 0.75; 1μM) to investigate how the drug affects cell morphology, viability, cell cycle distribution and expression of cyclin B1. To achieve this aim we applied light and transmission electron microscopy to observe morphological and ultra structural changes, image-based cytometry for apoptosis evaluation and cell cycle analysis, and then we conducted immunohistochemical and immunofluorescence staining to visualize cyclin localization and expression. Quantitive data about cyclin B1 expression were obtained from flow cytometry. Etoposide caused decrease in cell viability, induced apoptosis and G2/M arrest accompanied by enhanced expression of cyclin B1. Changes in expression and localization of cyclin B1 may constitute a part of the mechanism responsible for resistance of HL-60 cells to etoposide. Our results may reflect involvement of cyclin B1 in opposite processes − apoptosis induction and maintenance of cell viability in leukemia cells. We hypothesized possible roles and pathways by which cyclin B1 takes part in drug treatment response and chemosensitivity.

Anatomic study of the musculus longus capitis flap

‎Σάββατο, ‎11 ‎Ιουνίου ‎2016, ‏‎6:00:17 μμ

Abstract

Purpose

To clearly delineate the anatomy of the musculus longus capitis, determine its clinical applications for reconstruction surgery, and provide a safer surgical method of developing the longus capitis muscle flap.

Methods

Anatomical investigations were performed in seven adult cadavers (five cadavers for gross anatomy and two for transparent specimen preparation) with respect to the location, morphology, arterial supply, and innervation of the musculus longus capitis, as well as its spatial relationship with the cervical sympathetic trunk, superior cervical ganglion, carotid sheath, and other surrounding structures.

Results

The musculus longus capitis is located anterior to the C1–6 vertebrae, segmentally supplied by branches of the ascending cervical artery, innervated by the C1–5 nerve, and spatially close to the cervical sympathetic trunk, superior cervical ganglion, and carotid sheath. These anatomic findings indicate that the development of a cranial or caudal pedicled longus capitis muscle flap is feasible.

Conclusion

The musculus longus capitis can be developed into a cranial or caudal pedicled flap for repair of head and neck defects with negligible morbidity of the donor site.

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Thyroid Disorders

Laryngeal chondrosarcoma: A systematic review of 592 cases.

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎2 minutes ago | Chin OY, Dubal PM, Sheikh AB, Unsal AA, Park RC, Baredes S, Eloy JA

Related Articles

Laryngeal chondrosarcoma: A systematic review of 592 cases.
Laryngoscope. 2016 Jun 12;
Authors: Chin OY, Dubal PM, Sheikh AB, Unsal AA, Park RC, Baredes S, Eloy JA
Abstract
OBJECTIVES/HYPOTHESIS: Laryngeal chondrosarcomas are rare entities that arise from the cartilaginous structures of the larynx, including the cricoid, thyroid cartilage, epiglottis, and arytenoid cartilages. These tumors represent a minority of malignancies involving the larynx and can be mistaken for benign pathologies. The treatment has historically been surgical excision, often by total laryngectomy. This review investigates treatment modalities and patient outcomes.
STUDY DESIGN: Systematic review using PubMed/MEDLINE and EMBASE database.
METHODS: The databases were used to identify articles reporting cases of chondrosarcomas occurring exclusively in the larynx. Variables analyzed included patient demographics, presenting symptoms, grade, therapeutic approach, patient outcomes, and follow-up.
RESULTS: Five hundred and ninety-two cases were identified. The average age reported was 62.5 years. There was a 3:1 male to female ratio. The most common surgical approach was local excision in 178 cases, followed by total laryngectomy in 174 cases. Nonsurgical treatment such as radiotherapy and chemotherapy was only used in 0.8% and 0.2%, respectively. Disease-specific survival rates for 1, 5, 10, and 20 years were 97.7%, 91.4%, 81.8%, and 68.0%, respectively, with no differences when comparing 5-year survival rates for location, grade, and therapy.
CONCLUSION: Laryngeal chondrosarcomas are rare with a good prognosis. Various surgical approaches exist, with no difference noted in 5-year survival outcomes. Nonsurgical approaches were rarely used for these lesions.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2016.
PMID: 27291822 [PubMed - as supplied by publisher]

A meta-analysis examining the independent association between thyroid nodule size and malignancy.

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎4 minutes ago

Related Articles

A meta-analysis examining the independent association between thyroid nodule size and malignancy.
Gland Surg. 2016 Jun;5(3):312-7
Authors: Hammad AY, Noureldine SI, Hu T, Ibrahim Y, Masoodi HM, Kandil E
Abstract
BACKGROUND: Tumor size is recognized as an important predictor of malignancy in many types of cancers. However, there is no clear line of characterization when it comes to the association between thyroid nodule size and malignancy risk prediction; and the current data remains inconsistent across different studies. The aim of our study is to examine the association between nodule size and malignancy using meta-analysis of the current literature.
METHODS: Data sources were gathered through systemic search of PubMed, Embase and other scientific databases for articles published between January 1, 1996 and June 1, 2013. A reference group with nodule sizes <3 cm was set as a control group. Two other nodule size categories were established and these included nodules from 3-5.9 cm and nodules ≥6 cm in size. Primary outcome was a histologically proven malignancy per nodule size category. The effect sizes of clinicopathologic parameters, which are the quantitative measures of association strength between two variables, were calculated by the means of odds ratios (OR). The effect sizes were then combined using a random-effects model.
RESULTS: Seven studies met our inclusion criteria with 10,817 thyroid nodules evaluated. Malignancy was identified in 2,206 (20.4%) nodules. After adjusting for patient age and gender, nodules that measured 3-5.9 cm had a 26% greater malignancy risk compared to those measuring <3 cm [OR, 1.26; 95% confidence interval (CI): 1.13-1.39]. However, nodules 6 cm or larger had a 16% lower risk of malignancy compared to those measuring <3 cm (OR, 0.84; 95% CI: 0.73-0.98).
CONCLUSIONS: Thyroid nodule size predicts cancer risk. However, a threshold effect of thyroid nodule size 6 cm or greater is significantly associated with a more benign disease.
PMID: 27294039 [PubMed]


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Endoscopic thyroidectomy: retroauricular approach.

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎4 minutes ago

Related Articles

Endoscopic thyroidectomy: retroauricular approach.
Gland Surg. 2016 Jun;5(3):327-35
Authors: Lee DY, Baek SK, Jung KY
Abstract
The incidence of thyroid cancer has abruptly increased recently, with a female predominance. Conventional thyroidectomy using transcervical incision inevitably leaves an unfavorable neck scar; therefore, various extracervical approaches have been introduced to improve cosmetic satisfaction after thyroidectomy. Several reports demonstrated that these extracervical approaches have advantages not only in terms of cosmesis but also in terms of surgical outcomes and postoperative functional preservation. The retroauricular approach has advantages as the dissection area is smaller than that in the transaxillary approach (TA) and surgical anatomy is familiar to the head and neck surgeons. In addition, there is no concern about paresthesia around the nipple or anterior chest, and surgical direction makes central neck dissection easier than with the other extracervical approaches. Herein, we aim to introduce the surgical procedure of retroauricular approach thyroidectomy and present our experiences of postoperative outcomes.
PMID: 27294041 [PubMed]


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Endoscopic thyroidectomy: retroauricular approach.

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎11 minutes ago | Lee DY, Baek SK, Jung KY

Related Articles

Endoscopic thyroidectomy: retroauricular approach.
Gland Surg. 2016 Jun;5(3):327-35
Authors: Lee DY, Baek SK, Jung KY
Abstract
The incidence of thyroid cancer has abruptly increased recently, with a female predominance. Conventional thyroidectomy using transcervical incision inevitably leaves an unfavorable neck scar; therefore, various extracervical approaches have been introduced to improve cosmetic satisfaction after thyroidectomy. Several reports demonstrated that these extracervical approaches have advantages not only in terms of cosmesis but also in terms of surgical outcomes and postoperative functional preservation. The retroauricular approach has advantages as the dissection area is smaller than that in the transaxillary approach (TA) and surgical anatomy is familiar to the head and neck surgeons. In addition, there is no concern about paresthesia around the nipple or anterior chest, and surgical direction makes central neck dissection easier than with the other extracervical approaches. Herein, we aim to introduce the surgical procedure of retroauricular approach thyroidectomy and present our experiences of postoperative outcomes.
PMID: 27294041 [PubMed]

The Effect of Levothyroxine Discontinuation Timing on Postoperative Hypothyroidism after Hemithyroidectomy for Papillary Thyroid Microcarcinoma.

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎11 minutes ago | Ha TK, Kim DW, Park HK, Baek JW, Lee YJ, Park YM, Kim do H, Jung SJ, Ahn KJ

Related Articles

The Effect of Levothyroxine Discontinuation Timing on Postoperative Hypothyroidism after Hemithyroidectomy for Papillary Thyroid Microcarcinoma.
Int J Endocrinol. 2016;2016:3240727
Authors: Ha TK, Kim DW, Park HK, Baek JW, Lee YJ, Park YM, Kim do H, Jung SJ, Ahn KJ
Abstract
Objective. No previous studies regarding the appropriate timing of thyroid hormone discontinuation after hemithyroidectomy have been published. This study aimed to identify the appropriate timing for levothyroxine discontinuation after hemithyroidectomy among patients with papillary thyroid microcarcinoma (PTMC). Methods. This study retrospectively evaluated 304 patients who underwent ≥1 attempt to discontinue levothyroxine after hemithyroidectomy for treating PTMC between January 2008 and December 2013. Fifty-three patients were excluded because of preoperative hypothyroidism or hyperthyroidism, a history of thyroid hormone or antithyroid therapy, no available serological data, or a postoperative follow-up of <24 months. We evaluated the associations of successful levothyroxine discontinuation with patient age, sex, preoperative serological data, underlying thyroid gland histopathology, anteroposterior diameter of the residual thyroid gland, number of discontinuation attempts, and initial discontinuation timing. Results. Among the 251 included patients, 125 patients (49.8%) achieved successful levothyroxine discontinuation during the follow-up period after hemithyroidectomy. There was a significant difference in the outcomes for patients who underwent an initial discontinuation attempt at ≤3 months and ≥4 months after hemithyroidectomy (p < 0.001). There were significant differences in the discontinuation outcomes according to underlying thyroid histopathology (p = 0.001), preoperative thyroid-stimulating hormone levels (p < 0.001), and number of discontinuation attempts (p < 0.001). Conclusions. Among patients with PTMC, the initial levothyroxine discontinuation attempt is recommended at ≥4 months after hemithyroidectomy.
PMID: 27293432 [PubMed]

Laryngeal chondrosarcoma: A systematic review of 592 cases.

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎11 minutes ago | Chin OY, Dubal PM, Sheikh AB, Unsal AA, Park RC, Baredes S, Eloy JA

Related Articles

Laryngeal chondrosarcoma: A systematic review of 592 cases.
Laryngoscope. 2016 Jun 12;
Authors: Chin OY, Dubal PM, Sheikh AB, Unsal AA, Park RC, Baredes S, Eloy JA
Abstract
OBJECTIVES/HYPOTHESIS: Laryngeal chondrosarcomas are rare entities that arise from the cartilaginous structures of the larynx, including the cricoid, thyroid cartilage, epiglottis, and arytenoid cartilages. These tumors represent a minority of malignancies involving the larynx and can be mistaken for benign pathologies. The treatment has historically been surgical excision, often by total laryngectomy. This review investigates treatment modalities and patient outcomes.
STUDY DESIGN: Systematic review using PubMed/MEDLINE and EMBASE database.
METHODS: The databases were used to identify articles reporting cases of chondrosarcomas occurring exclusively in the larynx. Variables analyzed included patient demographics, presenting symptoms, grade, therapeutic approach, patient outcomes, and follow-up.
RESULTS: Five hundred and ninety-two cases were identified. The average age reported was 62.5 years. There was a 3:1 male to female ratio. The most common surgical approach was local excision in 178 cases, followed by total laryngectomy in 174 cases. Nonsurgical treatment such as radiotherapy and chemotherapy was only used in 0.8% and 0.2%, respectively. Disease-specific survival rates for 1, 5, 10, and 20 years were 97.7%, 91.4%, 81.8%, and 68.0%, respectively, with no differences when comparing 5-year survival rates for location, grade, and therapy.
CONCLUSION: Laryngeal chondrosarcomas are rare with a good prognosis. Various surgical approaches exist, with no difference noted in 5-year survival outcomes. Nonsurgical approaches were rarely used for these lesions.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2016.
PMID: 27291822 [PubMed - as supplied by publisher]

A meta-analysis examining the independent association between thyroid nodule size and malignancy.

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎11 minutes ago | Hammad AY, Noureldine SI, Hu T, Ibrahim Y, Masoodi HM, Kandil E

Related Articles

A meta-analysis examining the independent association between thyroid nodule size and malignancy.
Gland Surg. 2016 Jun;5(3):312-7
Authors: Hammad AY, Noureldine SI, Hu T, Ibrahim Y, Masoodi HM, Kandil E
Abstract
BACKGROUND: Tumor size is recognized as an important predictor of malignancy in many types of cancers. However, there is no clear line of characterization when it comes to the association between thyroid nodule size and malignancy risk prediction; and the current data remains inconsistent across different studies. The aim of our study is to examine the association between nodule size and malignancy using meta-analysis of the current literature.
METHODS: Data sources were gathered through systemic search of PubMed, Embase and other scientific databases for articles published between January 1, 1996 and June 1, 2013. A reference group with nodule sizes <3 cm was set as a control group. Two other nodule size categories were established and these included nodules from 3-5.9 cm and nodules ≥6 cm in size. Primary outcome was a histologically proven malignancy per nodule size category. The effect sizes of clinicopathologic parameters, which are the quantitative measures of association strength between two variables, were calculated by the means of odds ratios (OR). The effect sizes were then combined using a random-effects model.
RESULTS: Seven studies met our inclusion criteria with 10,817 thyroid nodules evaluated. Malignancy was identified in 2,206 (20.4%) nodules. After adjusting for patient age and gender, nodules that measured 3-5.9 cm had a 26% greater malignancy risk compared to those measuring <3 cm [OR, 1.26; 95% confidence interval (CI): 1.13-1.39]. However, nodules 6 cm or larger had a 16% lower risk of malignancy compared to those measuring <3 cm (OR, 0.84; 95% CI: 0.73-0.98).
CONCLUSIONS: Thyroid nodule size predicts cancer risk. However, a threshold effect of thyroid nodule size 6 cm or greater is significantly associated with a more benign disease.
PMID: 27294039 [PubMed]

Laryngeal chondrosarcoma: A systematic review of 592 cases.

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎12 minutes ago | Chin OY, Dubal PM, Sheikh AB, Unsal AA, Park RC, Baredes S, Eloy JA

Related Articles

Laryngeal chondrosarcoma: A systematic review of 592 cases.
Laryngoscope. 2016 Jun 12;
Authors: Chin OY, Dubal PM, Sheikh AB, Unsal AA, Park RC, Baredes S, Eloy JA
Abstract
OBJECTIVES/HYPOTHESIS: Laryngeal chondrosarcomas are rare entities that arise from the cartilaginous structures of the larynx, including the cricoid, thyroid cartilage, epiglottis, and arytenoid cartilages. These tumors represent a minority of malignancies involving the larynx and can be mistaken for benign pathologies. The treatment has historically been surgical excision, often by total laryngectomy. This review investigates treatment modalities and patient outcomes.
STUDY DESIGN: Systematic review using PubMed/MEDLINE and EMBASE database.
METHODS: The databases were used to identify articles reporting cases of chondrosarcomas occurring exclusively in the larynx. Variables analyzed included patient demographics, presenting symptoms, grade, therapeutic approach, patient outcomes, and follow-up.
RESULTS: Five hundred and ninety-two cases were identified. The average age reported was 62.5 years. There was a 3:1 male to female ratio. The most common surgical approach was local excision in 178 cases, followed by total laryngectomy in 174 cases. Nonsurgical treatment such as radiotherapy and chemotherapy was only used in 0.8% and 0.2%, respectively. Disease-specific survival rates for 1, 5, 10, and 20 years were 97.7%, 91.4%, 81.8%, and 68.0%, respectively, with no differences when comparing 5-year survival rates for location, grade, and therapy.
CONCLUSION: Laryngeal chondrosarcomas are rare with a good prognosis. Various surgical approaches exist, with no difference noted in 5-year survival outcomes. Nonsurgical approaches were rarely used for these lesions.
LEVEL OF EVIDENCE: N/A. Laryngoscope, 2016.
PMID: 27291822 [PubMed - as supplied by publisher]

The Effect of Levothyroxine Discontinuation Timing on Postoperative Hypothyroidism after Hemithyroidectomy for Papillary Thyroid Microcarcinoma.

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎12 minutes ago | Ha TK, Kim DW, Park HK, Baek JW, Lee YJ, Park YM, Kim do H, Jung SJ, Ahn KJ

Related Articles

The Effect of Levothyroxine Discontinuation Timing on Postoperative Hypothyroidism after Hemithyroidectomy for Papillary Thyroid Microcarcinoma.
Int J Endocrinol. 2016;2016:3240727
Authors: Ha TK, Kim DW, Park HK, Baek JW, Lee YJ, Park YM, Kim do H, Jung SJ, Ahn KJ
Abstract
Objective. No previous studies regarding the appropriate timing of thyroid hormone discontinuation after hemithyroidectomy have been published. This study aimed to identify the appropriate timing for levothyroxine discontinuation after hemithyroidectomy among patients with papillary thyroid microcarcinoma (PTMC). Methods. This study retrospectively evaluated 304 patients who underwent ≥1 attempt to discontinue levothyroxine after hemithyroidectomy for treating PTMC between January 2008 and December 2013. Fifty-three patients were excluded because of preoperative hypothyroidism or hyperthyroidism, a history of thyroid hormone or antithyroid therapy, no available serological data, or a postoperative follow-up of <24 months. We evaluated the associations of successful levothyroxine discontinuation with patient age, sex, preoperative serological data, underlying thyroid gland histopathology, anteroposterior diameter of the residual thyroid gland, number of discontinuation attempts, and initial discontinuation timing. Results. Among the 251 included patients, 125 patients (49.8%) achieved successful levothyroxine discontinuation during the follow-up period after hemithyroidectomy. There was a significant difference in the outcomes for patients who underwent an initial discontinuation attempt at ≤3 months and ≥4 months after hemithyroidectomy (p < 0.001). There were significant differences in the discontinuation outcomes according to underlying thyroid histopathology (p = 0.001), preoperative thyroid-stimulating hormone levels (p < 0.001), and number of discontinuation attempts (p < 0.001). Conclusions. Among patients with PTMC, the initial levothyroxine discontinuation attempt is recommended at ≥4 months after hemithyroidectomy.
PMID: 27293432 [PubMed]

A meta-analysis examining the independent association between thyroid nodule size and malignancy.

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎12 minutes ago | Hammad AY, Noureldine SI, Hu T, Ibrahim Y, Masoodi HM, Kandil E

Related Articles

A meta-analysis examining the independent association between thyroid nodule size and malignancy.
Gland Surg. 2016 Jun;5(3):312-7
Authors: Hammad AY, Noureldine SI, Hu T, Ibrahim Y, Masoodi HM, Kandil E
Abstract
BACKGROUND: Tumor size is recognized as an important predictor of malignancy in many types of cancers. However, there is no clear line of characterization when it comes to the association between thyroid nodule size and malignancy risk prediction; and the current data remains inconsistent across different studies. The aim of our study is to examine the association between nodule size and malignancy using meta-analysis of the current literature.
METHODS: Data sources were gathered through systemic search of PubMed, Embase and other scientific databases for articles published between January 1, 1996 and June 1, 2013. A reference group with nodule sizes <3 cm was set as a control group. Two other nodule size categories were established and these included nodules from 3-5.9 cm and nodules ≥6 cm in size. Primary outcome was a histologically proven malignancy per nodule size category. The effect sizes of clinicopathologic parameters, which are the quantitative measures of association strength between two variables, were calculated by the means of odds ratios (OR). The effect sizes were then combined using a random-effects model.
RESULTS: Seven studies met our inclusion criteria with 10,817 thyroid nodules evaluated. Malignancy was identified in 2,206 (20.4%) nodules. After adjusting for patient age and gender, nodules that measured 3-5.9 cm had a 26% greater malignancy risk compared to those measuring <3 cm [OR, 1.26; 95% confidence interval (CI): 1.13-1.39]. However, nodules 6 cm or larger had a 16% lower risk of malignancy compared to those measuring <3 cm (OR, 0.84; 95% CI: 0.73-0.98).
CONCLUSIONS: Thyroid nodule size predicts cancer risk. However, a threshold effect of thyroid nodule size 6 cm or greater is significantly associated with a more benign disease.
PMID: 27294039 [PubMed]

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Dermatology

An observational study to evaluate the long-term outcomes of treatment with etanercept in patients with plaque-type psoriasis

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎3 hours ago | T. Luger, R.E. Schopf, A. Schwanke, S. Langhammer, T. Meng, P.A. Löschmann

Abstract

Background

There is an unmet need for long-term, real-life data on the effect of a drug-free interval between treatment cycles in patients with plaque psoriasis being treated with etanercept, which is licensed for intermittent and continuous treatment.

Objective

The aim of this study was to determine the average duration of the drug-free interval between etanercept treatment cycles in patients with plaque psoriasis.

Methods

This was a non-interventional, open-label, multicentre, prospective study in patients for whom the decision had already been made to initiate treatment with etanercept during routine practice in German centres. Clinical outcomes were documented over 36 months with study visits every 12 weeks. The primary endpoint was the duration of the treatment-free interval between etanercept treatment cycles (24 weeks/cycle). Secondary endpoints assessed efficacy [Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), static Physician's Global Assessment (sPGA)], health-related outcomes [EuroQol-5 Dimensions (EQ-5D), Dermatology Life Quality Index (DLQI)] and safety.

Results

A total of 955 patients were enrolled from 224 centres; 926 of these were included in the safety analyses and 720 patients from the safety population were included in the efficacy analysis. The mean duration of drug-free intervals was 12.9 ± 12.8 weeks. Efficacy and health-related quality of life outcomes measures showed consistent improvement that occurred within 12 weeks of treatment with etanercept. There was a descriptive difference between the continuous and intermittent treatment subgroups, as subjects in the latter showed a deterioration at the first visit following an interval. However, retreatment with etanercept resulted in a clinical efficacy identical to the initial effect. The incidence of physician-assessed, drug-related adverse events and serious adverse events was 13.1% and 1.9%, respectively.

Conclusion

The mean duration of drug-free intervals was relatively short, most patients experienced improvements in disease activity and health-related quality of life within 12 weeks of either continuous or intermittent treatment with etanercept, and there were no new safety signals. ClinicalTrials.gov identifier: NCT00708708.

A Rare Presentation of a Dermoid Cyst with Draining Sinus in a Child: Case Report and Literature Review

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎4 hours ago | Chen Yan, David W. Low

Abstract

Orbitofacial dermoid cysts in children are treated using surgical excision. Dermoid cysts of the frontotemporal region usually present as superficial, slow-growing masses without deep extension. We report a rare case wherein a frontotemporal dermoid in a 21-month-old girl presented with a draining sinus tract to the skin and extended intracranially through the sphenoid bone. It was removed surgically and a dermoid cyst was removed from the frontotemporal region, extending superficially from the skin sinus tract through the sphenoid bone and attaching to the dura of the anterior temporal lobe. In addition to our case presentation, a literature review was performed to identify the few reported similar cases in the published literature, the combination of which suggests that frontotemporal dermoid cysts with associated draining sinus tracts may require preoperative imaging with computed tomography or magnetic resonance imaging before surgical intervention because of the high likelihood of intracranial extension.

Catastrophic cryofibrinogenaemia associated with chronic lymphocytic leukaemia and salvage therapy using plasmapheresis and cyclophosphamide

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎5 hours ago | M. AlGain, R. Damade, F. Aucouturier, J. Rivet, M. Jachiet, M. Malphettes, G. Hickman, R. Szalat, A. Saussine, A. de Masson, A. Petit, M. Rybojad, M. Bagot, B. Arnulf, J.D. Bouaziz

Histopathology and reflectance confocal microscopy features of photodamaged skin and actinic keratosis

‎Today, ‎14 ‎Ιουνίου ‎2016, ‏‎5 hours ago | J.M. Tan, D. Lambie, S. Sinnya, A. Sahebian, H.P. Soyer, T.W. Prow, M. Ardigò

Abstract

Background

Actinic keratosis (AK) usually co-exists in areas of severe photodamage, but the clinical applicability of reflectance confocal microscopy (RCM) in diagnosing AK currently depends on a set of parameters yet to be defined in comparison to photodamaged skin (PD).

Objective

To correlate the RCM features of PD and AK with histopathology.

Methods

Twenty participants with a mean age of 64 years and skin phototype I and II were studied. RCM was performed on two PD and one AK within a field of 25 cm² on the left dorsal forearm, followed by shave biopsies. Blinded evaluation of the histopathological and RCM images using established parameters in AK were performed retrospectively in consensus with an expert confocalist, correlated with the histopathological diagnosis by a board-certified dermatopathologist.

Results

A total of 57/60 areas were included. There were 43/57 (75%) and 14/57 (25%) histopathologically confirmed PD and AK respectively. Individual corneocytes, stratum corneum disruption, dermal inflammatory cells, increased vascularity/dilated vessels and solar elastosis were detected in PD and AK upon histopathology and RCM. The features in favour of AK were parakeratosis, hyperkeratosis, more severe keratinocyte pleomorphism and architectural disruption, and the presence of epidermal inflammatory cells. PD also demonstrated keratinocyte pleomorphism and architectural disruption though this was generally less severe than AK. A small subset of PD exhibited a comparable degree of keratinocyte pleomorphism and architectural disruption to the AKs in the cohort.

Conclusions

The viable epidermis demonstrates PD and AK to be part of a disease continuum corresponding to field cancerization. Individual corneocytes, stratum corneum disruption, dermal inflammatory cells, increased vascularity/dilated vessels and solar elastosis may be present in PD; whereas, parakeratosis and hyperkeratosis may represent the key to distinguishing AK from PD using RCM. The significance of epidermal inflammatory cells in the RCM diagnosis of AK remains to be elucidated.

CDK4/6-Inhibitoren

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎9:17:17 μμ

Entwicklungen der Immunmodulation nach Transplantation im Hinblick auf De-novo-Malignome und Tumorrezidive

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎5:10:38 μμ

Zusammenfassung

Hintergrund

Organtransplantierte Patienten haben ein erhöhtes Risiko, maligne Tumoren zu entwickeln. Im langfristigen Verlauf nach Organtransplantation stellen maligne Tumoren nach den kardiovaskulären Erkrankungen die zweithäufigste Todesurasche dar. Ziel dieses Reviews ist eine überblickende Darstellung der Zusammenhänge zwischen Immunmodulation und Tumorentstehung nach Organtransplantation.

Ergebnisse und Schlussfolgerung

Neben individuellen Risikofaktoren werden die immunologischen Veränderungen nach Organtransplantation als Ursache des erhöhten Krebsrisikos angesehen. Histokompatibilität, HLA-Status, die kumulative Immunsuppressionsdosis in der Induktions-, Erhaltungs- und Abstoßungsbehandlung, das mit spezifischen Immunsuppressiva assoziierte Malignitätsrisiko sowie eine erhöhte Inzidenz onkogener viraler Infektionen scheinen zum erhöhten Krebsrisiko nach Organtransplantation beizutragen. Ein gründliches Tumorscreening vor und nach Transplantation, antivirale Prophylaxen und eine so niedrig wie möglich dosierte Immunsuppression sind gegenwärtige Strategien, um das Risiko für die Entstehung maligner Tumore nach Transplantation zu senken. Die Entwicklung neuer Immunsuppressiva und Protokolle zur Toleranzinduktion und klinische Erfahrungen mit systemischen und lokalen immunbasierten Tumortherapien können zukünftig ebenso dazu beitragen wie ein besseres Verständnis der Pathomechanismen der Kanzerogenese unter Immunsuppression.

New treatment offers hope for children with debilitating skin and muscle disease

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎3:27:17 μμ

Patients who have failed multiple drug treatments show significant improvements.

Triple paradoxical reaction due to adalimumab

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎2:09:32 μμ | J.F. Mir-Bonafe, A. Lopez-Ferrer, A. Laiz, L. Puig

Next-generation sequencing identified a novel mutation of COL7A1 in a Chinese pedigree of dystrophic epidermolysis bullosa

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎2:09:32 μμ | S. Zheng, X.G. Xu, Y. Lv, X.-H. Gao, H.D. Chen

Sentinel lymph node biopsy versus PET-CT in AJCC stages I and II of melanoma

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎2:09:32 μμ | M.A. Chessa, E. Dika, A. Patrizi, P.A. Fanti, B.M. Piraccini, G. Veronesi, S. Diodato, S. De Vivo, S. Fanti

Atypical Forms of Hand, Foot, and Mouth Disease: A Prospective Study of 47 Italian Children

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎12:50:44 μμ | Iria Neri, Arianna Dondi, Andreas Wollenberg, Lorenza Ricci, Giampaolo Ricci, Giulia Piccirilli, Tiziana Lazzarotto, Annalisa Patrizi

Abstract

Background

Atypical forms of hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 have been reported in recent years. High fever and severe cutaneous lesions are common, whereas neurologic complications are rare. Eczematous areas of patients with atopic dermatitis show more lesions. The goal of the current study was to describe the clinical characteristics of children with atypical HFMD and to investigate the involvement of the different enterovirus serotypes associated.

Methods

All patients referred to our service for atypical HFMD from January 2012 to February 2014 were enrolled and classified as having the diffuse form (lesions extended to the trunk), the acral form (lesions with a mainly acral distribution), or eczema coxsackium (lesions on preexisting eczematous areas).

Results

Data from 47 patients were analyzed (median age 22 months [range 4–84 mos]); viral genotyping was performed in 11 cases. Sixty-two percent of the subjects developed the acral form, 23% eczema coxsackium, and 15% the diffuse form. Most patients had a nonclassical vesicular eruption and moderate to severe extent of cutaneous involvement. Approximately 80% of patients had palmoplantar purpuric macules. Most children younger than 2 years old had the acral form, most patients with eczema coxsackium were age 2 years and older, and the diffuse form was similarly distributed between the two age groups. Coxsackievirus A6 was detected in 9 of 11 genotyped cases.

Conclusion

Our prospective study allowed the identification of three HFMD phenotypes differing from the classical form. Clinical care of these patients should include symptomatic treatment of extracutaneous features and, if necessary, hospitalization for complications.

Ultrasound Diagnosis and Staging in Pediatric Hidradenitis Suppurativa

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎12:50:44 μμ | Ximena Wortsman, Carolyn Rodriguez, Carolina Lobos, Gonzalo Eguiguren, Maria Teresa Molina

Abstract

Hidradenitis suppurativa (HS) can affect children, and ultrasound has been proven to be useful in diagnosis and staging. The sonographic characteristics of HS in children have not been reported. We studied color Doppler ultrasound images of children (≤15 years old; n = 12) with clinically and sonographically positive criteria for HS. Sonographic scoring of hidradenitis suppurativa (SOS-HS) was used to stage the cases sonographically. Subclinical pseudocysts were found in 92% of the cases, fluid collections in 83%, and fistulous tracts in 58%. Retained hair tracts in the fluid collections and fistulous tracts were present in 100% of patients; 67% of cases were SOS-HS stage II. In 92% of cases, management was modified after the ultrasound examination. In conclusion, ultrasound can be a reliable and safe imaging tool to support diagnosis and staging and may help in the noninvasive monitoring of treatment in children.

Prognosis and Management of Congenital Hair Shaft Disorders without Fragility—Part II

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎12:50:44 μμ | Gaurav Singh, Mariya Miteva

Abstract

Hair shaft disorders are characterized by congenital or acquired abnormalities of the hair shaft. The objective of this study was to review the literature regarding the prognosis and treatment options for hair shaft disorders. We used keywords in the search engines PubMed and Medline to identify all publications in English related to the prognosis and management of hair shaft disorders. Data were extracted from 96 articles that met search criteria. Findings were limited to case reports and small case series, as no studies were found. Disorders that improve in childhood include pili torti, trichorrhexis invaginata, woolly hair, and pili trianguli et canaliculi. Others, such as trichorrhexis nodosa, monilethrix, pili annulati, and pili bifurcati, improve with minoxidil. Oral retinoids have been found to improve hair abnormalities in trichorrhexis invaginata and monilethrix. There is no specific treatment for congenital hair shaft abnormalities. Gentle hair care is the mainstay of care for hair shaft disorders associated with fragility. Practices for gentle care include no brushing, backcombing, chemical products, tight braids, heat exposure, or mechanical grooming. Furthermore, any inherited or congenital disorder requires genetic counseling as part of management.

Prognosis and Management of Congenital Hair Shaft Disorders with Fragility—Part I

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎12:50:44 μμ | Gaurav Singh, Mariya Miteva

Abstract

Hair shaft disorders are characterized by congenital or acquired abnormalities of the hair shaft. The objective was to review the literature regarding the prognosis and treatment options of hair shaft disorders. We used keywords in the search engines PubMed and Medline to identify all publications in the English language related to the prognosis and management of hair shaft disorders. Data were extracted from 96 articles that met search criteria. Findings were limited to case reports and small case series, as no studies were found. Disorders that improve in childhood include pili torti, trichorrhexis invaginata, wooly hair, and pili trianguli et canaliculi. Others, such as trichorrhexis nodosa, monilethrix, pili annulati, and pili bifurcati improve with minoxidil. Oral retinoids have improved hair abnormalities in trichorrhexis invaginata and monilethrix. There is no specific treatment for congenital hair shaft abnormalities. Gentle hair care is the mainstay of care for hair shaft disorders associated with fragility. Practices for gentle care include no brushing, backcombing, chemical products, tight braids, heat exposure, or mechanical grooming. Any inherited or congenital disorder requires genetic counseling as part of management.

Late-Onset Nail Changes Associated with Hand, Foot, and Mouth Disease: A Clinical Analysis of 56 Cases

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎12:50:44 μμ | Dong-ling Long, Shi-yuan Zhu, Cai-zi Li, Cui-yan Chen, Wan-tao Du, Xi Wang

Abstract

Objectives

To investigate the development and clinical characteristics of nail changes in hand, foot, and mouth disease (HFMD).

Methods

A telephone survey was conducted with the parents of patients diagnosed with HFMD in the Fourth General Hospital of Nanhai from June to August 2013 to document nail changes within 3 months of diagnosis of HFMD.

Results

Valid survey results were obtained from 273 cases. Definitive nail changes were identified in 56 patients (20.5%). More boys (25.8%) than girls (10.6%) (p < 0.01) showed changes. The age distribution ranged from 1 to 5 years, and nail changes were rare in children younger than 1 year of age (p < 0.01). Nail changes were usually seen 1 to 2 months after the onset of HFMD and lasted for 1 to 8 weeks, most for approximately 4 weeks. Toenails or fingernails could be affected and the changes were more likely to occur synchronously. Fingernails were more commonly involved than toenails. When both fingernails and toenails were involved, this typically occurred synchronously. Although there were cases with all toenails and fingernails involved (16.1%), we did not encounter any instances involving 13 to 19 nails. The nail changes mainly presented as onychomadesis. Spontaneous recovery without special treatment was the course for all patients. No relapse or new nail involvement was identified.

Conclusions

Nail change associated with HFMD usually occurs within 1 to 2 months after onset, mainly presents as onychomadesis, and is a self-limited process. Possible mechanisms are discussed.

Risk Factors for Premature Hair Graying in Young Turkish Adults

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎12:50:44 μμ | Asli Akin Belli, Fatma Etgu, Seyran Ozbas Gok, Bilge Kara, Gursoy Dogan

Abstract

Background

Premature hair graying (PHG) is a common condition resulting in loss of self-esteem. Studies investigating PHG risk factors for both sexes with a large number of patients are scarce. We sought to investigate the socioclinical risk factors for PHG in young Turkish men and women and the differences between the sexes.

Methods

A cross-sectional study was conducted in 1,119 participants who answered a survey about PHG and some socioclinical characteristics between February and July 2015. The number of gray hairs, onset age of hair graying, and family history of PHG were asked about, as well as demographic characteristics, anthropometric measures, body mass index, smoking, alcohol consumption, sports life, diet, medical history, educational status, occupation, marital status, monthly income, and Fitzpatrick skin type.

Results

Of 1,119 participants, 315 (28.1%) had PHG and 804 did not. Maternal and paternal PHG, alcohol consumption, presence of chronic disease, educational status, hair loss, perceived stress scale (PSS) score, age, and height were significantly higher in subjects with PHG. Rates of maternal and paternal PHG were high in women with PHG, and the rate of paternal PHG was high in men with PHG. According to the multivariate ordinal regression analysis, PSS score, age, hair loss, and family history of PHG were correlated with the severity of PHG.

Conclusion

PHG is closely related to factors causing oxidative stress, such as emotional stress, alcohol consumption, and chronic diseases in genetically predisposed men and women.

Asymmetrical proliferative pattern loss linked to cyclin D1 overexpression during malignant transformation of the lip epithelium

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎12:07:00 μμ | N.G. Garcia, M.A. González-Moles, I. Ruiz-Ávila, M. Bravo, P. Ramos-García, E.M. Minicucci, M.A.C. Domingues, D.T. Oliveira

Abstract

Background

There is inadequate knowledge on the involvement of oncogenic mechanisms linked to the cyclin (CCND1) gene in lip squamous cell carcinoma (LSCC).

Objective

The aim of this study was to analyse the implication of cyclin D1 in the malignant transformation of lip lesions.

Methods

We immunohistochemically studied 45 actinic cheilitis cases (15 mild dysplasia, 15 moderate dysplasia, 15 severe dysplasia/carcinoma in situ), 30 LSCC cases with adjacent non-tumour epithelium and 15 normal oral epithelium samples for detection of cyclin D1, β-catenin and Ki-67.

Results

Cyclin D1 and Ki-67 expressions were significantly increased in the basal layer of premalignant epithelia and peripheral layers of tumour nests vs. controls. Premalignant epithelia had lost their asymmetrical proliferative pattern.

Conclusion

Lip carcinogenesis was associated with loss of the asymmetrical proliferative pattern, a preventive mechanism against lip oncogenesis, and with cyclin D1 overexpression.

Short-term efficacy and safety of new biologic agents targeting IL-23/Th17 pathway for moderate to severe plaque psoriasis: a systematic review and network meta-analysis

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎11:45:53 πμ | F. Gómez-García, D. Epstein, B. Isla-Tejera, A. Lorente, A. Vélez García-Nieto, J. Ruano

Abstract

A new generation of biologics targeting IL-23/Th17 pathway has been developed. This study aimed to assess the short-term effectiveness and safety of these new agents using a network meta-analysis. Twenty seven randomized clinical trials (n=10,629) were identified by a comprehensive systematic literature review (PROSPERO 2015:CRD42015025472). Quality of evidence was assessed following Cochrane compliant rules and GRADE approach. Efficacy and safety outcomes at weeks 10-16 were compared using a random-effects network meta-analysis within a frequentist framework to estimate pooled odds ratios (OR) of direct and indirect comparisons among the therapeutic options. There were 6 direct drug-to-drug comparisons in the network, with a high degree of consistency between the direct and the indirect evidence. From the available evidence, infliximab 5mg.kg-1 every eight weeks (OR: 118.89; 95%CI: 60.91-232.04) and secukinumab 300mg every four weeks (OR: 87.07;95%CI: 55.01-137.82) are shown as among the most effective short-term treatment, but are ranked as the biologic most likely to produce any adverse event (AE) or an infectious AE, respectively. Ustekinumab 90mg every twelve weeks, the third most efficacious (OR: 73.67; 95%CI: 46.97-115.56), was the only agent that did not show increased risk of adverse events when compared with placebo. Treatment recommendations should also consider long term outcomes and costs.

This article is protected by copyright. All rights reserved.

Statin use and the risk of herpes zoster: a nested case-control study using primary care data from the UK Clinical Research Practice Datalink

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎11:45:53 πμ | A. Matthews, M. Turkson, H. Forbes, S.M. Langan, L. Smeeth, K. Bhaskaran

Abstract

Background

Statins are commonly prescribed worldwide and recent evidence suggests they may increase the risk of herpes zoster.

Objective

To quantify the effect of statin exposure on the risk of zoster in the UK.

Methods

A matched case-control study was conducted using data from UK primary care and hospital records. Patients >18 years with an incident diagnosis of zoster were matched to up to four controls on age, sex and general practice. Exposures were: ever use of a statin; daily dosage of most recent statin prescription; time since most recent statin prescription. The primary outcome was an incident diagnosis of zoster. Odds ratios were estimated from conditional logistic regression and adjusted for potential confounders.

Results

A total of 144,959 incident cases of zoster were matched to 549,336 controls. Adjusted analysis suggested strong evidence for an increase in risk of zoster related to statin exposure (OR:1.13, 95% CI:1.11,1.15). There was also an increasing risk with increasing dose in current and recent users (p-trend<0.001), and an attenuation of excess risk in previous users as time since last exposure increased (p-trend<0.001).

Conclusion

These findings are consistent with the hypothesis that statin therapy leads to an increase in the risk of zoster.

This article is protected by copyright. All rights reserved.

The SCAR Scale (Scar Cosmesis Assessment and Rating Scale): Development and validation of a new outcome measure for postoperative scar assessment

‎Yesterday, ‎13 ‎Ιουνίου ‎2016, ‏‎11:45:53 πμ | J. Kantor

In order to effectively discriminate between various surgical interventions, it is critical to utilize a valid and feasible outcome measure for postoperative scar quality. Despite the large number of studies published in the dermatology, general surgery, and plastic surgery literature on the relative merits of various surgical techniques, no ideal scar scale exists to effectively assess the quality of postoperative scars. Until now, studies have relied on one of several scales for scar rating,^1-5 many of which were developed for burn, rather than linear, scars. Moreover, none of these scales were developed or validated by dermatologists, none were developed expressly for tracking the evolution of linear postoperative scars, and none rigorously included input from patients in its development.

This article is protected by copyright. All rights reserved.

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Lumbar spinal atypical teratoid rhabdoid tumor.

Dhir A, Tekautz T, Recinos V, Murphy E, Prayson Ra, Ruggieri P, Wolff J · Tuesday, June 14, 2016, 14:51

Related Articles

Lumbar spinal atypical teratoid rhabdoid tumor.

J Clin Neurosci. 2015 Dec;22(12):1988-9

Authors: Dhir A, Tekautz T, Recinos V, Murphy E, Prayson RA, Ruggieri P, Wolff J

Abstract
We describe a pediatric patient with an atypical teratoid rhabdoid tumor (AT/RT) exclusively of the lumbar spine, with a different presentation from the two previously reported pediatric lumbar AT/RT. AT/RT are rare pediatric tumors of the central nervous system, with a dismal prognosis. Although there is sufficient literature on brain AT/RT, spinal AT/RT continues to be a rare entity, with a lumbar location even less frequently reported. A 30-month-old African American boy with multiple comorbidities presented with the inability to ambulate, encopresis and urinary dribbling. The MRI showed an intradural extramedullary mass extending downwards from the L3-4 level. He underwent an L3-S2 laminoplasty. The surgically resected mass was marked by sheets of cells with large nuclei and prominent nucleoli. The tumor cells stained with antibodies to synaptophysin and CAM5.2, and showed no immunoreactivity to INI-1 antibody. He was diagnosed with a World Health Organization Grade IV AT/RT. There was no mutation detected in the SMARCB1 gene on a comprehensive analysis of his blood. The boy is currently being treated according to the Medical University of Vienna AT/RT protocol, with no evidence of tumor recurrence 8 months after surgery. To our knowledge, this is the only report of a lumbar AT/RT in an African American child.

PMID: 26234633 [PubMed - indexed for MEDLINE]

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Vertebral Compression Fracture Related to Pancreatic Cancer With Osteoblastic Metastasis: A Case Report and Literature Review.

Chih Yp, Wu Wt, Lin Cl, Jou Hj, Huang Yh, Chen Lc, Chou Lw · Tuesday, June 14, 2016, 14:51

Related Articles

Vertebral Compression Fracture Related to Pancreatic Cancer With Osteoblastic Metastasis: A Case Report and Literature Review.

Medicine (Baltimore). 2016 Feb;95(5):e2670

Authors: Chih YP, Wu WT, Lin CL, Jou HJ, Huang YH, Chen LC, Chou LW

Abstract
Compression fracture of the vertebral body is common in the older patients. The possible etiology like osteoporosis or cancer metastasis should be included as a possibility in the differential diagnosis for severe back pain, to prevent delays in diagnosis and treatment. More severe fractures can cause significant pain, leading to inability to perform activities of daily living, and life-threatening in the older patient.We report a rare case of a 61-year-old man suffering from severe lower back pain and intermittent abdominal fullness. He came to our clinic, where muscle power was normal, but could not stand up or change posture because of severe back pain. Plain film and magnetic resonance imaging of lumbar spine both revealed osteoblastic lesion at L2 spine. Abdomen computed tomography showed a mass at the pancreatic body. The pancreatic cancer with osteoblastic metastasis was diagnosed. After receiving multimodality therapy such as percutaneous vertebroplasty and pain controlling, we provided effective palliation of symptoms, aggressive rehabilitation program, and better quality of life.Our case highlights the benefits of multidisciplinary cancer treatment for such patient, preventing the complications such as immobilization accompanied with adverse effects like musculoskeletal, respiratory, and cardiovascular systems. All clinicians should be informed of the clinical findings to provide patients with suitable therapies and surveys. 

PMID: 26844499 [PubMed - indexed for MEDLINE]

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177 Lu-OPS201 targeting somatostatin receptors: in vivo biodistribution and dosimetry in a pig model

Tuesday, June 14, 2016, 14:51

Abstract

Background

¹⁷⁷Lu is used in peptide receptor radionuclide therapies for the treatment of neuroendocrine tumors. Based on the recent literature, SST2 antagonists are superior to agonists in tumor uptake. The compound OPS201 is the novel somatostatin antagonist showing the highest SST2 affinity. The aim of this study was to measure the in vivo biodistribution and dosimetry of ¹⁷⁷Lu-OPS201 in five anesthetized Danish Landrace pigs as an appropriate substitute for humans to quantitatively assess the absorbed doses for future clinical applications.

Results

¹⁷⁷Lu-OPS201 was obtained with a specific activity ranging from 10 to 17 MBq/μg. Prior to administration, the radiochemical purity was measured as s > 99.7 % in all cases. After injection, fast clearance of the compound from the blood stream was observed. Less than 5 % of the injected activity was presented in blood 10 min after injection. A series of SPECT/CT and whole-body scans conducted until 10 days after intravenous injection showed uptake mostly in the liver, spine, and kidneys. There was no visible uptake in the spleen. Blood samples were taken to determine the time-activity curve in the blood. Time-activity curves and time-integrated activity coefficients were calculated for the organs showing visible uptake. Based on these data, the absorbed organ dose coefficients for a 70-kg patient were calculated with OLINDA/EXM. For humans after an injection of 5 GBq ¹⁷⁷Lu-OPS201, the highest predicted absorbed doses are obtained for the kidneys (13.7 Gy), the osteogenic cells (3.9 Gy), the urinary bladder wall (1.8 Gy), and the liver (1.0 Gy). No metabolites of ¹⁷⁷Lu-OPS201 were found by radio HPLC analysis. None of the absorbed doses calculated will exceed organ toxicity levels.

Conclusions

The ¹⁷⁷Lu-OPS201 was well tolerated and caused no abnormal physiological or behavioral signs. In vivo distributions and absorbed doses of pigs are comparable to those observed in other publications. According to the biodistribution data in pigs, presented in this work, the expected radiation exposure in humans will be within the acceptable range.

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177 Lu-OPS201 targeting somatostatin receptors: in vivo biodistribution and dosimetry in a pig model

Tuesday, June 14, 2016, 14:51

177 Lu-OPS201 targeting somatostatin receptors: in vivo biodistribution and dosimetry in a pig model:

Abstract

Background

177Lu is used in peptide receptor radionuclide therapies for the treatment of neuroendocrine tumors. Based on the recent literature, SST2 antagonists are superior to agonists in tumor uptake. The compound OPS201 is the novel somatostatin antagonist showing the highest SST2 affinity. The aim of this study was to measure the in vivo biodistribution and dosimetry of 177Lu-OPS201 in five anesthetized Danish Landrace pigs as an appropriate substitute for humans to quantitatively assess the absorbed doses for future clinical applications.

Results

177Lu-OPS201 was obtained with a specific activity ranging from 10 to 17 MBq/μg. Prior to administration, the radiochemical purity was measured as s > 99.7 % in all cases. After injection, fast clearance of the compound from the blood stream was observed. Less than 5 % of the injected activity was presented in blood 10 min after injection. A series of SPECT/CT and whole-body scans conducted until 10 days after intravenous injection showed uptake mostly in the liver, spine, and kidneys. There was no visible uptake in the spleen. Blood samples were taken to determine the time-activity curve in the blood. Time-activity curves and time-integrated activity coefficients were calculated for the organs showing visible uptake. Based on these data, the absorbed organ dose coefficients for a 70-kg patient were calculated with OLINDA/EXM. For humans after an injection of 5 GBq 177Lu-OPS201, the highest predicted absorbed doses are obtained for the kidneys (13.7 Gy), the osteogenic cells (3.9 Gy), the urinary bladder wall (1.8 Gy), and the liver (1.0 Gy). No metabolites of 177Lu-OPS201 were found by radio HPLC analysis. None of the absorbed doses calculated will exceed organ toxicity levels.

Conclusions

The 177Lu-OPS201 was well tolerated and caused no abnormal physiological or behavioral signs. In vivo distributions and absorbed doses of pigs are comparable to those observed in other publications. According to the biodistribution data in pigs, presented in this work, the expected radiation exposure in humans will be within the acceptable range.

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177 Lu-OPS201 targeting somatostatin receptors: in vivo biodistribution and dosimetry in a pig model

Tuesday, June 14, 2016, 14:51

Abstract

Background

¹⁷⁷Lu is used in peptide receptor radionuclide therapies for the treatment of neuroendocrine tumors. Based on the recent literature, SST2 antagonists are superior to agonists in tumor uptake. The compound OPS201 is the novel somatostatin antagonist showing the highest SST2 affinity. The aim of this study was to measure the in vivo biodistribution and dosimetry of ¹⁷⁷Lu-OPS201 in five anesthetized Danish Landrace pigs as an appropriate substitute for humans to quantitatively assess the absorbed doses for future clinical applications.

Results

¹⁷⁷Lu-OPS201 was obtained with a specific activity ranging from 10 to 17 MBq/μg. Prior to administration, the radiochemical purity was measured as s > 99.7 % in all cases. After injection, fast clearance of the compound from the blood stream was observed. Less than 5 % of the injected activity was presented in blood 10 min after injection. A series of SPECT/CT and whole-body scans conducted until 10 days after intravenous injection showed uptake mostly in the liver, spine, and kidneys. There was no visible uptake in the spleen. Blood samples were taken to determine the time-activity curve in the blood. Time-activity curves and time-integrated activity coefficients were calculated for the organs showing visible uptake. Based on these data, the absorbed organ dose coefficients for a 70-kg patient were calculated with OLINDA/EXM. For humans after an injection of 5 GBq ¹⁷⁷Lu-OPS201, the highest predicted absorbed doses are obtained for the kidneys (13.7 Gy), the osteogenic cells (3.9 Gy), the urinary bladder wall (1.8 Gy), and the liver (1.0 Gy). No metabolites of ¹⁷⁷Lu-OPS201 were found by radio HPLC analysis. None of the absorbed doses calculated will exceed organ toxicity levels.

Conclusions

The ¹⁷⁷Lu-OPS201 was well tolerated and caused no abnormal physiological or behavioral signs. In vivo distributions and absorbed doses of pigs are comparable to those observed in other publications. According to the biodistribution data in pigs, presented in this work, the expected radiation exposure in humans will be within the acceptable range.

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Arthroscopic treatment of tibial eminence fracture: a systematic review of different fixation methods

Osti, L., Buda, M., Soldati, F., Del Buono, A., Osti, R., Maffulli, N. · Tuesday, June 14, 2016, 14:51

Introduction

Arthroscopy procedures are the gold standard for the management of tibial spine avulsion. This review evaluates and compares different arthroscopic treatment options for tibial spine fractures.

Source of data

PubMed, Medline, Ovid, Google Scholar and Embase databases were systematically searched with no limit regarding the year of publication.

Areas of agreement

An arthroscopic approach compared with arthrotomy reduces complications such as soft-tissue lesions, post-operative pain and length of hospitalization.

Areas of controversy

The use of suture techniques, compared to cannulated screw technique, avoids a second surgery for removal of the screws, but requires longer immobilization and partial weight bearing.

Growing points

Clinical outcomes and radiographic results do not seem to differ in relation to the chosen method of fixation.

Areas timely for developing research

Further studies are needed to produce clear guidelines to define the best choice in terms of clinical outcomes, function and complications.

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Human neurexin-3{alpha} antibodies associate with encephalitis and alter synapse development

Gresa-arribas, N., Planaguma, J., Petit-pedrol, M., Kawachi, I., Katada, S., Glaser, C. A., Simabukuro, M. M., Armangue, T., Martinez-hernandez, E., Graus, F., Dalmau, J. ·Tuesday, June 14, 2016, 14:51

Objective:

To report a novel autoimmune encephalitis in which the antibodies target neurexin-3α, a cell adhesion molecule involved in the development and function of synapses.

Methods:

Five patients with encephalitis and antibodies with a similar pattern of brain reactivity were selected. Antigen precipitation and determination of antibody effects on cultured rat embryonic neurons were performed with reported techniques.

Results:

Immunoprecipitation and cell-based assays identified neurexin-3α as the autoantigen of patients' antibodies. All 5 patients (median age 44 years, range 23–50; 4 female) presented with prodromal fever, headache, or gastrointestinal symptoms, followed by confusion, seizures, and decreased level of consciousness. Two developed mild orofacial dyskinesias, 3 needed respiratory support, and 4 had findings suggesting propensity to autoimmunity. CSF was abnormal in all patients (4 pleocytosis, 1 elevated immunoglobulin G [IgG] index), and brain MRI was abnormal in 1 (increased fluid-attenuated inversion recovery/T2 in temporal lobes). All received steroids, 1 IV immunoglobulin, and 1 cyclophosphamide; 3 partially recovered, 1 died of sepsis while recovering, and 1 had a rapid progression to death. At autopsy, edema but no inflammatory cells were identified. Cultures of neurons exposed during days in vitro (div) 7–17 to patients' IgG showed a decrease of neurexin-3α clusters as well as the total number of synapses. No reduction of synapses occurred in mature neurons (div 18) exposed for 48 hours to patients' IgG. Neuronal survival, dendritic morphology, and spine density were unaffected.

Conclusion:

Neurexin-3α autoantibodies associate with a severe but potentially treatable encephalitis in which the antibodies cause a decrease of neurexin-3α and alter synapse development.

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Relationship Between Bariatric Surgery and Bone Mineral Density: a Meta-analysis

Tuesday, June 14, 2016, 14:51

Abstract

Background

A meta-analysis regarding bone loss after bariatric surgery, designed to compare surgical and nonsurgical groups, has not yet been performed. Therefore, we performed a meta-analysis to compare the differences between bariatric surgical groups and nonoperated controls with regard to bone mineral density.

Methods

In March 2015, we performed a review of the literature using PubMed, EMBASE, and the Cochrane Library. The search focused on retrospective and prospective studies, including but not limited to randomized studies published in English.

Results

Among 1299 studies that were initially screened, ten met the selection criteria. For all types of bariatric surgery, bone density at the femoral neck was lower in the surgical group than in the nonsurgical control group (mean difference [MD] −0.05 g/cm²; 95 % confidence interval [CI], −0.07 to −0.02; p = 0.001); no difference in bone density was found between the two groups at the lumbar spine (MD −0.01 g/cm²; 95 % CI −0.07 to 0.05; p = 0.661). The analysis of Roux-en-Y gastric bypass showed similar results.

Conclusion

Bone density at the femoral neck decreased after bariatric surgery, compared to that in nonsurgical controls, whereas bone density at the lumbar spine did not show a difference between groups. Further larger scale studies with comparative nonsurgical controls are warranted to overcome the heterogeneity among studies in this analysis and to add evidence of possible bone loss subsequent to bariatric surgical procedures.

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The need to immobilise the cervical spine during cardiopulmonary resuscitation and electric shock administration in out-of-hospital cardiac arrest

Desroziers, M., Mole, S., Jost, D., Tourtier, J.-p. · Tuesday, June 14, 2016, 14:51

In cases of out-of hospital cardiac arrest (OHCA), falling to the ground can cause brain and neck trauma to the patient. We present a case of a man in his mid-60s who suffered from an OHCA resulting in a violent collapse. The patient received immediate cardiopulmonary resuscitation, but his spine was immobilised only after a large frontal haematoma was found. The resuscitation efforts resulted in return of spontaneous circulation and discharge from hospital. After this, doctors performed angioplasty, followed by a cardiopulmonary bypass. Later, CT scan examination reported a displaced and unstable fracture of the 6th vertebra without bone marrow involvement. The patient underwent a second operation. 40 days later, he was able to return home without sequela. This case shows the importance of analysing the circumstances of a fall, considering the possibility of two concomitant diagnoses and prioritising investigations and treatment.

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A case report of acute injury in ankylosing spondylitis

Tuesday, June 14, 2016, 14:51

Publication date: Available online 13 June 2016
Source:Journal of Acute Disease
Author(s): Yu-Hang Yeh, Yu-Jang Su
Ankylosing spinal disorders tend to fracture after minor trauma because of its changed biomechanical properties. Herein we presented an ankylosing spinal disorders case with cervical spine fracture in a trauma after neck protection and surgical airway application. On CT scan of cervical spine, ankylosing spondylitis with an extension C4–C5 fracture was found. The patients' family decided not to receive operation to immobilize his cervical spine, then he was admitted to our surgical intensive care unit. He was discharged against medical advice two months later with a permanent tracheostomy with ventilator dependence due to high-level spinal cord injury. Timely identification of unstable fractures is instrumental in avoiding adverse neurologic sequela.

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