Κυριακή 31 Ιανουαρίου 2021

Endoscopic salvage treatment of histoacryl after stent application on the anastomotic leak after gastrectomy: A case report.

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Endoscopic salvage treatment of histoacryl after stent application on the anastomotic leak after gastrectomy: A case report.

World J Clin Cases. 2021 Jan 06;9(1):262-266

Authors: Kim HS, Kim Y, Han JH

Abstract
BACKGROUND: Endoscopic approach could effectively manage postoperative anastomotic leakage. Various endoscopic methods have been developed for the treatment of anastomotic leakage.
CASE SUMMARY: A 53-year-old woman developed anastomotic leak after laparoscopic proximal gastrectomy. Endoscopic clip closure failed due to strong wall tension; therefore, a fully covered self-expandable esophageal metal stent (fc-SEMS) was placed to cover the leak after it was filled with a mixture of fibrin glue and histoacryl. However, fluoroscopy with gastrograffin showed dye leaking out of the fc-SEMS. Using the previous fluoroscopic image for guidance, a catheter was inserted at the leakage site. The radiocontrast dye was injected and was seen spreading along the sinus tract. Thereafter, histoacryl was injected. Seven days after the last procedure, upper gastrointestinal contrast studies showed no leaks. The patient was subsequently discharged 9 d after histoacryl injection without any complications.
CONCLUSION: To seal an anastomosis leak after stent application, salvage technique using histoacryl injection at the leakage site with fluoroscopy guidance could be considered cautiously.

PMID: 33511194 [PubMed]

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Immunosuppressant treatment for IgG4-related sclerosing cholangitis: A case report.

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Immunosuppressant treatment for IgG4-related sclerosing cholangitis: A case report.

World J Clin Cases. 2021 Jan 06;9(1):267-273

Authors: Kim JS, Choi WH, Lee KA, Kim HS

Abstract
BACKGROUND: Immunoglobulin G4-related disease (IgG4-RD) is a multi-system fibroin-flammatory disorder that can involve any organ, including the salivary glands, pancreas, and biliary tree. Treatment of immunoglobulin G4-related sclerosing cholangitis (IgG4-SC) is similar to that for IgG4-RD, but progression is irreversible in some cases. We present a case of IgG4-SC in which an immuno-suppressant induced marked clinical and radiologic improvement.
CASE SUMMARY: A 63-year-old male presented with a prominent itching sensation and wholebody jaundice. He showed obstructive-pattern jaundice, an elevated IgG4 level, and infiltration of a large number of IgG4-positive cells in the ampulla of Vater. The imaging findings of intrahepatic duct (IHD) and common bile duct dilation, an elevated serum IgG4 level, and characteristic histological findings led to diagnosis of IgG4-SC that compatible with the 2019 ACR/EULAR classification criteria. We planned to treat the patient with high-dose glucocorticoid (GC), followed by cyclophosphamide pulse therapy. After treatment with high-dose GC and an immunosuppressant, imaging studies showed that IHD dilatation had completely resolved.
CONCLUSION: Prompt diagnosis and appropriate treatment of IgG4-SC are important. Because there is a risk of relapse of IgG4-SC, the GC dose should be gradually reduced, and a maintenance immunosuppressant should be given.

PMID: 33511195 [PubMed]

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Intraparenchymal hemorrhage after surgical decompression of an epencephalon arachnoid cyst: A case report.

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Intraparenchymal hemorrhage after surgical decompression of an epencephalon arachnoid cyst: A case report.

World J Clin Cases. 2021 Jan 06;9(1):274-277

Authors: Wang XJ

Abstract
BACKGROUND: This study reports the clinical presentation of intraparenchymal hemorrhage as a rare complication after surgical decompression of an intracranial epencephalon arachnoid cyst (IEAC) at the posterior cranial fossa.
CASE SUMMARY: The clinical information of a patient with an IEAC was reported, and the related literature was reviewed. A female patient with nausea presented to our hospital. Computed tomography demonstrated an IEAC located at the posterior cranial fossa, which was large and required surgical intervention. After operation, postoperative intraparenchymal hemorrhage was detected. She had a good recovery with conservative treatment 1 mo later.
CONCLUSION: Though postoperative intraparenchymal hemorrhage is rare after surgical decompression of an IEAC, more attention should be paid to such a complication.

PMID: 33511196 [PubMed]

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Krukenberg tumor with concomitant ipsilateral hydronephrosis and spermatic cord metastasis in a man: A case report.

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Krukenberg tumor with concomitant ipsilateral hydronephrosis and spermatic cord metastasis in a man: A case report.

World J Clin Cases. 2021 Jan 06;9(1):278-283

Authors: Tsao SH, Chuang CK

Abstract
BACKGROUND: Tumors of the spermatic cord are rare, and approximately 25% are malignant neoplasms. Metastatic spermatic cord tumors are even rarer. Several studies have revealed that the most frequent primary tumors metastasizing to the spermatic cord and peritesticular tissues are neoplasms of the stomach and prostate. Furthermore, metastasis to the spermatic cord or epididymis may occur via retrograde lymphatic and hematic routes. We present the case of a man with gastric cancer that metastasized to the spermatic cord and epididymis, with concomitant ipsilateral hydronephrosis after surgical resection and chemotherapy for his primary tumor.
CASE SUMMARY: A 71-year-old man underwent total gastrectomy for pT4aN2 poorly differentiated gastric adenocarcinoma in December 2016. Two months after surgery, he received adjuvant chemotherapy with TS-1 from February 2017 to February 2018. Surveillance computed tomography (CT) was performed in June 2018, which did not reveal any sign of tumor recurrence. In November 2019, he presented with left lower quadrant abdominal pain and a palpable left inguinal-scrotal mass. CT revealed left mild hydronephrosis and a left scrotal mass measuring 4.0 cm × 1.7 cm. Tumor biomarkers, including alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), beta-human chorionic gonadotropin (βHCG), carcinoembryonic antigen (CEA), and carbohydrate antigen 19-9 (CA19-9) were all normal. Renal and testicular echography showed left hydronephrosis and a left peritesticular soft tissue lesion with blood flow. Diagnostic ureteroscopy showed left lower ureter narrowing without an intraluminal lesion. A bi opsy was obtained for the indurated spermatic cord and epididymis, which showed poorly differentiated adenocarcinoma. Immunohistochemical staining demonstrated that the tumor was diffusely and strongly positive for homeobox protein CDX2. The features were consistent with metastatic adenocarcinoma of a primary gastric tumor.
CONCLUSION: In patients with a history of primary cancer, an inguinal mass of unknown cause with accompanying ipsilateral hydronephrosis may be a sign of distant metastasis from a primary tumor, especially of gastrointestinal origin.

PMID: 33511197 [PubMed]

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Simultaneous bilateral acromial base fractures after staged reverse total shoulder arthroplasty: A case report.

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Simultaneous bilateral acromial base fractures after staged reverse total shoulder arthroplasty: A case report.

World J Clin Cases. 2021 Jan 06;9(1):284-290

Authors: Kim DH, Kim BS, Cho CH

Abstract
BACKGROUND: Acromial and scapular spine fractures after reverse total shoulder arthroplasty (RTSA) are a well-known complication that may negatively impact the effects of long-term outcomes. However, to the best of our knowledge, there has been no report of simultaneous bilateral fractures of the acromion or scapular spine that occurred following staged RTSA.
CASE SUMMARY: A 79-year-old right-handed male visited our outpatient clinic with a chief complaint of pain and limited motion of both shoulder joints for a one-year duration. Based on plain radiographs and magnetic resonance images, the preoperative diagnosis was bilateral cuff tear arthropathy with failed rotator cuff repair. This patient was treated with staged bilateral RTSA at a two-month interval. At 5 and 3 mo after right and left side surgery, the patient returned to the outpatient clinic with severe pain and limited motion of both shoulder joints for 2 wk without a traumatic event. A computed tomography scan revealed non-displaced acromial base fractures of both shoulders. Considering bilateral involvement, fracture location, and patient's demand, open reduction and internal fixation (ORIF) using plate for bilateral acromial base fractures were performed. At 2 years after ORIF, the fracture was completely healed, and the patient was satisfied with shoulder status.
CONCLUSION: This report describes an extremely rare case of simultaneous bilateral acromial base fractures after staged RTSA managed successfully by ORIF with a pre-contoured plate designed for distal clavicle fractures. Although acromial fracture after RTSA can be treated conservatively, simultaneous bilateral fractures may warrant surgical intervention as a means of addressing difficulties in activities of daily living.

PMID: 33511198 [PubMed]

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Efficacy of cartilage conduction hearing aids in children.

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Efficacy of cartilage conduction hearing aids in children.

Int J Pediatr Otorhinolaryngol. 2021 Jan 16;142:110628

Authors: Nishiyama T, Oishi N, Ogawa K

Abstract
OBJECTIVES: Cartilage conduction hearing aids (CC-HAs) are novel hearing aids that use the third hearing pathway of cartilage conduction. We assessed the efficacy of CC-HAs and the hearing effects and safety of additional tape compression over the transducer in children with hearing loss.
METHODS: The patients (n = 42) underwent a one-month free trial of CC-HAs. Forty of them were patients with auditory canal atresia or stenosis. CC-HA-aided and unaided hearing thresholds (48 fitted ears) were determined using standard audiograms, after which participants could choose to purchase the device or not. We calculated the purchase rates and compared the patient characteristics between the purchase and non-purchase groups along with the purchase reason (or not). We applied additional tape compression over the CC-HA transducer and assessed the hearing effects and side effects.
RESULTS: CC-HA led to hearing improvements at all frequencies. Overall, 72.92% of participants purchased a CC-HA after the trial. By applying additional tape compression over the CC-HA transducer, the stability and hearing gains were improved mainly at low frequencies, and no side effects such as dermatitis were observed.
CONCLUSIONS: CC-HAs are efficacious in producing hearing improvements in children, especially in patients with atresia or canal stenosis who cannot use air conduction hearing aids. Furthermore, we found that the additional tape compression over the transducer was an easy and a safe method for improving the hearing effects and stability of the CC-HA.

PMID: 33494042 [PubMed - as supplied by publisher]

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Identification of Prostaglandin F2 Receptor Negative Regulator (PTGFRN) as an internalizable target in cancer cells for antibody-drug conjugate development

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journal.pone.0246197.g005&size=inline

by Jorge Marquez, Jianping Dong, Chun Dong, Changsheng Tian, Ginette Serrero

Antibody-drug conjugates (ADC) are effective antibody-based therapeutics for hematopoietic and lymphoid tumors. However, there is need to identify new targets for ADCs, particularly for solid tumors and cancers with unmet needs. From a hybridoma library developed against cancer cells, we selected the mouse monoclonal antibody 33B7, which was able to bind to, and internalize, cancer cell lines. This antibody was used for identification of the target by immunoprecipitation and mass spectrometric analysis, followed by target validation. After target validation, 33B7 binding and target positivity were tested by flow cytometry and western blot analysis in several cancer cell lines. The ability of 33B7 conjugated to saporin to inhibit in vitro proliferation of PTFRN positive cell lines was investigated, as well as the 33B7 ADC in vivo effect on tumor growth in athymic mice. All flow cytometry and in vitro internalization assays were analyzed for statistical significanc e using a Welsh's T-test. Animal studies were analyzed using Two-Way Analysis of Variance (ANOVA) utilizing post-hoc Bonferroni analysis, and/or Mixed Effects analysis. The 33B7 cell surface target was identified as Prostaglandin F2 Receptor Negative Regulator (PTGFRN), a transmembrane protein in the Tetraspanin family. This target was confirmed by showing that PTGFRN-expressing cells bound and internalized 33B7, compared to PTGFRN negative cells. Cells able to bind 33B7 were PTGFRN-positive by Western blot analysis. In vitro treatment PTGFRN-positive cancer cell lines with the 33B7-saporin ADC inhibited their proliferation in a dose-dependent fashion. 33B7 conjugated to saporin was also able to block tumor growth in vivo in mouse xenografts when compared to a control ADC. These findings show that screening antibody libraries for internalizing antibodies in cancer cell lines is a good approach to identify new cancer targets for ADC development. These results suggest PTGFRN is a possible therapeutic target via antibody-based approach for certain cancers.
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Complicated acute frontal sinusitis in a child presenting with acute ischemic stroke.

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Complicated acute frontal sinusitis in a child presenting with acute ischemic stroke.

Int J Pediatr Otorhinolaryngol. 2021 Jan 22;143:110631

Authors: Davison WL, Gudis DA

Abstract
Acute stroke as a complication of sinusitis is exceedingly rare, and even more so in children. Here we present the case of a healthy 9-year-old male who had an acute stroke in the setting of severe acute pansinusitis. The patient was started on parenteral antibiotics and underwent urgent endoscopic sinus surgery and adenoidectomy, ultimately making a full neurologic recovery. Of the previously reported cases of stroke as a complication of sinusitis, all showed evidence of carotid artery pathology. This is the first report to our knowledge of acute sinusitis presenting as stroke with normal arterial anatomy and function.

PMID: 33508675 [PubMed - as supplied by publisher]

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Nasopharyngeal microbiome analyses in otitis-prone and otitis-free children.

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Nasopharyngeal microbiome analyses in otitis-prone and otitis-free children.

Int J Pediatr Otorhinolaryngol. 2021 Jan 21;143:110629

Authors: Xu L, Earl J, Bajorski P, Gonzalez E, Pichichero ME

Abstract
OBJECTIVES: About 10-15% children develop frequent acute otitis media (AOM) confirmed by tympanocentesis. These children are designated sOP (stringently defined otitis-prone) because all AOM episodes have been microbiologically confirmed. The cause of otitis-proneness in sOP children is multi-factorial, including frequent otopathogen nasopharyngeal (NP) colonization and deficiency in innate and adaptive immune responses. A largely unexplored contributor to otitis proneness is NP microbiome composition. Since the microbiome modulates otopathogen NP colonization and immune responses, we hypothesized that the NP microbiome composition in sOP children might be dysregulated.
METHODS: We performed 16S rRNA sequencing to analyze microbiome composition in 157 NP samples from 28 sOP and 68 AOM-free children when they were 6 months or 12 months old and healthy. Bioinformatic approaches were employed to examine the composition difference between the two populations and its correlation with changes in levels of inflammatory cytokines.
RESULTS: A different global microbiome profile and reduced alpha diversity was observed in the NP microbiome of sOP children when 6 months old, compared with that from AOM-free children of the same age. This difference was resolved when groups were compared at 12 months old. We found 4 bacterial genera-Bacillus, Veillonella, Gemella, and Prevotella-correlated with higher levels of pro-inflammatory cytokines in the NP. Those 4 bacterial genera were in lower abundance in sOP compared to AOM-free children.
CONCLUSION: Dysbiosis occurs in the NP microbiome of sOP children at an early age even when they were healthy. This dysbiosis correlates with a lower inflammatory state in the NP of these children.

PMID: 33516061 [PubMed - as supplied by publisher]

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Comparative evaluation of improvement in periodontal and glycemic health status of type 2 diabetes mellitus patients after scaling and root planing with or without adjunctive use of diode laser

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Abstract

Background

Periodontal treatment in diabetic patients reduces systemic inflammatory burden and hence should be closely coordinated with the patient's overall clinical diabetic management.

Objective

To evaluate the effectiveness of diode laser (DL) (Biolase EpicTM, 940 nm, Irvine, CA, USA) as an adjunct to scaling root and planing (SRP) on periodontal health and glycated hemoglobin (HbA1c) level of type 2 diabetes mellitus (T2DM) patients suffering from generalized chronic periodontitis (CP), currently, stage II or above/grade B or C periodontitis.

Materials and methodology

After initial screening of 55 T2DM patients, a total of 44 T2DM-CP patients (between the age group of 30 and 65 years) were selected and randomly assigned into two groups. The groups were divided into control group (n=22), treated with scaling and root planing alone (SRP alone), and experimental group (n=22), treated with scaling and root planing along with laser therapy (SRP + DL). Laser irradiation was accomplished at perio pocket setting of 0.8 W (average) in a pulse interval of 1.0 ms and pulse length of 1.0 ms delivering 24 J of energy using a 300-μm fiber optic delivery system.

Results

Thirty-seven out of 44 enrolled T2DM-CP patients completed the study. Both treatment modalities, i.e., SRP alone and SRP+DL resulted in mean significant (p < 0.001) improvement in periodontal health parameters (plaque index (PI), gingival index (GI), probing pocket depth (PPD) and clinical attachment loss (CAL)) and glycemic level (RBS, FBS, and HbA1c) in T2DM-CP patients after 6 months, and was higher in SRP+DL group in comparison to SRP alone. Among the periodontal health parameters, the mean PPD reduction and CAL gain were 51.78% and 48.26% in control as compared to 61.56% and 62.54% in experimental group respectively, whereas the mean significant reduction in HbA1c was 13.8% in SRP alone and 22.52% in SRP+DL group after 6 months (p < 0.05).

Conclusion

Periodontal treatment involving SRP+DL contributes to improved periodontal health parameters and HbA1c level in T2DM-CP patients.

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Supraclinoid internal carotid artery blister-like aneurysms: hypothesized pathogenesis and microsurgical clipping outcomes

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Abstract

Background

Blister-like aneurysms (BLAs) on the supraclinoid segment of the internal carotid artery (ICA) are an enigma of cerebrovascular disease. Neither has a definite pathogenesis been so far identified, nor have uniform treatment guidelines been established for them. Our aim was to develop a hypothesis regarding the evolution of BLAs according to their macroscopic morphologies and to evaluate the efficacy of microsurgical clipping.

Methods

The clinical data and morphological features of 15 consecutive patients with 16 BLAs on the supraclinoid ICA were retrospectively reviewed. The treatment strategies were analyzed, and functional outcomes were evaluated using the modified Rankin scale (mRS). Favorable outcomes were defined as a mRS score of 0–2.

Results

Morphologically, aneurysm growth with expansion of the aneurysm neck before the surgical procedure occurred in two ruptured and one unruptured aneurysm. Daughter bleb formation was observed in two ruptured and five unruptured aneurysms. A varied degree of parent artery sclerosis was observed in nine patients. Thirteen patients were treated with direct surgical clipping, one patient was treated with clipping and wrapping, and the remaining patient was treated with an encircling clipping graft. Favorable and unfavorable outcomes were observed in 13 and two cases, respectively. Follow-up angiograms revealed 4 cases of stenosis with respective degree of mild, 30%, 50%, and 80% without any neurological dysfunction.

Conclusions

We suggest a hypothesis that BLAs on the supraclinoid ICA may share different evolving mechanisms between ruptured and unruptured lesions. A majority of them can be reliably and safely obliterated by direct clipping technique, except for the aneurysms accompanied with severely atherosclerotic parent walls.

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