Bilateral subtrochanteric femur insufficiency fractures after bariatric surgery: a case report

There have been case reports of proximal femur insufficiency fractures in patients who have previously undergone bariatric surgery. We present a follow-up case of a patient who developed bilateral complete proximal femur insufficiency fractures several years after bariatric surgery. Our patient underwent bilateral intramedullary fixation with a satisfactory postoperative outcome. We review and discuss the definition and pathogenesis of atypical femur fractures (AFFs), which may represent a larger category of insufficiency fractures not exclusive to bisphosphonate use, which includes patients with fractures after bariatric surgery.

[Ethical, pedagogical, socio-political and anthropological implications of quaternary prevention]

The concept of quaternary prevention, resulting from a reflection on the doctor-patient relationship, is presented as a renewal of the ageold ethical requirement: first, a doctor must not harm; second, the doctor must control himself/herself. The origin of the concept, its endorsement by the World Organization of Family Doctors (WONCA) and the European Union of General Practitioners (UEMO), its dissemination, and the debates to which it has given rise, are presented by a panel of authors from 12 countries and 3 continents. This collective text deals more specifically with the ethics of prevention, the importance of teaching Quaternary prevention and Evidence Based Medicine, the social and political implications of the concept of quaternary prevention, and its anthropological dimensions.

Dietary transition and obesity in selected Arabicspeaking countries: a review of the current evidence

Escalating obesity rates have become a significant public health problem in the Middle East and North Africa (MENA) region and have been associated with shifts towards a westernized diet. This integrative review aimed to examine the current dietary trends and transitions and their association with obesity in Arabic-speaking countries of the MENA region. Relevant databases were searched for studies in MENA countries between 1998 and 2014 that investigated obesity trends and changes in dietary patterns at the regional level in all age groups. A total of 39 articles fulfilled the inclusion criteria. All the articles noted that obesity was increasingly prevalent and that there was a significant dietary shift away from traditional dietary patterns; 51% reported a shift towards a westernized diet and half found that the western diet was correlated with increased obesity. Culturally relevant dietary health education and health promotion strategies are warranted to address both the dietary shifts towards the westernized diet and the increasing obesity.

Tin-carbon clusters and the onset of microscopic level immiscibility: Experimental and computational study

We report the experimental observation and computational analysis of the binary tin-carbon gas phase species. These novel ionic compounds are generated by impact of C60(-) anions on a clean tin target at some kiloelectronvolts kinetic energies. Positive Sn(m)C(n)(+) (m = 1-12, 1 ≤ n ≤ 8) ions were detected mass spectrometrically following ejection from the surface. Impact induced shattering of the C60(-) ion followed by sub-surface penetration of the resulting atomic carbon flux forces efficient mixing between target and projectile atoms even though the two elements (Sn/C) are completely immiscible in the bulk. This approach of C60(-) ion beam induced synthesis can be considered as an effective way for producing novel metal-carbon species of the so-called non-carbide forming elements, thus exploring the possible onset of molecular level miscibility in these systems. Sn2C2(+) was found to be the most abundant carbide cluster ion. Its instantaneous formation kinetics and its measured kinetic energy distribution while exiting the surface demonstrate a single impact formation/emission event (on the sub-ps time scale). Optimal geometries were calculated for both neutral and positively charged species using Born-Oppenheimer molecular dynamics for identifying global minima, followed by density functional theory (DFT) structure optimization and energy calculations at the coupled cluster singles, doubles and perturbative triples [CCSD(T)] level. The calculated structures reflect two distinct binding tendencies. The carbon rich species exhibit polyynic/cummulenic nature (tin end capped carbon chains) while the more stoichiometrically balanced species have larger contributions of metal-metal bonding, sometimes resulting in distinct tin and carbon moieties attached to each other (segregated structures). The Sn2C(n) (n = 3-8) and Sn2C(n)(+) (n = 2-8) are polyynic/cummulenic while all neutral Sn(m)C(n) structures (m = 3-4) could be described as small tin clusters (dimer, trimer, and tetramer, correspondingly) attached to a nearly linear carbon chain. For example, the 1:1 (Sn:C) Sn3C3 and Sn4C4 clusters are composed of all-tin triangle and rhombus, correspondingly, with a short carbon chain (C3, C4) attached on top. The cationic Sn3C(n)(+) (n = 1-5) and Sn4C(n)(+) (n = 1-4) species exhibit various intermediate geometries. Structure calculations at the CCSD(T) level are essential since the segregation effect is not as easily evident based on the most stable structures calculated by DFT alone. Dependences of bond energies (per atom) reflect the evolution of the segregation effect. The mass spectral abundances could be reasonably rationalized in terms of calculated stabilities of the cluster ions with respect to various dissociation channels.

Endoscopic ultrasound-guided fine-needle aspiration biopsy of autoimmune pancreatitis: diagnostic clues and pitfalls

INTRODUCTION

Autoimmune pancreatitis (AIP) is an inflammatory process that has characteristic clinical, radiographic, and pathologic features but may mimic pancreatic malignancy. In this study, we reviewed our experience in the endoscopic ultrasound-guided fine-needle aspiration evaluation of pancreatic lesions in patients with AIP.

MATERIALS AND METHODS

We searched the cytopathology archives and identified a total of 6 cases that had endoscopic ultrasound-guided fine-needle aspiration evaluation and subsequent tissue biopsy or resection with a diagnosis of AIP. The clinical, cytologic, and histopathologic features were reviewed.

RESULTS

The original cytologic diagnoses included negative, atypical, and suspicious for malignancy in 2 cases each. On retrospective review, these cases were characterized cytologically by the presence of mixed epithelial cells, mixed lymphocytes, and plasma cells, as well as cellular stromal fragments. Cytologic atypia of epithelial cells was observed in 4 of 6 cases, including mild (3 cases) and moderate (1 case) atypia. KRAS mutation analysis was performed in 4 cases with an indeterminate cytology diagnosis, which was negative in all cases.

CONCLUSIONS

Our results demonstrate that the presence of trilineage epithelial, lymphoplasmacytic, and stromal elements may be suggestive but not definitive for a diagnosis of AIP. The role of KRAS mutation analysis in AIP remains inconclusive and may warrant further evaluation.

Direct experimental observation of a new mechanism for sputtering of solids by a large polyatomic projectile: velocity-correlated cluster emission

We have measured kinetic energy distributions of Ta(n)C(n)(+) (n=1-10) and Ag(n)(+) (n=1-9) cluster ions sputtered off Ta and Ag targets, following impact of C(60)(-) at 14 keV kinetic energy. A gradual increase of the most probable kinetic energies with increased size of the emitted cluster was observed (nearly the same velocity for all n values). This behavior is in sharp contrast to that reported for cluster emission induced by the impact of a monoatomic projectile. Our observation is in good agreement with a mechanism based on the new concept of a superhot moving precursor as the source of the emitted clusters.

Tall cell variant of papillary thyroid microcarcinoma: clinicopathologic features with BRAF(V600E) mutational analysis

BACKGROUND

The tall cell variant of papillary thyroid carcinoma is an aggressive subtype that generally presents as a large tumor in the advanced stage; however, little is known about the tall cell variant of microcarcinoma (tumors measuring <1 cm). In this study, we compare the tall cell variant of microcarcinoma (microTCV) with classic papillary microcarcinomas to examine the hypothesis that, despite the small size, the microTCV may be more aggressive than the classic papillary microcarcinoma.

METHODS

We identified 27 microTCV patients and compared their clinicopathologic features and BRAF(V600E) mutational status with classic papillary microcarcinomas matched by age and size. The patients with microTCV included 22 women and 5 men aged 33 to 74 years (median age, 56 years). All patients underwent total thyroidectomy; 20 patients had lymph node dissection.

RESULTS

Tumor size in microTCV patients ranged from 2 mm to 10 mm (median, 7 mm). Extrathyroidal extension and lymphovascular invasion were seen in 9 (33%) and 4 (15%) tumors, respectively. Thirteen patients (48%) harbored multifocal papillary carcinomas. Metastasis to central compartment lymph nodes was seen in 8 patients and to lateral cervical nodes in 3 patients. Nine of the 25 patients (36%) presented at an advanced stage (stage III/IVA). The BRAF(V600E) mutation was detected in 25 of 27 tumors (92.6%). In contrast, age- and size-matched classic papillary microcarcinomas (n=26) showed no extrathyroidal extension (p=0.002), lymphovascular invasion in 1, central compartment lymph node metastasis in 2, lateral cervical node metastasis in 1, multifocal tumors in 10 (38.5%), the BRAF(V600E) mutation in 20 (76.9%), and it infrequently presented in stage III/IVA (7.7%, p=0.02).

CONCLUSIONS

The microTCV form is associated with aggressive features at presentation, and it should be differentiated from other papillary thyroid microcarcinomas.

Review of Eastern coral snake (Micrurus fulvius fulvius) exposures managed by the Florida Poison Information Center Network: 1998-2010

CONTEXT

Envenomation by the Eastern coral snake is rare but may be associated with significant morbidity. While effective, acquisition of North American Coral Snake Antivenin (NACSAV) is difficult because production was discontinued for many years.

OBJECTIVE

The purpose of this study is to characterize coral snake exposures in Florida and determine the effects of varying treatment paradigms on patient outcomes.

METHODS

This study is an observational case series of cases received at Florida poison centers. Included cases were Eastern coral snake exposures occurring between January 1, 1998 and October 31, 2010. Excluded cases included those found to be unrelated or those not followed for at least 24 h post envenomation. Case comments were reviewed to obtain data. Comparisons were made between asymptomatic patients receiving empiric antivenom therapy (empiric group) and those asymptomatic patients who received antivenom upon developing signs of systemic envenomation (withhold group).

RESULTS

Of the 553 cases identified, 387 were included in the final analysis. According to case comments, 56.3% of patients had no reported systemic symptoms. Most commonly, patients were reported to have pain (40.6%), paresthesias (28.4%), nausea (12.7%), and emesis (11.4%). NACSAV was administered to 252 patients (65%). Of those patients receiving NACSAV, 18.25% were reported to have had an adverse reaction. Patients in the withhold group (n = 106) had significantly fewer minor, moderate, and major outcomes than patients in the empiric group (n = 134, p < 0.01).

DISCUSSION

While patients in the withhold group had favorable outcomes compared with those in the empiric group, this strategy cannot be applied to all patients presenting asymptomatic to healthcare facilities due to study limitations.

CONCLUSION

Further studies are needed to determine what treatment strategy is most appropriate for asymptomatic patients presenting to healthcare facilities.