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There are various orbital implant options following enucleation. In cases of severe infection, such as panophthalmitis with extraocular extension, it is reasonable to consider a two-staged approach to decrease the risk of infectious complications. One option, illustrated by this case, is enucleation with insertion of an antimicrobial-eluting cement implant, followed by a secondary procedure to exchange the cement with a permanent orbital implant. We report on a patient with clinical, ultrasound, and radiographical findings consistent with infectious panophthalmitis with extra-scleral extension. Intolerable pain and progressive orbital involvement in a blind eye were the indications for enucleation. To reduce the risk of persistent infection, a gentamycin-eluting cement implant (Palacos® R + G as an intraorbital implant) was utilized in the initial procedure. Two months later, the cement implant was removed, and a scleral-wrapped porous implant was placed into a quiet socket without signs of inflammation or infection. In the setting of severe infection, a two-staged procedure utilizing an antimicrobial-eluting implant can be considered.

One of the main causes of stricture at hepaticojejunostomy site after surgery for congenital biliary dilatation is inflammation or infection associated with bile leak. The aim of this study was to determine the risk factors and outcomes of bile leak after laparoscopic surgery. We retrospectively reviewed the demographics and outcomes of patients who underwent laparoscopic surgery for congenital biliary dilatation between September 2013 and December 2019. Data from patients with bile leak were compared to data from patients without bile leak. Fourteen of 78 patients had bile leak. Hepatic duct diameter at anastomosis was the only risk factor of bile leak. Patients with the diameter ≤ 10 mm had higher incidence of bile leak than in patients with the diameter > 10 mm (P = 0.0023). Among them, bile leak occurred more frequently in patients operated on by non-qualified surgeons based on the Japan Society for Endoscopic Surgery endoscopic surgical skill qualification system than by qualified surgeons (P = 0.027). However, none of the patients with bile leak developed anastomotic stricture afterwards. Although good technical skill is necessary to avoid bile leak in narrow hepatic duct cases (≤ 10 mm), slight bile leak may not result in anastomotic stricture.

Podstawka Zuzanna, Pińkowska Oliwia, Byś Aleksandra, Gawda Piotr. Effectiveness of Fascial Manipulation Method (FM®). Journal of Education, Health and Sport. 2020;10(9):506‑513. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2020.10.09.061 https://apcz.umk.pl/czasopisma/index.php/JEHS/article/view/JEHS.2020.10.09.061 https://zenodo.org/record/4042195 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2020; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 16.09.2020. Revised: 21.09.2020. Accepted: 22.09.2020. Effectiveness of Fascial Manipulation Method (FM®) Zuzanna Podstawka1, Oliwia Pińkowska1, Aleksandra Byś1, Piotr Gawda1 1 Department of Sports Medicine. Medical University of Lublin, Poland. Corresponding author: Zuzanna Podstawka, Department of Sports Medicine, Address: Chodźki 7, 20-093 Lublin, Poland +48 81 448 67 60, department.sports.medicine@umlub.pl Acknowledgments The result of the present study does not constitute an endorsement of the product by the authors or the journal. Conflict of interest The authors declare that they have no conflict of interest. Abstract Background Fascial Manipulation® (FM®) is a manual method of treatment created by Luigi Stecco that centres on the muscular fascia. Fascia is a fibrous collagenous tissue which, with its wide strands, connects all the connective tissues in the body into a whole. Fascia can also cause restriction of motion of the organs as a result of an injury, inflammation or infection. FM® technique bases on identification and therapy of specific points, which are located at the point of convergence of the vectorial forces of the muscles involved in every movement. The aim of this literature review was to analyze publications on the use of FM® in treatment of pain and functional dysfunctions. Materials and methods Material for this literature review was found by two independent authors using PubMed, Cochrane library, ScienceDirect and PEDro databases. In order to identify appropriate studies, a combination of keywords ,,fascial manipulation”, „pain”, „dysfunction” was used. Finally, 10 publications were qualified for a literature review. Results In the analyzed ten publications, improvement after treatment, reduction of pain and better functional outcome in patients conditions were figured. Six authors had some similar conclusions which state that the positive results of treatment last over time. One study presented opposite findings and state that the treatment has not brought long-lasting effects. Conclusions Considering all the reports on this subject, it is suggested that FM® therapy is worth considering in treatment of pain disorders, orthopaedic dysfunctions and postural disabilities. Further research of the subject on whether the treatment results are sustainable is necessary. Key words: fascial manipulation; pain; dysfunction; manual therapy

Introduction: Ventilator-associated events (VAEs) are objective measures as defined by the Centers for Disease Control and Prevention (CDC). To reduce VAEs, some hospitals have started patients on higher baseline positive end-expiratory pressure (PEEP) to avoid triggering VAE criteria due to respiratory fluctuations.Methods: At our institution, VAEs were gathered from January 2014 through December 2019. Using the CDC-defined classifications, VAEs were split into two groups to separate patients with hypoxemia only (VAC) and those with hypoxemia and evidence of inflammation or infection (IVAC-plus). We used the geometric distribution to calculate the daily event probability before and after the protocol implementation. A probability threshold was used to determine if the days between events was exceeded during the post-protocol period.Results: A total of 306 VAEs were collected over the study period. Of those, 155 were VACs and 107 were IVAC-plus events during the pre-protocol period. After implementing the protocol, 24 VACs and 20 IVAC-plus events were reported. There was a non-significant decrease in daily event probabilities in both the VAC and IVAC-plus groups (0.083 vs. 0.068 and 0.057 vs. 0.039, respectively).Conclusion: We concluded a starting PEEP of 8 cmH2O is unlikely to be an effective intervention at reducing the probability of a VAE. Until specific guidelines by the CDC are established, hospitals should consider alternative methods to reduce VAEs.

Objective: The aim of this study was to evaluate the meniscal regeneration and arthritic changes after partial meniscectomy and application of either polyurethane scaffold or novel multilayer meniscal scaffold in a rabbit model. Methods: Sixteen NewZealand rabbits were randomly divided into three groups. A reproducible 1.5-mm cylindrical defect was created in the avascular zone of the anterior horn of the medial meniscus bilaterally. Defects were filled with the polyurethane scaffold in Group 1 (n:6) and with novel multilayer scaffold in Group 2 (n:6). Rabbits in Group 3 (n:4) did not receive any treatment and defects were left empty. All animals were sacrificed after 8 weeks and bilateral knee joints were taken for macroscopic, biomechanical, and histological analysis. After excision of menisci, inked condylar surfaces and tibial plateaus were evaluated for arthritic changes. Digital photographs of excised menisci were also obtained and surface areas were measured by a computer software. Indentation testing of the tibial condyles and compression tests for the relevant meniscal areas was also performed in all groups. Histological analysis was made and all specimens were scored according to Rodeo scoring system. Results: No signs of inflammation or infection were observed in any animals. A significant difference was observed between meniscus surface areas of the multilayer scaffold group (20.13 ± 1.91 mm2) and the group with empty meniscus defects (15.62 ± 2.04 mm2) (p = 0.047). The results of biomechanical compression tests revealed a significant difference between the Hayes scores of the second group (1.728) and the empty defect group (0,467) (p = 0.029). Intact meniscal tissue showed higher mechanical properties than all the defected samples. Multilayer scaffold group demonstrated the closest results compared to healthy meniscus tissue. Tibia indentation tests and histological evaluation showed no significant differences between groups (p = 0.401 and p = 0.186 respectively). Conclusions: In this study, the initial evaluation of novel multilayer meniscal scaffold prevented the shrinkage that may occur in the meniscus area and demonstrated superior biomechanical results compared to empty defects. No adverse events related to scaffold material was observed. Besides, promising biomechanical and histological results, comparable to polyurethane scaffold, were obtained. Keywords: Meniscal scaffold, Multi-layer meniscus scaffold, Composite scaffold, PHBV, Luffa Cylindirica fiber, Strontium ranelate

Background : Physical exercise is a non-pharmacological treatment for various diseases. Aging is associated with deteriorating physiological function, and elderly individuals generally have inflammation or infection in the digestive tract. This study aimed to examine the effects of mild and moderate physical exercise intensities on the indicators of inflammation risk of the gaster in a male Wistar rat aging model created with D-galactose induction. Methods : This experimental research study had a post-test-only group design. The study included 24 3-month-old male Wistar rats weighing 200-300 g. The rats were equally divided into four groups (saline,+light-intensity physical exercise, and D-galactose+moderate-intensity physical exercise)D-galactose, D-galactose. D-galactose was continuously administered at 300 mg/ml/kg body weight. The study period was four weeks. The number of fibrocytes, mucosal thickness, and the number and size of mucosal glands were analyzed. Results : D-galactose induction triggered aging. Physical exercise had an effect on weight gain and decreased the number of fibrocytes. However, there were no effects on mucosal thickness and the number and size of mucosal glands. Conclusions : Physical exercise of mild/moderate intensity had an effect on the number of fibrocytes but did not have impact on the mucosal thickness or the number and size of mucosal glands.

Background:. Closed incision negative pressure therapy (ciNPT) has been shown to improve wound healing for patients at high risk for wound complications. Current devices consist of opaque interface dressings that do not allow ongoing visual evaluation of the surgical incision and utilize a negative pressure of −80 mm Hg to −125 mm Hg. The Negative Pressure Platform Wound Dressing (NP-PWD) was developed to address these aspects. This case series is the first evaluation of the NP-PWD in a clinical setting. Methods:. Patients aged 18–85 undergoing an operation with an anticipated incision and primary closure were screened. Demographics, comorbidities, and operation performed were recorded. Following closure, the incision was measured and photographed before NP-PWD placement. The NP-PWD was removed at the first postoperative check (POC) between postoperative days (PODs) 3–5. Subjects were followed until PODs 9–14. POCs consisted of incision assessment, measurement, photography, and adverse event monitoring. Results:. A total of 8 patients with 10 incisions were included in the study. Five patients were men. Median age was 56 years (IQR 53–74 years). All incisions were intact and without inflammation or infection at all POCs. Three adverse events, including small blisters and interruption of therapy, were noted. Conclusions:. This case series reports that patients tolerated the NP-PWD on closed surgical incisions well and that all incisions were intact without evidence of inflammation or infection after 2 weeks of follow-up. Future controlled, clinical studies should further examine the safety and efficacy of the use of the NP-PWD.

Dura substitutes are applied in duraplasty to repair lost or damaged dura. Collagen-based dura substitutes are mainstream products in both the US and Chinese markets. In this study, dura substitute devices with potential dura regeneration ability are evaluated. The dura substitutes are composed of fibrous type I collagen that were purified from bovine tendon. Physical and chemical characterization demonstrated that the tested dura substitute has desirable porous scaffolding structures and is composed of highly purified type I collagen. The collagen dura substitutes were further investigated in vivo with a rabbit model for 6 months to evaluate their safety and performance to repair and regenerate dura. No inflammation or infection was observed during the course of in vivo study. The integration of the collagen dura substitutes with surrounding tissue was normal as compared to native tissue. The macroscopic and microscopic histological assessments of the sampled animal tissue showed that the damaged dura were regenerated. The collagen dura substitutes were resorbed between 3 and 6 months along with newly regenerated dura. Both tissue adhesion and dura repair was the worst in blank control group as compared to those in the collagen dura substitutes. Taken together, regenerative collagen dura substitutes demonstrated with suitable physicochemical properties. The in vivo evaluation in a rabbit model further demonstrated the safety and performance of such substitutes for dura repair and regeneration.

Aims Calprotectin (CLP) is produced in neutrophils and monocytes and released into body fluids as a result of inflammation or infection. The aim of this study was to evaluate the utility of blood and synovial CLP in the diagnosis of chronic periprosthetic joint infection (PJI). Methods Blood and synovial fluid samples were collected prospectively from 195 patients undergoing primary or revision hip and knee arthroplasty. Patients were divided into five groups: 1) primary total hip and knee arthroplasty performed due to idiopathic osteoarthritis (OA; n = 60); 2) revision hip and knee arthroplasty performed due to aseptic failure of the implant (AR-TJR; n = 40); 3) patients with a confirmed diagnosis of chronic PJI awaiting surgery (n = 45); 4) patients who have finished the first stage of the PJI treatment with the use of cemented spacer and were qualified for replantation procedure (SR-TJR; n = 25), and 5) patients with rheumatoid arthritis undergoing primary total hip and knee arthroplasty (RA; n = 25). CLP concentrations were measured quantitatively in the blood and synovial fluid using an immunoturbidimetric assay. Additionally, blood and synovial CRP, blood interleukin-6 (IL-6), and ESR were measured, and a leucocyte esterase (LE) strip test was performed. Results Patients with PJI had higher CLP concentrations than those undergoing aseptic revision in blood (median PJI 2.14 mg/l (interquartile range (IQR) 1.37 to 3.56) vs AR-TJR 0.66 mg/l (IQR 0.3 to 0.83); p < 0.001) and synovial fluid samples (median PJI 20.46 mg/l (IQR 14.3 to 22.36) vs AR-TJR 0.7 mg/l (IQR 0.41 to 0.95); p < 0.001). With a cut-off value of 1.0 mg/l, blood CLP showed a sensitivity, specificity, positive predictive value, and negative predictive value of 93.3%, 87.5%, 89.4%, and 92.1%, respectively. For synovial fluid with a cut-off value of 1.5 mg/l, these were 95.6%, 95%, 95.5%, and 95%, respectively. Conclusion This small study suggests that synovial and blood CLP are useful markers in chronic PJI diagnosis with similar or higher sensitivity and specificity than routinely used markers such as CRP, ESR, IL-6, and LE. CLP was not useful to differentiate patients with PJI from those with rheumatoid arthritis. Cite this article: Bone Joint J 2021;103-B(1):46–55.

OBJECTIVES This review summarizes current evidence on causes and management strategies for delayed pain post-cochlear implantation (CI) surgery, without clinical evidence of inflammation or infection. METHODS The systematic review was undertaken in line with Preferred Reporting Items for Systematic review and Meta-Analysis Protocols 2015 guidelines. A literature search was undertaken, with inclusion of patients who underwent CI and presented with delayed pain (>3 months post-operatively) around their device site without an identifiable cause. Analysis was undertaken using MATLAB (MathWorks, Natick, MA) and the R-software package (www.r-project.org). RESULTS 4 articles (48 patients), all retrospective case series, met inclusion criteria. The mean onset of pain post-CI was 60 months and mean follow-up was 15.8 months, there was no difference in the prevalence of pain between device brands (p=0.13). The majority (90%) did not have any hearing deterioration, and investigations did not reveal a cause for the pain in any of the patients. In terms of management, medical therapies, including oral therapy (analgesia, non-steroidal anti-inflammatories, antibiotics) and local treatments (topical, injections) resolved pain in 41% and 63%, respectively. Surgical intervention (explantation, magnet replacement, tympanic neurectomy), where undertaken, resolved pain in 100%. A minority had an identifiable infective microorganism cultured from intra-operative soft tissue or biofilm samples. CONCLUSIONS Evidence for the causes and management of delayed pain post-CI without clinical evidence of inflammation is scarce. A stepwise approach is deemed best, with decisions being made on an individual basis, evaluating each patient's specific circumstances and priorities. Further evaluation of explanted devices would allow for better understanding of the causes and treatment of this group of patients.

OBJECTIVE To compare the use of stainless steel staples with absorbable staples for closure of skin incisions in dogs undergoing tibial plateau leveling osteotomy (TPLO). STUDY DESIGN Prospective study. SAMPLE POPULATION Client-owned dogs (n = 80). METHODS With client consent, dogs were randomly assigned a staple type (stainless steel or absorbable) immediately prior to closure of a TPLO skin incision. Incisions were compared for length, staple type and number, and an inflammation-infection score 2 weeks after surgery. RESULTS Overall, 18.8% of incisions were diagnosed with inflammation or infection. No difference was found between inflammation-infection scores, incision length, number of staples used, or general anesthetic time between the 2 staple groups. However, wound closure was faster with stainless steel staples (22.50 seconds; range, 11-180) by approximately 30 seconds compared with absorbable staples (56.50 seconds; range, 18-190; P

Wound healing is a complicated process consisting of overlapping phases directed and regulated by many mediators of healing produced locally at the wound. The end goal of wound healing is the production of tissue at the site of injury which has a similar structure and provides protection to the body. Any alterations in the normal healing process can lead to delayed healing or additional tissue damage. Factors that contribute to aberrant wound healing can be species-specific and include both intrinsic (systemic) factors and extrinsic (environmental) factors. Management of wounds and recognition of alterations can be optimised by adoption of a structured framework for wound assessment, such as the TIME principle (acronym referring to the following categories: tissue, inflammation or infection, moisture, and edge of wound or epithelial advancement). This review article provides an overview of the phases of wound healing, variation of healing among different species, factors reported to delay healing, and an introduction to the TIME principle as a structured approach to clinical evaluation of wounds.La cicatrisation des plaies est un processus compliqué composé de phases superposées dirigées et régulées par de nombreux médiateurs de cicatrisation produits localement au niveau de la plaie. L'objectif final de la cicatrisation est la production de tissu sur le site de la blessure qui a une structure similaire et offre une protection au corps. Toute altération du processus normal de cicatrisation peut entraîner un retard de cicatrisation ou des lésions tissulaires supplémentaires. Les facteurs qui contribuent à une cicatrisation aberrante des plaies peuvent être spécifiques à l'espèce et inclure à la fois des facteurs intrinsèques (systémiques) et des facteurs extrinsèques (environnementaux). La gestion des plaies et la reconnaissance des altérations peuvent être optimisées par l'adoption d'un cadre structuré pour l'évaluation des plaies, tel que le principe du TIME (acronyme faisant référence aux catégories suivantes : tissu, inflammation ou infection, humidité et bord de la plaie ou avancement épithélial). Cet article de synthèse donne un aperçu des phases de cicatrisation des plaies, de la variation de la cicatrisation entre les différentes espèces, des facteurs signalés comme retardant la cicatrisation et une introduction au principe TIME en tant qu'approche structurée de l'évaluation clinique des plaies.La cicatrización de heridas es un proceso complicado que consta de fases superpuestas dirigidas y reguladas por muchos mediadores de cicatrización producidos localmente en la herida. El objetivo final de la cicatrización de heridas es la producción de tejido en la zona lesional que tenga una estructura similar y brinde protección al cuerpo. Cualquier alteración en el proceso de cicatrización normal puede provocar un retraso en la curación o daño adicional en los tejidos. Los factores que contribuyen a la cicatrización aberrante de heridas pueden ser específicos de la especie e incluyen tanto factores intrínsecos (sistémicos) como factores extrínsecos (ambientales). El manejo de heridas y el reconocimiento de alteraciones se pueden optimizar mediante la adopción de un marco estructurado para la evaluación de heridas, como el principio TIME (acrónimo que se refiere a las siguientes categorías: tejido, inflamación o infección, humedad y borde de la herida o avance epitelial). Este artículo de revisión proporciona una descripción general de las fases de cicatrización de heridas, la variación de la cicatrización entre diferentes especies, los factores que retrasan la cicatrización y una introducción al principio TIME como un enfoque estructurado para la evaluación clínica de heridas.Die Wundheilung ist ein komplizierter Prozess, der aus überlappenden Phasen besteht, die durch viele Heilungsmediatoren, die direkt an der Wunde produziert werden, bestimmt und reguliert wird. Das Endziel der Wundheilung ist die Produktion von Gewebe an der Stelle der Verletzung, welches eine ähnliche Struktur aufweist und einen Schutz für den Körper darstellt. Jede Änderung des normalen Heilungsprozesses kann zu verzögerter Heilung oder zusätzlichem Gewebeschaden führen. Faktoren, die zu abweichender Wundheilung beitragen, können Spezies-spezifisch sein und sowohl intrinsische (systemische) wie auch extrinsische (Umwelt) Faktoren beinhalten. Wundmanagement und das Erkennen von Veränderungen kann durch Einsatz eines strukturierten Rahmens zur Erfassung der Wundheilung optimiert werden, wie das TIME Prinzip (ein Akronym, welches sich auf die folgenden Kategorien bezieht: Gewebe, Entzündung oder Infektion, Feuchtigkeit, und Wundrand oder Zunahme der Epithelbildung). Dieser Review Artikel bietet einen Überblick über die Phasen der Wundheilung, die Variationen der Heilung bei den verschiedenen Spezies, den Faktoren, die die Wundheilung verlangsamen, und eine Einführung der TIME Prinzipien als strukturelle Herangehensweise zur klinischen Evaluierung von Wunden.創傷治癒は、重なり合った段階からなる複雑なプロセスであり、創傷部位で局所に産生される多くの治癒メディエーターによって制御されている。創傷治癒の最終目的は、損傷部位に類似した構造を持ち、生体を保護する組織を作り出すことである。正常な治癒過程に何らかの変化があると、治癒の遅れや組織の損傷を引き起こす可能性がある。異常な創傷治癒を引き起こす要因は種によって異なり、内在性 (全身性) 要因及び外的 (環境性) 要因の両方が含まれる。創傷の管理と変化の認識は、TIME原則 (組織、炎症または感染、水分、創縁または上皮化促進の頭文字) のような構造化された創傷評価の枠組みを採用することで最適化できる。本総説では、創傷治癒の段階、生物種による治癒の違い、治癒を遅らせる要因の報告、創傷の臨床評価のための構造化されたアプローチとしてのTIME原則の紹介を行っている。.伤口愈合是一个复杂的过程, 由伤口局部产生的许多愈合介质指导和调节的重叠阶段组成。伤口愈合的最终目标是在损伤部位产生具有相似结构并为身体提供保护的组织。正常愈合过程的任何改变都可能导致延迟愈合或额外的组织损伤。导致异常伤口愈合的因素可能具有种属特异性, 包括内在 (全身) 因素和外在 (环境) 因素。伤口管理和变化识别可通过采用伤口评估的结构化框架进行优化, 例如TIME原则 (首字母缩写指以下类别: 组织、炎症或感染、水分和伤口边缘或上皮化) 。本综述文章概述了伤口愈合阶段、不同物种之间的愈合差异、报告延迟愈合的因素, 并引入TIME原则作为伤口临床评价的结构化方法。.A cicatrização de feridas é um processo complicado que consiste em fases sobrepostas direcionadas e reguladas por diversos mediadores de cicatrização produzidos localmente na ferida. O objetivo final da cicatrização de feridas é a produção de tecido no local da lesão que apresenta estrutura similar e fornece proteção para o corpo. Quaisquer alterações no processo normal de cicatrização por levar a um retardo na cicatrização ou dano adicional ao tecido. Fatores que contribuem para a cicatrização de feridas aberrante podem ser espécie-específicos e incluem tanto fatores intrínsecos (sistêmicos) quanto extrínsecos (ambientais). O manejo de feridas e o reconhecimento das alterações podem ser otimizados pela adoção de um roteiro estruturado para avaliação de feridas, como o princípio TIME (sigla que se refere às seguintes categorias: tecido, inflamação ou infecção, umidade e borda da ferida ou avanço epitelial). Este artigo de revisão fornece uma visão geral das fases de cicatrização de feridas, variação da cicatrização entre diferentes espécies, fatores que podem atrasar a cicatrização e uma introdução ao princípio TIME como uma abordagem estruturada para avaliação clínica de feridas.

Background Compromised wound healing in cranio-maxillo-facial surgery is a threat to the patient's rehabilitation. Therapy of chronic and/or infected wounds is time- and cost-consuming, burdensome and occasionally futile. Cold atmospheric plasma is a new approach that promises to overcome these limitations. The aim of this proof-of-concept study was to evaluate the clinical outcome of cold plasma irradiation in patients with impaired wound healing who are refractory to conservative wound therapy and/or revision surgery. Materials and methods We enrolled six patients (mean age: 63.5 years; SD 8.8 years; 1 female and 5 males) who experienced various cranio-maxillo-facial surgical procedures and suffered from wound healing disturbances. In addition to established wound care, all wounds were irradiated with cold atmospheric plasma. The primary outcome variable was the attainment of complete wound closure. Results In all patients, complete remission in terms of wound closure was observed within a mean time of 15.5 weeks (range: 4–38 weeks). No undesirable side effects were observed, and no inflammation or infection occurred after cold plasma initiation. Conclusion The use of cold atmospheric plasma might offer a reliable, conservative treatment option in complicated wound healing disturbances in cranio-maxillo-facial surgery.

OBJECTIVE. In the 29 years since the initial description of Modic type 1 vertebral endplate changes there has been ongoing debate regarding their cause. Studies have attributed Modic type 1 vertebral endplate changes to traumatic injury to the vertebral endplate, localized action of proinflammatory mediators, and more recently low-grade bacterial infection. Can we reconcile these conflicting data about the underlying cause of Modic type 1 vertebral endplate changes? Are we now in a position to conclude whether Modic type 1 vertebral endplate changes are secondary to injury, inflammation, or infection? CONCLUSION. We argue that the processes are not disparate but are in fact closely linked, each potentially instigating a chain of events leading to the MRI findings of Modic type 1 vertebral endplate change. A method of delineating which process is predominantly at play in an individual patient is required so that tailored treatment options can be offered with huge potential benefit to individuals and societ...

Purpose The treatment of wound healing disturbances of the radial forearm free flap donor site after reconstructive surgery is typically long and burdensome and often requires additional surgery. Cold atmospheric plasma is a promising approach to overcome these impairments. The aim of this proof of concept study was to evaluate the clinical outcome of plasma irradiation in patients with wound healing disorders with exposed brachial tendons of the radial forearm. Patients and Methods Four patients (mean age 64.2 years, range 44 to 80) who had undergone radial forearm free flap procedures and developed wound healing disturbance leading to exposed flexor tendons were included in the present prospective case series. In addition to routine wound care, all sites were irradiated with cold atmospheric plasma. The primary outcome variable was complete wound closure. Results In all patients, complete wound repair in terms of the absence of tendon exposure was observed within a mean treatment time of 10.1 weeks (range 4.9 to 16). No undesirable side effects were observed, and no inflammation or infection occurred. Conclusions Cold atmospheric plasma could offer a reliable conservative treatment option for complicated wound healing disturbances. This was exemplarily shown in the case of radial forearm free flap donor site morbidity with exposed flexor tendons in the present study.

Purpose The finding of an anterior chamber cilium after small incision cataract surgery is rare, with only five prior cases being found on literature review. Strategies include observation if there is no evidence of inflammation or infection and prompt removal if the situation changes.1-5 This case adds to the number of case reports and highlights that unexpected findings such as this can be seen on the first postoperative day exam and the clinical decisions made to remove it promptly. Observations A 69 year-old woman had uncomplicated phacoemulsification cataract extraction with posterior chamber intraocular lens implantation in the right eye using a superonasal corneal incision and inferotemporal paracentesis. Examination at 1 day noted a cilium in the anterior chamber. The cilium was removed the same day without complications. Conclusions and importance This case report shows that intraocular cilia can occasionally be seen following routine small incision sutureless cataract surgery even when there is no evidence of it immediately following surgery.

PURPOSE: To review sutureless intrascleral intraocular lens (IOL) fixation methods. METHODS: Review of published literature. RESULTS: Sutureless intrascleral IOL fixation methods are newer and have been developed to eliminate the suture-related complications of sutured scleral fixation methods such as suture-induced inflammation or infection and IOL dislocation or subluxation due to suture degradation or suture breakage. Sutureless intrascleral fixation methods aim for intrascleral haptic fixation to achieve stability of the IOL. Various methods of sutureless scleral fixation have been described. Using a needle, a blade, or a trochar, sclerostomies are created in all techniques for intraocular access. Some surgeons prefer to create scleral tunnels, whereas others use scleral flaps for scleral fixation of haptics. The stability of IOLs is attained by the scar tissue formed around the haptics. CONCLUSIONS: Short-term results of these new methods are acceptable; studies including more cases with longer follow-up are needed to determine their long-term success. [ J Cataract Refract Surg . 2016;32(9):586–597.]

Malignant lymphomas are neoplasms with diffuse proliferation of neoplastic lymphocytes and their precursor cells. Diffuse large B-cell lymphoma, which is a subtype of non-Hodgkin`s lymphomas, rarely occurs in the head and neck area and is especially rare in the maxillary sinus. We report a case of a 76-year-old female patient who was referred to the oral and maxillofacial surgery office for evaluation of a dental abscess as a clinical diagnosis. Laboratory tests revealed no signs of inflammation or infection; therefore, incisional biopsy was performed. The final diagnosis was diffuse large B-cell lymphoma in the maxillary sinus. Here we describe this case with a review of relevant literature.

Osteonecrosis of the jaw (ONJ) is a rare and severe necrotic bone disease reflecting a compromise in the body’s osseous healing mechanisms and unique to the craniofacial region. Antiresorptive and antiangiogenic medications have been suggested to be associated with the occurrence of ONJ; yet, the pathophysiology of this disease has not been fully elucidated. This article raises the current theories underlying the pathophysiology of ONJ. The proposed mechanisms highlight the unique localization of ONJ. The evidence-based mechanisms of ONJ pathogenesis include disturbed bone remodeling, inflammation or infection, altered immunity, soft tissue toxicity, and angiogenesis inhibition. The role of dental infections and the oral microbiome is central to ONJ, and systemic conditions such as rheumatoid arthritis and diabetes mellitus contribute through their impact on immune resiliency. Current experimental studies on mechanisms of ONJ are summarized. The definitive pathophysiology is as yet unclear. Recent studies are beginning to clarify the relative importance of the proposed mechanisms. A better understanding of osteoimmunology and the relationship of angiogenesis to the development of ONJ is needed along with detailed studies of the impact of drug holidays on the clinical condition of ONJ.

Semen analysis not only evaluates the number and quality of the sperm, but also evaluates the presence of other types of cells in the semen, and differentiates the round cells into leukocytes (white blood cells), immature sperm or non-cellular material. The presence of increased numbers of round cells in the semen should be evaluated using special staining to determine the type of cells. Increased concentration of leukocytes may be related to inflammation or infection, resulting in impairment of sperm function.

Immunologists thought they knew the main players in our immune system. But they have become convinced that temporary immune command posts erected by the body, called tertiary lymphoid structures (TLS) or tertiary lymphoid organs, are far more important to the body's defenses than previously realized. These organized congregations of immune tissue can sprout at sites of inflammation or infection almost anywhere in the body. They appear to instigate immune system counterattacks against pathogens and tumors—and may also promote the self-directed attacks of autoimmune diseases and the rejection of transplanted organs. These days, research on TLS "is exploding," says immunologist Andreas Habenicht of the University of Munich in Germany. Armed with new understanding of the signals that create these structures, drug companies have even begun testing compounds to block TLS formation in people with autoimmune diseases.

Objective: To identify the most appropriate, most suitable and most efficient dressing for split-thickness skin graft (STSG) donor sites. Comparing the wound healing rate, pain severity and duration, as well as the dressing change frequency in four randomised patient groups. Methods: A single-centre non-blinded randomised controlled trial was carried out during 2010–2014. All patients treated for skin defects/lesions (due to burns, trauma or ulcers) using STSG were included in the study. All patients were randomly allocated in four different donor site treatment groups; polyurethane (PU group, Mepilex); polyurethane with silicone membrane (PUSM group; Mepilex border,); transparent, breathable film (TBF group; Mepitel film) and cotton gauze dressings (CG group) using Excel 2007. We evaluated: wound healing time, pain severity and duration, the frequency of dressing change, donor site re-epithelialisation, donor site complications (signs of inflammation or infection). Patients were assessed on postoperative days: 1, 3, 6, 9, 12, 15, 18 and 21. Results: After random allocation of study participants the number of patients in each group were: PU group n=25; PUSM group n=24; TBF group n=24; CG group n=25. The groups were homogenous according to gender, age, main pathology, donor site area and wound size. The STSG donor site healing time varied from 9 to 21 days. The mean healing time in the CG group was 14.76 days, whereas in the PU, PUSM, and TBF group it was significantly shorter; 12.25 days, 11.63 days and 10 days, respectively. Patients in the TBF group demonstrated the most rapid healing time with 66.7% of STSG donor sites healed by postoperative day 9. The pain duration interval in modern dressing groups (PU, PUSM and TBF groups) was 0–9 days, whereas it was 6–18 day in the CS group. Pain intensity mean on postoperative day 1 was 2.21 in the PU group; 1.67 in the PUSM group; 1.46 in the TBF group and 3.04 in the CG group. The average pain duration in Group PU, PUSM, and TBF was 4.08 days; 2.5 days; 2.29 days, respectively. The average number of times each dressing was changed in each group was, 2.83 times in the PU group and PUSM group and 1.46 times in the TBF group. The CG dressing group were changed once when the donor site wound re-epithelialised. There was one patient in the PU group who experienced signs of infection, was treated accordingly and excluded from the study. Conclusion: The fastest healing time was demonstrated by patients in the TBF group. The pain was not as severe and for a shorter period of time in modern dressing study groups. However, the pain was lightest and felt shortest in TBF dressing group. The modern dressings PU and PUSM had to be changed more frequently than TBF.

This review brings together and consolidates the large amount of research on acute phase proteins (APPs) that has been undertaken in chickens. Acute phase proteins are secreted from the liver as a result of inflammation or infection that can be measured in plasma. They have been well-characterised in other farm animal species and have been measured in a wide variety of poultry research areas. The acceleration in chicken APP research is in response to increased interest in ways the immune responses of the chicken can be measured and compared during infection or environmental or nutritional changes. All APPs that have been identified and characterised in chickens are described in the following review and their responses during infection discussed. The APPs are tabulated with basal values and classification to provide a comparative and useful reference. The ways APPs can be measured in chickens and the assays available are also described. This review will detail the functions of the positive APPs in chickens and their behaviour during an APR.

Adhesive arachnoiditis is a rare condition, often complicated by syringomyelia. This pathologic entity is usually associated with prior spinal surgery, spinal inflammation or infection, and hemorrhage. The usual symptoms of arachnoiditis are pain, paresthesia, and weakness of the low extremities due to the nerve entrapment. A few cases have had no obvious etiology. Previous studies have reported one family with multiple cases of adhesive arachnoiditis. We report a second family of Belgian origin with multiple cases of arachnoiditis and secondary syringomyelia in the affected individuals.

Reconstructing continuity defects of the mandible is still challenging for surgeons. The currently applied conventional titanium bridging plates have considerable rates of complications. Now, a new technology enables an individual shape-identical creation of a mandibular implant in a form-board design by the method of LaserCUSING ® using pure titanium. This technology has been successfully performed in previous examinations to individually reconstruct mandibular continuity defects. This pilot study evaluated the surgical procedure in 10 female Gottingen mini pigs. First, a computed tomography scan from a mini pig cranium was performed. A three-dimensional model of the mandible was designed by data conversion. Based on the data, a customized mandibular implant resembling the natural shape was virtually created and manufactured. Then, a continuity defect of the left mandible was created in a standardized way. The implants were inserted into the defect and the wounds were allowed to heal for 21, 35, 56 and 180 days. During the healing period, no signs of inflammation or infection were observed. After the sacrifice of the minipigs the mandibles were resected. Histological microsections using Donath's sawing and grinding technique were manufactured and stained with Masson Goldner trichrome staining. The histomorphological results showed a pronounced ossification at the outer and inner surface of the implants. This animal study describes a promising approach to optimize customized implants for the application in humans.

INTRODUCTIONA facial nerve palsy combined with parotid enlargement usually suggests malignancy. It is highly unusual for facial nerve palsy to result from a benign situation such as inflammation or infection of the gland.PRESENTATION OF CASEWe present a rare case of facial nerve palsy due to parotid abscess.DISCUSSIONA literature search retrieved thirty-two cases of facial nerve palsy due to benign parotid lesions since 1969. Only nine reported the presence of a parotid abscess. The etiology of paralysis remains unknown although certain factors such as the virulence of the offending organisms or perineuritis, have been suggested. Best diagnostic evaluation and management are discussed.CONCLUSIONIn clinical practice, exclusion of malignancy is mandatory, as it represents the most common cause of facial palsy in the presence of a parotid lump.

The functional and phenotypic diversity of macrophages has long been appreciated, and it is now clear that it reflects a complex interplay between hard-wired differentiation pathways and instructive signals in specific tissues (Lawrence T, Natoli G. 2011, Nat Rev Immunol 11: 750–761). Recent studies have begun to unravel the molecular basis for the integration of these intrinsic developmental pathways with extracellular signals from the tissue microenvironment that confer the distinct phenotypes of tissue-resident macrophages (Lavin Y et al. 2014. Cell 159: 1312–1326; Gosselin D et al. 2014. Cell 159: 1327–1340). Macrophage phenotype and function is particularly dynamic during inflammation or infection, as blood monocytes are recruited into tissues and differentiate into macrophages, and depending on the nature of the inflammatory stimulus, they may acquire distinct functional phenotypes (Xue J et al. 2014. Immunity 40: 274–288; Murray PJ et al. 2014. Immunity 41: 14–20). Furthermore, these functional activation states can be rapidly modified in response to a changing microenvironment. Here we will discuss several key signaling pathways that drive macrophage activation during the inflammatory response and discuss how these pathways are integrated to “fine-tune” macrophage phenotype and function.

Tissue-resident memory T cells (TRM) have been shown to afford superior protection against infection, particularly against pathogens that enter via the epithelial surfaces of the body. Although TRM are often concentrated at sites of prior infection, it has been shown that TRM can disseminate throughout the body. We examined the relative effectiveness of global versus targeted CD8+ TRM lodgment in skin. The site of initial T cell priming made little difference to skin lodgement, whereas local inflammation and Ag recognition enhanced TRM accumulation and retention. Disseminated TRM lodgment was seen with the skin, but required multiple exposures to Ag and was inferior to targeted strategies. As a consequence, active recruitment by inflammation or infection resulted in superior TRM numbers and maximal protection against infection. Overall, these results highlight the potency of localized TRM deposition as a means of pathogen control as well as demonstrating the limitations of global TRM lodgment.

Rationale: Retained foreign body (FB) in soft tissues of children is commonly encountered in the emergency room. The FBs include different kinds of material and associate with some nonspecific symptoms. They usually penetrate the skin or other soft tissues and show some entry holes. Patient: A 4-month-old male infant was admitted to our department due to the edema on the right of scrotum, higher skin temperature, and a funicular lump with serious haphalgesia in the right groin and scrotum. Diagnoses: Imaging studies revealed a foreign body in right spermatic cord. A surgical exploration was performed, and a hair was dislodged. The pathological diagnosis was hyperplastic fibrous connective tissue and inflammatory reaction. Interventions: A surgical exploration was performed to dislodge the foreign body. Outcomes: The boy had an uneventful course after the surgery and was discharged from the hospital one week later. The incision healed well when the boy came back for follow-up one week later. Lessons: We still have no idea that how this FB got to the soft tissue. Few previous studies can be retrieved to help us. But we can learn that foreign body should be one of consideration for the origin of inflammation or infection of soft tissues even there is not any laceration and penetration injuries.

• Current terminology uses the 2008 European Association of Urology guidelines, but variably used historical terms suggest inflammation or infection that is rarely found. • Central sensitisation is important in causing visceral and muscle hyperalgesia throughout the pelvis. • There can be considerable overlap between urogenital pain conditions. • Men who have a chronic urological pain condition often have a disturbance of urinary, bowel and sexual function. • Working with urologists as well as a multidisciplinary team is essential.

Inflammation occurs as part of the pathology of many dementias including most neurodegenerative disorders, amyloidosis and stroke. Only a small proportion of all cases of dementia are primarily due to inflammation or infection. These cases are important because they can be treated with a chance of improvement or stabilization of cognitive impairment. In general they present more rapidly than the primary degenerative dementias, with atypical features such as focal deficit, seizures or diminuition of consciousness. Abnormalities on magnetic brain imaging and CSF examination will usually point the clinician towards this group of conditions. This article provides an introduction to the clinical syndromes of infectious and inflammatory causes of dementia, including relevant investigations. Specific treatment of these rare disorders, however, is beyond the scope of this chapter.

A medieval mandible with an unusual bilateral periosteal reaction, probably related to chronic inflammation or infection, is presented.

Oral and pharyngeal mucositis present significant management problems for patients undergoing radiation for head and neck cancers. The incidence and severity of these sequelae of radiation have increased with the use of altered fractionated schedules and concurrent chemotherapy. Directed therapies for the prevention of mucositis have yet to be established. Over the past several decades, therapies have been and continue to be designed that interfere with the causative factors of mucositis in an effort to diminish its incidence. These novel therapies protect normal mucosa either through direct radioprotection or manipulation of growth factors and cytokines that are involved in mucosal repopulation. Other therapies have tried to counter inflammation or infection with the belief that the insult from radiation is exacerbated by these normal response mechanisms to injury. It has become clear that the quality of life of patients and the economic costs of supportive therapies needed because of toxicities of cancer therapies are significant concerns. Research leading to a better understanding of the mechanisms of mucosal injury will ideally result in more specific, more targeted, and effective strategies for prevention of mucositis rather than current management algorithms that rely primarily on costly symptom management.

Vitiligo is a common, acquired, pigmentary disorder of skin and hair resulting from the destruction of functional melanocytes. It is characterized by well-circumscribed, asymptomatic depigmented macules. Ichthyosis is a group of genetic skin disorders characterized by dry, scaly skin that may be thick or very thin. Conjunctivitis is an inflammation or infection of the conjunctiva, the thin transparent layer of tissue that lines the inner surface of the eyelid and covers the white part of the eye. Here we report an unusual case of vitiligo with icthyosis and conjunctivitis in a 5 yr old boy.

The presence of an appendiceal fecalith should not be considered as a categorical sign of acute appendicitis. The fecalith may, however, be responsible for abdominal pain--right lower quadrant tenderness without associated appendicitis, i.e. appendiceal colic. When a patient presents with right lower quadrant abdominal tenderness, abdomino-pelvic computerized tomography (CT) may establish this diagnosis by demonstrating the presence of the appendicolith but without evidence of appendiceal inflammation or infection. Spontaneous migration of the appendicolith may result in cure. In this previously unpublished clinical case, the CT demonstrates the spontaneous passage of the appendicolith, which coincided in time with the resolution of the abdominal pain syndrome. When a patient presents with typical symptoms of appendiceal colic and CT findings of an appendicolith without appendicitis, appendectomy will certainly relieve the pain. But if the stone passes spontaneously, the need for appendectomy is debatable, particularly in a high-risk patient.

In infants and children, iron deficiency (ID) can have several adverse effects on health including lethargy, alterations of immune defense mechanisms and impaired growth and cognitive development. The purpose of this study was to determine the prevalence of ID in a group of preschool Inuit children attending childcare centres in Nunavik using conventional measurements of iron status and a relatively new parameter, soluble transferrin receptor (sTfR). sTfR is especially useful in the presence of inflammation or infection. Two hundred forty-five Inuit children aged between 11 and 54 months (mean (SD) = 25.0 (9.6) months) were recruited between 2006 and 2010 in 10 of the 14 Nunavik communities. About half of the children were male and 52.3% (n=128) were less than 24 months old at the time of the study. Sixty-five children were excluded because they lacked one or more of the parameters under analysis, leaving 180 subjects for the assessment of iron status. ID defined either as serum ferritin 1...

In infants and children recovering from severe malnutrition, iron deficiency is common, and the ability to absorb iron during such recovery is uncertain. The objective of this study was to determine iron absorption during recovery from malnutrition.During the later stages of recovery from malnutrition, erythrocyte incorporation of orally administered 58Fe was determined as a surrogate for iron absorption. Based on four indices, subjects were classified as iron-sufficient, iron-deficient or indeterminate.Of the 25 subjects, 9 were classified as iron sufficient, 5 as indeterminate and 11 as iron deficient; all but 5 had evidence of inflammation or infection. Geometric mean erythrocyte incorporation of 58Fe was 32.0% of the dose in the iron-deficient subjects, which was not significantly different (p = 0.073) than the 13.1% in the iron-sufficient subjects. Incorporation of 58Fe by the iron-sufficient subjects did not differ significantly from that by normal subjects in the same age range. Surprisingly, we found no correlation of erythrocyte incorporation of 58Fe and reticulocyte count.Even in the presence of infection or inflammation, iron absorption by children during a late stage of recovery from malnutrition is not impaired.

Computed Tomograpy (CT) scan and Magnetic Resonance Imaging (MRI) evaluation of the larynx and hypopharynx can be tricky for the untrained eye. We discuss a peculiar pattern of the supraglottic airway at the level of the base of the epiglottis seen on axial CT and MR images, resembling a “black hat” or a “black sombrero.” The level of the base of the epiglottis also corresponds to that of the hyoid bone, where two valuable hypopharyngeal sub-sites are visible- the pyriform sinuses and the posterior hypophayngeal wall. A hat has basically two parts, an apical convex crown and a basal horizontal brim. (Figure 1.A) Correlating the hat’s appearance on axial CT and MR imaging, the hat appears black due to the presence of air at the supraglottic level wherein the crown is positioned anteriorly and the brim positioned posteriorly. (Figure 1.B) The top-most convex part of the crown corresponds to the base of the epiglottis. Anterior to it is the pre-epiglottic fat plane and the body of the hyoid bone. The crown is also flanked by the paraglottic fat plane on both sides that appears hypodense (dark) on CT and hyperintense (bright) on T1 MRI. On the other hand, the posterior-most portion of the hat’s brim abuts the posterior hypopharyngeal wall - laterally outlining the pyriform sinuses on each side. The area where the crown joins the brim corresponds to the aryepiglotic folds that are delineated laterally by the medial walls of the pyriform sinuses while its medial aspects correspond to portions of the supraglottis. (Figure 2) The size and configuration of the hat varies and can range from one with a big crown and a small brim (resembling a “bowler” or “derby hat”) to one with a tall crown and a floppy brim (resembling a “Mexican sombrero”). (Figures 2, 3) Infiltrating tumors and inflammatory processes can distort the hat’s usual symmetric configuration, and can be useful in determining possible sites of inflammation or infection, tumor origin, and spread to hypopharyngeal and supraglottic structures, as the hat’s center represents a potential space at the supraglottic area devoid of any soft tissue structures. (Figure 4) In radiology, “the bowler hat sign” and “Mexican hat sign” have been used to describe gastrointestinal polyps.1,2,3 The former “is produced by the acute angle of attachment of the polyp to the mucosa” while the latter “consists of two concentric rings and is produced by visualizing a pedunculated polyp head-on.”1 The “Mexican hat sign” has also been used to describe osmotic demyelination on MRI.4 To our knowledge, these terms have not been applied to the interpretation of supraglottic and hypopharyngeal CT and MRI axial images. Recognition of the “Black Sombrero” pattern can be helpful in understanding the anatomic relationship of the supraglottic and hypopharynx structures on axial CT and MR imaging, particularly in the evaluation of supraglottic and hypopharyngeal tumor spread.

Thrombocytosis or a high platelet count (a count greater than 400 x 10(9)/L) is a common observation especially with the increased ordering of routine complete blood counts. When found, it may create a diagnostic challenge as transient elevations in platelet counts can occur for a number of reasons such as inflammation or infection, and these usually resolve spontaneously; but an elevated platelet count may be the only indication of an underlying serious disease to which no other clinical findings pertain. The report details a case of extreme thrombocytosis which masked an underlying diagnosis of inflammatory bowel disease.

The maturation of dendritic cells (DCs) following exposure to microbial products or inflammatory mediators plays a critical role in initiating the immune response. We now find that maturation can also occur under steady state conditions, triggered by alterations in E-cadherin-mediated DC-DC adhesion. Selective disruption of these interactions induces the typical features of DC maturation including the upregulation of costimulatory molecules, MHC class II, and chemokine receptors. These events were triggered at least in part by activation of the β-catenin pathway. However, unlike maturation induced by microbial products, E-cadherin-stimulated DCs failed to release immunostimulatory cytokines, exhibiting an entirely different transcriptional profile. As a result, E-cadherin-stimulated DCs elicited an entirely different T cell response in vivo, generating T cells with a regulatory as opposed to an effector phenotype. These DCs induced tolerance in vivo and may thus contribute to the elusive steady state “tolerogenic DCs”.

Neck masses are common and often the result of self-limited inflammation or infection. Congenital masses and neoplasms are additional benign causes. However, a neck mass can signal a malignant tumor, so it is important to understand what represents an abnormal mass and to recognize warning signs and symptoms. Patients at risk of serious clinical problems may be identified through findings on history taking (e.g., progressive enlargement of the mass, prolonged hoarseness) and physical examination (e.g., unilateral nasal obstruction, intraoral induration). Suspicion of a malignant process calls for referral to a subspecialist in head and neck disorders.

Postpneumonectomy esophago-pleural fistula (EPF) is rare and potentially life-threatening. It is mainly caused by surgical injury, local cancer recurrence, and chronic inflammation or infection. Patients with postpneumonectomy EPF usually present with empyema. We report a case of a clinically asymptomatic esophago-pleural fistula, diagnosed accidentally in a 64-year-old woman more than 30 years after right lobe pneumonectomy due to tuberculosis. Contrast-enhanced CT, chest radiography, and esophagogramm were the imaging modalities used together with esophagoscopy in diagnosing the EPF; however, contrast-enhanced CT in combination with oral given contrast-media is the first imaging technique of choice to evaluate esophago-pleural fistula.

SummaryWe present three cases of intralobar bronchopulmonary sequestrations with associated congenital bronchogenic cysts. As congenital abnormalities tend to be found together, these cases question the notion that intralobar sequestrations only occur secondary to chronic inflammation or infection, and suggest they can be congenital lesions.

Summary Objective: Otitis externa (OE), also known as ‘‘swimmer’s ear’’, is an inflammation or infection of the external auditory canal. Many risk factors have been identified, mainly excessive moisture in the canal from swimming. Study design/ methods: To study the leading risk factors of otitis externa. Eighty-seven children aged 3.5–12 years (mean 68 ± 6.5 months) who were diagnosed with otitis externa from December 1999 to March 2001 were studied for age, sex, cerumen cleaning habits, signs and symptoms. Findings were compared to an age-matched control group of 90 children without otitis externa. Results: Sixty-one children (70.1%) in the study group had their ears cleaned with a cotton-tip applicator (Q-tip) during the 10 days preceding the diagnosis of otitis externa. In the control group, only 31(34%) used applicators routinely during the 10 days prior to diagnosis (P < 0.001). Other risk factors for otitis externa were swimming in a pool (34%), wax removal (5.8%) and ventilation tubes (1.1%). Conclusions: Use of a cotton-tip applicator to clean the ear seems to be the leading cause of otitis externa in children and should be avoided. © 2003 Elsevier Ireland Ltd. All rights reserved.

Dendritic cells (DCs), monocytes, and/or macrophages initiate host-protective immune responses to intracellular pathogens in part through interleukin-12 (IL-12) production, although the relative contribution of tissue resident versus recruited cells has been unclear. Here, we showed that after intraperitoneal infection with Toxoplasma gondii cysts, resident mononuclear phagocytes are replaced by circulating monocytes that differentiate in situ into inflammatory DCs (moDCs) and F4/80(+) macrophages. Importantly, NK cell-derived interferon-γ (IFN-γ) was required for both the loss of resident mononuclear phagocytes and the local differentiation of monocytes into macrophages and moDCs. This newly generated moDC population and not the resident DCs (or macrophages) served as the major source of IL-12 at the site of infection. Thus, NK cell-derived IFN-γ is important in both regulating inflammatory cell dynamics and in driving the local differentiation of monocytes into the cells required for initiating the immune response to an important intracellular pathogen.

Os autores apresentam o estudo de oito crianças com diagnóstico de discite estabelecido através da avaliação clínica, neurológica e ortopédica. A comprovação de alterações inflamatórias em um espaço discal, vertebral e em tecidos moles foi possível em estudos por imagem, sendo discutidos aqueles obtidos por radiologia convencional, tomografia computadorizada e ressonância magnética. The authors report the study of eight children with diskitis diagnosed through clinical, neurogical and orthopedic evaluation. The evidence of self limiting inflammation or infection of the intervertebral disk space and of soft tissue were avaliable by image studies. Findings with routine roentgenograms, computed tomography and magnetic resonance imaging are discussed.

Amyloid A (AA) patients who experience disease progression and develop renal failure have not received sufficient benefit from agents that treat inflammation or infection. We are investig...

The acute phase response is the part of the innate defence system of an animal against trauma, inflammation or infection. During this response, there is increased production and release of certain plasma proteins known as acute phase proteins, which include C-reactive protein (CRP), serum amyloid A (SAA) and fibrinogen (Fg). CRP consists of five identical subunits of 206 amino acids with a molecular weight of approximately 23 kDa. There is strong evidence from numerous studies that CRP is a predictor of inflammation. The acute-phase protein serum amyloid A (SAA) is a clinically useful marker of inflammation. SAA plays not only an important role in the development of AA amyloidosis (an important complication of rheumatoid arthritis) but also interacts with events closely involved in the metabolic syndrome as a high- and low-grade inflammatory modulator. Fibrinogen (Fg) is a high molecular weight plasma adhesion protein and is a biomarker of inflammation. It is synthesized and assembled in hepatocytes and fibroblasts and when secreted into the circulation, its plasma half-life ranges from 3 to 4 days. Several cytokines, are involved in the induction of acute phase protein synthesis, but the mutual importance of these cytokines seems to be cell-type specific and to vary in various experimental settings. Here we revisited the classic acute phase proteins SAA, C-Reactive protein and fibrinogen in their role in inflammation and their interrelationship with some cytokines.

A contact lens (CL) can act as a vector for microorganisms to adhere to and transfer to the ocular surface. Commensal microorganisms that uneventfully cohabitate on lid margins and conjunctivae and potential pathogens that are found transiently on the ocular surface can inoculate CLs in vivo. In the presence of reduced tissue resistance, these resident microorganisms or transient pathogens can invade and colonize the cornea or conjunctiva to produce inflammation or infection.The literature was reviewed and used to summarize the findings over the last 30 years on the identification, enumeration, and classification of microorganisms adherent to CLs and their accessories during the course of normal wear and to hypothesize the role that these microorganisms play in CL infection and inflammation.Lens handling greatly increases the incidence of lens contamination, and the ocular surface has a tremendous ability to destroy organisms. However, even when removed aseptically from the eye, more than half of lenses are found to harbor microorganisms, almost exclusively bacteria. Coagulase-negative Staphylococci are most commonly cultured from worn lenses; however, approximately 10% of lenses harbor Gram-negative and highly pathogenic species, even in asymptomatic subjects. In storage cases, the incidence of positive microbial bioburden is also typically greater than 50%. All types of care solutions can become contaminated, including up to 30% of preserved products.The process of CL-related microbial keratitis and inflammation is thought to be preceded by the presence or transfer or both of microorganisms from the lens to the ocular surface. Thus, this detailed understanding of lens-related bioburden is important in the understanding of factors associated with infectious and inflammatory complications. Promising mechanisms to prevent bacterial colonization on lenses and lens cases are forthcoming, which may decrease the incidence of microbially driven CL complications.

In a prospective, randomised trial of 54 hands in 47 patients incisions were randomised to be closed by either absorbable subcuticular (polyglytone 6211, Caprosyn), or non-absorbable interrupted (polybutester, Novafil), sutures after single-portal endoscopic release of the carpal tunnel. There was a significant reduction in pain scores on days 1 and 2 in the patients treated with an absorbable continuous subcuticular suture, and no difference in inflammation or infection. There was no difference in the cosmetic appearance between the two groups after three months.