Evidence for the founder effect of a novel ACVRL1 splice-site mutation in Hungarian hereditary hemorrhagic telangiectasia families

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Idiopathic Inflammatory Myopathies: An update

2016-06-12T18-56-49Z
Source: Journal of Interdisciplinary Histopathology
Bulent KURT, Serdar TASDEMIR, Ertugrul CELIK, Kemal INAN.
Idiopathic inflammatory myopathies (IIM) are a heterogeneous group of disease with complex clinical features. It has been sub-classified as: (1) Dermatomyositis, (2) Polymyositis, and (3) Inclusion body myositis (IBM). Nowadays, there are some studies in literature suggest necrotizing autoimmune myopathy and immune-mediated necrotizing myopathy should also be added to this group of disease. There is a debate in the diagnosis of IIMs and up until now, about 12 criteria systems have been proposed. Some of the criteria systems have been used widely such as Griggs et al.s proposal for IBM. Clinical findings, autoantibodies, enzymes, electrophysiological, and muscle biopsy findings are diagnostic tools. Because of diseases complexity, none of the findings are diagnostic alone. In this study, we discussed the diagnostic criteria of IMMs and described detailed morphological features.


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Adrenal, metabolic and cardio-renal dysfunction develops after pregnancy in rats born small or stressed by physiological measurements during pregnancy

Key points

• Women born small are at an increased risk of developing pregnancy complications. Stress may further increase a woman's likelihood for an adverse pregnancy.
• Adverse pregnancy adaptations can lead to long-term diseases even after her pregnancy.
• The current study investigated the effects of stress during pregnancy on the long-term adrenal, metabolic and cardio-renal health of female rats that were born small.
• Stress programmed increased adrenal Mc2r gene expression, a higher insulin secretory response to glucose during intraperitoneal glucose tolerance test (+36%) and elevated renal creatinine clearance after pregnancy.
• Females that were born small had increased homeostatic model assessment-insulin resistance and elevated systolic blood pressure after pregnancy, regardless of stress exposure.
• These findings suggest that being born small or being stressed during pregnancy programs long-term adverse health outcomes after pregnancy. However, stress in pregnancy does not exacerbate the long-term adverse health outcomes for females that were born small.

Abstract

Females born small are more likely to experience complications during their pregnancy, including pregnancy-induced hypertension, pre-eclampsia and gestational diabetes. The risk of developing complications is increased by stress exposure during pregnancy. In addition, pregnancy complications may predispose the mother to diseases after pregnancy. We determined whether stress during pregnancy would exacerbate the adrenal, metabolic and cardio-renal dysfunction of growth-restricted females in later life. Late gestation bilateral uterine vessel ligation was performed in Wistar Kyoto rats to induce growth restriction. At 4 months, growth-restricted and control female offspring were mated with normal males. Those allocated to the stressed group had physiological measurements [metabolic cage, tail cuff blood pressure, intraperitoneal glucose tolerance test (IPGTT)] conducted during pregnancy whilst the unstressed groups were unhandled. After the completion of pregnancy, dams were aged to 12 months and blood pressure, and metabolic and renal function were assessed. At 13 months, adrenal glands, pancreases and plasma were collected at post-mortem. Females stressed during pregnancy had increased adrenal Mc2r gene expression (+22%), higher insulin secretory response to glucose during IPGTT (+36%) and higher creatinine clearance (+29%, indicating increased estimated glomerular filtration rate). In contrast, females that were born small had increased homeostatic model assessment-insulin resistance (+54%), increased water intake (+23%), urine output (+44%) and elevated systolic blood pressure (+7%) regardless of exposure to stress. Our findings suggest that low maternal birth weight and maternal stress exposure during pregnancy are both independently detrimental for long-term adrenal, metabolic and cardio-renal health of the mother, although their effects were not exacerbated.

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Rapid reaction: Responders need to level-up to match lethal capability of mass shooters

EMS leaders, field personnel should review and reconsider their preparedness to respond to active shooters

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Factors associated with mucosal pain in patients with partial removable dental prostheses

Summary

The aim of this study was to investigate factors associated with mucosal pain in patients with partial removable dental prostheses (PRDPs). In this hospital-based cross-sectional study, 333 patients wearing 500 PRDPs (mean age 71·4 years, men 33·3%) were consecutively recruited from prosthetic clinic of a dental hospital in Japan. Subjects rated pain intensity and frequency of denture-bearing mucosa. An examiner recorded age, gender and systemic diseases as well as dental, mucosa, denture, sensory, behavioural- and psychological-related characteristics that were possibly associated with the mucosal pain. Multivariate analyses were performed to analyse factors related to mucosal pain. Pain intensity was rated as more than score 0 (presence) in 34·2% (171/500) PRDPs, and pain was experienced after denture delivery in 42·8% (214/500) PRDPs. Logistic regression analyses showed that younger age, mucosal damage, poor mucosal condition, bone prominence, poor residual ridge, higher pain sensitivity, presence of awake bruxism, perception of oral dryness, interim denture wear and high number of missing teeth were significant independent predictors for the presence of the mucosal pain intensity and/or frequency (P < 0·05). Multiple factors are associated with mucosal pain in patients with PRDPs. Oral mucosal characteristics, age, pain sensitivity and behavioural factors seem to be more critical for mucosal pain than distribution of missing teeth and number of abutment teeth.

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Rapid reaction: Responders need to level-up to match lethal capability of mass shooters

What happened: A single gunman with an assault rifle killed 50 people and injured dozens more at Pulse, a gay nightclub, in Orlando early Sunday morning. Surgeons expect the death toll, already the worst mass shooting in U.S. history, to climb because of the severity of patient injuries. The shooter's father told NBC news that his son, Omar Mateen, recently became very angry after seeing two men kissing.

Why it's significant: Paramedics, alongside firefighters and police officers, once again, find themselves on the frontlines of terror and chaos in an American city. The targeted victims — more than 300 people in a gay night club — represent an identifiable, non-random category congregated at a relatively soft target. Previous mass shooters have targeted churchgoers, college students, and elementary school teachers and children.

Top takeaways: Each time a mass shooter strikes EMS leaders and field personnel need to reassess their individual and agency preparedness for a similar incident in their community. In the days ahead we will learn more about the incident, the response of Orlando police and fire departments, and the heroic actions of bystanders and responders to save lives. Meanwhile, here are three immediate considerations for active shooter incident response.

1. Level-up training and response capabilities.
The moniker of 'worst mass shooting in U.S. history' is likely to be short-lived. EMS agencies need to level-up their active shooter, rescue task force and bleeding control training to match the lethal capabilities of a single shooter. An incident with 53 wounded puts a much greater strain on a regional trauma system's prehospital and hospital providers than an incident involving five or 15 patients. Immediately review active shooter response plans, triage and bleeding control supply caches, and systems for distributing trauma patients among hospitals.

2. Everyone needs to learn and practice active shooter response.
Generations of children have practiced fire drills in school and carry those skills with them into adulthood. A large percentage of working adults receive basic training in fire extinguisher use. Some adults learn to specialize in suppression of structure fires.

We need a similar national and ongoing effort to teach all Americans to recognize an active shooter and act swiftly and decisively to run, hide, or fight. Some citizens will also learn to use and carry a firearm. The Orlando shooter engaged in gunfire with an officer working at the club.

This incident, like many previous mass shooters, was not concluded until a massive law enforcement response engaged, contained and killed the shooter. There is no single solution for mass shooter response. Instead it take a collaborative approach from the targets of the shooter, other bystanders, initial public safety responders and later-arriving tactical specialists.

A casualty is carrier out of the Pulse nightclub early Sunday morning. (AP Photo/Steven Fernandez)

3. Expect multiple and dynamic scenes.
One of the surprises of this incident is its containment to a single, densely occupied building. The shooter does not appear to have targeted multiple locations, attempted escape, or committed crimes before reaching the Pulse nightclub. Part of the real-time response across a jurisdiction needs to be gathering intelligence from other 911 calls and public safety reports to determine the scope and boundaries of the incident.

Finally, an Orlando-based paramedic, listening to Orlando fire department radio communications, on public radio channel, posted information about the incident as it developed as a comment on the Pulse Facebook page. The immediate availability of scene information for public consumption and wide-spread distribution adds a significant additional challenge for incident commanders.

Learn more about active shooter response and training:

• Hybrid Targeted Violence vs. Active Shooter Incidents
• Paris massacre rapid response: EMS leaders must prepare for Hybrid Targeted Violence in the U.S.
• Rapid Response: Active shooter or active stabber" The EMS response is the same
• Rapid Response: Mass murder at Ore. college shows challenge, importance of good PIO work
• Why police need to train to use and carry an IFAK
• Rapid Response: Clear and concise radio communication is key to MCI management
• Self-care tips to recover from a traumatic EMS incident
• Active shooter incident: Overcome adrenaline to focus on one patient at a time

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Md. fire co. honors EMS, firefighters at ceremony

By David Anderson
The Aegis

BEL AIR, M.D. —Volunteer fire and EMS companies in Harford County traditionally celebrate their high-achieving members each year with a formal banquet, but the Bel Air Volunteer Fire Company tried something slightly different this year.

Company leaders held a formal celebration in the main firehouse on South Hickory Avenue, instead of a banquet hall or banquet facilities of another local fire company.

They honored longtime members for their service, top responders on fire and EMS calls and remembered members killed in the line of duty or who passed away in the last year.

Members and guests, including state and local elected leaders, socialized and ate hors d'oeuvres before the awards ceremony.

Edward Hopkins, Bel Air's former fire chief and the county's current director of emergency services, was the master of ceremonies.

"We hope you enjoy the new format," he told the audience.

Hopkins said later that the company held a private dinner for members in April, for "just family and friends, quality time with each other."

"We think this setting is a little more intimate," he said of the firehouse. "It's a closer environment, where all of our invited guests can be more up close and personal with the people receiving the awards."

Company leaders honored the top fire and EMS responders, auxiliary members who have supported firefighters and EMS workers, members who have given decades of service to the company and members who died in 2015.

Those members include Erik Steciak, 29, a paid paramedic with Bel Air and a captain with the West Friendship Volunteer Fire Department in Howard County. He died Jan. 6, 2015, after he was struck by a Bel Air fire company utility truck at the scene of an earlier accident in the 300 block of Patterson Mill Road.

A person who had been injured in the crash was in a house at the end of a driveway, and officials decided a four-wheel-drive vehicle was the best way to get to the patient. The truck slid on the icy driveway and struck Capt. Steciak.

"This smart kid, just trying to help out, was stolen from us," Chief Rick Davis Jr. said.

Company President Joseph Price said Capt. Steciak's parents "are in our thoughts and prayers ever since that tragic day on Jan. 6 of last year."

Capt. Steciak was the second member of the BAVFC who died in the line of duty since the company's founding in 1890, Price noted.

The first was Edward Hopkins' father, Harry E. Hopkins Jr., who died of a heart attack in 1974 while he was working in the Bel Air firehouse.

Price and two members of the West Friendship company lit a blue candle in Capt. Steciak's memory. The blue color is in honor of EMS workers, Price said.

Company leaders also honored Charles "Charlie" Head, a life member, Carroll Barnes, a former chief, David "Dave" Case Jr., a former fire lieutenant and life member, Ed Kelly Jr., a lifetime member and Roy "Sewell" Matthews, a lifetime member and former captain, all who died in 2015.

Members who died earlier this year, including former Chief Richard "Dick" Woodward, auxiliary member Janie Foard and member Tyler Smith, also were remembered.

2015 a 'very important and busy year'
Price said 2015 was a "very important and busy year" for the Bel Air fire company, typically among Harford County's busiest fire and EMS units.

Company leaders and the community marked the BAVFC's 125th anniversary during the summer.

The company handled 2,308 fire calls, 7,436 EMS calls, and auxiliary members put in 733 hours on emergency calls and company events in 2015.

"The challenges continue, and we will face challenges in the future, no question about it, but it's a partnership between the membership, the board and the officers," Price said.

The top fire responders last year were Davis, who had 1,244 calls; Mark Ensor, 1,066; Mark Johnson, 929; Bill Snyder, 915; Mike Fields, 847; Richard Presberry, 834; Scott McNutt, 806; Jordan Bosse, 774; Ken Ward, 750; Kevin Kadolph, 742; Nick McGowan Jr., 741; Brett Godwin, 734; Adam Siemek, 701; Brian Winchester, 694; Aaron Bellmyer, 656; Tyler Smith, 647; Will Price, 627; Steve Cox, 589; Gary Kadolph, 586 and Evan Anderson, who had 581 calls.

The top EMS responders were Ed Beksinski, who had 248 calls; Denise Collins, 206; James Drake, 201; Jason Langenfelder, 163; Mike Fields, 161; Jim Plumer, 157; Peter Cioloca, 137; Kevin Kadolph, 120; Stephen Brown, 115 and Matthew Miller, who had 105 calls.

Five emergency vehicle drivers were also honored for their commitments, which involves staying in the firehouse so they can be on hand to drive a fire truck or ambulance.

The honorees were Steve Cox, who served 1,280 duty hours, Bill Marshall, 516; Jeff Ey, 474, Paul Chizmar, 312 and Adam Siemek, 306 hours.

Years of service recognized
Members honored for 10 years of service are Laura Crocker, Dylan Baumgardner, James Rainwater, Leigha Reader, Charlie Walls and Jeff Winter.

WendyBelcher, GaryKadolph and KevinKadolph have served 15 years, and SusanFroelich, Todd McKinney and Virginia Holloway are 20-year members.

The 25-year members include Mike Fields, Jeff Ey, Bob Kral, Rich Gardiner, Steve Bittner, Craig Blessing and John Eid.

Walt Holloway, who has served for 40 years, and Richard Presberry, who has served for 45, received proclamations from town, county and state leaders.

Hopkins recognized Holloway, a published author, for his "second passion," chronicling Bel Air and Harford County history.

"Now he's protecting and preserving the history of Harford County," Hopkins said.

Presberry was a firefighter and engine driver. He said he currently helps the company any way he can.

"I'm here to help and support Chief Davis," he said after the ceremony.

Member Greg Sentman earned the Chief's Award from Davis for his efforts to create designs for three fire engines and two ambulances the company purchased last year.

Davis estimated it takes about 100 hours per unit to create the specs.

Copyright 2016 The Aegis

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Witnesses Call Orlando Shooting 'Devastating'

Police say approximately 50 people have been killed inside a Florida nightclub, and at least 53 were wounded after a gunman opened fire. (June 12)

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Witnesses Call Orlando Shooting 'Devastating'

Police say approximately 50 people have been killed inside a Florida nightclub, and at least 53 were wounded after a gunman opened fire. (June 12)

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Witnesses Call Orlando Shooting 'Devastating'

Police say approximately 50 people have been killed inside a Florida nightclub, and at least 53 were wounded after a gunman opened fire. (June 12)

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Witnesses Call Orlando Shooting 'Devastating'

Police say approximately 50 people have been killed inside a Florida nightclub, and at least 53 were wounded after a gunman opened fire. (June 12)

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EEG power and glucose fluctuations are coupled during sleep in young adults with type 1 diabetes

Publication date: August 2016
Source:Clinical Neurophysiology, Volume 127, Issue 8
Author(s): Sarah S. Farabi, David W. Carley, Lauretta Quinn
ObjectiveTo determine the coupling between brain activity and glucose variations during sleep in young adults with type 1 diabetes mellitus (T1DM).Methods27 participants, age 18–30, wore a continuous glucose monitoring system (CGMS) and underwent in-laboratory overnight polysomnography (PSG). Quantitative electroencephalogram (qEEG) metrics were determined from the PSG and included Delta, Theta, Alpha, Sigma, Beta and Gamma Band power at 5-min intervals. Wavelet Coherence Analysis was employed to determine the time varying and frequency specific coupling between glucose and EEG Band power. ANOVA was used to compare differences across fluctuation speeds and EEG bands.ResultsThere was a high degree of time varying and frequency specific coupling between glucose variations and EEG power in all EEG Bands during sleep. The average number of intervals of statistically significant coherence was highest for fluctuations periods between 10 and 30min in all Bands (p<0.0001 for each). Mean significant coherence was negatively correlated with hemoglobin A1c, a marker of glycemic control.ConclusionsThe relationship between glucose and EEG power during sleep is time varying and frequency dependent in young adults with T1DM.SignificanceUnderstanding the time varying mutual relationship between glucose changes and brain activity during sleep may have implications for disease management in T1DM.



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Recovery function of somatosensory evoked brain response in patients with carpal tunnel syndrome: A magnetoencephalographic study

Publication date: August 2016
Source:Clinical Neurophysiology, Volume 127, Issue 8
Author(s): Katsuyuki Iwatsuki, Akihito Yoshida, Takaaki Shinohara, Tomonori Nakano, Jun-ichi Uemura, Sae Goto, Masaaki Hirayama, Minoru Hoshiyama, Hitoshi Hirata
ObjectiveThe recovery function of somatosensory evoked magnetic fields (SEFs) was recorded to investigate excitatory and inhibitory balance in the somatosensory cortex of patients with carpal tunnel syndrome.MethodsSEFs were recorded in patients and controls. Recordings were taken following median nerve stimulation with single and double pulses with interstimulus intervals of 10–200ms. The root mean square for the N20m component following the second stimulation was analyzed. SEFs following stimulation of the first and middle digits were also recorded and the location for the equivalent current dipoles was estimated in three-dimensional planes.ResultsDistances on the vertical axis between the equivalent current dipoles for the first and third digits were shorter in patients than in control participants. The root mean square for the N20m recovered earlier in patients compared to controls; this was statistically significant at an interstimulus interval of 10ms. There was no relationship between N20m recovery and the equivalent current dipole location in the primary somatosensory cortex.ConclusionsCarpal tunnel syndrome was associated with functional disinhibition and destruction of the somatotopic organization in the primary somatosensory cortex.SignificanceDisinhibitory changes might induce a maladaptation of the central nervous system relating to pain.



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Real-time multi-channel monitoring of burst-suppression using neural network technology during pediatric status epilepticus treatment

Publication date: Available online 11 June 2016
Source:Clinical Neurophysiology
Author(s): Christos Papadelis, Seyedeh Fatemeh Salimi Ashkezari, Chiran Doshi, Sigride Thome, Phillip L. Pearl, Patricia Ellen Grant, Robert C. Tasker, Tobias Loddenkemper
ObjectiveTo develop a real-time monitoring system that has the potential to guide the titration of anesthetic agents in the treatment of pediatric status epilepticus (SE).MethodsWe analyzed stored multichannel electroencephalographic (EEG) data collected from 12 pediatric patients with generalized SE. EEG recordings were initially segmented in 500 ms time-windows. Features characterizing the power, frequency, and entropy of the signal were extracted from each segment. The segments were annotated as bursts (B), suppressions (S), or artifacts (A) by two electroencephalographers. The EEG features together with the annotations were inputted in a three-layer feed forward neural network (NN). The sensitivity and specificity of NNs with different architectures and training algorithms to classify segments into B, S, or A were estimated.ResultsThe maximum sensitivity (95.96% for B, 89.25% for S, and 75% for A) and specificity (89.36 for B, 96.26% for S, and 99.8% for A) was observed for the NN with 10 nodes in the hidden layer. By using this NN, we designed a real-time system that estimates the burst-suppression index (BSI).ConclusionsOur system provides a reliable real-line estimate of multichannel BSI requiring minimal memory and computation time.SignificanceThe system has the potential to assist intensive care unit attendants in the continuous EEG monitoring.



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Prolonged phone-call posture causes changes of ulnar motor nerve conduction across elbow

Publication date: August 2016
Source:Clinical Neurophysiology, Volume 127, Issue 8
Author(s): Luca Padua, Daniele Coraci, Carmen Erra, Pietro Emiliano Doneddu, Giuseppe Granata, Paolo Maria Rossini
ObjectivePostures and work-hobby activities may play a role in the origin and progression of ulnar neuropathy at the elbow (UNE), whose occurrence appears to be increasing. The time spent on mobile-phone has increased in the last decades leading to an increased time spent with flexed elbow (prolonged-phone-posture, PPP). We aimed to assess the effect of PPP both in patients with symptoms of UNE and in symptom-free subjects.MethodsPatients with pure sensory symptoms of UNE and negative neurophysiological tests (MIN-UNE) and symptom-free subjects were enrolled. We evaluated ulnar motor nerve conduction velocity across elbow at baseline and after 6, 9, 12, 15, and 18min of PPP in both groups. Fifty-six symptom-free subjects and fifty-eight patients were enrolled. Globally 186 ulnar nerves from 114 subjects were studied.ResultsConduction velocity of ulnar nerve across the elbow significantly changed over PPP time in patients with MIN-UNE, showing a different evolution between the two groups.ConclusionsPPP causes a modification of ulnar nerve functionality in patients with MIN-UNE.SignificancePPP may cause transient stress of ulnar nerve at elbow.



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Electroencephalographic characteristics of epileptic seizures in preterm neonates

Publication date: August 2016
Source:Clinical Neurophysiology, Volume 127, Issue 8
Author(s): Soňa Janáčková, Steward Boyd, Elissa Yozawitz, Tammy Tsuchida, Marie-Dominique Lamblin, Sophie Gueden, Ronit Pressler
ObjectiveAlthough seizures are more common in the neonatal period than in any other stage of childhood, those in preterm neonates are still poorly described. The aim of this study was to assess electro-clinical characteristics of seizures occurring before a corrected age of 40weeks in neonates born prematurely.MethodRetrospective analysis of EEG-documented seizures in neonates born prematurely. Seizures in a group of term neonates served as controls.ResultsFifty-six prematurely born and 46 term born neonates were included. Median duration of seizures was 52s in preterm and 96s in term neonates. Seizures were focal or multifocal. In least mature neonates, they involved smaller regions of onset and remained localised. With increasing corrected age, propagation became more frequent. The electrographic pattern – maximal frequency of oscillation and the onset pattern also evolved with age. Electro-clinical seizures were observed in 25% of preterm versus 50% of term neonates; almost all electro-clinical seizures involved the central (motor) regions.ConclusionIctal EEG features undergo changes depending on corrected age. Most seizures are subclinical, thus EEG is essential for diagnosis.SignificanceRelating ictal EEG pattern to corrected age can improve diagnosis and ultimately management.



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Resolution of cerebral pathophysiology immediately following thrombectomy in acute ischaemic stroke: Monitoring via quantitative EEG

Publication date: Available online 11 June 2016
Source:Clinical Neurophysiology
Author(s): Emma Schleiger, Andrew Wong, Stephen Read, Alan Coulthard, Simon Finnigan




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Effectiveness of Two Combined Techniques of Ultrasound Therapy and Stretching in the Treatment of Mechanical Neck Pain: A Randomized Controlled Trial

2016-06-12T08-19-14Z
Source: International Journal of Therapies and Rehabilitation Research
Reda Fawzy, Eman Embaby.
Background: The application of heat prior to or during stretching is advocated to enhance muscles flexibility and decrease pain. Yet, the difference in the timing of heat application with stretching has not been investigated in chronic mechanical neck pain. Objective: To compare the effectiveness of two combined treatment techniques of ultrasound (US) therapy and static stretch (SS) of the upper fibers of trapezius (UT) in the treatment of chronic mechanical neck pain. Methods: Fifty patients (their age range of 20 to 35) with chronic mechanical neck pain were randomized in two groups: Group I received a simultaneous application of US therapy and SS of the UT muscle; Group II received US therapy followed by SS of the UT muscle. Neck pain, neck disability and side-bending range of motion (ROM) were measured before and after the intervention. Results: All outcome measures improved similarly in both groups, with the exception that greater improvements (P


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Video: About 20 shot in Florida night club

Police: Mass shooting inside Florida night club being investigated as an 'act of terrorism'

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Video: About 20 shot in Florida night club

Police: Mass shooting inside Florida night club being investigated as an 'act of terrorism'

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Video: About 20 shot in Florida night club

Police: Mass shooting inside Florida night club being investigated as an 'act of terrorism'

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Primary Epithelioid Angiosarcoma of the Adrenal Gland: Report of a Case and Review of the Literature

2016-06-12T06-46-51Z
Source: Journal of Interdisciplinary Histopathology
Malek Mohamed Ayadi, Nadia Boujelben, Raoudha Doghri, Mouna Rezgani, Imen Abbes, maha driss, Riadh Chargui, Karima Mrad, Khaled Rahal.
Primary mesenchymal neoplasms of the adrenal gland are extremely rare. The most common primary sarcoma is adrenal angiosarcoma. We report the case of a 51-year-old patient who presented with left flank pain. After ultrasound investigations, the patient underwent surgical removal of an adrenal tumor. The gross adrenal specimen showed extensive cystic changes with old hemorrhage and necrosis. Histologically, irregular branching vascular channels were seen intermixed with solid areas of epithelioid cells. Immunohistochemical staining of tumor cells was positive with antibodies to cytokeratin and CD31. After a 12 months follow-up, the patient is still well with no sign of a relapse. Because of the epithelioid appearance and frequent expression of epithelial immunohistochemical markers, primary epithelioid angiosarcoma of the adrenal gland can be confounded with adrenal carcinomatous metastases. We report our findings with a brief literature review and discussion of differential diagnosis.


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Radiotherapy-Induced Ovarian Sarcoma Following the Treatment of Cervical Cancer: Exceptional Case Report and Review of the Literature

2016-06-12T06-46-51Z
Source: Journal of Interdisciplinary Histopathology
Malek Mohamed Ayadi, Olfa El Amine El Hadj, Ines Zemni, Hatem Bouzaiene, Jamel Ben Hassouna, Amor Gamoudi, Khaled Rahal.
Primary ovarian sarcomas are rare gynecological tumors accounting for


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Haematological splenomegaly does not directly relate to portal hypertension: From a clinical study to surgical choice

2016-06-12T06-43-06Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Antonio Manenti, Fabio Forghieri, Maurizio Zizzo, Dario Colasanto, Mario Luppi.
Background: Splenomegaly induces an increased inflow into the portal venous system; however, in the absence of pathology of the liver and of a portal vein system, secondary portal hypertension is unusual. We analyzed this problem through a clinical observational method. Methods: We selected 20 patients with splenomegaly secondary to B-cell chronic lymphocytic leukaemia; their imaging tests and clinical pathways were re-examined. Results: In the absence of diseases of the liver or of the portal venous system, an increased portal blood flow, secondary to the splenomegaly, could not be considered the sole cause of portal hypertension. Conclusions: The normal liver has a high venous capacity, and in the absence of other factors, the sole increase in portal venous flow cannot directly justify portal hypertension. This conclusion is still well founded, even if multiple humoral mediators, some of which are also released from the spleen in a number of pathological conditions, can differentially modulate the haemodynamics of hepatic sinusoids.


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Profile of autopsied homicidal victims of eastern Nepal: An observational study

2016-06-12T06-43-06Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Abhishek Karn, Birendra Kumar Mandal, Amshu Pradhan, Shivendra Jha, Bishwanath Yadav, Pramod Kumar Shrestha.
Objective: This study was performed to create a profile of the victims of intentional homicide in eastern Nepal. Methods: This is an observational study of homicidal victims autopsied from January 01, 2009 to December 31, 2011 at the Department of Forensic Medicine and Toxicology, a tertiary referral centre in Dharan, Nepal, analyzing: age, sex, educational condition, marital status and occupation of victims, homicidal method employed, motive, season of the year and toxicological study, along with few details on the victims personal history (alcohol and drug abuse). Results: The homicidal victim profile attained matched that of a man who was a young adult between 25 to 34 years of age, illiterate, unmarried, unemployed, alcoholic and was killed intentionally by sharp weapons or firearms during the September to October period. The most frequent reason for being killed was an argument that led to assault and eventually death. Conclusion: The study of this occurrence should ultimately result in enhanced prevention from these prospective evaluations of the profile. Preventive interventions at the national, social and medical level would be fundamental in saving the lives of potential victims.


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Giant-cell tumor of the patella: An uncommon cause of fracture

2016-06-12T06-43-06Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Esther Carbó-Laso, Rubén Pérez-Mañanes, Coral Sánchez-Pérez, Lydia Mediavilla-Santos, José Antonio Calvo-Haro, Miguel Cuervo-Dehesa, Javier Vaquero-Martín.
Primary patellar tumors are highly unusual. Most are benign neoplasms with giant-cell tumors being the most common, followed by chondroblastomas and aneurysmal bone cysts. Intralesional curettage and bone grafting is the treatment of choice for most giant-cell tumors in the patella. The use of adjuvants can reduce the high recurrence rate. This is a case report of a giant-cell tumor in a 61-year-old man who was diagnosed with a pathological fracture in the patella after minimal trauma. Extended curettage through an osteotomy made in the medial cortical of the patella was performed. The tumor cavity was filled with high viscosity bone cement and the medial cortical was repositioned. Histological analysis showed mononuclear cells and numerous multinucleated giant cells, confirming the diagnosis. Twenty-four months after surgery, the patient was asymptomatic and there was no evidence of local recurrence. Epidemiology, symptomatology, imagenology, histopathology, treatment options and prognoses of giant-cell tumors of the patella are discussed herein.


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Giant calculus in ileal neo-ureter constructed for iatrogenic complete ureteric avulsion: A case report and review of literature

2016-06-12T06-43-06Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Arif Akhtar, Mohammad Habib Raza.
Complete ureteric avulsion is a rare and ill-fated complication of diagnostic and therapeutic ureteroscopy. Extensive avulsion with devitalization in the proximal ureter may require ileal-ureteric substitution. Use of a bowel segment for ileal reconstruction is a proven and practical method with acceptable complications. Herein, we report a case of giant calculus formation in such an ileal neo-ureter reconstructed for complete ureteric avulsion during ureteroscopic lithotripsy. The calculus was successfully treated by laparotomy and enterotomy. To the best of our knowledge, no similar case has been previously reported in the literature.


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Metabolic abnormalities and genitourinary tract anatomical alternations in patients with recurrent urolithiasis

2016-06-12T06-43-06Z
Source: Archives of Clinical and Experimental Surgery (ACES)
John Neil, Jose Binu.
Background: Preventing the recurrence of episodes of stone formation is the focus of interest for patients. This retrospective study aimed to determine the prevalence of metabolic abnormalities and anatomical alterations of the genitourinary tract in patients with recurrent urolithiasis. Methods: Patients who had recurrent renal calculi were included. Laboratory assessment was performed on two 24-hour samples of urine. The first 24-hour urine was a random specimen and the second was obtained after the patient had been on a sodium-, oxalate- and calcium-restricted diet for at least one week. The patients with hypercalciuria further underwent fasting and calcium load testing and were assessed in terms of parathyroid hormone levels. Urine culturing was conducted to rule out urinary tract infection. All patients were evaluated with ultrasound and intravenous pyelography for any anatomical abnormalities. Results: A total of 30 patients (20 male and 10 females) were included in the study. The most frequently found metabolic alterations were hypercalciuria, low urinary volume, urinary tract infection and hyperoxaluria. Anatomic alterations were found in 26.5% of patients, mainly in the form of renal cysts, pelvi-ureteric junction obstructions, horse shoe kidneys and atrophic kidney. Conclusions: 80% of patients with recurrent stone disease had some measure of metabolic abnormality to account for the disease. The use of two 24-hour urine samples significantly improved the detection rate of metabolic abnormalities compared to a single sample. The major limitation of this study was the small number of patients as well as the short study duration.


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Outcome of the lay open vs. excision and primary closure treatment modalities for chronic sacrococcygeal pilonidal sinus in the local Saudi Arabian community

2016-06-12T06-43-06Z
Source: Archives of Clinical and Experimental Surgery (ACES)
Bader Hamza Shirah, Hamza Assad Shirah.
Background and Objectives: Sacrococcygeal pilonidal sinus is a chronic condition for which the treatment options remain controversial based on the high recurrence rates. Before 1997, excision and primary closure was the most popular method offered in our local community surgical practice. In this study, we aim to evaluate the results of treatment outcomes of the lay open method offered in 1997 to our local community patients and compare it to the excision and primary closure method, hoping it may help in opening up wider frontiers in the surgical practice on our local community to provide the best health care. Materials and Methods: Between January 1997 and December 2011, 600 patients with chronic sacrococcygeal pilonidal sinus were included in our study. 443 were male and 157 were female (age range: 1639). The lay open method was performed on 300 patients who agreed to the newly offered procedure, and excision with primary closure was performed on the other 300 patients that refused surgery with the lay open method. Results: The recurrence rate was 0% for the lay open technique, and 3% for the excision with primary closure method. All patients had undergone 5 years of follow-up. Conclusion: When the lay open technique is performed in a meticulous and carefully prepared manner with superb postoperative care and regular follow-up, it is more promising than excision with primary closure in treating chronic sacrococcygeal pilonidal sinus, and may successfully achieve a zero (0%) recurrence rate, low postoperative complications, and acceptable cosmetic wounds.


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Video: About 20 shot in Florida night club

Police: Mass shooting inside Florida night club being investigated as an 'act of terrorism'

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What Does it Mean to be Healthy? Hispanics in the Southeastern Idaho Agricultural Industry

Abstract

In contrast to many studies of first generation Hispanics residing in the U.S., our study focused on participants of both genders who were formally employed outside the home. The purpose of this study was to explore the meaning of health among southeast Idaho Hispanics employed in the agro-industry. Using qualitative methodology, we interviewed twenty participants employed at a potato processing plant. We found that men and women had differing concepts of health based upon their gender roles and the value placed on work outside the home, which influenced their willingness to access formal health care. Based on our findings, there is a need for public health officials in Idaho to collaborate with employers to develop and implement workplace clinics.

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Emotional processing and psychopathic traits in male college students: an event-related potential study

Publication date: Available online 11 June 2016
Source:International Journal of Psychophysiology
Author(s): Amy L. Medina, Elvira Kirilko, Jillian Grose-Fifer
Emotional processing deficits are often considered a hallmark of psychopathy. However, there are relatively few studies that have investigated how the late positive potential (LPP) elicited by both positive and negative emotional stimuli are modulated by psychopathic traits, especially in undergraduates. Attentional deficits have also been posited to be associated with emotional blunting in psychopathy, consequently, results from previous studies may have been influenced by task demands. Therefore, we investigated the relationship between the neural correlates of emotional processing and psychopathic traits by measuring event-related potentials (ERPs) during a task with a relatively low cognitive load. A group of male undergraduates were classified as having either high or low levels of psychopathic traits according to their total scores on the Psychopathic Personality Inventory-Revised (PPI-R). A subgroup of these participants then passively viewed complex emotional and neutral images from the International Affective Picture System (IAPS) while their EEG was recorded. As hypothesized, in general the late LPP elicited by emotional pictures was found to be significantly reduced for participants with high Total PPI-R scores relative to those with low scores, especially for pictures that were rated as less emotionally arousing. Our data suggest that male undergraduates with high, but subclinical levels of psychopathic traits did not maintain continued higher-order processing of affective information, especially when it was perceived to be less arousing in nature.



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