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Zhang D, Fan H, Liu X, Wang S, Lang X, Ma W, Pang Y. Multiple Bowen's disease due to long-term narrow-band ultraviolet B phototherapy: A case report and literature review. J Cosmet Dermatol 2024; 23:1583-1587. [PMID: 38279518 DOI: 10.1111/jocd.16189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE By presenting a case study on multiple instances of Bowen's disease and the consistent use of narrow-band ultraviolet B (NB-UVB) phototherapy over a three-year period, our aim is to enhance the comprehension of domestic clinicians regarding the disease. Additionally, we seek to review existing literature, encouraging dermatologists to consider clinical secondary primary lesion diagnoses. METHOD Our approach involves analyzing a diagnosed case of multiple Bowen's disease, examining clinical manifestations, histopathology, imaging results, and treatment methods related to NB-UVB phototherapy. We aim to facilitate discussion and understanding through a comprehensive literature analysis. RESULTS An elderly male with a 30-year history of psoriasis vulgaris initiated continuous NB-UVB therapy three years ago. A year later, he developed red patches and plaques with distinct borders and scaly surfaces on his face, trunk, lower extremities, and scrotum. Histopathological examination confirmed Bowen's disease. Treatment involved liquid nitrogen cryotherapy, with no recurrence observed during the one-year follow-up. CONCLUSION This case highlights that Bowen's disease, typically solitary, can manifest as multiple instances, especially in individuals with a history of psoriasis vulgaris. While NB-UVB stands as the primary treatment for psoriasis vulgaris, caution is warranted due to the potential risk of skin tumor induction with prolonged high-dose usage. Clinicians should be vigilant in monitoring and assessing the long-term implications of such therapies.
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Affiliation(s)
- Dong Zhang
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Huiping Fan
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xuankai Liu
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Shuai Wang
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Xiaoqiao Lang
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Weiyuan Ma
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
| | - Yunyan Pang
- Department of Dermatology, Affiliated Hospital of Weifang Medical University, Weifang, China
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Barg M, Melamed B, Aviram A, Mei-Dan E, Barrett J, Melamed N. Risk of intrapartum cesarean delivery in twin pregnancies: A retrospective cohort study. Int J Gynaecol Obstet 2024. [PMID: 38654541 DOI: 10.1002/ijgo.15557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/04/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE To compare the risk of intrapartum cesarean delivery (CD) between patients with twin and singleton pregnancies undergoing a trial of labor and identify risk factors for intrapartum CD in twin pregnancies. METHODS The present study was a retrospective cohort study of patients with a twin or singleton pregnancy who underwent a trial of labor at ≥340/7 weeks in a single center (2015-2022). The primary outcome was the rate of intrapartum CD. In twin pregnancies, this outcome was limited to CD of both twins. The association of plurality with intrapartum CD was estimated using multivariable Poisson regression. RESULTS A total of 20 754 patients met the study criteria, 669 of whom had a twin pregnancy. Patients with twins had a greater risk of intrapartum CD (of both twins) than those with singleton pregnancies (22.1% vs 15.9%, respectively; aRR 1.38 [95% CI: 1.15-1.66]), primarily due to a greater risk of failure to progress. In addition, 4.1% of the twin pregnancies had a CD for the second twin, resulting in an overall CD rate in twin pregnancies of 26.2%. Variables associated with intrapartum CD in twin pregnancies included nulliparity (aOR 3.50, 95% CI: 2.34-5.25), birthweight discordance >20% (aOR 2.47, 95% CI: 1.27-4.78), and labor induction (aOR 1.64, 95% CI: 1.07-2.53). The rate of intrapartum CD was highest when all three risk factors were present (67% [95% CI: 41%-87%]). CONCLUSION Twin pregnancies are associated with a greater risk of intrapartum CD than singleton pregnancies. Information on the individualized risk of intrapartum CD may be valuable when counseling patients with twins regarding mode of delivery.
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Affiliation(s)
- Moshe Barg
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Ben Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, Toronto, Ontario, Canada
| | - Amir Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Elad Mei-Dan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, Toronto, Ontario, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
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Martínez-Varea A, Prasad S, Domenech J, Kalafat E, Morales-Roselló J, Khalil A. Association of fetal growth restriction and stillbirth in twin compared with singleton pregnancies. Ultrasound Obstet Gynecol 2024. [PMID: 38642338 DOI: 10.1002/uog.27661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 03/02/2024] [Accepted: 03/18/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE Twin pregnancies are at an increased risk of stillbirth compared to singletons. Fetal growth restriction (FGR) is a leading cause of perinatal mortality and morbidity, in both singleton and multiple pregnancies. Whether the contribution of FGR to stillbirth in twin pregnancies differs from that in singletons is yet to be determined. The main aim of this study was to determine the association between FGR and stillbirth in twin compared to singleton pregnancies. The secondary objectives include an assessment of the contribution of FGR to stillbirths, stratified by gestational age at delivery. Furthermore, we aimed to compare the association between FGR and stillbirth in twin pregnancies using the twin-specific versus singleton birthweight charts, stratified by chorionicity. METHODS This was a cross-sectional study including pregnancies receiving obstetric care and birth at St George's Hospital, London. The exclusion criteria included triplet and higher order pregnancies, those resulting in miscarriage or livebirths at or prior to 23+6 weeks, or had a termination of pregnancy, or with missing data on the gestational age at birth. FGR and small for gestational age (SGA) were defined as birthweight <5th and <10th centile, respectively. While standard logistic regression was used for singleton pregnancies, the association of FGR and SGA designation with stillbirth in twin pregnancies was investigated with mixed-effects logistic regression models. For twin pregnancies, intercepts were allowed to vary for twin pairs to account for inter-twin dependency. Analyses were stratified by gestational age at delivery and chorionicity. RESULTS The study included 95,342 singleton and 3,576 twin pregnancies. There were 494 (0.52%) stillbirths in singleton and 41 (1.15%) stillbirths in twin pregnancies (17 dichorionic and 24 monochorionic). FGR and SGA were significantly associated with stillbirth in singleton pregnancies, across all gestational ages at delivery (before 32 weeks- SGA: OR 2.36; 95% CI 1.78-3.13, p<0.001 and FGR: OR 2.67; 95% CI 2.02- 3.55, p<0.001; between 32-36 weeks- SGA: OR 2.70; 95% CI 1.71-4.31, p<0.001 and FGR: OR 2.82; 95% CI 1.78- 4.47, p<0.001; above 36 weeks- SGA: OR 3.85; 95% CI 2.83 - 5.21, p<0.001 and FGR: OR 4.43; 95% CI 3.16 - 6.12, p<0.001) A greater proportion of fetuses from twin pregnancies were diagnosed as SGA and FGR when singleton compared to the twin-specific chart was used (48.43% vs. 9.12%, and 36.73% vs. 6.23%, respectively). When stratified by gestational age at delivery, both SGA and FGR determined by the twin-specific charts were associated with significantly increased odds of having a stillbirth for those delivered before 32 weeks (SGA: OR 3.87; 95% CI 1.56-9.50, p=0.003 and FGR: OR 5.26; 95% CI 2.11-13.01, p<0.001), those delivered between 32-36 weeks (SGA: OR 6.67; 95% CI 2.11-20.41, p=0.001 and FGR: OR 9.54; 95% CI 3.01-29.40, p<0.001) and those delivered beyond 36 weeks (SGA: OR 12.68 95% CI 2.47-58,15, p=0.001 and FGR: OR 23.84; 95% CI 4.62-110.25, p<0.001), whereas the association of stillbirth with either SGA or FGR was inconsistent when analysed using singleton charts (before 32 weeks- SGA: p=0.014 and FGR: p=0.005; between 32-36 weeks- SGA: p=0.036 and FGR: p=0.008; above 36 weeks- SGA: p=0.080 and FGR: p=0.063). For dichorionic twins delivered before 32 weeks, the odds of an SGA or FGR fetus having a stillbirth was increased when analysed using twin-specific charts. In contrast, monochorionic twins delivered before 32 weeks showed lower and non-significant associations with stillbirth for both SGA and FGR cases using either twin-specific or singleton charts. In dichorionic twin pregnancies delivered between 32-36 weeks, the OR for stillbirth of SGA using twin birthweight chart was 6.70 (95% CI 0.80-56.46, p=0.059), and using singleton chart was 0.92 (95% CI 0.11-7.71, p=0.934) and statistically non-significant. Similarly, the OR for stillbirth of FGR using twin birthweight chart and singleton chart was 9.59 (95% CI 1.14-81.06, p=0.025), and 1.40 (95% CI 0.17-11.76, p=0.735), respectively. On the other hand, in monochorionic twin pregnancies delivered between 32-36 weeks, the OR for stillbirth of SGA and FGR using twin birthweight chart was 9.37 (95% CI 2.20- 37.72, p=0.001), and 13.55 (95% CI 3.12 - 55.94 p < 0.001) respectively. CONCLUSIONS Our study demonstrates a significant association between SGA, particularly for FGR, with increased odds of stillbirths in singleton pregnancies across all gestational ages. For twin pregnancies, when twin-specific charts were used, SGA and in particular FGR were associated with a significantly increased risk of stillbirth, across all gestational ages at delivery. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- A Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - S Prasad
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - J Domenech
- Department of Economics and Social Sciences, Universitat Politecnica de Valencia, Valencia, Spain
| | - E Kalafat
- Department of Obstetrics and Gynecology, Koc University Hospital, Istanbul, Turkey
| | - J Morales-Roselló
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Twin and Multiple Pregnancy Centre for Research and Clinical Excellence, St George's University Hospital, St George's University of London, London, UK
- Fetal Medicine Unit, Liverpool Women's Hospital, Liverpool, UK
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Qian W, Chen Y, Zhu Q, Chen A, Lan Q. Microsurgical clipping of multiple intracranial aneurysms via the keyhole approach. World Neurosurg 2024:S1878-8750(24)00638-7. [PMID: 38642836 DOI: 10.1016/j.wneu.2024.04.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 04/12/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Keyhole surgery has been widely used to clip various intracranial aneurysms. Here, the feasibility of microsurgical clipping of multiple intracranial aneurysms via the keyhole approach was further investigated. METHODS The clinical data of 80 patients with multiple intracranial aneurysms treated with keyhole surgery were retrospectively analyzed. The patients included 25 males and 55 females, with an average age of 57.5 years. There were 13 patients with unruptured aneurysms, 67 patients with ruptured aneurysms (small aneurysms accounted for 52.2% of ruptured aneurysms), and a total of 198 aneurysms. A 4 cm incision and a bone hole of approximately 2.5 cm were used, per craniotomy standards. Forty-eight cases were treated via the supraorbital keyhole approach, 45 cases via the pterional keyhole approach, and three cases via the interhemispheric keyhole approach. RESULTS A bilateral and unilateral keyhole approach was applied in 18 and 62 cases, respectively. A total of 170 ipsilateral and 7 contralateral aneurysms were clipped. The complete clipping rate was 98.9%. During the follow-up period of 6-12 months after surgery, the Glasgow outcome scale score was 5 points in 74 cases, 4 points in five cases, and 3 points in one case. The prognosis was associated with the preoperative Hunt-Hess classification but not with the number of operative sides, the operation opportunity, or the number of clipped aneurysms. CONCLUSION Early keyhole surgical clipping of multiple intracranial aneurysms is an effective treatment. Among ruptured aneurysms, small aneurysms are common and need attention and timely treatment.
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Hendricks LAJ, Verbeek KCJ, Schuurs-Hoeijmakers JHM, Mensenkamp AR, Brems H, de Putter R, Anastasiadou VC, Villy MC, Jahn A, Steinke-Lange V, Baldassarri M, Irmejs A, de Jong MM, Links TP, Leter EM, Bosch DGM, Høberg-Vetti H, Tveit Haavind M, Jørgensen K, Mæhle L, Blatnik A, Brunet J, Darder E, Tham E, Hoogerbrugge N, Vos JR. Lifestyle Factors and Breast Cancer in Females with PTEN Hamartoma Tumor Syndrome (PHTS). Cancers (Basel) 2024; 16:953. [PMID: 38473316 DOI: 10.3390/cancers16050953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/15/2024] [Accepted: 02/17/2024] [Indexed: 03/14/2024] Open
Abstract
Females with PTEN Hamartoma Tumor Syndrome (PHTS) have breast cancer risks up to 76%. This study assessed associations between breast cancer and lifestyle in European female adult PHTS patients. Data were collected via patient questionnaires (July 2020-March 2023) and genetic diagnoses from medical files. Associations between lifestyle and breast cancer were calculated using logistic regression corrected for age. Index patients with breast cancer before PHTS diagnosis (breast cancer index) were excluded for ascertainment bias correction. In total, 125 patients were included who completed the questionnaire at a mean age of 44 years (SD = 13). This included 21 breast cancer indexes (17%) and 39 females who developed breast cancer at 43 years (SD = 9). Breast cancer patients performed about 1.1 times less often 0-1 times/week physical activity than ≥2 times (ORtotal-adj = 0.9 (95%CI 0.3-2.6); consumed daily about 1.2-1.8 times more often ≥1 than 0-1 glasses of alcohol (ORtotal-adj = 1.2 (95%CI 0.4-4.0); ORnon-breastcancer-index-adj = 1.8 (95%CI 0.4-6.9); were about 1.04-1.3 times more often smokers than non-smokers (ORtotal-adj = 1.04 (95%CI 0.4-2.8); ORnon-breastcancer-index-adj = 1.3 (95%CI 0.4-4.2)); and overweight or obesity (72%) was about 1.02-1.3 times less common (ORtotal-adj = 0.98 (95%CI 0.4-2.6); ORnon-breastcancer-index-adj = 0.8 (95%CI 0.3-2.7)). Similar associations between lifestyle and breast cancer are suggested for PHTS and the general population. Despite not being statistically significant, results are clinically relevant and suggest that awareness of the effects of lifestyle on patients' breast cancer risk is important.
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Affiliation(s)
- Linda A J Hendricks
- Department of Human Genetics, Radboudumc Expert Center for PHTS, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Institute for Medical Innovation, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Katja C J Verbeek
- Department of Human Genetics, Radboudumc Expert Center for PHTS, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Institute for Medical Innovation, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Janneke H M Schuurs-Hoeijmakers
- Department of Human Genetics, Radboudumc Expert Center for PHTS, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Arjen R Mensenkamp
- Department of Human Genetics, Radboudumc Expert Center for PHTS, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Institute for Medical Innovation, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Hilde Brems
- Department of Human Genetics, University of Leuven, 3000 Leuven, Belgium
| | - Robin de Putter
- Center for Medical Genetics, Ghent University Hospital, 9000 Ghent, Belgium
| | - Violetta C Anastasiadou
- Karaiskakio Foundation, Nicosia Cyprus and Archbishop Makarios III Children's Hospital, Nicosia 2012, Cyprus
| | | | - Arne Jahn
- Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Technische Universitat Dresden, 01062 Dresden, Germany
- Hereditary Cancer Syndrome Center Dresden, 01307 Dresden, Germany
- German Cancer Consortium (DKTK), 69120 Dresden, Germany
| | - Verena Steinke-Lange
- Medical Genetics Center, 80335 Munich, Germany
- Arbeitsgruppe Erbliche Gastrointestinale Tumore, Medizinische Klinik und Poliklinik IV-Campus Innenstadt, Klinikum der Universität München, 81377 Munich, Germany
| | - Margherita Baldassarri
- Medical Genetics, University of Siena, 53100 Siena, Italy
- Med Biotech Hub and Competence Center, Department of Medical Biotechnologies, University of Siena, 53100 Siena, Italy
- Genetica Medica, Azienda Ospedaliero-Universitaria Senese, 53100 Siena, Italy
| | - Arvids Irmejs
- Institute of Oncology, Riga Stradins University, 1007 Riga, Latvia
- Breast Unit, Pauls Stradins Clinical University Hospital, 1002 Riga, Latvia
| | - Mirjam M de Jong
- Department of Genetics, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Thera P Links
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Edward M Leter
- Department of Clinical Genetics, Maastricht University Medical Center, 6229 ER Maastricht, The Netherlands
| | - Daniëlle G M Bosch
- Department of Clinical Genetics, Erasmus MC Rotterdam, 3015 GD Rotterdam, The Netherlands
| | - Hildegunn Høberg-Vetti
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, 5021 Bergen, Norway
| | - Marianne Tveit Haavind
- Western Norway Familial Cancer Center, Department of Medical Genetics, Haukeland University Hospital, 5021 Bergen, Norway
| | - Kjersti Jørgensen
- Department of Medical Genetics, Oslo University Hospital, 0450 Oslo, Norway
| | - Lovise Mæhle
- Department of Medical Genetics, Oslo University Hospital, 0450 Oslo, Norway
| | - Ana Blatnik
- Department of Clinical Cancer Genetics, Institute of Oncology Ljubljana, 1000 Ljubljana, Slovenia
| | - Joan Brunet
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL-IDIBGI, 08916 Barcelona, Spain
| | - Esther Darder
- Hereditary Cancer Program, Catalan Institute of Oncology, IDIBELL-IDIBGI, 08916 Barcelona, Spain
| | - Emma Tham
- Department of Clinical Genetics, Karolinska University Hospital, 14186 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institute, 17177 Stockholm, Sweden
| | - Nicoline Hoogerbrugge
- Department of Human Genetics, Radboudumc Expert Center for PHTS, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Institute for Medical Innovation, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Janet R Vos
- Department of Human Genetics, Radboudumc Expert Center for PHTS, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
- Radboud Institute for Medical Innovation, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
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Kim JH, Lee JH, Sim YJ, Kim GC, Jeong HJ. Uropathogenic distribution and antibiotic resistance patterns according to multidrug-resistant bacteria colonization status in patients with stroke. Medicine (Baltimore) 2024; 103:e36980. [PMID: 38277567 PMCID: PMC10817124 DOI: 10.1097/md.0000000000036980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024] Open
Abstract
Urinary tract infections (UTI) are common in patients with stroke. The colonization of multidrug-resistant organisms (MDR) has recently become a global issue, and infection with MDR is associated with a poorer prognosis. This study aimed to investigate the uropathogenic distribution in stroke patients according to MDR colonization and investigate the infection risk and antibiotic resistance of each uropathogen to help determine initial antibiotic treatment. This study is a retrospective study conducted on patients who underwent inpatient treatment for stroke at Kosin University Gospel Hospital in 2019 to 2021. The participants were classified into Group VRE if vancomycin-resistant Enterococcus (VRE) colonization was confirmed, Group CRE if carbapenem-resistant Enterobacteriaceae (CRE) colonization was confirmed, and Group Negative if no MDR colonization was confirmed. Urine culture was performed if symptomatic UTI was suspected. Uropathogenic distribution, antibiotic resistance patterns were assessed by one-way analysis of variance, independent t-test, and Pearson chi-square test. And the infection risk factors for each uropathogen were assessed by multinomial logistic regression analysis. Six hundred thirty-three participants were enrolled. The mean age of all participants was 69.77 ± 14.91, with 305 males and 328 females, including 344 hemorrhagic strokes and 289 ischemic strokes. No growth in urine culture was the most common finding (n = 281), followed by Escherichia coli (E.coli) (n = 141), and Enterococcus spp. (n = 80). Group Negative had significantly more cases of no growth in urine culture than Group VRE (Odds ratio [OR], 11.698; 95% confidence interval [CI], 3.566-38.375; P < .001) and than Group CRE (OR, 11.381; 95% CI, 2.665-48.611; P < .001). Group VRE had significantly more E.coli (OR, 2.905; 95% CI, 1.505-5.618; P = .001), and more Enterococcus (OR, 4.550; 95% CI, 2.253-9.187; P < .001) than Group Negative. There was no statistical difference in antibiotic resistance according to MDR colonization in E coli, but for Enterococcus spp., Group VRE and CRE showed significantly more resistance to numerous antibiotics than Group Negative. MDR colonization increases the risk of UTI and is associated with greater antibiotic resistance. For appropriate administration of antibiotics in UTI, continuous monitoring of the latest trends in uropathogenic distribution is required, and clinicians should pay more attention to the use of initial empirical antibiotics in patients with MDR colonization.
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Affiliation(s)
- Ju Hyeon Kim
- Department of Physical Medicine and Rehabilitation, Kosin University Gospel Hospital, Busan, Korea
| | - Jae Hyun Lee
- Department of Physical Medicine and Rehabilitation, Kosin University Gospel Hospital, Busan, Korea
| | - Young-Joo Sim
- Department of Physical Medicine and Rehabilitation, Kosin University Gospel Hospital, Busan, Korea
| | - Ghi Chan Kim
- Department of Physical Medicine and Rehabilitation, Kosin University Gospel Hospital, Busan, Korea
| | - Ho Joong Jeong
- Department of Physical Medicine and Rehabilitation, Kosin University Gospel Hospital, Busan, Korea
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Kassi L, Lantos E, Sheran J, Yee LM. A Spontaneous Tubal Heterotopic Triplet Pregnancy Resulting in Viable Twin Deliveries. AJP Rep 2024; 14:e7-e10. [PMID: 38269124 PMCID: PMC10805573 DOI: 10.1055/a-2201-5796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 10/20/2023] [Indexed: 01/26/2024] Open
Abstract
There are limited U.S. reports of spontaneous triplet heterotopic pregnancies discussing both maternal and fetal outcomes. A 34-year-old patient at 7 weeks of gestation presented to the emergency department with abdominal pain. She was diagnosed with a spontaneous heterotopic triplet pregnancy, consisting of a twin monochorionic-diamniotic intrauterine gestation and a ruptured left ectopic pregnancy. She underwent a laparoscopic unilateral salpingectomy. Her antepartum course was complicated by gestational diabetes mellitus and fetal growth restriction. Delivery of liveborn twins was via a cesarean delivery at 32 weeks. Timely intervention and management of a ruptured spontaneous triplet heterotopic pregnancy can result in a viable twin delivery with overall favorable maternal and newborn outcomes, although long-term implications due to prematurity and other twin sequelae exist.
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Affiliation(s)
- Luce Kassi
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Emma Lantos
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jordan Sheran
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lynn M. Yee
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Fresch R, Stephens K, DeFranco E. The Combined Influence of Maternal Medical Conditions on the Risk of Primary Cesarean Delivery. AJP Rep 2024; 14:e51-e56. [PMID: 38269123 PMCID: PMC10805565 DOI: 10.1055/s-0043-1777996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 10/22/2023] [Indexed: 01/26/2024] Open
Abstract
Background Common maternal medical comorbidities such as hypertensive disorders, diabetes, tobacco use, and extremes of maternal age, body mass index, and gestational weight gain are known individually to influence the rate of cesarean delivery. Numerous studies have estimated the risk of individual conditions on cesarean delivery. Objective To examine the risk for primary cesarean delivery in women with multiple maternal medical comorbidities to determine the cumulative risk they pose on mode of delivery. Study Design In this population-based retrospective cohort study, we analyzed data from Ohio live birth records from 2006 to 2015 to estimate the influence of individual and combinations of maternal comorbidities on rates of singleton primary cesarean delivery. The exposures were individual and combinations of maternal medical conditions (chronic hypertension [CHTN], gestational hypertension, pregestational diabetes, gestational diabetes, tobacco use, advanced maternal age, and maternal obesity) and outcomes were rates and adjusted relative risk (aRR) of primary cesarean delivery. Results There were 1,463,506 live births in Ohio during the study period, of which 882,423 (60.3%) had one or more maternal medical condition, and of those 243,112 (27.6%) had primary cesarean delivery. The range of rates and aRR range of primary cesarean delivery were 13.9 to 29.3% (aRR 0.78-1.68) in singleton pregnancies with a single medical condition, and this increased to 21.9 to 48.6% (aRR 1.34-3.87) in pregnancies complicated by multiple medical comorbidities. The highest risk for primary cesarean occurred in advanced maternal age, obese women with pregestational diabetes, and CHTN. Conclusion A greater number of maternal medical comorbidities during pregnancy is associated with increasing cumulative risk of primary cesarean delivery. These data may be useful in counseling patients on risk of cesarean during pregnancy.
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Affiliation(s)
- Robert Fresch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Kendal Stephens
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Emily DeFranco
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Cincinnati College of Medicine, Cincinnati, Ohio
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Dawgiałło M, Zasztowt-Sternicka M, Jagielska A, Kuthan R, Kanecki K, Nitsch-Osuch A. Colonization with drug-resistant pathogens among patients in long-term care facilities and under home hospice care - a cross-sectional study. Ann Agric Environ Med 2023; 30:606-610. [PMID: 38153061 DOI: 10.26444/aaem/166465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION AND OBJECTIVE The spread of drug-resistant bacteria is deemed a worldwide threat. Patients in long-term care, including those under palliative care, are exposed to a high risk of colonization and infection with drug-resistant pathogens. This refers primarily to long-term care facilities as opposed to home care. A cross-sectional study was carried out between 1 January 2018 - 30 June 2019. The study was approved by the Bioethics Committee at the Medical University of Warsaw (KB/222/2017). OBJECTIVE The aim of the study was to assess the frequency and type of colonization with drug-resistant pathogens among patients in long-term care facilities and those under home hospice care. An additional aim was evaluation the risk of pathogen transmission according to the type of provided long-term care. MATERIAL AND METHODS The study included 129 participants: 68 patients under the care of 3 long-term care facilities in Warsaw, Poland, 42 patients under home hospice care, and 19 household members of hospice patients. All included participants provided written informed consent. Oropharyngeal and rectal swabs were obtained from all participants for microbiological assessment. RESULTS Colonization with pathogens was more common in long-term care facilities residents (82.4%) than in at-home hospice patients (42.9%). Risk of colonization was significantly lower in patients staying at home than in long-term care facilities patients (OR 0.16; 95% CI 0.06-0.38). CONCLUSIONS Conclusions. Risk of colonization with drug-resistant pathogens depends on the type of care and is significantly higher in patients staying at long-term care facilities. Systemic measures, such as microbiological screening, are necessary to provide optimal patient care and to ensure epidemiological safety, both to patients and their caregivers.
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Affiliation(s)
- Magdalena Dawgiałło
- Department of Social Medicine and Public Health, Medical University, Warsaw, Poland
| | - Monika Zasztowt-Sternicka
- Department of Social Medicine and Public Health, Medical University, Warsaw, Poland
- Doctoral School, Medical University, Warsaw, Poland
| | - Anna Jagielska
- Department of Social Medicine and Public Health, Medical University, Warsaw, Poland
| | - Robert Kuthan
- Department of Medical Microbiology, Medical University, Warsaw, Poland
| | - Krzysztof Kanecki
- Department of Social Medicine and Public Health, Medical University, Warsaw, Poland
| | - Aneta Nitsch-Osuch
- Department of Social Medicine and Public Health, Medical University, Warsaw, Poland
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10
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Berezowsky A, Ardestani S, Hiersch L, Shah BR, Berger H, Halperin I, Retnakaran R, Barrett J, Melamed N. Glycemic control and neonatal outcomes in twin pregnancies with gestational diabetes mellitus. Am J Obstet Gynecol 2023; 229:682.e1-682.e13. [PMID: 37393013 DOI: 10.1016/j.ajog.2023.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/23/2023] [Accepted: 06/26/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Preliminary data suggest that strict glycemic control in twin pregnancies with gestational diabetes mellitus may not improve outcomes but might increase the risk of fetal growth restriction. OBJECTIVE This study aimed to investigate the association of maternal glycemic control with the risk of gestational diabetes mellitus-related complications and small for gestational age in twin pregnancies complicated by gestational diabetes mellitus. STUDY DESIGN This was a retrospective cohort study of all patients with a twin pregnancy complicated by gestational diabetes mellitus in a single tertiary center between 2011 and 2020, and a matched control group of patients with a twin pregnancy without gestational diabetes mellitus in a 1:3 ratio. The exposure was the level of glycemic control, described as the proportion of fasting, postprandial, and overall glucose values within target. Good glycemic control was defined as a proportion of values within target above the 50th percentile. The first coprimary outcome was a composite variable of neonatal morbidity, defined as at least 1 of the following: birthweight >90th centile for gestational age, hypoglycemia requiring treatment, jaundice requiring phototherapy, birth trauma, or admission to the neonatal intensive care unit at term. A second coprimary outcome was small for gestational age, defined as birthweight <10th centile or <3rd centile for gestational age. Associations between the level of glycemic control and the study outcomes were estimated using logistic regression analysis and were expressed as adjusted odds ratio with 95% confidence interval. RESULTS A total of 105 patients with gestational diabetes mellitus in a twin pregnancy met the study criteria. The overall rate of the primary outcome was 32.4% (34/105), and the overall proportion of pregnancies with a small for gestational age newborn at birth was 43.8% (46/105). Good glycemic control was not associated with a reduction in the risk of composite neonatal morbidity when compared with suboptimal glycemic control (32.1% vs 32.7%; adjusted odds ratio, 2.06 [95% confidence interval, 0.77-5.49]). However, good glycemic control was associated with higher odds of small for gestational age compared with nongestational diabetes mellitus pregnancies, especially in the subgroup of diet-treated gestational diabetes mellitus (65.5% vs 34.0%, respectively; adjusted odds ratio, 4.17 [95% confidence interval, 1.74-10.01] for small for gestational age <10th centile; and 24.1% vs 7.0%, respectively; adjusted odds ratio, 3.97 [95% confidence interval, 1.42-11.10] for small for gestational age <3rd centile). In contrast, the rate of small for gestational age in gestational diabetes mellitus pregnancies with suboptimal control was not considerably different when compared with non-gestational diabetes mellitus pregnancies. In addition, in cases of diet-treated gestational diabetes mellitus, good glycemic control was associated with a left-shift of the distribution of birthweight centiles, whereas the distribution of birthweight centiles among gestational diabetes mellitus pregnancies with suboptimal control was similar to that of nongestational diabetes mellitus pregnancies. CONCLUSION In patients with gestational diabetes mellitus in a twin pregnancy, good glycemic control is not associated with a reduction in the risk of gestational diabetes mellitus-related complications but may increase the risk of a small for gestational age newborn in the subgroup of patients with mild (diet-treated) gestational diabetes mellitus. These findings further question whether the gestational diabetes mellitus glycemic targets used in singleton pregnancies also apply to twin pregnancies and support the concern that applying the same diagnostic criteria and glycemic targets in twin pregnancies may result in overdiagnosis and overtreatment of gestational diabetes mellitus and potential neonatal harm.
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Affiliation(s)
- Alexandra Berezowsky
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Shakiba Ardestani
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Liran Hiersch
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Baiju R Shah
- Division of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Howard Berger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - Ilana Halperin
- Department of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada; Division of Endocrinology, University of Toronto, Toronto, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
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Weitzner O, Barrett J, Murphy KE, Kingdom J, Aviram A, Mei-Dan E, Hiersch L, Ryan G, Van Mieghem T, Abbasi N, Fox NS, Rebarber A, Berghella V, Melamed N. National and international guidelines on the management of twin pregnancies: a comparative review. Am J Obstet Gynecol 2023; 229:577-598. [PMID: 37244456 DOI: 10.1016/j.ajog.2023.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/20/2023] [Accepted: 05/22/2023] [Indexed: 05/29/2023]
Abstract
Twin gestations are associated with increased risk of pregnancy complications. However, high-quality evidence regarding the management of twin pregnancies is limited, often resulting in inconsistencies in the recommendations of various national and international professional societies. In addition, some recommendations related to the management of twin gestations are often missing from the clinical guidelines dedicated to twin pregnancies and are instead included in the practice guidelines on specific pregnancy complications (eg, preterm birth) of the same professional society. This can make it challenging for care providers to easily identify and compare recommendations for the management of twin pregnancies. This study aimed to identify, summarize, and compare the recommendations of selected professional societies from high-income countries on the management of twin pregnancies, highlighting areas of both consensus and controversy. We reviewed clinical practice guidelines of selected major professional societies that were either specific to twin pregnancies or were focused on pregnancy complications or aspects of antenatal care that may be relevant for twin pregnancies. We decided a priori to include clinical guidelines from 7 high-income countries (United States, Canada, United Kingdom, France, Germany, and Australia and New Zealand grouped together) and from 2 international societies (International Society of Ultrasound in Obstetrics and Gynecology and the International Federation of Gynecology and Obstetrics). We identified recommendations regarding the following care areas: first-trimester care, antenatal surveillance, preterm birth and other pregnancy complications (preeclampsia, fetal growth restriction, and gestational diabetes mellitus), and timing and mode of delivery. We identified 28 guidelines published by 11 professional societies from the 7 countries and 2 international societies. Thirteen of these guidelines focus on twin pregnancies, whereas the other 16 focus on specific pregnancy complications predominantly in singletons but also include some recommendations for twin pregnancies. Most of the guidelines are recent, with 15 of the 29 guidelines published over the past 3 years. We identified considerable disagreement among guidelines, primarily in 4 key areas: screening and prevention of preterm birth, using aspirin to prevent preeclampsia, defining fetal growth restriction, and the timing of delivery. In addition, there is limited guidance on several important areas, including the implications of the "vanishing twin" phenomenon, technical aspects and risks of invasive procedures, nutrition and weight gain, physical and sexual activity, the optimal growth chart to be used in twin pregnancies, the diagnosis and management of gestational diabetes mellitus, and intrapartum care.This consolidation of key recommendations across several clinical practice guidelines can assist healthcare providers in accessing and comparing recommendations on the management of twin pregnancies and identifies high-priority areas for future research based on either continued disagreement among societies or limited current evidence to guide care.
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Affiliation(s)
- Omer Weitzner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | - Kellie E Murphy
- Ontario Fetal Centre, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - John Kingdom
- Ontario Fetal Centre, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Amir Aviram
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Elad Mei-Dan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, North York General Hospital, University of Toronto, Toronto, Canada
| | - Liran Hiersch
- Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Greg Ryan
- Ontario Fetal Centre, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Tim Van Mieghem
- Ontario Fetal Centre, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Nimrah Abbasi
- Ontario Fetal Centre, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Nathan S Fox
- Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY
| | - Andrei Rebarber
- Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY
| | - Vincenzo Berghella
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada.
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12
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Jang HG, Choi S, Noh OK, Hwang JH, Lee JH. Comparison of neonatal outcomes between multiples and singletons among very low birth weight infants: the Korean Neonatal Network cohort study. J Matern Fetal Neonatal Med 2023; 36:2245530. [PMID: 37558283 DOI: 10.1080/14767058.2023.2245530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/04/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023]
Abstract
OBJECTIVE To compare neonatal outcomes between multiples and singletons among very low birth weight infants, this was a prospective cohort study that was conducted by collecting data registered in the Korean Neonatal Network database. METHODS From January 2013 to December 2016, there were 8265 infants in the Korean Neonatal Network database, and 2958 of them were from multiples. Among them, 2636 infants were twins, 308 infants were triplets, and 14 infants were quadruplets. Maternal and neonatal variables including and mortality major morbidity were compared. Finally, the predicted rates of major morbidity between singletons and multiples. RESULTS Multiples had higher gestational age, birth weight, Apgar score at 5 min, rates of cesarean section and artificial reproductive technology but lower maternal hypertension, oligohydramnios, chorioamnionitis rates and Clinical Risk Index for Babies scores II without base excess than the singletons. In univariate analysis, multiples had a lower incidence of respiratory distress syndrome, bronchopulmonary dysplasia, and sepsis. The mortality rate was not significantly different for overall gestational ages except for those born at ≤26 weeks of gestation. In multivariate logistic analysis, the incidences of intraventricular hemorrhage (grade ≥3), and retinopathy of prematurity requiring treatment were significantly higher than the singletons. CONCLUSIONS Mortality was not significantly different between multiples and singletons according to overall gestational age, except for multiples born at ≤26 weeks. A significant higher risk of intraventricular hemorrhage and retinopathy of prematurity requiring treatment was found in multiples. A new strategy to improve the mortality of immature multiples born at ≤26 weeks of gestation should be developed.
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Affiliation(s)
- Hyeon Gu Jang
- Department of Pediatrics, Samcheok-si Public Health Center, Samcheok, South Korea
| | - Seoheui Choi
- Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea
| | - O Kyu Noh
- Department of Bioinformatics, Department of Radiation Oncology, Ajou University School of Medicine, Suwon, South Korea
| | - Jong Hee Hwang
- Department of Pediatrics, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, South Korea
| | - Jang Hoon Lee
- Department of Pediatrics, Ajou University School of Medicine, Suwon, South Korea
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13
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Aviram A, Barrett J, Mei-Dan E, Yoon EW, Melamed N. A prediction tool for mode of delivery in twin pregnancies-a secondary analysis of the Twin Birth Study. Am J Obstet Gynecol 2023:S0002-9378(23)02032-X. [PMID: 37979823 DOI: 10.1016/j.ajog.2023.11.1230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/12/2023] [Accepted: 11/13/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND One of the controversies regarding the management of twin gestations relates to the mode of delivery. Currently, counseling regarding the mode of delivery and the chance of successful vaginal twin delivery is based on the average risk for intrapartum cesarean delivery in the general population of twin pregnancies. Decision support tools that provide an individualized risk for intrapartum cesarean delivery based on the unique characteristics of each patient can improve counseling and decision-making regarding the choice of mode of delivery in twin pregnancies. OBJECTIVE This study aimed to develop and validate a prediction model to determine the risk for intrapartum cesarean delivery in twin pregnancies. STUDY DESIGN In this secondary analysis of the Twin Birth Study, a multicenter randomized controlled trial, we considered the subgroup of individuals who underwent a trial of vaginal delivery. Candidate predictors included maternal age, parity, previous cesarean delivery, conception method, chorionicity, diabetes and hypertension in pregnancy, gestational age at birth, the onset of labor, presentation of the second twin, sonographic fetal weight estimation, and fetal sex. The co-primary outcomes were overall intrapartum cesarean delivery and cesarean delivery of the second twin. Multivariable logistic regression models were used to estimate the probability of the study outcomes. Model performance was evaluated using measures of discrimination (the area under the receiver operating characteristic curve), calibration, and predictive accuracy. Internal validation was performed using the bootstrap resampling technique. RESULTS A total of 1221 individuals met the study criteria. The rate of overall intrapartum cesarean delivery and cesarean delivery for the second twin was 25.4% and 5.7%, respectively. The most contributory predictor variables were nulliparity, term birth (≥37 weeks), a noncephalic presentation of the second twin, previous cesarean delivery, and labor induction. The models for overall intrapartum cesarean delivery and cesarean delivery of the second twin had good overall discriminatory accuracy (area under the receiver operating characteristic curve, 0.720; 95% confidence interval, 0.688-0.752 and 0.736; 95% confidence interval, 0.669-0.803, respectively) and calibration (as illustrated by the calibration plot and Brier scores of 0.168; 95% confidence interval, 0.156-0.180 and 0.051; 95% confidence interval, 0.040-0.061, respectively). The models achieved good specificity (66.7% and 81.6%, respectively), high negative predictive value (86.0% and 96.9%, respectively), and moderate sensitivity (68.1% and 57.1%, respectively). CONCLUSION The prediction models developed in this study may assist care providers in counseling individuals regarding the optimal timing and mode of delivery in twin pregnancies by providing individualized estimates of the risk for intrapartum cesarean delivery.
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Affiliation(s)
- Amir Aviram
- Division of Maternal-Fetal Medicine, DAN Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada.
| | - Jon Barrett
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Elad Mei-Dan
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Ontario, Canada, (d)Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, Canada
| | - Eugene W Yoon
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, North York General Hospital, University of Toronto, Ontario, Canada, (d)Maternal-infant Care (MiCare) Research Centre, Mount Sinai Hospital, Toronto, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, DAN Women and Babies Program, Sunnybrook Health Sciences Centre, University of Toronto, Ontario, Canada
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Jain M, Varghese P, Kumar M, Baisakh M, Tripathy S. Two Discrete Intra-articular Synovial Hemangiomas of a Knee Joint Presenting as Chronic Knee Pain. J Orthop Case Rep 2023; 13:13-17. [PMID: 38025371 PMCID: PMC10664226 DOI: 10.13107/jocr.2023.v13.i11.3988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 09/03/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Synovial hemangioma (SH) is a rare benign soft-tissue tumor of vascular origin. That can be extraarticular, juxta-articular, or intraarticular. The knee joint is the most common joint involved. Symptoms can be variable and diagnosis can be made using magnetic resonance imaging. Differentials can be ruled out by biopsy and the gold standard treatment is complete excision of the lesion. Case Report A 20-year-old male presented to outpatient clinic with a chief complaint of right-sided anterior knee pain for 2 years aggravated for 2 months. Ultrasonography and magnetic resonance imaging showed two discrete intra-articular lesions. The lesion was hypointense on T1W and hyperintense on T2W and STIR sequence that was enhancing on contrast. There were adjoining dilated vessels. With a provisional diagnosis of hemangioma, FNAC was done and then complete excision was done using a medial parapatellar arthrotomy. The patient is doing well at 1-year follow-up. Conclusion Knee joint SH is a rare presentation to orthopedic outdoors and has slight female predominance with pre-existing history of trauma. In the present study, both cases were of patella-femoral type (anterior and infra-patellar fat pad). For such lesions, en bloc excision is the gold standard procedure to prevent recurrence, same procedure was followed in our study, and good functional outcome was achieved.
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Affiliation(s)
- Mantu Jain
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | | | - Manjoy Kumar
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
| | - Manas Baisakh
- Department of Pathology, Prolife Diagnostics, Bhubaneswar, Odisha, India
| | - Sujit Tripathy
- Department of Orthopedics, AIIMS, Bhubaneswar, Odisha, India
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15
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Wang J, Zhang A, Wang B, Yuan J, Zhu J, Li M, Liu H, Cheng L, Kong P. Multiple ossified intracranial and spinal meningiomas: a rare case report and literature review. Front Neurol 2023; 14:1253915. [PMID: 37885473 PMCID: PMC10598861 DOI: 10.3389/fneur.2023.1253915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 09/04/2023] [Indexed: 10/28/2023] Open
Abstract
Ossified intracranial meningiomas (OIM) and ossified spinal meningiomas (OSM) are rare neoplasms of mesenchymal origin that predominantly manifest in the spinal cord and infrequently in the cranial region, accounting for ~0. 7-5.5% of all meningiomas. It is extremely rare to have multiple intracranial and spinal lesions accompanied by ossification. Herein, we report this rare case for the first time. A 34-year-old woman presented with paresthesia and limb weakness in the right lower limb and gradually worsened. Approximately half a year later, she could only walk with crutches. Magnetic resonance imaging of the brain and spinal cord showed multiple meningiomas, and histopathological examination confirmed multiple OIM and OSM (WHO grade 1). Multiple OIM and OSM are extremely rare with diverse imaging features, and it is easily confused with other tumors. Histopathological examination is the final diagnostic method.
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Affiliation(s)
- Jian Wang
- Department of Neurology, Affiliated Aerospace Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Anbang Zhang
- Department of Neurology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang, Guizhou, China
| | - Boya Wang
- Department of Neurology, People's Hospital of Fenggang County, Zunyi, Guizhou, China
| | - Jingmeng Yuan
- Department of Neurology, Affiliated Aerospace Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Junchi Zhu
- Department of Neurology, Affiliated Aerospace Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Mengjiao Li
- Department of Neurology, Affiliated Aerospace Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Henli Liu
- Department of Neurology, Affiliated Aerospace Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Lijuan Cheng
- Department of Neurology, Affiliated Aerospace Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Ping Kong
- Department of Neurology, Affiliated Aerospace Hospital of Zunyi Medical University, Zunyi, Guizhou, China
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Lao CK, Ou JH, Fan YC, Wu TS, Sun PL. Clinical manifestations and susceptibility of Scedosporium/Lomentospora infections at a tertiary medical centre in Taiwan from 2014 to 2021: A retrospective cohort study. Mycoses 2023; 66:923-935. [PMID: 37449538 DOI: 10.1111/myc.13632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/15/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Scedosporiosis/lomentosporiosis is a globally emerging and crucial fungal infection. However, clinical data on Scedosporium/Lomentospora infections in Taiwan are scarce. OBJECTIVES This study aimed to explore the clinical characteristics of Scedosporium/Lomentospora-infected patients and evaluate the susceptibility of these isolates to antifungal agents. METHODS The clinical features of Scedosporium/Lomentospora-infected patients at a tertiary teaching hospital in Northern Taiwan between 2014 and 2021 were retrospectively reviewed; isolates from these patients were identified to species level for antifungal susceptibility testing. RESULTS Among 44 patients, 27 (61.4%) had scedosporiosis/lomentosporiosis, whereas 17 (38.6%) were colonised with Scedosporium/Lomentospora species. Scedosporium apiospermum was the main coloniser; scedosporiosis was primarily caused by S. boydii. Trauma history, steroid and immunosuppressant use were the most common risk factors for developing these infections. Among 27 patients with scedosporiosis/lomentosporiosis, one was lost to follow-up and seven (7/26, 26.9%) died. Most patients with S. apiospermum infection have a history of trauma, leading to cutaneous, bone and ocular infections. Pulmonary, sinus and disseminated infections and mortality were frequently reported in patients with S. boydii infection. Voriconazole's minimum inhibitory concentration was low for S. boydii, S. apiospermum and S. aurantiacum. Caspofungin, micafungin and anidulafungin were active against S. boydii and S. apiospermum. A potentially novel Scedosporium species was identified in this study, with distinct clinical manifestations and antifungal susceptibility. CONCLUSIONS At our centre, S. boydii is the main causative species of scedosporiosis; voriconazole could be the first-line treatment in Taiwan. Our study supports the importance of speciation, rather than only categorising these isolates into S. apiospermum species complex.
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Affiliation(s)
- Chong Kei Lao
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
| | - Jie-Hao Ou
- Department of Plant Pathology, National Chung Hsing University, Taichung, Taiwan
| | - Yun-Chen Fan
- Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Lun Sun
- Research Laboratory of Medical Mycology, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Dermatology, Chang Gung Memorial Hospital, Linkou Medical Centre, Taoyuan, Taiwan
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Sileo FG, Accurti V, Baschat A, Binder J, Carreras E, Chianchiano N, Cruz-Martinez R, D'Antonio F, Gielchinsky Y, Hecher K, Johnson A, Lopriore E, Massoud M, Nørgaard LN, Papaioannou G, Prefumo F, Salsi G, Simões T, Umstad M, Vavilala S, Yinon Y, Khalil A. Perinatal outcome of monochorionic triamniotic triplet pregnancy: multicenter cohort study. Ultrasound Obstet Gynecol 2023; 62:540-551. [PMID: 37204929 DOI: 10.1002/uog.26256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/08/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Monochorionic (MC) triplet pregnancies are extremely rare and information on these pregnancies and their complications is limited. We aimed to investigate the risk of early and late pregnancy complications, perinatal outcome and the timing and methods of fetal intervention in these pregnancies. METHODS This was a multicenter retrospective cohort study of MC triamniotic (TA) triplet pregnancies managed in 21 participating centers around the world from 2007 onwards. Data on maternal age, mode of conception, diagnosis of major fetal structural anomalies or aneuploidy, gestational age (GA) at diagnosis of anomalies, twin-to-twin transfusion syndrome (TTTS), twin anemia-polycythemia sequence (TAPS), twin reversed arterial perfusion (TRAP) sequence and or selective fetal growth restriction (sFGR) were retrieved from patient records. Data on antenatal interventions were collected, including data on selective fetal reduction (three to two or three to one), laser surgery and any other active fetal intervention (including amniodrainage). Data on perinatal outcome were collected, including numbers of live birth, intrauterine demise, neonatal death, perinatal death and termination of fetus or pregnancy (TOP). Neonatal data such as GA at birth, birth weight, admission to neonatal intensive care unit and neonatal morbidity were also collected. Perinatal outcomes were assessed according to whether the pregnancy was managed expectantly or underwent fetal intervention. RESULTS Of an initial cohort of 174 MCTA triplet pregnancies, 11 underwent early TOP, three had an early miscarriage, six were lost to follow-up and one was ongoing at the time of writing. Thus, the study cohort included 153 pregnancies, of which the majority (92.8%) were managed expectantly. The incidence of pregnancy affected by one or more fetal structural abnormality was 13.7% (21/153) and that of TRAP sequence was 5.2% (8/153). The most common antenatal complication related to chorionicity was TTTS, which affected just over one quarter (27.6%; 42/152, after removing a pregnancy with TOP < 24 weeks for fetal anomalies) of the pregnancies, followed by sFGR (16.4%; 25/152), while TAPS (spontaneous or post TTTS with or without laser treatment) occurred in only 4.6% (7/152) of pregnancies. No monochorionicity-related antenatal complication was recorded in 49.3% (75/152) of pregnancies. Survival was apparently associated largely with the development of these complications: there was at least one survivor beyond the neonatal period in 85.1% (57/67) of pregnancies without antenatal complications, in 100% (25/25) of those complicated by sFGR and in 47.6% (20/42) of those complicated by TTTS. The overall rate of preterm birth prior to 28 weeks was 14.5% (18/124) and that prior to 32 weeks' gestation was 49.2% (61/124). CONCLUSION Monochorionicity-related complications, which can impact adversely perinatal outcome, occur in almost half of MCTA triplet pregnancies, creating a challenge with regard to counseling, surveillance and management. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F G Sileo
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - V Accurti
- Fetal Medicine and Surgery Service, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - A Baschat
- Johns Hopkins Center for Fetal Therapy, Department of Gynecology and Obstetrics, Johns Hopkins University, Baltimore, MD, USA
| | - J Binder
- Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria
| | - E Carreras
- Maternal-Fetal Medicine Unit, Department of Obstetrics and Reproductive Medicine, Grup de Recerca en Medicina Materna I Fetal, Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - N Chianchiano
- Fetal Medicine Unit, Bucchieri La Ferla-Fatebenefratelli Hospital, Palermo, Italy
| | - R Cruz-Martinez
- Fetal Surgery Center, Instituto Medicina Fetal México, Queretaro/Guadalajara, Jalisco, Mexico
| | - F D'Antonio
- Center for Fetal Care and High-Risk Pregnancy, Department of Obstetrics and Gynecology, University 'G. d'Annunzio' of Chieti-Pescara, Chieti, Italy
| | - Y Gielchinsky
- Fetal Medicine Center, Helen Schneider Hospital for Women, Rabin Medical Center, Petach Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Johnson
- Department of Obstetrics and Gynecology, The Fetal Center at Children's Memorial Hermann Hospital, University of Texas Health Science Center, McGovern Medical School, Houston, TX, USA
| | - E Lopriore
- Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Massoud
- Department of Obstetrics and Fetal Medicine, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Lyon, France
| | - L N Nørgaard
- Center of Fetal Medicine and Pregnancy, Department of Obstetrics, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - G Papaioannou
- Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, Athens, Greece
| | - F Prefumo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - G Salsi
- Obstetric Unit, Department of Medical and Surgical Sciences, University of Bologna and IRCCS Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Bologna, Italy
| | - T Simões
- Department of Maternal-Fetal Medicine and Maternity Dr. Alfredo da Costa, Nova Medica School, Lisbon, Portugal
| | - M Umstad
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - S Vavilala
- Department of Fetal Medicine, Fernandez Hospital, Hyderabad, Telangana, India
| | - Y Yinon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel Hashomer, Israel
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
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Sutedja E, Widjaya MRH, Dharmadji HP, Suwarsa O, Pangastuti M, Usman HA, Firdaus CP. Lupus Erythematosus Profundus with Multiple Overlying Cutaneous Ulcerations: A Rare Case. Clin Cosmet Investig Dermatol 2023; 16:2721-2726. [PMID: 37790903 PMCID: PMC10544172 DOI: 10.2147/ccid.s430068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/20/2023] [Indexed: 10/05/2023]
Abstract
Lupus erythematosus profundus (LEP) is a rare subset of chronic cutaneous lupus erythematosus (CCLE), with a reported incidence of 1-3% in all LE cases. The most common cutaneous clinical presentation includes indurated plaques or subcutaneous nodules with an overlying normal skin. The clinical findings range from skin redness to features of CCLE, such as scaling, follicular plugging, and atrophy. Ulceration is rare and occurs in 28% of all LEP cases. We present a case report of LEP with multiple cutaneous ulcers on the right cheek and scalp accompanied by cicatricial alopecia. No other systemic manifestations were noted. Histopathological examination revealed periadipocyte, perivascular, and perivascular infiltration of lymphocytes, eosinophils, and plasma cells, supporting the diagnosis of LEP. The topical treatments given to the patient were sunscreen, 2% mupirocin cream, and wound dressing with dialkyl carbamoyl chloride (DACC). The patient was also treated systemically with oral corticosteroids and hydroxychloroquine. Clinical improvements were observed in the 3rd month of follow-up, and ulcer healing resulted in atrophic scars and fading erythematous macules. LEP is seldom associated with systemic or discoid lupus erythematosus. This occurs twice as frequently as a distinct entity does. Diagnosis accuracy plays an important role in determining the appropriate wound care, topical, and systemic treatments for LEP patients with multiple overlying cutaneous ulcerations.
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Affiliation(s)
- Endang Sutedja
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Muhamad Radyn Haryadi Widjaya
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Hartati Purbo Dharmadji
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Oki Suwarsa
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Miranti Pangastuti
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Hermin Aminah Usman
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
| | - Chaerani Pratiwi Firdaus
- Department of Dermatology and Venereology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin Hospital, Bandung, West Java, Indonesia
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19
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Miwa S, Tanaka T, Aiba H, Yamada S, Otsuka T, Tsuchiya H. Multiple Bone Cysts Caused by Hyperparathyroidism: A Case Report and Review of the Literature. Cancer Diagn Progn 2023; 3:590-596. [PMID: 37671306 PMCID: PMC10475927 DOI: 10.21873/cdp.10259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/13/2023] [Indexed: 09/07/2023]
Abstract
Background Brown tumor, a skeletal complication of severe hyperparathyroidism, comprises reparative granulation tissue and proliferating fibrous tissue with hemosiderin deposition. Multiple brown tumors are extremely rare complications of primary hyperparathyroidism. Case Report A 41-year-old woman presented with pain in the left knee. Radiography showed multiple cystic lesions in both femurs and the left proximal tibia, and additional radiography showed multiple cystic lesions in the left humerus and ulna. Magnetic resonance imaging (MRI) revealed multiple cystic lesions in the bilateral femurs, left proximal tibia, and ilium. Laboratory tests revealed hypercalcemia (albumin-corrected calcium level, 13.9 mg/dl), hypophosphatemia (phosphate level, 1.6 mg/dl), elevated level of alkaline phosphatase level (614 U/l), and markedly elevated parathyroid hormone (PTH) level (1,070 pg/ml; normal range=10-65 ng/l). 99mTc-hexakis-2-methoxyisobutyl-isonitrile scintigraphy revealed tracer accumulation in the left upper parathyroid gland, which was consistent with parathyroid tumor. Although resection of the parathyroid tumor was planned, the patient developed parathyroid apoplexy before tumor excision. After the parathyroid apoplexy, serum calcium and PTH levels temporarily normalized. Resurgence of the PTH level was observed 2 years after the diagnosis, and the patient underwent left upper parathyroidectomy. One year after the tumor excision, the patient had no symptoms, and MRI showed shrinkage of the cystic bone lesions. Conclusion This report emphasizes the importance of considering hyperparathy-roidism as a differential diagnosis for patients with multiple bone lesions.
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Affiliation(s)
- Shinji Miwa
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
| | - Tomohiro Tanaka
- Department of Gastroenterology and Metabolism, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hisaki Aiba
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Satoshi Yamada
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takanobu Otsuka
- Department of Orthopaedic Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroyuki Tsuchiya
- Department of Orthopedic Surgery, Graduate School of Medical Sciences, Kanazawa University, Kanazawa, Japan
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20
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Margulis AV, Calingaert B, Kawai AT, Rivero-Ferrer E, Anthony MS. Distribution of gestational age at birth by maternal and infant characteristics in U.S. birth certificate data: Informing gestational age assumptions when clinical estimates are not available. Pharmacoepidemiol Drug Saf 2023; 32:1012-1020. [PMID: 37067897 DOI: 10.1002/pds.5633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/29/2023] [Accepted: 04/13/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE We aimed to describe the distribution of gestational age at birth (GAB) to inform the estimation of GAB when clinical or obstetric estimates are not available for perinatal pharmacoepidemiology studies. METHODS We estimated GAB (median, mode, mean, and standard deviation) and percentage born at each gestational week in groups based on plurality and other variables for live births in CDC's U.S. birth data. RESULTS In 2020, 3 617 213 newborns had birth certificates with nonmissing GAB. Among singletons (3 501 693), median and mode GAB were both 39 weeks. Births with lower median GAB were from women with eclampsia (37 weeks) or receiving intensive care (37 weeks); newborns receiving intensive care (37 weeks); newborns with birth weight <2500 g (35 weeks), <1500 g (28 weeks), or <1000 g (25 weeks); and newborns not discharged alive (23 weeks). Among twins (112 633), median GAB was 36 weeks (mode, 37 weeks). Additional noteworthy groups were women with 0-6 prenatal visits (median, 34 weeks) or 7-8 prenatal visits (median, 35 weeks) or aged 15-19 years (median, 35 weeks). CONCLUSIONS Some maternal and infant groups had distinct GAB distributions in the United States. This information can be useful in estimating GAB when individual-level clinical estimates are not available, such as in database studies of medication use during pregnancy.
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Affiliation(s)
- Andrea V Margulis
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Brian Calingaert
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, North Carolina, USA
| | - Alison T Kawai
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Waltham, Massachusetts, USA
| | - Elena Rivero-Ferrer
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Barcelona, Spain
| | - Mary S Anthony
- Pharmacoepidemiology and Risk Management, RTI Health Solutions, Research Triangle Park, North Carolina, USA
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21
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Patigaroo SA, Sangoo M, Maqbool T, Qayoom S. Angina Bullosa Hemorrhagica - A Case Series. Indian J Dermatol 2023; 68:563-568. [PMID: 38099116 PMCID: PMC10718240 DOI: 10.4103/ijd.ijd_663_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Abstract
Angina bullosa hemorrhagica (ABH) is an oral subepithelial blood blister with poorly understood etiopathogenesis, which is not attributable to blood dyscrasias or vesiculobullous disorders. These hemorrhagic bullae spontaneously rupture within minutes to hours, resulting in ragged, often painless, superficial erosions that heal spontaneously within 1 week without scarring. The lesions are usually solitary, and sometimes cause extreme anxiety in patients. Treatment is generally symptomatic. We report a series of four such patients. No treatment was given, except for reassurance and anxiolytics.
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Affiliation(s)
- Suhail A. Patigaroo
- From the Postgraduate Department of ENT and HNS, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Mushtaq Sangoo
- From the Postgraduate Department of ENT and HNS, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Tabish Maqbool
- From the Postgraduate Department of ENT and HNS, Government Medical College, Srinagar, Jammu and Kashmir, India
| | - Seema Qayoom
- Department of Dermatology, SKIMS Medical College, Srinagar, Jammu and Kashmir, India
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22
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Wang N, Zhang M, Zhu J, Zhu Y, Wu J. Multiple idiopathic cervical root resorption: A systematic review. Oral Dis 2023; 29:2409-2422. [PMID: 36251582 DOI: 10.1111/odi.14406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 10/08/2022] [Accepted: 10/12/2022] [Indexed: 11/28/2022]
Abstract
The current literature on multiple idiopathic cervical root resorption (MICRR), a rare and aggressive form of external root resorption, is limited to case reports and series. Therefore, we performed a systematic review of this condition. A comprehensive search of PubMed, Embase, Web of science, Cochrane Library, CNKI, and WANFANG was conducted using key terms relevant to MICRR, supplemented by a grey literature search. Risk of bias was assessed using Cochrane's and Joanna Briggs Institute's tools. A total of 36 studies with 47 cases were included. MICRR is more common among younger females and may be related to hormonal changes and denosumab use. Initially, the premolars are usually affected but all permanent teeth may eventually be involved. Cone-beam computed tomography is recommended for diagnosis and assessment of resorptive lesions. The management is focused on complete removal and restoration of the resorptive tissue to maintain the tooth's structural integrity. However, MICRR usually has a poor prognosis. Due to its invasive and aggressive behavior, MICRR requires greater attention.
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Affiliation(s)
- Ningxiang Wang
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
- Department of Stomatology, Nanjing Hospital of Chinese Medicine, Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Mei Zhang
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Jiaye Zhu
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yaoyao Zhu
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Juan Wu
- Department of Periodontology, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
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23
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Tang H, Wang X, Bie Z, Yang Z, Wang B, Li S, Liu P. Pituitary adenomas with multiple cell lineage combinations: clinicopathological features and short-term prognosis. J Neurosurg 2023; 139:810-821. [PMID: 36708537 DOI: 10.3171/2022.12.jns222118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/09/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE There are few published data concerning pituitary adenomas (PAs) derived from multiple lineages. In this study the authors aimed to determine the clinicopathological characteristics and prognostic profiles of PAs with multiple cell lineage combinations (PAwMCs). METHODS The authors reviewed data on 723 patients with PAs who had undergone surgery between 2018 and 2021 and identified 93 cases (12.9%) of PAwMC. They collected detailed data on these cases, including clinical information, pathological features, and prognosis. From among 589 cases of PAs with only one cell lineage (PAwOCs), they randomly selected 100 cases to investigate differences between the two tumors. To enable investigation of the characteristics of different subgroups, they further subclassified PAwMCs into 4 groups according to the following specified combinations of pituitary-associated transcription factors: group A, immunopositive for pituitary-specific positive transcription factor 1 (Pit1) and steroidogenic factor 1 (SF1); group B, immunopositive for Pit1 and T-box transcription factor (Tpit); group C, immunopositive for SF1 and Tpit; and group D, immunopositive for Pit1, SF1, and Tpit. RESULTS Compared with PAwOC, PAwMC was more often associated with hormone hypersecretion (31.0% vs 50.0%, p = 0.037) and had worse short-term prognoses with lower complete response rates (58.7% vs 30.0%, p = 0.026) and more postoperative complications (19.4% vs 35.9%, p = 0.041). Each of the 4 PAwMC subgroups had its own clinical features. Overall, PAwMCs displayed more neurological manifestations than evidence of hypersecretion, which may be attributable to a disparity between pituitary-associated transcription factors and endocrine-related manifestations. Moreover, multiple cell lineages, tumor size (p = 0.011), and Knosp grade (p = 0.013) were all found to be critical predictors of the prognosis of PAwMC. CONCLUSIONS The authors described a special subtype of PAs, which derived from multiple lineages. They found a unique effect of the combination of distinct cell lineages on PAs and present detailed clinicopathological and prognostic profiles of these special PAs. These data will contribute to a more comprehensive view of PAs and assist in the selection of treatment.
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Affiliation(s)
- Hanlu Tang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; and
| | - Xingchao Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; and
| | - Zhixu Bie
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; and
| | - Zhijun Yang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; and
| | - Bo Wang
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; and
| | - Shiwei Li
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; and
| | - Pinan Liu
- 1Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University; and
- 2Department of Neural Reconstruction, Beijing Neurosurgery Institute, Capital Medical University, Beijing, China
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24
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Sharma V, Bhaskar S, Tiwari S. Multiple Symptomatic Spinal Intradural Arachnoid Cysts: A Case Report. Asian J Neurosurg 2023; 18:696-697. [PMID: 38152537 PMCID: PMC10749836 DOI: 10.1055/s-0043-1774376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
A spinal arachnoid cyst is a rare entity representing only 1 to 3% of spinal canal lesions. Very few of them are reported to be symptomatic. Moreover, occurrence in multiples is even rarer. Extradural type is more common than intradural. In the spine, it is rare in the sacral region. Other common pathologies, such as a dermoid or epidermoid cyst, are often considered at presentation. Even magnetic resonance imaging can miss the diagnosis sometimes. We report a case with symptoms of paraparesis and incontinence at presentation, initially misdiagnosed as a dermoid cyst, later found to be multiple intradural arachnoid cysts located in the sacral region. Spinal arachnoid cysts may cause debilitating symptoms. The disease is completely curable if the detection and classification are early as in our case.
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Affiliation(s)
- Vikrant Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Suryanarayanan Bhaskar
- Department of Neurosurgery, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Albahlal JM, Alzahrani A, Khan H. Multiple Bony Mallet Finger Injuries in One Hand of a 14-Year-Old Boy. Cureus 2023; 15:e44441. [PMID: 37791208 PMCID: PMC10544867 DOI: 10.7759/cureus.44441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/05/2023] Open
Abstract
Bony mallet finger injuries, commonly seen as isolated incidents, typically occur in active individuals. We report a rare case of simultaneous avulsion fractures at the distal phalangeal bases of the second, third, and fourth fingers on the right hand of a 14-year-old boy following a forced passive flexion injury during a football game. The patient initially received conservative management with a finger extension splint for the distal interphalangeal (DIP) joints. However, one week after the injury, we performed surgical fixation on all affected digits using the K-wire extension block method due to multiple fractures and the patient's intolerance for the mallet finger splint. After six weeks, all K-wires were removed, and physiotherapy sessions began. Three months post-injury, the second and fourth DIP joints demonstrated an "Excellent" outcome, and the third DIP joint demonstrated a "Good" outcome based on Crawford's criteria for outcome assessment of mallet finger injury after management. This case highlights the importance of early detection and appropriate management of concomitant mallet finger injuries in pediatric patients to prevent potential complications that could impair hand function and quality of life.
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Affiliation(s)
| | | | - Hayat Khan
- Orthopedic Surgery, Dr. Sulaiman Alhabib Medical Group, Riyadh, SAU
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26
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Xu H, Liu W, Liu C, Zhai Y, Zhao H, Guo R, Lv L, Zhang S. Case report: Ileocecal preservation for multiple small intestinal duplications. Front Pediatr 2023; 11:1205155. [PMID: 37342532 PMCID: PMC10277474 DOI: 10.3389/fped.2023.1205155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 05/22/2023] [Indexed: 06/23/2023] Open
Abstract
Small-intestinal duplication is a rare congenital developmental anomaly that is mainly single; multiple small-intestinal duplications are rare. Most malformations are located in the ileocecal region. The primary surgical treatment is complete resection of the malformations and adjacent intestinal ducts. However, the ileocecal junction plays an important role in children, and it is difficult to preserve it; multiple intestinal repairs increase the risk of postoperative intestinal fistula, which is a challenge for pediatric surgeons. Herein, we report a case of ileocecal preservation surgery for the treatment of multiple small intestinal duplication malformations near the ileocecal area. The child underwent laparoscopically assisted cyst excision and multiple intestinal repairs and had good postoperative recovery and follow-up.
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Affiliation(s)
- Hongxiu Xu
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
| | - Weiqiang Liu
- Department of Pediatric Surgery, Zhucheng Maternal and Child Health Hospital, Weifang, China
| | - Chunqing Liu
- Zhucheng Longcheng Hospital of Traditional Chinese Medicine, Weifang, China
| | - Yunpeng Zhai
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
| | - Huashan Zhao
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
| | - Rui Guo
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
| | - Longfei Lv
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
| | - Shisong Zhang
- Department of Thoracic and Oncological Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
- Department of Thoracic and Oncological Surgery, Jinan Children’s Hospital, Jinan, China
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Lin J, Wang LF, Wu A, Teng F, Xian YT, Han R. Computed tomography-guided indocyanine green localization of multiple ipsilateral lung nodules. Wideochir Inne Tech Maloinwazyjne 2023; 18:305-312. [PMID: 37680733 PMCID: PMC10481448 DOI: 10.5114/wiitm.2023.124272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 01/03/2023] [Indexed: 09/09/2023] Open
Abstract
Introduction Approximately 20% of lung nodule (LN) patients have more than one moderate-to-high malignant risk LNs. When performing one-stage video-assisted thoracoscopic surgery (VATS) in patients with multiple LNs, the ability to simultaneously localize all of these nodules is critical to operative success. Aim To explore the efficacy and safety of computed tomography (CT)-guided indocyanine green (IG) localization for multiple ipsilateral LNs. Material and methods This was a retrospective study of 278 LN patients who underwent CT-guided IG localization prior to VATS resection. Of these patients, 68 underwent localization of multiple ipsilateral LNs, whereas 210 underwent localization of a single LN. Results In total, 160 LNs were localized in 68 patients in the multiple localization group, while one LN was localized for each of the 210 patients in the single localization group. A 100% technical success rate was achieved in both of these groups, and the mean respective localization durations in the multiple and single LN groups were 11.3 ±4.7 min and 6.3 ±2.7 min (p = 0.001). Of the patients in the multiple and single LN groups, 22 and 15, respectively, experienced pneumothorax (p = 0.001), while 14 and 20 experienced lung hemorrhage (p = 0.016). Wedge/segmental LN technical success rates in both of these groups were 100%. Conclusions The CT-guided IG-mediated localization of multiple ipsilateral LNs is a safe and effective strategy, although it requires a longer operative duration and is associated with higher rates of adverse events as compared to single nodule localization.
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Affiliation(s)
- Jia Lin
- Department of Interventional Radiology, Ningbo First Hospital, Ningbo, China
| | - Long-Fei Wang
- Department of Thoracic Surgery, Ningbo First Hospital, Ningbo, China
| | - Anle Wu
- Department of Interventional Radiology, Ningbo First Hospital, Ningbo, China
| | - Fei Teng
- Department of Interventional Radiology, Ningbo First Hospital, Ningbo, China
| | - Yu-Tao Xian
- Department of Interventional Radiology, Ningbo First Hospital, Ningbo, China
| | - Rui Han
- Department of Interventional Radiology, Ningbo First Hospital, Ningbo, China
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Bao YY, Yang KQ, Li KD, Fu ZM, Zhong JT, Zhou SH, Wu CC. Multiple Thyroglossal Duct Cysts: Clinical Experience and Literature Review. Ear Nose Throat J 2023:1455613231171828. [PMID: 37194164 DOI: 10.1177/01455613231171828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023] Open
Abstract
Thyroglossal duct cysts (TDCs) are generally single cyst, multiple TDCs are rare. We describe a case of multiple TDCs, discuss its characteristic features and management, and provide a review of the literature, to improve clinical diagnosis and treatment. We report an extremely rare case of multiple TDCs containing five cysts, together with a review of the relevant English medical literature. To the best of our knowledge, this is the first reported case of TDCs containing more than three cysts in the anterior cervical region. The five cysts were completely excised in a Sistrunk operation. Histological examination of the cystic lesions revealed TDCs. The patient recovered well and no recurrence was found during the 6-year of follow-up. Multiple TDCs are extremely rare, and may be misdiagnosed as a single cyst. Clinicians should be aware of the possibility of multiple thyroglossal duct cysts. Adequate preoperative radiological examinations should be performed, and careful interpretation of the CT or MRI scans is important to diagnosis and surgery.
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Affiliation(s)
- Yang-Yang Bao
- Department of Otolaryngology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, P.R. China
| | - Kai-Qiang Yang
- Department of Otolaryngology, Zhengzhou Yihe Hospital, Zhengzhou, P.R. China
| | - Ke-Da Li
- Department of Otolaryngology, The First People's Hospital of Xiaoshan District, Hangzhou, P.R. China
| | - Zi-Ming Fu
- Department of Otolaryngology, The First People's Hospital of Xiaoshan District, Hangzhou, P.R. China
| | - Jiang-Tao Zhong
- Department of Otolaryngology, The First People's Hospital of Xiaoshan District, Hangzhou, P.R. China
| | - Shui-Hong Zhou
- Department of Otolaryngology, The First People's Hospital of Xiaoshan District, Hangzhou, P.R. China
| | - Chang-Chen Wu
- Department of Otolaryngology, Affiliated Xiaoshan Hospital, Hangzhou Normal University, Hangzhou, P.R. China
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Cohen PR. Glomus Extradigital Tumor: A Case Report of an Extradigital Glomus Tumor on the Wrist and Comprehensive Review of Glomus Tumors. Cureus 2023; 15:e38737. [PMID: 37292537 PMCID: PMC10247156 DOI: 10.7759/cureus.38737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2023] [Indexed: 06/10/2023] Open
Abstract
A glomus tumor is a neoplasm composed of cells from the glomus body which is a contractile neuromyoarterial structure that affects blood pressure and thermoregulation by altering cutaneous blood flow. This cutaneous tumor can be benign or rarely malignant, solitary or multiple, and digital or extradigital. A benign glomus tumor usually presents as a non-familial, solitary, and subungual lesion. Multiple glomus tumors are less common, may be autosomal dominantly inherited, and extradigital. In contrast to a digital glomus tumor that often occurs within the nailbed or fingertip pulp of a young woman, a glomus extradigital tumor (GET) typically appears on the extremity or trunk of an older man. The diagnosis of a glomus tumor may be suspected based on clinical evaluation; it classically presents with a clinical triad of symptoms which includes lesion-associated tenderness, pin-point pressure pain, and cold sensitivity. However, cold-induced exacerbation of pain is frequently absent in extradigital glomus tumors; this may contribute to a delay in establishing the diagnosis of a glomus tumor in these individuals. Radiographic studies can support the diagnosis, but tissue specimen examination is necessary to establish the diagnosis. Resolution of tumor-associated pain is usually achieved following the complete excision of the neoplasm. A woman with a glomus tumor located on her wrist is described; her painful tumor was not sensitive to cold and was misdiagnosed clinically as a possible foreign body reaction to either a wood splinter or glass shard. The diagnosis of an extradigital glomus tumor was established after a microscopic examination of the tissue specimen following an excisional biopsy using a 3-millimeter punch biopsy tool. The neoplasm-related pain ceased and did not recur after the tumor had been completely removed. In conclusion, a glomus tumor is included in the differential diagnosis of a painful cutaneous neoplasm; however, misdiagnosis and/or substantial delay in diagnosis may occur if the tumor is extradigital or it lacks cold sensitivity or both. Therefore, the clinician needs to entertain the possibility of an extradigital glomus tumor when evaluating a patient with a tender, temperature-insensitive skin lesion that is not located on the fingers or toes.
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Affiliation(s)
- Philip R Cohen
- Dermatology, University of California, Davis Medical Center, Sacramento, USA
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Chávez-Peón Berle E, Hallman C, Kleinhenz K, Plattner BL. Multifocal spinal inflammatory myofibroblastic tumors in a juvenile paraparetic dog. Vet Radiol Ultrasound 2023; 64:E14-E18. [PMID: 36465030 DOI: 10.1111/vru.13195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/09/2022] [Accepted: 10/15/2022] [Indexed: 12/12/2022] Open
Abstract
A 1-year-old, female English Bulldog presented with a 10-day history of progressive paraparesis. Neuroanatomical localization was consistent with T3-L3 segment myelopathy. Magnetic resonance imaging (MRI) revealed a severely compressive, mildly contrast enhancing, extradural, dorsal, broad-based mass at the level of L3-4. Similar, non-compressive, smaller nodules were present along the extradural space and dura mater of the caudal lumbar spine. Owners elected euthanasia based on these imaging findings and progressive clinical signs. Necropsy, histopathology and immunohistochemistry revealed a mesenchymal mass and nodules, admixed with numerous inflammatory cells. The diagnosis of an extradural inflammatory myofibroblastic tumor (IMT) with a multifocal presentation was made.
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Affiliation(s)
- Erica Chávez-Peón Berle
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Clay Hallman
- Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Katie Kleinhenz
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
| | - Brandon L Plattner
- Department of Diagnostic Medicine and Pathobiology, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA
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Elias C, Nogueira PJ, Sousa P. Preterm birth characteristics and outcomes in Portugal, between 2010 and 2018-A cross-sectional sequential study. Health Sci Rep 2023; 6:e1054. [PMID: 36846533 PMCID: PMC9945543 DOI: 10.1002/hsr2.1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 11/23/2022] [Accepted: 12/29/2022] [Indexed: 02/25/2023] Open
Abstract
Introduction According to the World Health Organization, 11% of all children are born prematurely, representing 15 million births annually. An extensive analysis on preterm birth, from extreme to late prematurity and associated deaths, has not been published. The authors characterize premature births in Portugal, between 2010 and 2018, according to gestational age, geographic distribution, month, multiple gestations, comorbidities, and outcomes. Methods A sequential, cross-sectional, observational epidemiologic study was conducted, and data were collected from the Hospital Morbidity Database, an anonymous administrative database containing information on all hospitalizations in National Health Service hospitals in Portugal, and coded according to the ICD-9-CM (International Classification of Diseases), until 2016, and ICD-10 subsequently. Data from the National Institute of Statistics was utilized to compare the Portuguese population. Data were analyzed using R software. Results In this 9-year study, 51.316 births were preterm, representing an overall prematurity rate of 7.7%. Under 29 weeks, birth rates varied between 5.5% and 7.6%, while births between 33 and 36 weeks varied between 76.9% and 81.0%. Urban districts presented the highest preterm rates. Multiple births were 8× more likely preterm and accounted for 37%-42% of all preterm births. Preterm birth rates slightly increased in February, July, August, and October. Overall, respiratory distress syndrome (RDS), sepsis, and intraventricular hemorrhage were the most common morbidities. Preterm mortality rates varied significantly with gestational age. Conclusion In Portugal, 1 in 13 babies was born prematurely. Prematurity was more common in predominantly urban districts, a surprise finding that warrants further studies. Seasonal preterm variation rates also require further analysis and modelling to factor in heat waves and low temperatures. A decrease in the case rate of RDS and sepsis was observed. Compared with previously published results, preterm mortality per gestational age decreased; however, further improvements are attainable in comparison with other countries.
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Affiliation(s)
- Cecília Elias
- Unidade de Saúde Publica Francisco GeorgeACES Lisboa Norte, ARSLVTLisboaPortugal,EPI Task‐Force FMUL, Faculdade de MedicinaUniversidade de LisboaLisboaPortugal
| | - Paulo Jorge Nogueira
- EPI Task‐Force FMUL, Faculdade de MedicinaUniversidade de LisboaLisboaPortugal,NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRCNOVA University LisbonLisbonPortugal,Instituto de Medicina Preventiva e Saúde Pública, Faculdade de MedicinaUniversidade de LisboaLisboaPortugal,Área Disciplinar Autónoma de Bioestatística (Laboratório de Biomatemática), Faculdade de MedicinaUniversidade de LisboaLisboaPortugal,Instituto de Saúde Ambiental, Faculdade de MedicinaUniversidade de LisboaLisboaPortugal
| | - Paulo Sousa
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRCNOVA University LisbonLisbonPortugal
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Ni X, Hu J, Huang Y, Tao J, Zhu H. Higher clearance rates of multiple HPV infections may explain their lower risk of HSIL: A retrospective study in Wenzhou, China. J Med Virol 2023; 95:e28526. [PMID: 36698241 DOI: 10.1002/jmv.28526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/27/2023]
Abstract
Persistent human papilloma virus (HPV) infection is known to be associated with cervical lesions. The chief object of the study is to investigate if the pathogenicity of multiple HPV infections is different from a single infection. Furthermore, we would like to corroborate the discrepancy with clearance rates. Between August 1, 2020, and September 31, 2021, 5089 women underwent a colposcopy-directed biopsy in our hospital. We divided the 2999 patients who met the criteria into multiple and single HPV infection groups. The HPV genotypes were identified using the flow cytometry fluorescence hybridization technology. Binary logistic regression and survival analysis were used to perform statistics. Among HPV-positive individuals, 34.78% (1043/2999) were positive for 2 or more HPV types. After adjusting for the main factors, compared with single infection, multiple infections were associated with a significantly decreased risk of high squamous intraepithelial lesions (HSIL) (odds ratio [OR]: 0.570; 95% confidence interval [CI]: 0.468-0.694). In the mean time, the clearance rates of multiple infections were significantly higher (OR: 2.240; 95% CI: 1.919-2.614). When analyzing specific types covered by the 9-valent HPV vaccine, consistency between the lower risk of HSIL and the higher clearance rate was found in the most groups. Compared with a single infection, multiple HPV infections have a lower risk of HSIL, which may be related to its higher clearance rate. It suggests that aggressive treatment of multiple HPV infections early in their detection may be beneficial.
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Affiliation(s)
- Xinyu Ni
- Department of Gynecology, The First Affiliated Hospital of Wenzhou, Medical University, Wenzhou, China
| | - Jiaming Hu
- Department of Gynecology, The First Affiliated Hospital of Wenzhou, Medical University, Wenzhou, China
| | - Yin Huang
- Department of Gynecology, The First Affiliated Hospital of Wenzhou, Medical University, Wenzhou, China
| | - Jinxin Tao
- Department of Gynecology, The First Affiliated Hospital of Wenzhou, Medical University, Wenzhou, China
| | - Hua Zhu
- Department of Gynecology, The First Affiliated Hospital of Wenzhou, Medical University, Wenzhou, China
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Wang J, Shen N, Shen H. Successful Treatment of Multiple Plantar and Periungual Warts by Local Hyperthermia Treatment: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:981-985. [PMID: 37056314 PMCID: PMC10089273 DOI: 10.2147/ccid.s408406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/31/2023] [Indexed: 04/15/2023]
Abstract
Local hyperthermia treatment, a common immunoadjuvant therapy, has been used in treating various human papillomavirus (HPV) infections. For multiple warts, it can clear off all warts of the body through targeted irradiation on one wart. We reported a case of a 22-year-old patient with multiple plantar warts combined with periungual warts, in which previous treatments were ineffective. Therefore, we utilized local hyperthermia treatment at 44°C using the largest fused-wart plaque on the right plantar as the treatment target for 30-minute irradiation each time. The hyperthermia induction therapy was performed on day 1, 2, 3, 12 and 13, followed by weekly maintenance therapy for 6 times. After 2 months of treatment, both irradiated and non-irradiated lesions disappeared, and no recurrence occurred during the follow-up period. This case indicates that local hyperthermia treatment may be a safe and effective approach for patients with multiple, recalcitrant, and site-specific viral warts due to the ineffectiveness of conventional treatment.
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Affiliation(s)
- Jian Wang
- Department of Dermatology, Zhejiang Provincial Institute for Dermatoses Prevention and Cure, Huzhou City, Zhejiang Province, 313200, People’s Republic of China
| | - Ningning Shen
- Department of Dermatology, Zhejiang Provincial Institute for Dermatoses Prevention and Cure, Huzhou City, Zhejiang Province, 313200, People’s Republic of China
| | - Huiliang Shen
- Department of Dermatology, Zhejiang Provincial Institute for Dermatoses Prevention and Cure, Huzhou City, Zhejiang Province, 313200, People’s Republic of China
- Correspondence: Huiliang Shen, Department of Dermatology, Zhejiang Provincial Institute for Dermatoses Prevention and Cure, No. 61, Wuyuan Street, Wukang Town, Deqing County, Huzhou City, Zhejiang Province, 313200, People’s Republic of China, Email
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Gidener T, Dierkhising R, Mara KC, Therneau TM, Venkatesh SK, Ehman RL, Yin M, Allen AM. Change in serial liver stiffness measurement by magnetic resonance elastography and outcomes in NAFLD. Hepatology 2023; 77:268-274. [PMID: 35642504 PMCID: PMC9712594 DOI: 10.1002/hep.32594] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS The impact of disease progression in NAFLD on liver outcomes remains poorly understood. We aimed to investigate NAFLD progression using longitudinal liver stiffness measurements (LSM) by serial magnetic resonance elastography (MRE) and the association with liver outcomes. APPROACH AND RESULTS All adult patients with NAFLD who underwent at least two serial MREs for clinical evaluation at Mayo Clinic, Rochester, between 2007 and 2019 were identified from the institutional database. Progression and regression were defined based on LSM change of 19% above or below 19% of initial LSM, respectively, based on Quantitative Imaging Biomarker Alliance consensus. The association between change in LSM and liver-related outcomes occurring after the last MRE was examined using time-to-event analysis. A total of 128 participants underwent serial MREs (53% female, median age 59 years). The median time between paired MREs was 3.4 (range 1-10.7) years. NAFLD progression (LSM = +0.61 kPa/year) was identified in 17 patients (13.3%). NAFLD regression (-0.40 kPa/year) occurred in 35 patients (27.3%). Stable LSM was noted in 76 participants (59.4%). In NAFLD without cirrhosis at baseline ( n = 75), cirrhosis development occurred in 14% of LSM progressors and 2.9% of non-progressors ( p = 0.059) over a median 2.7 years of follow-up from the last MRE. Among those with compensated cirrhosis at baseline MRE ( n = 29), decompensation or death occurred in 100% of LSM progressors and 19% of non-progressors ( p < 0.001) over a median 2.5 years of follow-up after the last MRE. CONCLUSIONS Noninvasive monitoring of LSM by conventional MRE is a promising method of longitudinal NAFLD monitoring and risk estimation of liver-related outcomes in NAFLD.
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Affiliation(s)
- Tolga Gidener
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Ross Dierkhising
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Kristin C. Mara
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Terry M. Therneau
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | | | | | - Meng Yin
- Department of Radiology, Mayo Clinic, Rochester, MN
| | - Alina M. Allen
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
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Maia MDO, da Silveira CDG, Gomes M, Fernandes SES, Bezerra de Santana R, de Oliveira DQ, Amorim FFP, Neves FDAR, Amorim FF. Multidrug-Resistant Bacteria on Critically Ill Patients with Sepsis at Hospital Admission: Risk Factors and Effects on Hospital Mortality. Infect Drug Resist 2023; 16:1693-1704. [PMID: 36992963 PMCID: PMC10042244 DOI: 10.2147/idr.s401754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/17/2023] [Indexed: 03/31/2023] Open
Abstract
Purpose To evaluate the effect of MDRO infection on hospital mortality and the risk factors among critically ill patients with sepsis at hospital admission. Patients and Methods A cross-sectional study was performed between April 2019 and May 2020, followed by a cohort to evaluate hospital mortality that prospectively included all consecutive patients 18 years or older with sepsis admitted within 48 hours of hospital admission to an adult ICU in Brazil. Patients' characteristics, blood samples within one hour of ICU admission, and microbiological results within 48h of hospital admission were collected. In addition, descriptive statistics, binary logistic regression, and propensity score matching were performed. Results At least one MDRO was isolated in 85 patients (9.8%). The extended-spectrum beta-lactamase-producing Enterobacterales are the most frequent organism (56.1%). Hypoxemic acute respiratory failure (OR 1.87, 95% CI 1.02-3.40, p = 0.04), Glasgow Coma Score below 15 (OR 2.57, 95% CI 1.38-4.80, p < 0.01), neoplasm (OR 2.66, 95% CI 1.04-6.82, p = 0.04) and hemoglobin below 10.0 g/dL (OR 1.82, 95% CI 1.05-3.16, p = 0.03) were associated with increased MDRO. Admission from the Emergency Department (OR 0.25, 95% CI 0.14-0.43, p < 0.01) was associated with decreased MDRO. In the multivariate analysis, MDRO at hospital admission increased hospital mortality (OR 2.80, 95% CI 1.05-7.42, p = 0.04). After propensity score-matching adjusted to age, APACHE II, SOFA, and dementia, MDRO at hospital admission was associated with significantly high hospital mortality (OR 2.80, 95% CI 1.05-7.42, p = 0.04). The E-value of adjusted OR for the effect of MDRO infection on hospital mortality was 3.41, with a 95% CI of 1.31, suggesting that unmeasured confounders were unlikely to explain the entirety of the effect. Conclusion MDRO infection increased hospital mortality, and MDRO risk factors should be accessed even in patients admitted to ICU within 48 hours of hospital admission.
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Affiliation(s)
- Marcelo de Oliveira Maia
- Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
- Marcelo de Oliveira Maia, Programa de Pós-Graduação em Ciências da Saúde - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, 70701-907, Brazil, Email
| | - Carlos Darwin Gomes da Silveira
- Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Medical School, Centro Universitário do Planalto Central (UNICEPLAC), Brasília, Federal District, Brazil
| | - Maura Gomes
- Intensive Care Unit, Hospital Santa Luzia Rede D’Or São Luiz, Brasília, Federal District, Brazil
| | | | | | | | | | | | - Fábio Ferreira Amorim
- Graduation Program in Health Sciences of School Health Sciences, Escola Superior de Ciências da Saúde (ESCS), Brasília, Federal District, Brazil
- Graduation Program in Health Sciences, University of Brasília (UnB), Brasília, Federal District, Brazil
- Correspondence: Fábio Ferreira Amorim, Coordenação de Pesquisa e Comunicação Científica - Escola Superior de Ciências da Saúde, SMHN Quadra 03, conjunto A, Bloco 1 - Edifício FEPECS, Brasília, Federal District, 70701-907, Brazil, Email
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Sutera S, Giachino DF, Pelle A, Zuntini R, Pentenero M. Gingival Overgrowths Revealing PTEN Hamartoma Tumor Syndrome: Report of Novel PTEN Pathogenic Variants. Biomedicines 2022; 11. [PMID: 36672590 DOI: 10.3390/biomedicines11010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/23/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
PTEN hamartoma tumor syndrome (PHTS), is a spectrum of disorders caused by mutations of PTEN, in which non-cancerous growths, called hamartomas, develop in different areas of the body, often including the oral mucosa. PHTS also implies a recognized increased risk of malignancies, as PTEN is a tumor suppressor gene capable of inhibiting progression of several cancers. One of the main and most common clinical manifestation of PHTS are gingival overgrowths presenting as warty lumps. The current study describes patients with gingival or mucosal enlargements leading to the diagnosis of PHTS associated to novel PTEN pathogenic variants. Patients referred to us for gingival lumps suggestive of PHTS associated overgrowths were submitted to genetic analysis in the PTEN gene. Two related and two unrelated patients were investigated. PTEN novel pathogenic variant was found in all of them. Two patients also fulfilled diagnostic criteria of Cowden syndrome (CS). Mucocutaneous lesions, and particularly diffuse gingival overgrowths, are both early and major clinical signs revealing a potential diagnosis of PHTS. Further genetic and clinical assessments are needed in order to confirm and clarify the diagnosis within the PHTS spectrum, including, among others, the CS. A correct interpretation of oral clinical features potentially associated to PHTS is mandatory for diagnosis and a surgical approach can be useful just in case of impairment of periodontal health or for aesthetic needs. The increased risk of malignancies associated to PHTS makes a correct diagnosis pivotal to set up an appropriate lifelong surveillance, aiming at secondary cancer prevention.
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Alnaif A, Oiler I, D'Souza MS. Ponesimod: An Oral Second-Generation Selective Sphingosine 1-Phosphate Receptor Modulator for the Treatment of Multiple Sclerosis. Ann Pharmacother 2022:10600280221140480. [PMID: 36514282 DOI: 10.1177/10600280221140480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To describe the safety, efficacy, and potential role in therapy of ponesimod, which was recently approved by the Food and Drug Administration (FDA) as a therapeutic option for the treatment of multiple sclerosis (MS). DATA SOURCES A PubMed literature search using the following terms: ponesimod and MS (January 1, 2012-October 31, 2022). FDA product labeling was also reviewed for pertinent data sources. STUDY SELECTION AND DATA EXTRACTION All relevant English-language articles examining efficacy and/or safety of ponesimod were considered for inclusion. DATA SYNTHESIS Ponesimod is an orally administered second-generation sphingosine 1-phospate (S1-P) receptor modulator classified as a disease modifying treatment (DMT) for MS. Clinical studies have shown that ponesimod prevents relapse in patients with relapsing-remitting MS (RRMS) and has superior efficacy compared with teriflunomide. Nasopharyngitis, upper respiratory tract infections, headache, high blood pressure, and liver dysfunction were some of the common adverse effects associated with ponesimod. Dyspnea, bradyarrhythmias, atrioventricular conduction delays, and macular edema were some of the rare but serious adverse effects associated with ponesimod. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE IN COMPARISON WITH EXISTING AGENTS Some advantages of ponesimod over other S1-P receptor modulators approved for RRMS include selectivity for the S1-P1 receptor and short half-life, which allows for quick reversal of immunosuppressive effects. However, data from long-term efficacy and safety studies and more direct comparison studies with other DMTs are required. CONCLUSION Currently available data suggest that ponesimod is a useful addition to other high-efficacy DMTs available to treat patients with MS.
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Affiliation(s)
- Amal Alnaif
- Raabe College of Pharmacy, Ohio Northern University, Ada, OH, USA
| | - Isabelle Oiler
- Raabe College of Pharmacy, Ohio Northern University, Ada, OH, USA
| | - Manoranjan S D'Souza
- Raabe College of Pharmacy, Ohio Northern University, Ada, OH, USA.,Department of Pharmaceutical & Biomedical Sciences, Raabe College of Pharmacy, Ohio Northern University, Ada, OH, USA
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Zhang J, Ding D, Sun J, Zhang H, Dai Y, Li X, Ma X, Li X, Wu Y. A case report of multiple extramedullary plasmacytoma of the head and neck. Medicine (Baltimore) 2022; 101:e32203. [PMID: 36482521 PMCID: PMC9726292 DOI: 10.1097/md.0000000000032203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Multiple extramedullary plasmacytoma (EMP) of the head and neck is rare and a definitive first-line treatment has not been established. EMP successively as a benign mass occurring in multiple areas of the head and neck is rare. This report describes an atypical case with EMP occurring in multiple areas of the head and neck. PATIENT CONCERNS A 35-year-old woman was admitted due to complaints of sore throat discomfort accompanied by hoarseness. The patient had undergone surgical excision of the thyroid gland and parotid gland excision several years ago. Postoperative pathological examination both indicated EMP. This time, the woman suffered EMP in head and neck who was treated with a simple surgery. DIAGNOSIS Postoperative pathological examination of the tumor indicated EMP, and histopathological findings revealed the tumor to be a plasmacytoma. Immunopathological examination were consistent with the diagnosis of EMP. INTERVENTIONS The patient underwent surgical resection without radiotherapy. OUTCOMES Histopathological and immunopathological examination findings revealed the tumor to be EMP. The patient was recurrence-free and did not progress to multiple myeloma (MM) during 19 months follow-up. LESSONS Increasing the awareness of EMP of head and neck is warranted. Our case confirmed that surgical excision is beneficial in the treatment of small, localized EMP.
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Affiliation(s)
- Jin Zhang
- School of Clinical Medicine Jining Medical University, Jining, Shandong, China
| | - Detao Ding
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Juxing Sun
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Hui Zhang
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - YunBing Dai
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Xiaoying Li
- School of Clinical Medicine Jining Medical University, Jining, Shandong, China
| | - Xu Ma
- School of Clinical Medicine Jining Medical University, Jining, Shandong, China
| | - Xiaoyu Li
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Jining Medical University, Jining, Shandong, China
| | - Yungang Wu
- Department of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Jining Medical University, Jining, Shandong, China
- * Correspondence: Yungang Wu, Departments of Otolaryngology-Head and Neck Surgery, The Affiliated Hospital of Jining Medical University, Jining 272029, China (e-mail: )
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Lofty AR, Elbakry AM, Omar GAB, Hamdino M. Intralesional combined furosemide and digoxin in cutaneous warts treatment: A randomized controlled clinical trial. Dermatol Ther 2022; 35:e15935. [PMID: 36226802 DOI: 10.1111/dth.15935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/30/2022]
Abstract
Although being a benign lesion, Warts can affect the quality of life by causing discomfort, disfigurement, and social embarrassment besides the tendency to spread. Cutaneous wart treatment faces many challenges as the development of an antiviral drug that can eradicate the human papilloma virus (HPV) is difficult. This clinical study aimed to assess the efficacy and safety of intralesional combined furosemide and digoxin in the treatment of multiple cutaneous warts. This double blinded randomized clinical trial included 80 adult patients with multiple cutaneous warts (≥2 warts) who were randomized into two groups, Group I (40 patients) treated with intralesional combined furosemide and digoxin and Group II (40 patients) who were treated with intralesional normal saline solution as a control group, weekly till improvement or for maximum five sessions. Clinical and dermoscopic evaluation at baseline, every session, and monthly for 6 months after the last session to detect any recurrence was performed. Complete wart clearance was observed in 92.5% of patients in the intralesional combined furosemide and digoxin group (Group I) compared with 10.0% in saline group (Group II), with highly statistically significant difference (P-value = 0.000). Pain during injection in 95.0% and 45.0% of patients in Group I and Group II respectively, treatment group was superior compared to control group. Intralesional injection of combined furosemide and digoxin can be a safe and effective treatment option in multiple cutaneous warts with minimal side effects in this study.
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Affiliation(s)
- Amira Reda Lofty
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Asmaa Mohamed Elbakry
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy for Girls, Al-Azhar University, Cairo, Egypt
- Department of Pharmaceutics and Pharmaceutical Technology, Faculty of Pharmacy, Heliopolis University, Cairo, Egypt
| | - Ghada Abdel Badea Omar
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mervat Hamdino
- Dermatology and Venereology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
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Muacevic A, Adler JR, AlTawairqi SA, Khurshid A, Abdulaziz HA, Alotaibi AG, Alotaibi HO. A Single-Center Study of Patients With Synchronous Primary Malignancy: A Case Series. Cureus 2022; 14:e32839. [PMID: 36694511 PMCID: PMC9867554 DOI: 10.7759/cureus.32839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Multiple primary malignant tumors (MPMT) can be defined as more than two different tumors synchronously or metachronously forming in the same organ or different organs. The incidence of MPMTs varies dramatically between antemortem and postmortem examinations, becoming a serious medical issue. Evidence shows that the overall incidence of MPMTs is between 2.4% and 17%. Double primary malignancy (DPM) is considered the most common type of MPMT. In this case series, we present three cases of MPMT. The first case involved the colon and the breast, the second case involved the colon and the kidney, and the third case involved rectum and kidney.
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Kaleem Ullah M, Malamardi S, Siddaiah JB, A T, Prashant A, Vishwanath P, Riley LW, Madhivanan P, Mahesh PA. Trends in the Bacterial Prevalence and Antibiotic Resistance Patterns in the Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Hospitalized Patients in South India. Antibiotics (Basel) 2022; 11:antibiotics11111577. [PMID: 36358232 PMCID: PMC9686600 DOI: 10.3390/antibiotics11111577] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/02/2022] [Accepted: 11/07/2022] [Indexed: 11/11/2022] Open
Abstract
Exacerbation due to antimicrobial-drug-resistant bacteria among chronic obstructive pulmonary disease (AECOPD) patients contributes to mortality and morbidity. We examined the prevalence of the bacterial organisms and trends in drug resistance in AECOPD. In this retrospective study, between January 2016 to December 2020, among 3027 AECOPD patients, 432 (14.3%) had bacteria isolated. The regression and generalized estimating equations (GEE) were used for trends in the resistance patterns over five years, adjusting for age, gender, and comorbidities. Klebsiella pneumoniae (32.4%), Pseudomonas aeruginosa (17.8%), Acinetobacter baumannii (14.4%), Escherichia coli (10.4%), and Staphylococcus aureus (2.5%) were common. We observed high levels of drug resistance in AECOPD patients admitted to ICU (87.8%) and non-ICU (86.5%). A Cox proportional hazard analysis, observed infection with Acinetobacter baumannii and female sex as independent predictors of mortality. Acinetobacter baumannii had 2.64 (95% confidence interval (CI): 1.08−6.43) higher odds of death, compared to Klebsiella pneumoniae. Females had 2.89 (95% CI: 1.47−5.70) higher odds of death, compared to males. A high proportion of bacterial AECOPD was due to drug-resistant bacteria. An increasing trend in drug resistance was observed among females.
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Affiliation(s)
- Mohammed Kaleem Ullah
- Centre for Excellence in Molecular Biology and Regenerative Medicine, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India
- Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Sowmya Malamardi
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
- School of Psychology & Public Health, College of Science Health and Engineering, La Trobe University, Melbourne 3086, Australia
| | - Jayaraj Biligere Siddaiah
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Tejashree A
- Department of Microbiology, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Akila Prashant
- Centre for Excellence in Molecular Biology and Regenerative Medicine, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India
| | - Prashant Vishwanath
- Centre for Excellence in Molecular Biology and Regenerative Medicine, Department of Biochemistry, JSS Medical College, JSS Academy of Higher Education & Research, Mysore 570015, Karnataka, India
| | - Lee W. Riley
- Division of Infectious Disease and Vaccinology, School of Public Health, University of California, Berkeley, CA 94720, USA
- Correspondence: (L.W.R.); (P.A.M.)
| | - Purnima Madhivanan
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ 85724, USA
- Division of Infectious Diseases, College of Medicine, University of Arizona, Tucson, AZ 85724, USA
- Public Health Research Institute of India, Mysuru 570020, Karnataka, India
| | - Padukudru Anand Mahesh
- Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
- Correspondence: (L.W.R.); (P.A.M.)
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Brown GK, Finlay JR, Straw RC, Ziea JY, Leung B, O'Connell K, Thomson MJ, Campbell JE, Jones PD, Reddell P. Treatment of multiple synchronous canine mast cell tumours using intratumoural tigilanol tiglate. Front Vet Sci 2022; 9:1003165. [PMID: 36387404 PMCID: PMC9643212 DOI: 10.3389/fvets.2022.1003165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/30/2022] [Indexed: 02/16/2024] Open
Abstract
Mast cell tumours (MCTs) are common canine skin neoplasia. While they generally occur as single tumours, multiple synchronous MCTs (msMCTs) of de novo/non-metastatic origin are reported in a proportion of the patient population. Where there is no evidence of metastasis or lymphatic spread, MCTs are effectively controlled by surgery and other local therapies. However, treatment of de novo msMCTs can be more challenging, especially when they occur in surgically difficult locations. Here, we report the use of tigilanol tiglate, a novel small molecule registered as a veterinary pharmaceutical for the local treatment of non-metastatic MCTs, in the treatment of patients with msMCTs presenting at three Australian specialist referral centres. We also present a meta-analysis of the literature to provide a better understanding of the prevalence of canine msMCTs. Notably, nine patients with a total of 32 MCTs were treated during the study. A complete response was recorded in 26 (81%) of the individual MCTs on Day 28 after a single tigilanol tiglate injection. Of the 6 initially non-responsive MCTs, one achieved a complete response after a further tigilanol tiglate treatment. A complete response was reported at 6 months in all 22 of the tumours that were evaluable and that had recorded a complete response at Day 84. For the literature meta-analysis, 22 studies were found with prevalence estimates of msMCTs ranging from 3 to 40%; when combined, these studies yielded 3,745 patients with a prevalence of 13% (95% CI 10; 16). Overall, the results demonstrate the utility of intratumoural tigilanol tiglate as an option for the treatment of multiple MCTs where multiple surgical resections would have been required.
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Affiliation(s)
| | | | - Rodney C. Straw
- Brisbane Veterinary Specialist Centre, The Australian Animal Cancer Foundation, Albany Creek, QLD, Australia
| | - Joy Y. Ziea
- Brisbane Veterinary Specialist Centre, The Australian Animal Cancer Foundation, Albany Creek, QLD, Australia
| | - Becky Leung
- Brisbane Veterinary Specialist Centre, The Australian Animal Cancer Foundation, Albany Creek, QLD, Australia
| | | | | | | | | | - Paul Reddell
- QBiotics Group Limited, Yungaburra, QLD, Australia
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Debnath A, Pillinger KE, Martin AJ, Dobrzynski D, Cameron A, Shulder S. Clinical Outcomes and Treatment Strategies in Patients With Non-Carbapenemase-producing Carbapenem-Resistant Versus Carbapenem-Susceptible Enterobacterales Infections. Ann Pharmacother 2022:10600280221132019. [PMID: 36268974 DOI: 10.1177/10600280221132019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacterales (CRE) are difficult to treat and can cause significant morbidity and mortality, however most data reflect carbapenemase-producing infections. OBJECTIVE Our objective was to evaluate clinical outcomes of non-carbapenemase-producing CRE (nCP-CRE) compared with carbapenem-susceptible Enterobacterales (CSE) infections. METHODS This was a retrospective, multicenter, observational study (January 1, 2018 to December 31, 2020). The primary outcome was clinical success at 30 days with secondary outcomes, including clinical success at 90 days, clinical success based on treatment for nCP-CRE, persistent bacteremia, intensive care unit (ICU) admission, length of stay, and rate of Clostridioides difficile or multidrug resistant infections. RESULTS The final analysis included 211 patients: 142 (67%) with CSE and 69 (33%) with nCP-CRE infections. Prior carbapenem exposure was more common with nCP-CRE (15% vs 4%, P = 0.01). Clinical success at 30 days was similar between groups (77% vs 74%, P = 0.73). There were no differences in secondary outcomes. There was an overall low use of carbapenems (empiric 6%, definitive 7%). Most nCP-CRE infections were treated with a monotherapy carbapenem-sparing regimen (empiric 88%, definitive 90%). Limitations include the retrospective design and the high rate of urinary infections. CONCLUSION AND RELEVANCE Our study found no difference in clinical outcomes between nCP-CRE and CSE infections. Application of this study with future studies would help in determining optimal regimens for these infections.
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Affiliation(s)
- Ashita Debnath
- Department of Pharmacy, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Kelly E Pillinger
- Department of Pharmacy, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - Alysa J Martin
- Department of Pharmacy, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
| | - David Dobrzynski
- Division of Infectious Diseases, University of Rochester Medical Center, Rochester, NY, USA
| | - Andrew Cameron
- Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Stephanie Shulder
- Department of Pharmacy, Strong Memorial Hospital, University of Rochester Medical Center, Rochester, NY, USA
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Garg M, Sarma P, Chaturvedi S, Pant I. Multiple Primary Bilateral Cerebral Echinococcosis in an Adult: A Neurological Rarity. Asian J Neurosurg 2022; 17:647-650. [PMID: 36570753 PMCID: PMC9771622 DOI: 10.1055/s-0042-1757725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Although cases of intracranial hydatid cysts are commonly encountered, majority of them are secondary and are seen in children. Primary bilateral multiple intracranial hydatid cysts in adults are a neurological rarity. Intracranial involvement usually occurs following infestation of the other organs in the body by the pathogen. Multiple lesions in brain can manifest either following rupture of a single parent cyst in brain or by systemic dissemination from other organs. Here, we are presenting an adult patient who underwent successful surgical removal of multiple primary hydatid cysts of brain. A 47-year-old male patient presented with features of raised intracranial pressure and other focal deficits. Magnetic resonance imaging showed multiple cystic lesions on both sides of the cerebrum. Similar primary lesions elsewhere in the body were ruled out by other investigations. He underwent successful surgical removal of all the lesions. Intraoperative picture and histology were suggestive of hydatid cyst. In published literature, there are very few cases similar to ours. Echinococcosis should be considered as a differential diagnosis in multiple cystic lesions of the brain in endemic areas. Early diagnosis, proper surgical technique, and standard antihelminthic drug regimen are the key to achieve good outcome in these patients.
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Affiliation(s)
- Manish Garg
- Department of Neurosurgery, University College of Medical Sciences (UCMS) and Guru Teg Bahadur (GTB) Hospital, Delhi, India
| | - Pragyan Sarma
- Department of Neurosurgery, University College of Medical Sciences (UCMS) and Guru Teg Bahadur (GTB) Hospital, Delhi, India,Address for correspondence Pragyan Sarma, Mch, Associate Professor of Neurosurgery UCMS and GTB HospitalDelhi, 110096India
| | - Sujata Chaturvedi
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, Delhi, India
| | - Ishita Pant
- Department of Pathology, Institute of Human Behaviour and Allied Sciences, Delhi, India
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Hiersch L, Shah BR, Berger H, Geary M, McDonald SD, Murray-Davis B, Guan J, Halperin I, Retnakaran R, Barrett J, Melamed N. Screening Accuracy of the 50 g-Glucose Challenge Test in Twin Compared With Singleton Pregnancies. J Clin Endocrinol Metab 2022; 107:2854-2864. [PMID: 35931097 DOI: 10.1210/clinem/dgac472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The optimal 50 g-glucose challenge test (GCT) cutoff for the diagnosis of gestational diabetes mellitus (GDM) in twin pregnancies is unknown. OBJECTIVE This work aimed to explore the screening accuracy of the 50 g-GCT and its correlation with the risk of large for gestational age (LGA) newborn in twin compared to singleton pregnancies. A population-based retrospective cohort study (2007-2017) was conducted in Ontario, Canada. Participants included patients with a singleton (n = 546 892 [98.4%]) or twin (n = 8832 [1.6%]) birth who underwent screening for GDM using the 50 g-GCT. METHODS We compared the screening accuracy, risk of GDM, and risk of LGA between twin and singleton pregnancies using various 50 g-GCT cutoffs. RESULTS For any given 50 g-GCT result, the probability of GDM was higher (P = .0.007), whereas the probability of LGA was considerably lower in the twin compared with the singleton group, even when a twin-specific growth chart was used to diagnose LGA in the twin group (P < .001). The estimated false-positive rate (FPR) for GDM was higher in twin compared with singleton pregnancies irrespective of the 50 g-GCT cutoff used. The cutoff of 8.2 mmol/L (148 mg/dL) in twin pregnancies was associated with an estimated FPR (10.7%-11.1%) that was similar to the FPR associated with the cutoff of 7.8 mmol/L (140 mg/dL) in singleton pregnancies (10.8%). CONCLUSION The screening performance of the 50 g-GCT for GDM and its correlation with LGA differ between twin and singleton pregnancies.
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Affiliation(s)
- Liran Hiersch
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
- Lis Maternity Hospital, Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Givat Shmuel 5442381, Israel
| | - Baiju R Shah
- Institute for Clinical Evaluative Sciences, Department of Medicine and Institute for Health Policy, Management and Evaluation, Scientist, Sunnybrook Research Institute; Division of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Howard Berger
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Michael Geary
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sarah D McDonald
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology, and Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Beth Murray-Davis
- Division of Maternal-Fetal Medicine, Departments of Obstetrics and Gynecology, Radiology, and Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Jun Guan
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
| | - Ilana Halperin
- Department of Endocrinology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Ravi Retnakaran
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Division of Endocrinology, University of Toronto, Toronto, Ontario, Canada
| | - Jon Barrett
- Departments of Obstetrics and Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Nir Melamed
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Drissen MMCM, Vos JR, van der Biessen-van Beek DTJ, van der Post RS, Nagtegaal ID, van Kouwen MCA, Bisseling TM, Hoogerbrugge N. Detection and Yield of Colorectal Cancer Surveillance in Adults with PTEN Hamartoma Tumour Syndrome. Cancers (Basel) 2022; 14:4005. [PMID: 36010998 DOI: 10.3390/cancers14164005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 11/17/2022] Open
Abstract
Colorectal cancer surveillance (CCS) with colonoscopy every five years is advised for PTEN Hamartoma Tumour Syndrome (PHTS) patients aged ≥40 due to an increased colorectal cancer (CRC) risk. However, data to support CCS guidelines are scarce and available CRC risks are low (0-5% at age 50) and likely overestimated. We aimed to assess the detection and yield of CCS for PHTS patients without a CRC history. A retrospective cohort study including PHTS patients aged ≥40 with CCS at a PHTS expertise centre between 2011 and 2022. Adenomas with a ≥10 mm size, (tubulo)villous histology, or high-grade dysplasia were considered advanced. During 67 follow-up years, 37 patients (median age 47 years) underwent 61 colonoscopies. CCS yielded no CRCs. Adenomas were diagnosed in 13/37 (35%) patients during 23/100 colonoscopies (95% CI: 14-36), including one advanced adenoma. Baseline adenoma detection rates were similar to follow-up and higher in patients aged above 50 (50/100, 95% CI: 24-76) vs. age 50 or below (11/100, 95% CI: 3-30; p = 0.021). The low CRC and advanced adenoma yield allow for a more personalised surveillance program. Following our findings combined with literature on CRC risk and progression, we suggest starting CCS at age 40 with variable follow-up intervals between 1 and 10 years depending on previous colonoscopy findings.
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Sartor R, Capozzoli F, Venturini S, Crapis M, Passadore P, Valente M. Rapidly progressive ischemic strokes and transient antiphospholipid syndrome during a mild SARS-CoV-2 infection. Acta Biomed 2022; 93:e2022107. [PMID: 35671113 PMCID: PMC10510985 DOI: 10.23750/abm.v93is1.12609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 06/15/2023]
Abstract
SARS-CoV-2 infection is associated with an increased risk of thrombotic events, especially during severe forms of disease. Here we describe the clinical history of a patient with a mild form of Covid-19 infection presenting with multiple cerebral ischemic lesions that evolved in an atypical way.
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Affiliation(s)
- Roberto Sartor
- a:1:{s:5:"en_US";s:52:"Clinical Neurology, Udine University Hospital, Udine";}.
| | - Francesca Capozzoli
- Department of Neurology, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Sergio Venturini
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
| | - Paolo Passadore
- Department of Neurology, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
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Do T, Lee SJ, Lee J. Multiple De Novo Cerebral Arteriovenous Malformations in a Patient with Alcoholic Liver Cirrhosis. J Belg Soc Radiol 2022; 106:53. [PMID: 35651917 DOI: 10.5334/jbsr.2822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 05/10/2022] [Indexed: 11/30/2022] Open
Abstract
Cerebral arteriovenous malformations (cAVMs) are traditionally considered congenital anomalies. The literature includes only two reported cases of de novo solitary cAVMs associated with liver cirrhosis (LC). Here, we report a unique case of multiple de novo cAVMs in a patient with alcoholic LC. Teaching point: In patients with potential risks for de novo cAVM, including liver cirrhosis, the possibility of multiple de novo cAVMs should be considered.
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Rogers SJ, Lomax N, Alonso S, Lazeroms T, Riesterer O. Radiosurgery for Five to Fifteen Brain Metastases: A Single Centre Experience and a Review of the Literature. Front Oncol 2022; 12:866542. [PMID: 35619914 PMCID: PMC9128547 DOI: 10.3389/fonc.2022.866542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Stereotactic radiosurgery (SRS) is now mainstream for patients with 1-4 brain metastases however the management of patients with 5 or more brain metastases remains controversial. Our aim was to evaluate the clinical outcomes of patients with 5 or more brain metastases and to compare with published series as a benchmarking exercise. Methods Patients with 5 or more brain metastases treated with a single isocentre dynamic conformal arc technique on a radiosurgery linac were identified from the institutional database. Endpoints were local control, distant brain failure, leptomeningeal disease and overall survival. Dosimetric data were extracted from the radiosurgery plans. Series reporting outcomes following SRS for multiple brain metastases were identified by a literature search. Results 36 patients, of whom 35 could be evaluated, received SRS for 5 or more brain metastases between February 2015 and October 2021. 25 patients had 5-9 brain metastases (group 1) and 10 patients had 10-15 brain metastases (group 2). The mean number of brain metastases in group 1 was 6.3 (5-9) and 12.3 (10-15) in group 2. The median cumulative irradiated volume was 4.6 cm3 (1.25-11.01) in group 1 and 7.2 cm3 (2.6-11.1) in group 2. Median follow-up was 12 months. At last follow-up, local control rates per BM were 100% and 99.8% as compared with a median of 87% at 1 year in published series. Distant brain failure was 36% and 50% at a median interval of 5.2 months and 7.4 months after SRS in groups 1 and 2 respectively and brain metastasis velocity at 1 year was similar in both groups (9.7 and 11). 8/25 patients received further SRS and 7/35 patients received whole brain radiotherapy. Median overall survival was 10 months in group 1 and 15.7 months in group 2, which compares well with the 7.5 months derived from the literature. There was one neurological death in group 2, leptomeningeal disease was rare (2/35) and there were no cases of radionecrosis. Conclusion With careful patient selection, overall survival following SRS for multiple brain metastases is determined by the course of the extracranial disease. SRS is an efficacious and safe modality that can achieve intracranial disease control and should be offered to patients with 5 or more brain metastases and a constellation of good prognostic factors.
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Affiliation(s)
- Susanne J Rogers
- Radiation Oncology Center KSA-KSB, Canton Hospital Aarau, Aarau, Switzerland
| | - Nicoletta Lomax
- Radiation Oncology Center KSA-KSB, Canton Hospital Aarau, Aarau, Switzerland
| | - Sara Alonso
- Radiation Oncology Center KSA-KSB, Canton Hospital Aarau, Aarau, Switzerland
| | - Tessa Lazeroms
- Radiation Oncology Center KSA-KSB, Canton Hospital Aarau, Aarau, Switzerland
| | - Oliver Riesterer
- Radiation Oncology Center KSA-KSB, Canton Hospital Aarau, Aarau, Switzerland
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Zimbovskaya NA. Large enhancement of thermoelectric effects in multiple quantum dots in a serial configuration due to Coulomb interactions. J Phys Condens Matter 2022; 34:255302. [PMID: 35378523 DOI: 10.1088/1361-648x/ac640c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/04/2022] [Indexed: 06/14/2023]
Abstract
In the present work we theoretically study Seebeck effect in a set of several quantum dots in a serial configuration coupled to nonmagnetic conducting electrodes. We focus on the combined effect of intra-dot Coulomb interactions between electrons and the number of dots on the thermopower (S) and the thermoelectric figure of merit (ZT) of the considered transport junction within the Coulomb blockade regime. We show that a strong enhancement of the bothSand ZT may occur when the chemical potential of electrodes is situated within the Coulomb gap in the electron transmission spectrum thus indicating a possibility of significant increase of the efficiency of heat-to-electric energy conversion. The enhancement becomes more pronounced when the number of dots increases.
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Affiliation(s)
- Natalya A Zimbovskaya
- Department of Physics and Electronics, University of Puerto Rico-Humacao, CUH Station, Humacao, PR 00791, United States of America
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