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Hoffmann SS, Thiesson EM, Johansen JD, Hviid A. Association between atopic disease and vaccination granulomas: A nested case-control study. Contact Dermatitis 2024; 90:411-419. [PMID: 38059542 DOI: 10.1111/cod.14472] [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: 07/07/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND Vaccination granulomas are observed in 1% of all children vaccinated with an aluminium-adsorbed vaccine. Most children with granulomas also have aluminium contact allergy (CA). CA and atopic diseases are both highly prevalent among children and may be associated. OBJECTIVE To investigate the association between vaccination granulomas and atopic dermatitis (AD), asthma and rhinitis in children. METHODS We sourced a cohort of all Danish children born from 2009 to 2017 and conducted a nested case-control study, with cases defined as children with vaccination granulomas, matched to controls 1:10 on sex, socioeconomic class, gestational age and season of birth. All cases and controls were vaccinated with aluminium-adsorbed vaccines and followed until their second birthday. We used conditional logistic regression to estimate the odds ratios (ORs). RESULTS The study included 2171 cases with vaccination granulomas, and 21 710 controls. Children with a diagnosis of AD had a significantly higher risk of a vaccination granuloma (OR 1.50, 95% confidence intervals [CI] 1.25-1.80). No significant association was found between granulomas and asthma or rhinitis. The association between granulomas and AD was even higher in an additional sensitivity-analysis, following the children until their fourth birthday (OR 2.71, 95% CI 2.36-3.11). CONCLUSION AD was significantly associated with vaccination granulomas, but not with other atopic diseases, within both the first 2 and 4 years of life.
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Affiliation(s)
- Stine Skovbo Hoffmann
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | | | - Jeanne Duus Johansen
- National Allergy Research Centre, Department of Dermatology and Allergy, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Pharmacovigilance Research Center, Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark
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Ting IPL, Tan HZ, Teo HG, Kiing JW, Muniandy P. Spectrum of cutaneous granulomatous lesions: A 5-year experience in a tertiary care centre in Sarawak. Med J Malaysia 2023; 78:184-189. [PMID: 36988528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Granulomatous skin lesions can have various histopathological features leading to diagnostic confusion. The study aimed to determine the frequency and pattern of different granulomatous skin lesions. MATERIALS AND METHODS This was a 5-year retrospective study done between April 2017 and March 2022 at Dermatology Department, Sarawak General Hospital. Subjects with a clinicopathological diagnosis of granulomatous diseases were included in the analysis. RESULTS A total of 1718 skin biopsies were done during the study periods, with 49 (2.8%) confirmed granulomatous skin lesions. Most patients were aged 40-60 with a male predominance of 51%. Most of the skin biopsy samples were taken from the upper limb (36%). In this study, epitheloid granuloma was the commonest subtype (21, 43%) followed by suppurative granuloma (12, 24%), tuberculoid granuloma (8, 16%) and foreign body granuloma (5, 10%). The commonest aetiology of granulomatous skin lesions in our study was infections (30, 61%) followed by foreign body inoculation (8, 16%). Fungal infection was the most common infective cause, followed by cutaneous tuberculosis. CONCLUSION The major cause of granulomatous dermatoses in developing countries is still infections, fungal and tuberculosis being the leading causes.
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Affiliation(s)
- I P L Ting
- Sarawak General Hospital, Dermatology Department, Kuching, Sarawak, Malaysia.
| | - H Z Tan
- Sarawak General Hospital, Dermatology Department, Kuching, Sarawak, Malaysia
| | - H G Teo
- Sarawak General Hospital, Dermatology Department, Kuching, Sarawak, Malaysia
| | - J W Kiing
- Sarawak General Hospital, Dermatology Department, Kuching, Sarawak, Malaysia
| | - P Muniandy
- Sarawak General Hospital, Dermatology Department, Kuching, Sarawak, Malaysia
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Abstract
BACKGROUND/OBJECTIVES The aim is to determine the umbilical granuloma frequency of newborns and etiological factors. METHODS In this study, the records of 21344 newborns who were admitted to our hospital between February 2015 and August 2019, were examined. RESULTS 21191 newborns are included in the study. 2.4% of newborns was Syrian refugee and others were citizens of Turkey. Umbilical granuloma frequency was % 3.83. While umbilical granuloma frequency was 3.85% in Turkish citizen newborns, %3.01 in Syrians. Mean umbilical cord seperation time was 7.1 days in cases with umbilical granuloma. There was no statistically significant relationship determined between umbilical granuloma development and race and time of umbilical cord seperation (p >0.05) The frequency of umbilical granuloma was 3.5% for boys and 4.1% for girls. Umbilical granuloma was being observed statistically significantly higher in girls than in boys (p <0.05). 80.8% of the cases with umbilical granuloma were bathed before the umbilical cord seperation. A significant difference was determined between bathing before umbilical cord seperation and umbilical granuloma development (p < 0.05). CONCLUSION Umbilical granuloma, with frequency of 3.83% in newborns. Umbilical granuloma is more common in girls and newborns bathed before the umbilical cord seperation.
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Affiliation(s)
- Öztaş Tülin
- University of Health Sciences GaziYaşargil Training and Research Hospital, Department of Pediatric Surgery, Diyarbakir, Turkey
| | - Asena Muhammet
- University of Health Sciences GaziYaşargil Training and Research Hospital, Department of Pediatric Surgery, Diyarbakir, Turkey
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Paredes Méndez JE, Alosilla Sandoval PA, Vargas Marcacuzco HT, Junes Perez SI, Mestanza Rivasplata AL, Paucar Aguilar DR, Arenas Gamio JL. [Clinical significance of the presence of granulomas in Crohn's disease]. Rev Gastroenterol Peru 2020; 40:308-314. [PMID: 34087919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
UNLABELLED Epithelioid granuloma is a characteristic histological feature of Crohn's disease (CD), but their significance with respect to the severity and progression of the disease is still uncertain. OBJECTIVE To evaluate the clinical characteristics of CD patients in relation to the presence or not of granulomas in histological findings. MATERIALS AND METHODS An observational, descriptive, retrospective study in patients diagnosed with CD from January 2004 to December 2019 in the gastroenterology department of the Guillermo Almenara Irigoyen National Hospital, Lima-Peru. RESULTS 55 patients were included. Average age of 56 ± 8.2 years. The median time of disease was 16 months. Have two or more relapses per year (p<0.001; OR=9.75), age less than 30 years (p<0.001; OR=3.57) and a moderate to severe CDAI (≥220 points, OR=11.4, p <0.008) was significantly associated with the presence of granulomas. Severe endoscopic activity (p <0.003; OR=9.91) and the stenosing-penetrating phenotype (p<0.001; OR=22.1) also showed association with the presence of granulomas. The group of granulomas had a higher probability of corticosteroid use (p <0.024; OR=3.92) and immunomodulator (p <0.001; OR=7.10), besides the need for intestinal resection surgery (p<0.027; OR=5.07). CONCLUSIONS The presence of granulomas in CD may be associated with increased clinical severity, endoscopic severity, immunosuppressive therapy requirement and undergo for intestinal resection.
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Esianor BI, Jiang ZY, Diggs P, Yuksel S, Roy S, Huang Z. Pediatric tracheostomies in patients less than 2 years of age: Analysis of complications and long-term follow-up. Am J Otolaryngol 2020; 41:102368. [PMID: 31859007 DOI: 10.1016/j.amjoto.2019.102368] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 11/22/2019] [Accepted: 12/03/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE Identify variables that are predictive of morbidity and mortality in children under the age of two undergoing tracheostomy and to provide longitudinal data on this patient population. METHODS Patients were retrospectively identified using Current Procedural Terminology codes 31600, 31601, 31610 from 2009 to 2016. RESULTS Median age at time of tracheostomy was 0.43 years (interquartile range, 0.27-0.61). Patients were followed for a median of 1.39 years (range 0.03-4.25). Overall mortality rate in this cohort was 23.5% with the majority (81.3%) of deaths occurring >30 days following tracheostomy. The most frequently encountered major complication was cardiopulmonary arrest (10.29%) in the short-term follow up period (<30 days) and accidental decannulation (32.81%) during long-term follow up (>30 days). Peristomal skin breakdown was less likely to develop in patients who did not receive paralytics following tracheostomy. Most patients (54.4%) were discharged to home following initial admission and experienced a mean of 2.10 readmissions for any reason during the follow-up period. 64.4% of patients underwent surveillance direct laryngoscopy and bronchoscopy during the follow-up period and suprastomal granuloma formation was detected in 31.2% of these patients. 9 patients underwent decannulation at a median of 2 years from original tracheostomy placement. CONCLUSION Pediatric patients under the age of 2 undergoing tracheostomy exhibit high morbidity during both the initial hospital admission and the subsequent months following discharge. However, major complications were low and mortality was not directly related to tracheostomy status in any case.
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Affiliation(s)
| | - Zi Yang Jiang
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Sancak Yuksel
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Soham Roy
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Zhen Huang
- Department of Otorhinolaryngology-Head & Neck Surgery, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA.
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Paulucci BP. PMMA Safety for Facial Filling: Review of Rates of Granuloma Occurrence and Treatment Methods. Aesthetic Plast Surg 2020; 44:148-159. [PMID: 31637504 DOI: 10.1007/s00266-019-01522-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 03/03/2019] [Accepted: 10/09/2019] [Indexed: 12/17/2022]
Abstract
PMMA is composed of microspheres suspended in bovine collagen. Once injected in a dermal area, the carrier is absorbed, giving place to collagen that gives volume and maintains the spheres in the place. This process may give origin to exacerbate foreign body reaction and granuloma. The frequency of such complication is not clear. The primary objective was to review and compare the frequencies of granuloma between the published studies. The secondary aim was to compare the therapies and efficacies. The series of cases in which PMMA was used as facial filler were reviewed, and the rate of granulomas was compared; the case report studies describing those complications were also reviewed, and the therapies and outcomes were quantified. The data showed general frequency of PMMA-related complications of 4.9% and granulomas 1.9%; the incidence of granuloma was 1/2075 patients-year, and the time to development ranged from 6 to 180 months. The most used therapies were steroid, surgery or both, with satisfactory results. In conclusion, considering the actual risks and benefits of PMMA, we may affirm that it is a safe filler; doctors and patients must be conscious of potential risks when deciding for its use. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Abstract
Purpose To determine the prognosis for ocular toxocariasis (OT) according to the location of the granuloma and to identify factors associated with its recurrence within 1 year. Methods OT patients were classified according to the granuloma lesion. After grouping the patients as posterior or peripheral, we compared sex, age, intraocular pressure, best corrected visual acuity (BCVA), degree of inflammation, immunoglobulin E, eosinophil profiles, recurrence, and complications in each group. We also identified factors associated with recurrence within 1 year. Results A total of 29 (61.70%) patients had granuloma at the periphery, and 18 (38.30%) patients had granuloma around the posterior pole. There were no significant differences in ocular or systemic evaluations except the initial BCVA. The mean decimal BCVA of the posterior pole granuloma group was worse than that of the peripheral granuloma group (p = 0.042). After treatment, the mean BCVA of the posterior pole granuloma group improved significantly (p = 0.019), and the final mean BCVA was not significantly different between the groups (p = 0.673). Multiple logistic regression analyses revealed that recurrence within a year was associated with age at diagnosis (p = 0.007). Conclusions The initial BCVA of OT patients differed according to the location of the granuloma, but the BCVA after treatment was not significantly different between the groups. Younger age was associated with recurrence within 1 year.
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Affiliation(s)
- Jin-woo Kwon
- Department of Ophthalmology and Visual Science, St. Vincent’s Hospital, College of Medicine, Catholic University of Korea, Suwon, Republic of Korea
| | - Sun Young Lee
- Department of Ophthalmology and Visual Science, St. Vincent’s Hospital, College of Medicine, Catholic University of Korea, Suwon, Republic of Korea
| | - Donghyun Jee
- Department of Ophthalmology and Visual Science, St. Vincent’s Hospital, College of Medicine, Catholic University of Korea, Suwon, Republic of Korea
- * E-mail: (DHJ); (YKC)
| | - Yang kyung Cho
- Department of Ophthalmology and Visual Science, St. Vincent’s Hospital, College of Medicine, Catholic University of Korea, Suwon, Republic of Korea
- * E-mail: (DHJ); (YKC)
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Leung J, Sullivan KE, Perelygina L, Icenogle JP, Fuleihan RL, Lanzieri TM. Prevalence of Granulomas in Patients With Primary Immunodeficiency Disorders, United States: Data From National Health Care Claims and the US Immunodeficiency Network Registry. J Clin Immunol 2018; 38:717-726. [PMID: 30043271 DOI: 10.1007/s10875-018-0534-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 07/09/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Granulomas are a potentially severe condition that can last for several years in persons with primary immunodeficiency disorders (PIDD). We assessed the prevalence of granulomas in patients with PIDD. METHODS We used the Truven Health MarketScan® 2005-2015 Commercial Claims and Encounters and 2006-2015 Medicaid databases and the US Immunodeficiency Network (USIDNET) PIDD registry (a program of the Immune Deficiency Foundation). Our study population consisted of persons age < 65 years with PIDD, defined as persons with ≥ 2 claims with a diagnostic code for PIDD in MarketScan databases, or patients enrolled in USIDNET. Granulomas were identified using diagnostic codes in MarketScan or provider report in USIDNET. We calculated annual prevalence of PIDD and of granulomas among PIDD patients. RESULTS We identified 247,474 and 40,395 persons with PIDD among commercially and Medicaid-insured persons, respectively. PIDD prevalence was 6.0/10,000 in 2005 and 11.7/10,000 in 2015 among commercially insured persons and 5.5/10,000 in 2006 and 9.6/10,000 in 2015 among Medicaid-insured persons. The prevalence of granulomas among PIDD patients was 1.2 and 1.5% among commercially and Medicaid-insured persons, respectively. In USIDNET, prevalence of granulomas was 4.4% (177/4021). The proportion with granulomas was similar across age groups in MarketScan, but varied from 2 to 9% in USIDNET. The reported prevalence of granulomas differed depending on PIDD condition: 1-2% in the MarketScan data and 0-13% in USIDNET. CONCLUSION Granuloma prevalence in PIDD patients was 1-4%. Our study provides an estimate of the proportion of PIDD patients and suggests that granulomas are an uncommon occurrence among patients with PIDD.
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Affiliation(s)
- Jessica Leung
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-34, Atlanta, GA, 30333, USA.
| | - Kathleen E Sullivan
- Division of Allergy Immunology, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Ludmila Perelygina
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-34, Atlanta, GA, 30333, USA
| | - Joseph P Icenogle
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-34, Atlanta, GA, 30333, USA
| | - Ramsay L Fuleihan
- Division of Allergy and Immunology, Feinberg School of Medicine, Northwestern Medicine, Chicago, IL, 60611, USA
| | - Tatiana M Lanzieri
- National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-34, Atlanta, GA, 30333, USA
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9
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Wang Y, Tang XY, Yuan J, Wu SQ, Chen G, Zhang MM, Wang MG, Zhang WY, He JQ. Bone marrow granulomas in a high tuberculosis prevalence setting: A clinicopathological study of 110 cases. Medicine (Baltimore) 2018; 97:e9726. [PMID: 29369209 PMCID: PMC5794393 DOI: 10.1097/md.0000000000009726] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Granulomas were reported in 0.3% to 3% of bone marrow biopsies. The aim of the study was to evaluate the incidence and etiology of bone marrow granulomas (BMGs) in the West China Hospital, which located at a high tuberculosis (TB) prevalence area in China.A retrospective case review was performed on 11,339 bone marrow biopsies at the West China Hospital of Sichuan University between January 2011 and December 2015. Cases with BMGs were retrieved and their clinical data and histopathological features were collected, examined, and analyzed.Out of 11,339, 110 cases showed granulomatous lesions in the bone marrow biopsies (0.97%). Etiologies were indentified in 80 cases (72.8%), with infections being the most common (64.5%), following by malignancies (4.5%) and autoimmune diseases (3.6%). Among infectious cases, 87.32% (62/71) cases were diagnosed as TB, a positive acid-fast stain or/and polymerase chain reaction (PCR) result for mycobacterium TB DNA fragment amplification was obtained for 35 cases. In 30 cases (27.27%), a definite diagnosis could not be established.In a TB high prevalence region in China, with a combined histological, clinical, serological, and molecular approach, we were able to clarify the cause in 72.73% of the bone marrow granulomatous cases. TB is the most common underlying etiologies. Therefore, acid-fast stain and quantitative PCR for mycobacterium TB DNA amplification are recommended as a routine for bone marrow biopsies in TB high prevalence regions.
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Affiliation(s)
- Yu Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Xiao-Yan Tang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ji Yuan
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Shou-Quan Wu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Guo Chen
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Miao-Miao Zhang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Ming-Gui Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Wen-Yan Zhang
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jian-Qing He
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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Mookadam M, Mesinkovska N, Bridges AG. Evaluating the clinical and demographic features of extrafacial granuloma faciale. Cutis 2017; 100:E18-E22. [PMID: 28873117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Granuloma faciale (GF) is an uncommon cutaneous disease of uncertain etiology that predominantly affects the face. Extrafacial lesions are rare. The purpose of this study was to describe the clinical and demographic features of a series of patients with extrafacial manifestations of GF who were diagnosed and treated at a single center over more than 5 decades. We performed a retrospective medical record analysis for all patients diagnosed with extrafacial GF who were treated at Mayo Clinic (Rochester, Minnesota) from 1959 through 2013. During the study period, extrafacial GF was diagnosed in 10 patients (6 men, 4 women), all of whom were white. The mean age was 58.7 years (range, 26-87 years). Seven patients presented with both facial and extrafacial lesions. Although extrafacial lesions are rare in GF, this condition should be included in the differential diagnosis of well-demarcated plaques and nodules found on the arms and legs.
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Affiliation(s)
- Martina Mookadam
- Department of Family Medicine, Mayo Clinic, Scottsdale, Arizona, USA
| | - Natasha Mesinkovska
- Department of Dermatology and Dermatopathology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alina G Bridges
- Department of Dermatology and the Department of Laboratory Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Antuofermo E, Pais A, Polinas M, Cubeddu T, Righetti M, Sanna MA, Prearo M. Mycobacteriosis caused by Mycobacterium marinum in reared mullets: first evidence from Sardinia (Italy). J Fish Dis 2017; 40:327-337. [PMID: 27368155 DOI: 10.1111/jfd.12515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/14/2016] [Accepted: 05/16/2016] [Indexed: 06/06/2023]
Abstract
Mycobacterium marinum is a slow-growing non-tuberculous mycobacterium, and it is considered the most common aetiologic agent of mycobacteriosis in wild and cultured fish. The diagnosis is principally made by histology when positive Ziehl-Neelsen stain granulomas are detected. The aim of this study was to investigate the occurrence of mycobacteriosis in extensively cultured Mugilidae of two lagoons (Cabras and San Teodoro) from Sardinia by the use of histology, microbiology, PCR and DNA sequencing. Nine of 106 mullets examined were affected by mycobacteriosis, and the spleen was the most affected organ. The histology detected higher rate (100%) of infection in spleen than the culture and PCR (75% and 62.5%, respectively). The sequencing of hsp65 gene identified M. marinum as the primary cause of mycobacteriosis in the mullets examined. Mullets affected by mycobacteriosis were mainly fished in the San Teodoro lagoon characterized by critical environmental conditions. Histology remains the most common method in detecting fish affected by mycobacteriosis, and PCR-based methods are essential for species identification. Our finding are worthy of attention because mycobacteriosis caused by M. marinum in reared mullets was evidenced for the first time in Sardinia, suggesting that this disease may be underestimated also in other cultured fish species.
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Affiliation(s)
- E Antuofermo
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - A Pais
- Laboratory of Aquaculture and Aquatic Resources Management, Section of Animal Sciences, Department of Agriculture, University of Sassari, Sassari, Italy
| | - M Polinas
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - T Cubeddu
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - M Righetti
- Fish Disease Laboratory, State Veterinary Institute of Piedmont, Liguria and Aosta Valley, Torino, Italy
| | - M A Sanna
- Department of Veterinary Medicine, University of Sassari, Sassari, Italy
| | - M Prearo
- Fish Disease Laboratory, State Veterinary Institute of Piedmont, Liguria and Aosta Valley, Torino, Italy
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Trejo Bittar HE, Doberer D, Mehrad M, Strollo DC, Leader JK, Wenzel S, Yousem SA. Histologic Findings of Severe/Therapy-Resistant Asthma From Video-assisted Thoracoscopic Surgery Biopsies. Am J Surg Pathol 2017; 41:182-188. [PMID: 28079597 PMCID: PMC5234856 DOI: 10.1097/pas.0000000000000777] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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] [Indexed: 12/18/2022]
Abstract
The histologic changes occurring in severe/therapy-resistant asthma (SA) as defined by the European Respiratory Society/American Thoracic Society guidelines, particularly at the level of the distal airways are unknown. This study describes the clinical, radiologic, and histologic characteristics of 29 SA patients who underwent video-assisted thoracoscopic surgery lung biopsy. Pathologic observations were correlated with clinical features, especially the presence of autoimmune disease (AID) (15/29, 51.7%). Ten biopsies (10/29, 34.5%) showed only small airway manifestations of asthma, whereas in 19 (65.5%) asthmatic granulomatosis, manifested by asthmatic bronchiolitis supplemented by an alveolar septal mononuclear infiltrates with non-necrotizing granulomas, was present. SA patients without asthmatic granulomatosis showed more striking small airway injury, subbasement membrane thickening, and neutrophilic infiltrates. Cases with concurrent AID had a tendency to more parenchymal eosinophilic inflammation, more bronchiolocentric granulomas, and a suggestion of increased responsivity to nonsteroidal immunosuppressive therapy. Histologic examination of video-assisted thoracoscopic surgery lung biopsies in SA demonstrates diverse pathologies including cases associated with granulomatous inflammation in addition to eosinophilic infiltrates. This spectrum of histologies may link to a high incidence of AID.
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Affiliation(s)
| | - Daniel Doberer
- University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center, Pulmonary Allergy and Critical Care Medicine Division, Department of Medicine, Pittsburgh, PA, USA
| | - Mitra Mehrad
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, PA, USA
| | - Diane C. Strollo
- University of Pittsburgh Medical Center, Department of Cardiothoracic Surgery, Pittsburgh, PA, USA
| | - Joseph K. Leader
- University of Pittsburgh Medical Center, Department of Cardiothoracic Surgery, Pittsburgh, PA, USA
| | - Sally Wenzel
- University of Pittsburgh Asthma Institute at University of Pittsburgh Medical Center, Pulmonary Allergy and Critical Care Medicine Division, Department of Medicine, Pittsburgh, PA, USA
| | - Samuel A. Yousem
- University of Pittsburgh Medical Center, Department of Pathology, Pittsburgh, PA, USA
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Arya LK, Rathinam SR, Lalitha P, Kim UR, Ghatani S, Tandon V. Trematode Fluke Procerovum varium as Cause of Ocular Inflammation in Children, South India. Emerg Infect Dis 2016; 22:192-200. [PMID: 26812231 PMCID: PMC4734527 DOI: 10.3201/eid2202.150051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Larvae of this fluke are novel causes of granulomatous eye disease in children. Trematodes are recognized as a group of emerging parasites in tropical countries. We identified a trematode as a cause of ocular granulomas that developed in children who bathed in ponds or rivers in South India. DNA was isolated from patients’ surgically excised granulomas and from the trematode cercariae (larvae) released by the snail Melanoidestuberculata in water in which the children bathed. Real-time and conventional PCRs were performed that targeted ribosomal DNA regions spanning the internal transcribed spacer 2 and 28S sequences of this trematode. The PCR-amplified products were subjected to bidirectional sequencing. Analysis of sequences for the granuloma samples and the trematode cercariae showed maximum sequence similarity with Procerovumvarium (family Heterophyidae). Our results confirmed the etiology of the ocular infection, implicating snail vectors as environmental risk factors for ocular parasitosis.
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Amraoui N, Krich S, Meziane M, Gallouj S, Abid H, Elmrini A, Moumna K, Harmouch T, Mernissi F. Cutaneous tuberculosis revealing multifocal tuberculosis in immunocompetent patients. Int J Mycobacteriol 2016; 4:255-7. [PMID: 27649875 DOI: 10.1016/j.ijmyco.2015.05.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/18/2015] [Revised: 05/08/2015] [Accepted: 05/09/2015] [Indexed: 11/17/2022] Open
Abstract
Multifocal tuberculosis (TB) is rare. It occurs especially in immunocompromised patients. Association with skin involvement is rarer, and few cases are reported in the literature. The present study reports 7 cases of multifocal TB with cutaneous localization in immunocompetent patients. Cutaneous forms of TB included in this series are: gummas, scrofuloderma, vasculitis TB and lupus TB. The patients had at least two extra skin locations, namely: osteoarticular, lung, pleural, scrotal, muscular, digestive, laryngeal, nodal and splenic locations. These patients had no context of immunosuppression which is uncommon, but should be kept in mind, especially in endemic countries.
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Affiliation(s)
- N Amraoui
- Department of Dermatology Venereology, Hassan II University Hospital Fez, Morocco.
| | - S Krich
- Department of Dermatology Venereology, Hassan II University Hospital Fez, Morocco
| | - M Meziane
- Department of Dermatology Venereology, Hassan II University Hospital Fez, Morocco
| | - S Gallouj
- Department of Dermatology Venereology, Hassan II University Hospital Fez, Morocco
| | - H Abid
- Department of Orthopedy and Traumatology B4, Hassan II University Hospital Fez, Morocco
| | - A Elmrini
- Department of Orthopedy and Traumatology B4, Hassan II University Hospital Fez, Morocco
| | - K Moumna
- Department of Pathology, Hassan II University Hospital Fez, Morocco
| | - T Harmouch
- Department of Pathology, Hassan II University Hospital Fez, Morocco
| | - F Mernissi
- Department of Dermatology Venereology, Hassan II University Hospital Fez, Morocco
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Golemba AS, Ferreyra FGE, Rovai GB, Achinelli FR. [Pleural tuberculosis in a hospital in Northeast Argentina]. Medicina (B Aires) 2016; 76:76-80. [PMID: 27135844] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
Pleural tuberculosis ranks first in extrapulmonary sites. The aim of this study was to estimate the proportion pleural TB among TB cases, and characterize the presentation, diagnostic methods and outcomes of patients hospitalized in the ángela I. de Llano hospital, Corrientes, Argentina, between January 1, 2011 and June 30, 2014. We performed a descriptive and observational study. Ten patients were diagnosed with TB pleural effusion. The mean age was 48.5 ± 16.9 (16-63) years. The average evolution time before the consultation was 21.3 ± 11.6 (7-45) days. All were unilateral, exudates, with cell count of 2152 ± 687 (84-7000) cells; 8 cases had lymphocyte predominance. The average value of adenosine deaminase determination (ADA) was 92.7 ± 27.0 (60-150) IU/l. The pleural effusion smear was positive in 4 cases; development of Mycobacterium tuberculosis was obtained in 3 cases; histologically, three presented caseating granulomas. One death was recorded. Although pleural TB usually occurs in male patients, middle-aged, as a unilateral exudative pleural effusion with lymphocytic predominance, with less than a month's evolution, diagnostic certainty has its limitations, thus clinical suspicion, epidemiology, imaging, pathology and laboratory tests, and determination of adenosine deaminase levels, represent a valuable contribution to diagnosis.
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Affiliation(s)
- Alfredo S Golemba
- Servicio de Clínica Médica, Hospital ángela I. de Llano, Corrientes, Argentina. E-mail:
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Fukui S, Nakai Y, Matsumoto Y, Kagebayashi Y, Samma S. [Investigation of incidence and risk factors of subcutaneous granulomas induced by injection of leuprorelin acetate]. Hinyokika Kiyo 2015; 61:55-59. [PMID: 25812594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We investigated the incidence of granuloma and its related factors in 180 patients with prostate cancer who showed subcutaneous granuloma formation during androgen deprivation therapy with subcutaneously administered leuprorelin acetate. A granuloma was defined as a persistent induration over 30 mm in diameter in the injected portion. Small indurations which often developed and disappeared after every injection were excluded. The survey was performed using a questionnaire after receiving written informed consent. Among the 180 patients with prostate cancer, 21 (11.7%) developed a granuloma at the injection portion, and subsequently the injection of leuprorelin acetate had to be discontinued. Eighteen of the 21 patients alternatively received goserelin acetate. Three patients had high-grade granulomas with ulcer and abscess formation, and were successfully treated with oral antibiotics. The average duration between the first injection of leuprorelin acetate and granuloma formation was 20.2 months (range : 4 to 62 months). There was no association between granuloma formation and patient backgrounds, such as allergic predisposition and past history. Twenty-one of the 180 prostatic cancer patients developed subcutaneous granuloma induced by the injection of leuprorelin acetate. The investigation showed an unexpectedly high incidence of granuloma formation. We must explain the risk of developing subcutaneous granuloma to the patients before introducing leuprorelin acetate.
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Affiliation(s)
- Shinji Fukui
- The Department of Urology, Nara Prefecture General Medical Center
| | - Yasushi Nakai
- The Department of Urology, Nara Prefecture General Medical Center
| | | | | | - Shoji Samma
- The Department of Urology, Nara Prefecture General Medical Center
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Crouser ED, Judson MA. Proceedings of the 2014 AASOG conference. Sarcoidosis Vasc Diffuse Lung Dis 2015; 31:359-363. [PMID: 25591149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/28/2014] [Indexed: 06/04/2023]
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18
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Ortega J, Noguera A, García-Quirós A, Viana D, Selva L, de Juan L, Romero B, García-Parraga D, Crespo JL, Corpa JM. Lesional patterns associated with mycobacteriosis in an Atlantic horse mackerel, Trachurus trachurus (L.), aquarium population. J Fish Dis 2014; 37:591-595. [PMID: 23802507 DOI: 10.1111/jfd.12145] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/17/2013] [Accepted: 05/17/2013] [Indexed: 06/02/2023]
Affiliation(s)
- J Ortega
- Faculty of Veterinary Medicine, Biomedical Sciences Research Institute, PASACTA (Histología y AnatomíaPatológica), Universidad CEU Cardenal Herrera, Moncada, Valencia, Spain
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Wang L, Sun S, Wang S, Liang D, Ji W. [Clinical observation of traumatic granuloma after CO₂ laser cordectomy and laryngopharyngeal reflux]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2014; 49:374-378. [PMID: 25017220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE Through clinical observation of granuloma after CO₂ laser cordectomy under suspensive laryngoscope to discuss the effects of laryngopharyngeal reflux(LPR) to traumatic granuloma. METHODS According to the classification of depth and range of CO₂ laser cordectomy, 111 cases were divided into 5 groups, and the incidence of postoperative granuloma of each group was observed. The largest number of the 5 groups was 49 cases of type III CO₂ laser cordectomy which was subdivided into 4 groups according to whether or not laryngopharyngeal reflux and whether or not proton pump inhibitor (PPI) treatment. RESULTS In 111 cases, 56 cases (50.5%) developed granuloma after CO₂ laser cordectomy. The incidence of traumatic granuloma after surgery was 10% (1/10), 26.1% (6/23), 53.1% (26/49), 78.6% (11/14), 80.0% (12/15) in I, II, III, IV, V type, respectively. It had statistical significance in chi-square test between 5 kinds of operative classification and the incidences of postoperative granuloma (χ² = 20.32, P < 0.01) and Spearman correlation analysis showed positive correlation between classification of operation and incidences of granuloma (r = 0.44, P < 0.01). According to LPR (-), LPR (+)and PPI (+), PPI (-), the incidence of granuloma had statistical significance in these 4 group patients of 49 type III cases (χ²= 5.83, P < 0.05). The incidence of granuloma after surgery was the lowest in LPR (-) PPI (+) group (30%) and the highest in LPR (+) PPI (-) group (80%), and it showed significant difference (χ² = 6.25, P < 0.05). CONCLUSIONS With the increase of removal depth and the range after CO₂ laser cordectomy, it appears rising trend in incidence of granuloma. Laryngopharyngeal reflux and PPI therapy on the incidence of traumatic granuloma has certain influence.
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Affiliation(s)
- Liping Wang
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang 110004, China.
| | - Shishang Sun
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Sining Wang
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Dashuai Liang
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang 110004, China
| | - Wenyue Ji
- Department of Otorhinolaryngology, Shengjing Hospital, China Medical University, Shenyang 110004, China
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Aro L, Correa K, Martínez A, Ildefonso R, Yáñez JM. Characterization of Mycobacterium salmoniphilum as causal agent of mycobacteriosis in Atlantic salmon, Salmo salar L., from a freshwater recirculation system. J Fish Dis 2014; 37:341-348. [PMID: 23952471 DOI: 10.1111/jfd.12108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/22/2013] [Accepted: 02/27/2013] [Indexed: 06/02/2023]
Abstract
Thirty Atlantic salmon, Salmo salar L., with low corporal condition relative to other fish present in the culture system, were sampled from a freshwater recirculation pisciculture located in Chile. The most characteristic signs and lesions were cachexia and presence of multiple greyish-white granulomas within internal organs. The external and internal lesions, along with the microscopic, histologic and biochemical findings, were consistent with mycobacteriosis. The identification of Mycobacterium salmoniphilum as the causal agent of the lesions was possible through the use of molecular analyses. This study represents the first report of Mycobacterium salmoniphilum in a freshwater recirculation system and the first case of fish mycobacteriosis described in Chile.
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Affiliation(s)
- L Aro
- Aquainnovo S.A., Puerto Montt, Chile
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Brackers de Hugo L, Ffrench M, Broussolle C, Sève P. Granulomatous lesions in bone marrow: clinicopathologic findings and significance in a study of 48 cases. Eur J Intern Med 2013; 24:468-73. [PMID: 23414770 DOI: 10.1016/j.ejim.2012.11.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 11/03/2012] [Accepted: 11/12/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Granulomas in bone marrow are an infrequent finding related to various disorders. The aim of this study was to review our clinical experience with granulomatous bone marrow disease and to describe the contributions of recent diagnostic tools, such as (18)F-Fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) and molecular biology. METHODS Clinical, laboratory and morphological data on patients with a granuloma based on bone marrow biopsy analysed in the University Hospital Lyon from May 2004 to July 2010 were reviewed. RESULTS We identified 57 cases among 9641 bone marrow biopsies, representing an incidence of 0.59% in the series and an annual incidence of 9.5 cases per year. Nine biopsies performed for staging a known pathology were excluded from further analysis. Among the 48 remaining patients, associated disease was demonstrated in 79%, with infections being the most common (33%), following by sarcoidosis (21%), malignancy (19%) and therapy-induced granulomas (6%). One previously unpublished entity is described: infection with Bartonella henselae diagnosed using molecular biology from node and skin biopsies in two renal transplant patients. (18)F-FDG-PET, performed in 13 cases, showed hypermetabolic foci consistent with sarcoidosis in two cases. Positive PCR result for an infectious pathogen was obtained in three bone marrow samples (Mycobacterium tuberculosis, n=1; Mycobacterium genavense, n=2). CONCLUSION In comparison to previous research, our study reports high proportions of cases caused by sarcoidosis and unknown causes. (18)F-FDG-PET could show signs consistent with sarcoidosis and molecular biology is useful for the detection of fastidious bacteria in immunocompromised patients.
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Abstract
BACKGROUND Penis enlargement is increasingly in demand. Methods for penis enlargement can be classified into surgical, nonsurgical (filling), and mechanical. Each method has shown only relatively successful results. A new formulation of injectable, stabilized, hyaluronic acid (HA)-based, nonanimal gel is available that may have applications for this use. OBJECTIVES The authors propose a new technique for emicircumferential-injection filling of the penis and assess the safety and efficacy of this procedure compared with lipofilling. METHODS The authors retrospectively reviewed the charts of 83 patients who underwent penis enlargement with either their HA-injection technique or lipofilling between December 2007 and July 2011. Safety, efficacy, and patient satisfaction were assessed. RESULTS The circumferential enlargement obtained from both techniques ranged from 3.2 to 4.5 cm, with a decrement during erection. In all patients, the increase in penis length ranged from 1.8 to 3.6 cm. No complications were seen in patients treated with HA, whereas 8 patients treated with lipofilling developed granuloma, and another experienced fat necrosis. The vast majority (n = 72) of patients reported being "very satisfied" with the results. CONCLUSIONS The ideal technique for penis enlargement should be nonsurgical, with a satisfactory and predictable result, a low rate of complications, and long-term stability. Emicircumferential enlargement with HA filler meets these requirements. However, results have been durable but not definitive, and repeated treatment (with associated costs) is necessary.
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Affiliation(s)
- Giuseppe Sito
- Department of Plastic Surgery, University Federico II, Naples, Italy
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Ackuaku-Dogbe E. Histopathological features of tumours of the orbit and Adnexia seen in Korle-Bu teaching Hospital Ghana. West Afr J Med 2012; 31:58-62. [PMID: 23115098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Reports of histological types of orbital and adnexal tumours are few in the West African Sub-region and non-existent in Ghana. OBJECTIVE This study was to determine and report the histological types of orbital and adnexal tumours seen in the eye unit in Korle-bu Teaching Hospital METHODS This was a retrospective study of orbital and adnexal tumours in a referral orbit and oculoplastic clinic in a teaching hospital in Ghana. Biopsy specimen taken from the orbit, conjunctiva and eyelids of patients referred to the orbit and oculoplastic clinic of the eye unit between November 2005 and October 2009 were mailed to Royal Hallamshire Hospital Sheffield, UK for histological evaluation. Histology reports of these biopsy specimens were reviewed and analysed for types of tumours, frequency of occurrence, sex and age of patients. RESULTS A total of 190 histological specimen were taken. One hundred and four (54.7%) were malignant tumours, 53 (27.9%) benign tumours and 12 (6.3%) inflammatory lesions. Eighteen (9.5%) of biopsies taken were mostly degenerative conditions. CONCLUSION Our findings show, as reported from other centres, that squamous cell carcinomas are the commonest cancers of the orbit and adnexia, while malignant melanomas account for only 3.8% of cancers.
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Affiliation(s)
- E Ackuaku-Dogbe
- University of Ghana Medical School, Department of Surgery, Eye Unit, P. O. Box 4236, Accra, Ghana
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Terio KA, Kinsel MJ, Raphael J, Mlengeya T, Lipende I, Kirchhoff CA, Gilagiza B, Wilson ML, Kamenya S, Estes JD, Keele BF, Rudicell RS, Liu W, Patton S, Collins A, Hahn BH, Travis DA, Lonsdorf EV. Pathologic lesions in chimpanzees (Pan trogylodytes schweinfurthii) from Gombe National Park, Tanzania, 2004-2010. J Zoo Wildl Med 2011; 42:597-607. [PMID: 22204054 PMCID: PMC3693847 DOI: 10.1638/2010-0237.1] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [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] [Indexed: 11/21/2022] Open
Abstract
During a population decline or disease outbreak, the true risk of specific diseases to a wild population is often difficult to determine because of a lack of baseline disease information. To better understand the risk of disease in an endangered and scientifically important population of chimpanzees (Pan trogylodytes schweinfurthii), a health monitoring program was initiated in Gombe National Park, Tanzania. As part of this health monitoring program, comprehensive necropsies with histopathology were conducted on chimpanzees (n = 11; 5 male, 6 female), ranging in age from fetal to 44 yr, that were found dead between August 2004 and January 2010. In contrast to previous reports, respiratory disease was not noted as a cause of morbidity or mortality. Trauma was the most common cause of death in these 11 chimpanzees. All of the chimpanzees greater than 1 yr of age had intestinal and mesenteric parasitic granulomas associated with true strongyles consistent with Oesophagostomum spp. The relative numbers of granulomas increased with age and, in some cases, may have been a cause of weight loss and diarrhea. Simian immunodeficiency virus (SIV)cpz infection was documented in four deceased apes, all of whom exhibited varying amounts of lymphoid depletion including two females with marked CD4+ T cell loss consistent with endstage SIVmac or human immunodeficiency virus infections. Myocardial megalokaryosis was common in chimpanzees greater than 1 mo of age; yet myocardial interstitial fibrosis, a common lesion in captive chimpanzees, was uncommon and only noted in two aged chimpanzees. These findings provide important information on causes of morbidity and mortality in wild chimpanzees, information that can be used to interpret findings during population declines and lead to better management of this population in the context of disease risk.
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Affiliation(s)
- Karen A Terio
- Zoological Pathology Program, Zoological Pathology Program, LUMC Building 101, Room 0745, 2160 South First Street, University of Illinois, Maywood, Illinois 60153, USA.
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Guerin M, Haettich B, Bara C, Artru L, Prophette B, Célérier P, Maillard H. Lupus attributable to anti-TNF therapy and revealed by interstitial granulomatous dermatitis. Rheumatol Int 2011; 32:2937-40. [PMID: 21800115 DOI: 10.1007/s00296-011-2016-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2011] [Accepted: 07/10/2011] [Indexed: 12/23/2022]
Abstract
Interstitial granulomatous dermatitis belongs to the group of aseptic cutaneous granulomas. It is a histopathological entity encountered in various pathological situations, such as polyarthritis including rheumatoid arthritis, but also systemic lupus erythematosus. It may also occur after systemic administration of medication, thus representing a drug-induced, interstitial granulomatous outbreak. This has recently been described after anti-TNF therapy was taken. We are reporting the case of a patient treated using adalimumab for rheumatoid arthritis and having developed interstitial granulomatous dermatitis during treatment, which revealed lupus erythematosus attributable to the biotherapy. The clinical appearance of interstitial granulomatous dermatitis can vary, and the diagnosis is confirmed by anatomo-pathological examination. Drug-induced interstitial granulomatous outbreaks have specific histological criteria, and secondary cases involving anti-TNF medication have been described. Cases of lupus attributable to anti-TNF therapy have also been described, and they have specific biological characteristics. Like idiopathic lupus, they may be associated with interstitial granulomatous dermatitis, but the association of an anti-TNF-induced lupus and this type of granulomatous has not, to our knowledge, been described before. We are reporting one case, which emphasises the importance of carrying out a complete and systematic aetiological assessment for all cases of interstitial granulomatous dermatitis, including where there is systemic disease or following medical treatment, either of which may provide an evident cause for the granulomatosis. In particular, the outbreak of interstitial granulomatous dermatitis during anti-TNF treatment should lead to screening for a drug-induced lupus, which would require the patient to stop such treatment.
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Affiliation(s)
- M Guerin
- Department of Dermatology, General Hospital of Le Mans, 194 Avenue Rubillard, 72037 Le Mans, France
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Eydal M, Kristmundsson A, Bambir SH. Pseudobranchial X-cell pseudotumors in young wild and farmed atlantic cod Gadus morhua in Iceland. Dis Aquat Organ 2010; 91:83-88. [PMID: 20853745 DOI: 10.3354/dao02248] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
This study investigated the prevalence of pseudobranchial X-cell pseudotumors in 2 year classes of wild juvenile cod and to a lesser extent in older cod in NW Iceland. The disease was also monitored in farmed wild-caught juvenile cod. The youngest wild cod detected that had X-cell infections were 6.5 to 13.0 cm in length, with prevalence reaching a maximum level of 7%. The highest prevalence (23%) was recorded in 18.5 to 27.0 cm fish. The mean prevalence in older cod (25.0 to 76.0 cm in length) was 7% but decreased with increasing age. The mean prevalence of X-cell pseudotumors in farmed juvenile cod was < or =1% during winter rearing in land-based tanks. Higher prevalence (2 to 15%) was noted in dead and moribund fish. Diseased farmed fish were usually emaciated, and mortality due to the disease was noticeable.
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Affiliation(s)
- M Eydal
- Institute for Experimental Pathology, University of Iceland, Keldur, Vesturlandsvegur, IS-112 Reykjavik, Iceland.
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Bendayan D, Litman K, Hendler A, Polansky V. Liver tuberculosis in an HIV patient: diagnosis and management. Indian J Tuberc 2010; 57:152-156. [PMID: 21043314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Hepatic involvement is common in miliary and extra-pulmonary tuberculosis but is usually clinically silent. Therefore, it is rarely diagnosed. We report the case of a patient that presented with prolonged fever and hepatomegaly. Liver biopsy revealed non-necrotizing granulomas that led in turn to the diagnosis of generalized tuberculosis and HIV infection. The patient reported an old untreated tuberculosis and depression of the immune system provoked the reactivation of this old tuberculosis focus. We describe the clinical course of the disease and the challenges associated with the complexity of the treatment. Diagnosis of hepatic tuberculosis requires a high degree of suspicion especially in AIDS patients who show atypical presentations. However, it is a potential curable disease and good results have been obtained with the four drug regimen.
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Affiliation(s)
- D Bendayan
- Pulmonary and Tuberculosis Department, Shmuel Harofe Hospital, Beer Yaakov, Israel.
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Varga C, Szendi K. Carbon nanotubes induce granulomas but not mesotheliomas. In Vivo 2010; 24:153-156. [PMID: 20363987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Different types of carbon nanotubes may represent toxic hazards due to their size distribution and massive surface area. They may adsorb other toxic agents that can consequently be transported into the body. Hence the aim of this study was to confirm or reject the hypothesis of carcinogenicity of two types of carbon nanotubes. MATERIALS AND METHODS Well-defined single-walled and multi-walled carbon nanotubes were studied in a specific animal model for mesothelioma induction. RESULTS Short-term pilot studies were published on the asbestos fibre-like mesothelioma-inducing effects of carbon nanotubes based on the proposed mechanistic correlation on health effects of fibres of the same size. Our results with a simple in vivo, peritoneal exposure model refute such an interpretation. The present studies with rats indicate that early granuloma formation does not lead to the development of mesotheliomas during chronic exposure of peritoneal mesothelium to either single- or multi-walled carbon nanotubes of varied size. CONCLUSION Due to the limited toxicity data on carbon nanotubes, these results may be particularly important for risk assessment purposes.
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Affiliation(s)
- Csaba Varga
- Department of Environmental Health, Institute of Public Health Medicine, University of Pécs, Pécs, 7624 Hungary
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Shanggar K, Zulkifli MZ, Razack AH, Dublin N. Granulomatous prostatitis: a reminder to clinicians. Med J Malaysia 2010; 65:21-22. [PMID: 21265242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Granulomatous Prostatitis (GnP) is a heterogenous entity classified into specific infections, non-specific infections, post surgical i.e. post-transurethral resection of prostate (TURP) and rare secondary (systemic) causes. A total of 1388 reports of prostatic biopsy and prostatic chips from TURP were reviewed from 1995 and 2007. The results which showed granulomatous prostatitis were analyzed and retrospective data collected from the patient's records. A total of 9 cases with granulomatous prostatitis were identified. There are 3 types of entities which are the non-specific (NSGnP), post-TURP and the specific type. The incidence of GnP in our center is lower than reported by Stillwell et al. The majority of the patients were Malays.
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Affiliation(s)
- K Shanggar
- Fakulti Perubatan, Universiti Malaya, 50603 Kuala Lumpur, Malaysia.
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Sheng WH, Hung CC, Huang HH, Liang SY, Cheng YJ, Ji DD, Chang SC. First case of granulomatous amebic encephalitis caused by Acanthamoeba castellanii in Taiwan. Am J Trop Med Hyg 2009; 81:277-279. [PMID: 19635883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
We report the first case of granulomatous amebic encephalitis caused by Acanthamoeba in a previously healthy farmer in Taiwan who fell into a ditch. The DNA amplicons of amebas identified by polymerase chain reaction in the cerebrospinal fluid specimen and the ditch water specimens were identical and shared strong homology with A. castellanii . He survived after treatment with amphotericin B, rifampin, and corticosteroids.
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Affiliation(s)
- Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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O'Connor TM, Cagney D, Jahangir A, Brady A, Fitzgibbon J, Lee G, El-Gammal A, Brennan NJ. Characteristics of patients presenting with erythema nodosum and sarcoidosis. Ir Med J 2009; 102:181-184. [PMID: 19722355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We explored the relationship between erythema nodosum (EN) and sex, age, serum angiotensin converting enzyme (ACE), bronchoalveolar lavage lymphocytosis (BAL-I), interstitial granulomas and radiological stage in patients presenting with pulmonary sarcoidosis in Ireland. Sixty-nine patients diagnosed with sarcoidosis between 2003 and 2006 were studied. Forty one patients (59%) were male. Sixteen patients (23%) presented with EN. Forty one patients of 65 (63%) had transbronchial biopsies demonstrating non-caseating granulomas. Patients with sarcoidosis presenting with EN were more likely to be female (p=0.042), younger (p=0.012) and have earlier stage pulmonary disease (p=0.02). There were no correlations between serum ACE, interstitial granulomas and disease stage. BAL-I did however predict increasing disease radiological stage (p=0.042). In this study, one quarter of patients with sarcoidosis presented with EN among their presenting features. These patients were more likely to be young females with early stage radiological disease.
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Affiliation(s)
- T M O'Connor
- Department of Respiratory Medicine, Mercy University Hospital, Cork.
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Ben Mustapha N, Karoui S, Serghini M, Kallel L, Mekni A, Chebbi F, Matri S, Haouet S, Boubaker J, Ben Safta Z, Filali A. Frequency and predictive factors of granulomatous hepatitis in patients with peritoneal tuberculosis. Tunis Med 2009; 87:382-385. [PMID: 19927783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
AIMS The aims of our study were to determine the frequency of granulomatous hepatitis in patients with peritoneal tuberculosis, to identify factors for high risk and whether it is associated with higher frequency of antituberculous treatment side effects. METHODS We carried out a prospective study on patients with histologically proven peritoneal tuberculosis between January 1996 and December 2005. We performed a liver biopsy in all the patients before starting the antituberculous treatment. Granulomatous hepatitis was systematically searched in all patients. RESULTS The study was conducted in 52 patients, 9 men and 43 women of median age of 35,5 years. A granulomatous hepatitis was seen in 24 patients (46%). In univariate analysis the factors associated with a high risk of liver involvement were a higher level of gamma-glutamyl transpeptidase (44.5 + 36.8 IU/l vs 23.3 + 9.28 IU/l p = 0.005), a higher level of phosphatases alkalines (233.9 + 96.6 IU/l vs 189.4 + 49.9 IU/l p = 0.03) and a lower level of cholesterol (1.22 + 0.2 g/l vs 156 + 0.3 g/l p < 0.0001). In multivariate analysis, only a cholesterol level lower than 1,31 g/l was significantly associated with a granulomatous hepatitis (p = 0.006 OR [IC 95%]: 0.10 [0.02-052]). CONCLUSION We have found a frequent liver involvement in the case of peritoneal tuberculosis (46%). Cholesterol level lower than 1,31 gr/l was an independent predictor of granulomatous hepatitis in patients with peritoneal tuberculosis. We suggest, in this case, that percutaneous liver biopsy can be considered as an alternative to laparoscopy.
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Abstract
OBJECTIVES To evaluate and to compare the diagnostic value of videostroboscopy (VS) and high-speed glottography (HGG) in dysphonic patients. STUDY DESIGN Randomized, prospective study. METHODS A total of 162 patients underwent indirect laryngoscopy using both methods (VS and HGG). The resulting 324 films were evaluated by two professionals (laryngologists, MDs) using a standardized protocol containing established criteria to classify vocal fold vibratory movement qualities. RESULTS The rating "not assessable" was mentioned significantly more often in VS than in HGG (P < .001). In HGG, methodologic failures were less frequent, and the length of investigation was shorter. Even if the agreement between the two raters was higher in HGG (54%) compared with VS (42%), both percentage values show a low accordance in diagnostic findings. CONCLUSIONS Regardless of the method used (VS or HGG), perceptive evaluations of vibratory movements of vocal folds revealed a higher variability than assumed. This result supports the need for objective methods to analyze vocal fold vibratory movements. Therefore, real-time imaging of vocal fold vibratory movements using HGG will be necessary.
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Affiliation(s)
- Arno Olthoff
- Department of Phoniatrics and Pedaudiology, University of Göttingen, Göttingen, Germany.
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Pytrus T, Mowszet K, Krzesiek E, Rzeszutko M, Iwańczak B. [Diagnostic role of upper gastrointestinal endoscopy in pediatric inflammatory bowel diseases]. Pol Merkur Lekarski 2008; 25:460-464. [PMID: 19205374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
THE AIM OF THIS STUDY To evaluate the frequency and type of endoscopic and histopathological changes in upper gastrointestinal tract in children with inflammatory bowel diseases. MATERIAL AND METHODS The study included 97 patients aged from 3 to 18 years (mean age 12.8 years, 45 girls and 52 boys) with inflammatory bowel diseases (IBD), treated in the 2nd Chair and Department of Pediatrics, Gastroenterology and Feeding of Children from 2005 to 2007. These children were divided into 3 groups depending on the clinical diagnosis: group 1: 38 children with ulcerative colitis (UC), group 2: 26 children with Crohn's disease (CD), and group 3: 33 children with indeterminate colitis (IC). In all patients upper gastrointestinal endoscopy was performed. During endoscopy biopsies were routinely taken from the stomach (antral region), the duodenum and all mucosal changes. H. pylori infection was detected by a positive culture. The obtained results were analyzed using 2 test (p<0.05). RESULTS Esophageal changes were observed in 27.8% children with IBD, most frequently in CD and IC groups, respectively in 34.6% and 36.3% of children. No endoscopic abnormalities in the esophagus were noted in 72.2% of IBD children and the figure rises to 84.3% in UC children (p<0.05). Endoscopic examination of the stomach revealed no changes in 23.7% of IBD children, in 76.3% of these patients inflammatory lesions were observed. Only in 11.5% of the CD patient were no abnormalities in the stomach observed (p<0.05). In the CD group children mild endoscopic changes were observed in 53.8%, and severe in 34.6% of these patients. Ulceration of the duodenum, often in the descending part was revealed in 23.1% of CD children. Helicobacter pylori infection was found in 10.3% of the IBD children, most frequently in the IC group (12.1%). Histopathological examination confirmed esophageal changes in 31.9% of IBD patients, in the stomach and duodenum respectively in 77.3% and 48.4% of these children. Noncaseating granulomas were noted in 3.1% of the CD patients, partial villus atrophy was noted in 1 child with CD. CONCLUSIONS In the group of IBD children, various inflammatory changes during the upper endoscopy were observed. Endoscopic examination most frequently revealed inflammatory changes of the stomach, less frequently of the duodenum and of the esophagus. Histopathological examination of IBD patients most frequently confirmed stomach changes. Less frequently histopathological changes were observed of the duodenum and of the esophagus, particularly in CD children. In the group of IBD children H. pylori infection was noted in few of the patients. Upper endoscopy in the IBD children is an important diagnostic tool and should be a part of monitoring the activity of the disease and results of the therapy.
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Affiliation(s)
- Tomasz Pytrus
- Akademia Medyczna we Wrocławiu, II Katedra i Klinika Pediatrii, Gastroenterologii i Zywienia.
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Affiliation(s)
- M M Darzi
- Division of Veterinary Pathology, Faculty of Veterinary Sciences and Animal Health, Sher-e-Kashmir University of Agricultural Sciences and Technology Shuhama, Srinagar 190006, Jammu and Kashmir, India
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Abstract
OBJECTIVES To determine the prevalence of laryngopharyngeal (LP) abnormalities in hospitalized patients with dysphagia referred for flexible endoscopic evaluation of swallowing (FEES). STUDY DESIGN Retrospective, blinded review by two otolaryngologists of 100 consecutive FEES studies performed and video-recorded by a speech-language pathologist (SLP). METHODS Two otolaryngologists reviewed videos of 100 consecutive FEES studies on hospitalized patients with dysphagia for the presence of abnormal LP findings. RESULTS Sixty-one male and 38 female patients comprised the hospital dysphagia cohort. The mean age was 62. One subject could not be evaluated because of the severity of the retained secretions, leaving 99 subjects in the cohort. Seventy-six percent had been previously intubated, with a mean intubation duration of 13 days. The overall prevalence of abnormal LP findings was 79%. Forty-five percent of the patients presented with two or more findings, which included arytenoid edema (33%), granuloma (31%), vocal fold paresis (24%), mucosal lesions (17%), vocal fold bowing (14%), diffuse edema (11%), airway stenosis (3%), and ulcer (6%). There was a significant difference in LP findings between those individuals who had or had not been intubated. CONCLUSIONS Hospitalized patients with dysphagia are at high risk for LP abnormalities, particularly if they have been intubated, and may benefit from either 1) an initial joint examination by the SLP and otolaryngologist or 2) an otolaryngologist's review of the recorded examination conducted by the SLP. Such otolaryngology involvement could identify airway stenosis patients at an earlier stage, initiate granuloma treatment sooner, enable earlier biopsy of unexpected lesions, and allow follow-up of mucosal and neuromuscular findings that do not respond to medical management.
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Affiliation(s)
- Gregory N Postma
- Department of Otolaryngology, Center for Voice and Swallowing Disorders, Medical College of Georgia, Augusta, Georgia, USA.
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Liebana E, Johnson L, Gough J, Durr P, Jahans K, Clifton-Hadley R, Spencer Y, Hewinson RG, Downs SH. Pathology of naturally occurring bovine tuberculosis in England and Wales. Vet J 2007; 176:354-60. [PMID: 17728162 DOI: 10.1016/j.tvjl.2007.07.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 06/13/2007] [Accepted: 07/01/2007] [Indexed: 11/22/2022]
Abstract
The aim of this study was to obtain a contemporary data set of pathology in tuberculin reactor and in-contact cattle in England and Wales. Four hundred animals (200 reactors and 200 in-contacts) from 242 farms located in 14 counties in Western England and Wales were examined. The mean number of lymph nodes (LNs) with tuberculosis (TB)-like lesions per TB-confirmed animal was 1.7 in reactors and 1.5 in in-contact animals. Tuberculous lesions in both reactor and in-contact animals were most commonly observed in the LNs of the thorax, followed by the head and abdomen, particularly the mediastinal, retropharyngeal and tracheobronchial LNs. Twenty-five reactors had macroscopic lesions in the palatine tonsils. Among TB-confirmed cattle, 27% of reactors and 9% of in-contact animals had gross TB-like lesions in the lungs, particularly in the caudal lobes. Gross lesions that were not TB-confirmed were parasitic granulomas (45%), bacterial or mycotic club-forming pyogranulomas (27%) and bacterial abscesses (23%). Diagnostic sensitivity was maximised when bacteriology and histopathology were used concurrently. Stage IV granulomas, alone or in combination with other stages, constituted 63% of lesions, while 16% of lesions were stage I/II granulomas. Caseous necrosis and calcification were common features of the granulomas encountered in natural Mycobacterium bovis infections, even with pathology limited to a small number of sites. Granulomas often covered large areas of histological sections and typically contained only small numbers of acid fast bacilli.
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Affiliation(s)
- E Liebana
- Department of Pathology, Veterinary Laboratories Agency-Weybridge, Addlestone, Surrey, England, UK.
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38
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Shcherbynina MB, Zakrevs'ka OV, Korolenko HS, Lymar LI. [Evaluation of clinical characteristics and morphological state of gallbladder in patients with xanthogranulomatous cholecystitis]. Lik Sprava 2007:32-35. [PMID: 18416161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
There were studied the peculiarities of the state of patients with xantogranulomatous cholecystitis (XGC) using clinical and instrumental diagnostics performed in preoperative period as well as morphological state of the wall of removed gall-bladders. It was established that the prevalence of XGC among patients after cholecystectomy because of biliary calculosis is 0,93%. The frequency of XGC in women is three times higher than in men. There is prevalence of patients older than 50 years. The clinical period of XGC in men is twice shorter than among women and a polimorbid pathology is more often found in men than in women. XGC has no specific clinical signs. Morphologically the xantogranulomes are the combination of xanthom cells, lymphocytes and plasmocytes. To detail this process it is necessary to determine subpopulations of T- lymphocytes presented in the xantogranulome.
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Mirsaeidi SM, Masjedi MR, Mansouri SD, Velayati AA. Tuberculosis of the breast: report of 4 clinical cases and literature review. East Mediterr Health J 2007; 13:670-6. [PMID: 17687841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Nearly 18% of tuberculosis (TB) cases have only extrapulmonary manifestations. Breast tuberculosis is a rare type of extrapulmonary TB. This paper reports 4 cases of breast TB confirmed either pathologically or mycobacteriologically or both. These reports showed that TB should always be considered first in the differential diagnosis of granulomatous mastitis in TB-endemic areas. Therapy included at least 6 months of anti-TB medication and surgery when indicated.
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Affiliation(s)
- S M Mirsaeidi
- Kosair Children's Hospital Research Institute, Louisville, Kentucky, USA.
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Musso C, Castelo JS, Tsanaclis AMC, Pereira FEL. Prevalence of Toxocara-induced liver granulomas, detected by immunohistochemistry, in a series of autopsies at a Children's Reference Hospital in Vitoria, ES, Brazil. Virchows Arch 2007; 450:411-7. [PMID: 17333262 DOI: 10.1007/s00428-007-0388-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2006] [Revised: 01/05/2007] [Accepted: 02/12/2007] [Indexed: 10/23/2022]
Abstract
The aim of this investigation was to study the frequency of visceral larva migrans (VLM) granulomas in autopsies at a Children's Reference Hospital in Vitoria, ES Brazil, where anti-Toxocara antibodies are frequently detected in the serum of children admitted at the hospital. Two liver fragments from 310 autopsies of children aged between 1 and 15 years were paraffin embedded, and sections were stained with hematoxylin and eosin and submitted to detection of Toxocara antigens using a rabbit anti-Toxocara serum. Among the 24 cases with granulomatous lesions, ten had eosinophil-rich granulomas positively stained with the anti-Toxocara serum. Some were typical epithelioid granulomas, with a positive reaction in multinucleated giant cells, epithelioid cells, or necrotic debris. The results showed that VLM granulomas are the most frequent granulomatous hepatitis in children in our county. This agrees with the high prevalence of anti-Toxocara antibodies in the serum of children admitted to the Children's Reference Hospital. The 3.2% frequency of liver VLM granulomas in autopsies is less than the 30-39% frequency of positive serology in these children, probably reflecting the low larval burden in infected children.
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Affiliation(s)
- Carlos Musso
- Núcleo de Doenças Infecciosas, Centro Biomédico, UFES, Av Marechal Campos 1468, 29040-091, Vitória, ES, Brazil.
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Abstract
Sarcoidosis can affect any organ in the body. Frequently extrapulmonary manifestations of the disease are the major cause of morbidity. Treatment of extrapulmonary sarcoidosis often requires consideration of alternative immunosuppressive agents, topical therapy, or therapy that is not specifically directed against the granulomatous inflammation of the disease. This article reviews the clinical presentation and therapy of extrapulmonary sarcoidosis.
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Affiliation(s)
- Marc A Judson
- Division of Pulmonary and Critical Care Medicine, Medical University of South Carolina, Charleston, South Carolina 29466, USA.
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Dourakis SP, Saramadou R, Alexopoulou A, Kafiri G, Deutsch M, Koskinas J, Archimandritis AJ. Hepatic granulomas: a 6-year experience in a single center in Greece. Eur J Gastroenterol Hepatol 2007; 19:101-4. [PMID: 17272993 DOI: 10.1097/01.meg.0000243882.09820.d2] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUND Hepatic granulomas have been reported in 2-15% of unselected liver biopsies, with a wide clinical profile responsible for their presence. To date, no series concerning the prevalence and the etiology of granulomas from Greece has been reported. OBJECTIVES To evaluate the prevalence and the etiology of hepatic granulomas and to investigate whether there has been an alteration in distribution of diagnoses in our series compared with those published so far in the literature. STUDY The results of liver biopsy specimens performed in a Department of Medicine, between 1999 and 2004, were retrospectively reviewed and the cases revealing hepatic granulomas had their medical notes and the liver biopsies recorded. RESULTS Over the study period, 1768 liver biopsies were performed. Hepatic granulomas were identified in 66 (3.7%). Of those, 51 were female with a mean age of 57 years (range 34-74 years) and 15 were male with a mean age of 42 years (range 18-78 years). Autoimmune liver diseases including primary biliary cirrhosis, overlap syndrome and autoimmune hepatitis accounted for the majority of cases (68%), followed by sarcoidosis (7.5%), chronic hepatitis B virus and hepatitis C virus infection (7.5%), idiopathic (6%), drugs (3%) and other miscellaneous causes (7.5%). CONCLUSIONS Our series showed that autoimmune liver diseases, mainly primary biliary cirrhosis was the most common cause of granuloma formation, a finding rather similar to that stated in the studies from Western countries. A rather small number of idiopathic cases were recorded. Chronic viral hepatitis and sarcoidosis rates were equal, a finding possibly reflecting a fairly high proportion of viral hepatitis in our sample.
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Furst DE, Wallis R, Broder M, Beenhouwer DO. Tumor Necrosis Factor Antagonists: Different Kinetics and/or Mechanisms of Action May Explain Differences in the Risk for Developing Granulomatous Infection. Semin Arthritis Rheum 2006; 36:159-67. [PMID: 16884970 DOI: 10.1016/j.semarthrit.2006.02.001] [Citation(s) in RCA: 173] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Tumor necrosis factor (TNF) antagonists fall into 2 classes:etanercept (ETA) is a soluble TNF receptor, while infliximab (INF) and adalimumab (ADA) are monoclonal antibodies against TNF. All 3 drugs are effective in treating rheumatoid arthritis. However, these agents have been associated with an increased risk of granulomatous infections, such as tuberculosis and histoplasmosis. Several reports indicate that the incidence of granulomatous infections may potentially be higher in individuals treated with INF than ETA. METHODS We conducted a comprehensive literature search (1966 to 2004) to review the role of TNF in normal and disease states, and the mechanisms of action of the TNF inhibitors. Specifically, we searched for possible mechanisms for the apparent increase in granulomatous infections associated with TNF inhibitors and for reasons that there may be differences between them. RESULTS Infection may result from a number of differences between ETA and INF or ADA. First, binding avidities are different, with ETA binding in a 1:1 ratio and INF/ADA binding in 2 to 3:1 ratios. Second, the clearances of ADA, ETA, and INF are different, being about 13 times higher for ETA than INF or ADA, thus resulting in higher steady-state drug levels for ADA and INF. Also, the methods of administration are different, intravenously (for INF) versus subcutaneously (for ETA and ADA), which results in lower peak concentrations for ETA and ADA, potentially explaining some of the differences in effects on granuloma formation. Third, INF and ADA have somewhat different mechanisms of action from ETA: INF and ADA are associated with antibody-mediated cell lysis, while ETA is not; INF may induce apoptosis in some tissues (eg, gastrointestinal [GI] mucosa) while ETA does not--although this is controversial and may not be true at steady state in synovium, where both drugs seem to cause apoptosis; ETA binds lymphotoxin-alpha while INF does not (ETA may thus be more efficient at preventing granuloma formation by this mechanism than INF); finally, ADA and INF seem to inhibit IFN-gamma expression (probably indirectly), while ETA does not. CONCLUSIONS There are significant differences between the 2 classes of TNF antagonists in terms of both their kinetics and mechanisms of action. These differences may help explain the apparent differences in the incidence of granuloma-dependent infections among them.
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Affiliation(s)
- Daniel E Furst
- Department of Rheumatology, University of California at Los Angeles, Los Angeles, CA, USA.
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Hassan MF, Zhang Y, Engwerda CR, Kaye PM, Sharp H, Bickle QD. The Schistosoma mansoni hepatic egg granuloma provides a favorable microenvironment for sustained growth of Leishmania donovani. Am J Pathol 2006; 169:943-53. [PMID: 16936268 PMCID: PMC1698825 DOI: 10.2353/ajpath.2006.051319] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Parasitic co-infections are prevalent in many parts of the world. However, relatively little is known about how an underlying infection may impact on the host's ability to control a newly acquired parasite, especially if both infect the same organ. We have studied this using an experimental co-infection model in C57BL/6 mice involving Schistosoma mansoni and Leishmania donovani, two important human pathogens affecting the liver. We show that mice with established S. mansoni infections fail to control L. donovani growth in the liver and spleen. The failure occurs despite the development of a functional anti-L. donovani Th1 response that can mediate granuloma formation and effective clearance of amastigotes from foci of infection in the hepatic parenchyma. Instead, anti-leishmanial immunity fails within the S. mansoni egg granuloma, consistent with a lack of L. donovani granuloma assembly in this tissue microenvironment and consequent lack of NO production. Persisting amastigote replication in the S. mansoni egg granulomas may thus explain the increased L. donovani burden in the liver and spleen. These results may have implications for human S. mansoni and L. donovani co-infections and also demonstrate that granulomatous tissue responses to helminth organisms can form a discrete niche facilitating survival of intracellular pathogens.
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Affiliation(s)
- Mohammed F Hassan
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel St., London, WC1E 7HT, UK
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Oddó B D, Ciani A S, Vial C P. [Granulomatous amebic encephalitis caused by Balamuthia mandrillaris. First case diagnosed in Chile]. Rev Chilena Infectol 2006; 23:232-236. [PMID: 16896496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
The case of a 7 month-old baby boy is presented, with a history of several weeks of evolution of personality changes, convulsions and fever. While he was hospitalized, the brain image study showed multifocal cavity lesions, which varied from millimeters to 4 cm of diameter, not producing mass effect. Their biopsy revealed necrotizing encephalitis. In spite of treatment, the lesions progressed and the boy died. The autopsy demonstrated an extensive necrotizing encephalitis with fibrinoid necrotic arteritis, signs of organization, and the presence of parasitic elements with characteristics of trophozoites and cysts of free-living amoebas belonging to the genus Acanthamoeba or Balamuthia. In addition, hypoplasia-dysplasia of the thymus and signs of shock were found. The morphologic elements correspond to the disease described as granulomatous amebic encephalitis and the agent found was identified as Balamuthia mandrillaris (Centers for Diseases Control and Prevention, Atlanta, USA ).
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Affiliation(s)
- David Oddó B
- Departamento de Anatomía Patológica, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
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Abstract
Forty-four nodular and noninvasive cutaneous fungal granulomas were identified in 34 horses over a 14.5-year period. Cutaneous fungal granulomas were most common in young horses (mean age 6.1 +/- 4.2 years; range 1-19 years). There was no apparent breed or sex bias. Granulomas were either single or multiple, and most often occurred in the skin of the head and neck. The characteristic histological finding was a nodular dermal mass with a mean diameter of 7.3 mm (range 2.5-20 mm) and an intact overlying epithelium. Lesions most often exhibited intense lymphocytic inflammation, with admixed pyogranulomatous inflammation associated with a small to moderate number of fungal elements. Causative fungi were both pigmented and nonpigmented organisms of variable morphology. Penetrating plant material was identified in three cases. Granulomas caused by nonpigmented fungi were most common in horses from wet regions. Both pigmented and nonpigmented fungi were found in granulomas from horses in dry regions. Cutaneous fungal granulomas occurred in February through November, with peaks in April and July. No correlation of yearly incidence with annual average temperature or rainfall was detected. This study confirms that equine cutaneous fungal granuloma is relatively common in horses in the Pacific Northwest. Morphology of causative fungi was variable, but the signalment, history, and clinical and overall histological features were very similar. Surgical excision was curative.
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Affiliation(s)
- Beth A Valentine
- Veterinary Diagnostic Laboratory, College of Veterinary Medicine, Oregon State University, Corvallis, Oregon 97331, USA.
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Smith MA, Battafarano RJ, Meyers BF, Zoole JB, Cooper JD, Patterson GA. Prevalence of benign disease in patients undergoing resection for suspected lung cancer. Ann Thorac Surg 2006; 81:1824-8; discussion 1828-9. [PMID: 16631679 DOI: 10.1016/j.athoracsur.2005.11.010] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2004] [Revised: 11/03/2005] [Accepted: 11/04/2005] [Indexed: 12/20/2022]
Abstract
BACKGROUND In this era of expanded lung cancer screening, accurate differentiation of benign from malignant lesions remains an important problem. We sought to characterize our experience with focal pulmonary lesions suggestive of lung cancer and subsequently proven benign on surgical resection. METHODS A retrospective analysis was performed on 1,560 patients who underwent resection for focal pulmonary lesions at our institution from January 1995 to December 2002. Computed tomography and pathology reports were reviewed for all patients. Fluorine-18-fluorodeoxyglucose positron emission tomography studies were performed on 43 patients. RESULTS Benign processes were found on pathologic examination in 140 patients (9%). Resection was accomplished by thoracotomy in 103 patients (74%), video-assisted thoracoscopy in 36 patients (26%), and sternotomy in 1 patient (0.7%). Seventy patients (50%) underwent mediastinoscopy before resection. There was 1 (0.7%) perioperative death. Pathologic diagnoses from the pulmonary resections revealed granulomatous inflammation in 91 patients (65%), hamartoma in 17 patients (12%), pneumonia or pneumonitis in 14 patients (10%), fibrosis in 5 patients (4%), and other in 13 patients (9%). Fluorine-18-fluorodeoxyglucose positron emission tomography imaging suggested malignancy in 22 of 43 patients and benign lesion in 20 of 43 patients (1 study was not interpretable). Thirty-eight patients underwent needle biopsy before surgery. Of these, 29 samples were nondiagnostic, 5 samples were negative, and 4 samples were considered positive for malignancy. CONCLUSIONS Despite thorough clinical assessment, advanced imaging technology, and needle biopsy, many patients continue to undergo surgery for benign disease. Aggressive attempts to diagnose and treat early stage lung cancer must be tempered with this understanding.
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Affiliation(s)
- Michael A Smith
- Department of Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri, USA
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Harpaz N, Schiano T, Ruf AE, Shukla D, Tao Y, Fishbein TM, Sauter BV, Gondolesi GE. Early and frequent histological recurrence of Crohn's disease in small intestinal allografts. Transplantation 2006; 80:1667-70. [PMID: 16378058 DOI: 10.1097/01.tp.0000184621.63238.ec] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recurrence of Crohn's disease in small intestinal allografts, although rarely described, can cause serious morbidity and jeopardize graft survival among transplant recipients with Crohn's disease. However, systematic studies to determine the frequency, predictors, and clinical implications of recurrent Crohn's disease have not been reported METHODS We analyzed our transplant program's experience with small intestinal allografts in patients with Crohn's disease based on retrospective review of clinical and pathological records and corresponding pathology slides. RESULTS Of 67 patients undergoing 70 transplantations between 1998 and 2004, six adults (three males, three females; mean age 48.1 years) had Crohn's disease complicated by short gut syndrome and total parenteral nutrition failure. Four survivors surveyed endoscopically for a mean 29 (range, 20-40) months and underwent a mean 37 endoscopic examinations with biopsies (range, 31-44) while on maintenance immunosuppression. Despite absence of any endoscopic or clinical manifestations of Crohn's disease throughout this period, two patients had granulomatous enteritis characteristic of Crohn's disease in multiple biopsies, one patient in 8/44 examinations (18%) ranging from 34 days to 20 months postoperatively and the other in 6/32 examinations (19%) ranging from 20 days to 22 months postoperatively. No comparable changes occurred in 57 other patients without Crohn's disease followed endoscopically under the same protocol CONCLUSIONS Histological recurrence of Crohn's disease may occur in small intestinal allografts despite the absence of endoscopic and clinical disease manifestations. Such recurrences are probably not rare, may occur as early as 3 weeks after transplantation, and do not necessarily portend early clinical recurrence or mandate aggressive therapy to prevent allograft loss.
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Affiliation(s)
- Noam Harpaz
- Department of Pathology, The Mount Sinai Medical Center, New York, NY 10029, USA.
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Oztürk K, Uyar Y, Ulkü CH, Arbağ H, Keleş B, Yaman H. [Petrous bone lesions]. Kulak Burun Bogaz Ihtis Derg 2006; 16:241-5. [PMID: 17220654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES We evaluated the results of treatment and follow-up of patients with petrous bone lesions. PATIENTS AND METHODS We retrospectively evaluated 13 patients (5 females, 8 males; mean age 33.8+/-17.4 years; range 4.5 to 65 years) who were treated and followed-up for petrous bone lesions between 1990 and 2004. The diagnoses were cholesterol granuloma (n=2; 15.4%), chondrosarcoma (n=1; 7.7%), and cholesteatoma (n=10; 76.9%). RESULTS Patients with cholesterol granuloma had complaints of cephalgia and diplopia while those with cholesteatoma complained of otorrhea and hearing loss. One patient with cholesterol granuloma and eight patients with cholesteatoma underwent surgical operations with the use of middle skull base approach (n=1), transcochlear approach (n=2), translabyrinthine approach (n=1), and tympanopetrosectomy (n=5). Two cases with congenital cholesteatoma and one patient with cholesterol granuloma refused surgical intervention and were only followed-up. CONCLUSION Besides surgical intervention, follow-up by computed tomography or magnetic resonance imaging may be considered in patients with incidental petrous bone lesions, presenting with limited symptoms.
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Affiliation(s)
- Kayhan Oztürk
- Department of Otolaryngology, Medicine Faculty of Selçuk University, Konya, Turkey.
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Besharati MR, Rastegar A. Results and complications of external dacryocystorhinostomy surgery at a teaching hospital in Iran. Saudi Med J 2005; 26:1940-4. [PMID: 16380777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
OBJECTIVES To conduct a survey of outcomes, failure frequency rates, and other complications of dacryocystorhinostomy (DCR) at a teaching hospital in Iran. METHODS In this outcome study, we survey the results of DCR in 187 consecutive chronic dacryocystitis patients operated at the Eye Department of Yazd Medical University, Iran from March 2001 to April 2003. We investigated the results and probable complications of this surgical procedure. RESULTS Our data shows that the success rate of the operation was 90.4% with a confidence interval of 95% (86.3-94.5). The success rate was 91% in female and 89.3% in males (p=0.543). The failure rate was 9.6%. According to the methods used in this study, the success rate of the external method with silastic intubation was 96.3% and 88% without. These differences, however, were not statistically significant (p=0.08). The most frequent and important complication of DCR was failure and recurrence of epiphora or purulent discharge (9.6%). The less frequent complications included scar formation (8.6%), wound infection (5.3%) and granuloma formation (3.2%). There were no complications during the operation. CONCLUSION External DCR is an easy technique with a success rate of more than 90%, with few complications.
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Affiliation(s)
- Mohammad R Besharati
- Department of Ophthalmology, Shahid Sadoughi Medical Sciences University, Yazd, Iran.
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