Search

A utilização da pressão subatmosférica através de curativo à vácuo em pacientes com abdome aberto é usada cada vez mais para o fechamento abdominal temporário. O curativo à vácuo pode ser utilizado como uma “ponte” entre o surgimento da lesão inicial e a cirurgia de fechamento definitivo da ferida, naqueles casos em que o fechamento fascial primário não é possível. O objetivo deste trabalho é apresentar uma proposta prática para o fechamento abdominal temporário utilizando curativo à vácuo (técnica de Barker modificada), como alternativas as demais técnicas. O mecanismo de ação envolve o controle do exsudato, redução do edema intersticial perilesional, aumento do fluxo sanguíneo, estímulo à formação de tecido de granulação e contração da ferida. O curativo apresentou baixos custos, fácil aplicação e utilizando materiais disponíveis com frequência na maioria dos hospitais públicos. De acordo com a literatura, a técnica de Barker modificada apresenta bons resultados e índices de complicações semelhantes aos kits de TPN comerciais.

Cerebral infarction is known to cause secondary degeneration of the areas connected to the primarily damaged regions. This has been named as acute network injury and is usually recognized in newborns or babies by high signal intensity on diffusion-weighted imaging (DWI). In this article, we present 2 cases demonstrating several characteristics of network injury. Some features are comparable to previous studies and others are distinctive to our cases. The patients not only showed secondary injury in the thorough pyramidal tract along the longitudinal extensions of neural tracts as expected but also followed transverse connections to reach the contralateral hemisphere. The location of network injury varied according to the initial lesion and projected in an omnidirectional manner as long as the brain parts are interconnected. In addition, the cases well demonstrated the temporal changes on brain imaging. Network injury appeared on DWI around a week after major damage and then subsequently disappeared. The overall process of appearance to disappearance was completed within 2 weeks from the symptom onset. As ominous neurological outcomes are thought to be related to acute network injuries, a comprehensive understanding of the phenomenon is pivotal in improving diagnosis and management.

To assess vision, injection quantity, initial lesion size, and final anatomic status in patients with nAMD completing the treat-extend-stop (TES) protocol. Patients with nAMD received ≥ 3 monthly anti-VEGF injections followed by 1–2 week injection interval extensions, with intra/subretinal fluid resolution on SD-OCT, to 12 weeks. With quiescent disease, and 2 quarterly injections, patients were monitored alone beginning at 4 weeks extending by 1–2 week intervals until quarterly monitoring. Eighty-eight of 143 eyes with nAMD completed the TES protocol without disease recurrence. Sixteen (18.2%) developed sub-foveal geographic atrophy (GA), 25 (28.4%) developed fibrovascular scarring (FV) and 47 (53.4%) developed regressed choroidal neovascularization (rCNV) with 16.9 ± 13.3 average injections between the 3 groups which was not statistically significant. Average treatment time was 30.3 ± 26.1 months and subsequent follow-up was 23.2 ± 19.8 months. Average lesion size for FV was 18.77 ± 10.8mm2 vs. GA at 12.00 ± 9.99mm2 vs. regressed CNV at 7.12 ± 6.5mm2 (p

Background Surgical excision is a mainstay of treatment for non-melanoma skin cancer (NMSC); improving margin delineation can reduce the need for further monitoring/treatment. The objective of this pilot study was to determine if near-infrared radiation (NIR) application to skin causes visible changes in normal and NMSC skin, to help delineate margins. Materials/methods Eleven biopsy-proven NMSC lesions were included. The skin was then heated under a 175W NIR heating bulb; margins were traced onto acetate film before and after heating. Lesions were then randomly assigned to excision based on pre- or post-heating margins. Composite images were generated by overlaying the heat and no-heat lesion contours. All specimens were sent for histopathology. Results The range of closest margins in the control group was 2.0-3.0 mm with a median of 2.0 mm; the range in the intervention group was 4.0-9.0 mm with a median of 5.0 mm. Composite images showed larger heat contours when the initial lesion was larger. There was a statistically significant difference between the two groups. Overall, NIR light caused visible hyperaemia to skin, and more intense erythema to malignant skin lesions. Conclusion Near-infrared light may have use in an outpatient setting for skin cancer delineation, possibly reducing the rate of positive margins.

Aortic dissection (AD) is the most common catastrophic disease reported at cardiovascular emergency in hospitals. Herein, a tear in the tunica intima results into separation of layers of aortic wall leading to rupture and torrential bleed. Hypoxia and oxidative stress are associated with AD. The release of hypoxia inducible factor (HIF)-[Formula: see text] from the initial flap lesion in the tunica intima is the basis for aneurysmal prone factors. We framed a boundary value problem (BVP) to evaluate homeostatic saturation for oxygen dynamics using steady-state analysis. We prove uniqueness and existence of the solution of the BVP for gas exchange at capillary–tissue interface as a normal physiological function. Failure of homeostatic mechanism establishes hypoxia, a new quasi-steady-state in AD. We model permeation of two-layer fluid comprised of blood and HIF-[Formula: see text] through tunica media as a generalized [Formula: see text]-dimensional nonlinear evolution equation and solve it using Lie group of transformations method. We note that the two-layer fluid permeates the tunica media as solitary wave including solitons such as bright soliton, dark soliton, peregrine soliton, topological soliton, kink soliton, breather soliton and multi-soliton complex. Also, we introduce the main result and discuss the implications of soliton solution, using graphic interpretation, to describe the early stage of progression of AD.

Early childhood caries occurs immediately after the eruption of deciduous teeth. During this period, children are too young to be able to properly implement oral hygiene. Consequently, it is at a negligible level, with plenty of soft plaque on the deciduous tooth surfaces. The objective of this investigation was to determine the correlation between oral hygiene (shown with the OHI index) and the initial stages of early childhood caries: initial lesion (white spot) and superficial form, before and after local fluoride treatment. Material and methods: For determining the OHI index among our examinees we used the method of Green-Vermillion. It was determined in 117 examinees twice, during the first visit and immediately before physiological replacement of deciduous teeth. Patients were two to three years of age, diagnosed with initial stages of early childhood caries and fluoride preparate (amino fluoride solution) was applied once a week, for 6 months. Results: In 30 subjects treated with local fluoride treatment from both basic groups (with initial and superficial lesions), just before the physiological change of the teeth, we received a statistically significant improvement in the OHI index (p = 0.000038; p = 0.00006) at the end from the examination. Conclusion: From the conducted analysis of the obtained results, we can conclude that the level of oral hygiene is correlated with the progression of changes in the enamel. Oral hygiene and fluoride treatment significantly reduce soft tissue levels and improve the OHI index., Kариесот на раното детство се јавува веднаш по ерупцијата на млечните заби. Во овој период, детето е сèуште многу мало за да може правилно да ја спроведува својата орална хигиена. Од тие причини, оралната хигиена е на незначително ниво, со изобилство на меки наслаги на забните површини од млечните заби. Целта на ова истражување беше да ја одредиме корелацијата помеѓуоралната хигиена (прикажана со OHI индекс) и почетните стадиуми на кариесот на раното детство: иницијална лезија и суперфицијална форма, пред и после спроведен локален флуориден третман. Материјал и методи: Одредувањето на OHI индексот кај нашите испитаници го вршевме според методата на Green-Vermillion во два наврата: при првата посета, при дијагностицирање на заболувањето и непосредно пред физиолошката смена на забите, на крај од испитувањето. Во клиничкото иследување, беа вклучени 117 испитаници, на возраст од две до три години, со комплетно формирано млечно забало, кај кои дијагностициравме почетни стадиуми на циркуларен кариес: иницијална лезија или бела дамка (macula alba) и суперфицијална лезија. За локалeн флуориден третман аплициравме флуориден препарат (аминофлуориден раствор), еднаш неделно, во период од 6 месеци. Резултати: Кај 30 испитаницикои беа третирани со локален флуориден третман и од двете основни групи (соиницијални и суперфицијални лезии), непосредно пред физиолошката смена на забите,добивме статистички позначајно подобрувањето на OHI индексот (p =0,000038; p = 0,00006) на крајот од испитувањето. Заклучок: Од спроведените анализи на добиените резултати, можеме да констатираме дека нивото на оралната хигиена е во корелација со прогресијата на промените во емајлот. Оралната хигиена и флуоридниот третман значително влијаат врз намалување на нивото на меките наслаги и подобрување на OHI-индексот.

A middle-aged woman with idiopathic longitudinally extensive myelitis underwent repeat MR scan of cervical spine at 5-month follow-up, which showed new non-enhancing T2 hyperintensities, initially reported as myelitis recurrence. However, the hyperintensities involved both lateral corticospinal tracts caudal to the initial lesion and both dorsal columns rostral to the initial lesion and were therefore compatible with Wallerian degeneration. This radiological mimic should be considered in the differential of recurrence of myelitis.

Alveolar echinococcosis (AE) is caused by the intermediate stage of Echinococcus multilocularis. We aimed to correlate computed tomography (CT) data with histology to identify distinct characteristics for different lesion types. We classified 45 samples into five types with the Echinococcus multilocularis Ulm Classification for Computed Tomography (EMUC-CT). The various CT lesions exhibited significantly different histological parameters, which led us to propose a progression model. The initial lesion fit the CT type IV classification, which comprises a single necrotic area with the central located laminated layer, a larger distance between laminated layer and border zone, a small fibrotic peripheral zone, and few small particles of Echinococcus multilocularis (spems). Lesions could progress through CT types I, II, and III, characterized by shorter distances between laminated layer and border zone, more spems inside and surrounding the lesion, and a pronounced fibrotic rim (mostly in type III). Alternatively, lesions could converge to a highly calcified, regressive state (type V). Our results suggest that the CT types mark sequential stages of the infection, which progress over time. These distinct histological patterns advance the understanding of interactions between AE and human host; moreover, they might become prognostically and therapeutically relevant., publishedVersion

BACKGROUND: Circular caries occurs in the earliest age of the children (1 - 1.5 year), immediately after the eruption of the deciduous teeth. During this period, children are too young to be able to properly implement oral hygiene. Consequently, it is at a negligible level, with plenty of soft plaque on the deciduous tooth surfaces.OBJECTIVE: The main objective of this clinical trial was to determine the correlation between oral hygiene shown with Oral Hygiene index, and the initial stages of circular caries (initial lesion and superficial form), before and after topical fluoride treatment.MATERIAL AND METHODS: For determination of the OHI - index we used the method of Green - Vermillion. It was determined two times in 117 patients, during the first visit and immediately before physiological replacement of deciduous teeth. Patients were two to three years old and diagnosed with initial stages of circular caries. Amino fluoride solution was applied once a week, during six months.RESULTS: We obtained statistically significant improvement of OHI - index at the end of the test, among treated subjects from both major groups.CONCLUSION: It can be concluded that the level of oral hygiene is correlated with the progression of changes in enamel. Topical fluoride treatment has a positive impact on reducing ECC.

espanolLos hongos patogenos de las plantas son la mayor amenaza para la agricultura en el mundo; Para contrarrestar su efecto se utilizan fungicidas quimicos sinteticos, que causan efectos adversos sobre la salud humana y el medio ambiente. Los metodos fisicos para controlar patogenos estan surgiendo como una alternativa para manejar las enfermedades de los cultivos; sin embargo, han sido poco explorados. El tomate (Solanum lycopersicum) es el vegetal mas frecuentemente cultivado en el mundo y crece en una amplia gama de climas, tanto en campo como en invernadero. Uno de los factores mas limitantes para la produccion de tomate es la enfermedad foliar conocida como mildeo polvoso. El rendimiento y la calidad del fruto pueden reducirse debido a que la enfermedad puede desarrollarse rapidamente y los foliolos gravemente afectados mueren. En este trabajo, se evaluo el efecto de UV-C (254 nm) sobre el desarrollo del mildeo polvoso en condiciones de invernadero. Los foliolos se sometieron a diferentes tiempos de exposicion de UV-C y con la adquisicion de imagenes RGB y el analisis de imagenes se determino la tasa de crecimiento de la lesion. Los tiempos de exposicion que no causaron lesiones visibles en foliolos sanos, se utilizaron para medir el efecto sobre foliolos con la enfermedad. Despues de la infeccion natural, se determino el area de la lesion, el numero total de lesiones y la tasa de crecimiento con respecto al area inicial de la lesion. Comparando con foliolos no tratados, aplicaciones de 30 s o 60 s de UV-C cada 48 h por 10 dias, redujo significativamente la severidad del mildeo polvoso en los foliolos de tomate. Tambien comparamos la determinacion tradicional de la tasa de crecimiento utilizando un calibrador con un programa personalizado basado en la adquisicion y analisis de imagenes, indica que el ultimo es un sistema mas completo para seguir con precision la evolucion de la enfermedad. Este trabajo es un enfoque importante para aplicar la luz a los problemas agricolas de manera no invasiva en condiciones de precosecha de plantas, lo cual ha sido pobremente explorado, y demuestra la aplicacion del analisis de imagenes en el estudio de variables agricolas importantes. EnglishThe plant pathogenic fungi are the greatest threat to agriculture in the world; to counteract its effect synthetic chemical fungicides are used, which cause adverse effects on human health and the environment. Physical methods to control pathogens are emerging as an alternative for managing crop diseases; however, they have been little explored. Tomato (Solanum lycopersicum) is the most frequently cultivated vegetable in the world and it grows in a wide range of climates, both field and greenhouse. One of the most limiting factors for tomato production is the foliar disease known as powdery mildew. The yield and quality of the fruit can be reduced because the disease can develop rapidly and severely affected leaflets die. In this paper, the effect of UV-C (254 nm) on the development of powdery mildew under greenhouse conditions was evaluated. The leaflets were submitted to different UV-C exposure times and with the acquisition of RGB images and image analysis the growth rate of the lesion was determined. The exposure times that did not cause visible injuries in healthy leaflets were used to measure the effect on leaflets with the disease. After natural infection, the lesion area, the number of total lesions and the growth rate with respect to the initial lesion area were determined. Comparing with non-treated leaflets, 30 s or 60 s applications of UV-C each 48 h for 10 days, significantly reduced powdery mildew severity on tomato leaflets. We also compared traditional growth rate determination using a caliper with a custom program based on image acquisition and analysis, reporting that the latest is a more complete system to follow accurately the disease evolution. This work is an important approach of applying light to agricultural problems noninvasively in preharvest conditions, which has been poorly explored in agriculture, and it demonstrates the application of image analysis in the study of important agricultural variables.

The therapeutic benefits of LED in wound care have been reported since the 1990s. Nevertheless, studies directly related to the effects of LED phototherapy on the venous and arterial circulation and the healing process of pressure injuries are scarce in literature. Thus, the aim of this study was to evaluate the efficacy of a LED phototherapy prototype in participants with pressure injuries. In this pilot study 15 participants were randomized into three therapeutic groups. The experimental groups received applications of 630 and 940 nm LED three times a week for 8 weeks, with a dose of 6 J/cm2 in Group I. In group II, a dose of 8 J/cm2 in addition to the standard treatment. Group III (control group) received only daily standard treatment which consisted of cleaning the lesioned area with physiological solution, followed by application of an alginate hydrogel dressing over a period of 8 weeks. Pressure injuries were photographed and the area was measured by the Quantikov® image analyzer software. There was no statistically significant difference (p > 0.05) between the three groups when assessing the initial lesion area. At the end of 2 months, the median and interquartile ranges of the injuries were 5.90 (0.79–9.5) cm2 for group I, 0.54 (0.47–1.16) cm2 for group II and 26.76 (17.25–41.05) for group III. There was a statistically significant difference between treatment types (I x III and II x III) for pressure injuries over the 21 sessions. However, there was no significant difference between groups I x II that received different doses of LED phototherapy. The initial hypothesis was supported given that the combination of two wavelengths in the LED phototherapy with different doses may be helpful in accelerating the healing of pressure injuries.

Background: Fabry disease is rare, and the diagnosis is often delayed. Here, we describe a case of Fabry disease resulting in vasculopathy of the central nervous system. Magnetic resonance (MR) black-blood sequence (three-dimensional T1 volumetric isotropic turbo spin echo acquisition), with the unique advantage of imaging the vascular wall, facilitated a clear identification of the vasculopathy. Case presentation: A 27-year-old man visited our hospital for the treatment of " double vision 6d." After a series of examinations, the patient was diagnosed with Fabry disease, which caused vasculopathy of the central nervous system. Subsequently, the patient was treated with corticosteroids and his symptoms were attenuated. Two months after the initial treatment, the initial lesion in the vascular vessel disappeared, however, a new lesion appeared. Similarly, four months after the initial treatment, although the previous lesion disappeared, a new lesion appeared. Conclusions: This case highlights that clinicians should use MR black-blood sequence scan in a timely manner in case of young patients with migratory lesions of brain. In case of detection of a vascular lesion in combination with other systemic lesions, the possibility of Fabry disease should be considered.

Progress in diagnostic modalities, surgical procedures, and multidisciplinary treatment for pancreatic diseases has increased the number of long-term survivors after pancreatic resection. Several reports have focused on high-risk lesions (HRLs), including high-grade pancreatic intraepithelial neoplasia (PanIN), pancreatic ductal adenocarcinoma, high-grade intraductal papillary mucinous neoplasm (IPMN), and IPMN with an associated invasive carcinoma, in the remnant pancreas after partial pancreatic resection for pancreatic cancer or IPMN. The etiology of HRLs in the remnant pancreas is thought to be either isolated local recurrence of the initial lesion in the remnant pancreas or a newly developed primary lesion. Although it is difficult to distinguish between local recurrence and a new primary lesion, comparison of genetic alterations between two lesions may help with this distinction. Early detection of HRLs in the remnant pancreas may improve the prognosis of patients, and several investigators have proposed predictive factors for HRLs in the remnant pancreas after partial pancreatic resection for pancreatic cancer or IPMN. The reported short- and long-term outcomes of surgical resection of HRLs in the remnant pancreas are relatively favorable. Life-long surveillance of the remnant pancreas is recommended after partial pancreatic resection for pancreatic cancer or IPMN.

Case report A 43-year-old woman presented with a salmon-colored patch of 0.7 mm diameter in the right eye that extended into the lower fornix in the bulbar and tarsal conjunctiva, with irregular edges, and highly vascularized. Incisional biopsy was performed, showing it to be a low-grade conjunctival non-Hodgkin B cell lymphoma (or a mucosa associated lymphoid tissue [MALT] lymphoma). Discussion The lesion remained stable for 24 months of follow-up, when a relapse of the condition occurred, producing an enlargement of the initial lesion. The definitive diagnosis is made by biopsy of the affected tissue and histopathologic study.

Periosteal enchondromas located in the spine are rare. We reported an even more infrequent occurrence of a periosteal enchondroma in the cervical spine of a 19-year-old girl. During the operation, a giant (>8 cm × 5.5 cm × 5 cm) ossified periosteal enchondroma with involvement of posterior structures and muscles of the axis was resected. The pathological examination revealed that the tumor consisted of enchondroid tissue with typical chondrocytes, confirming the diagnosis of periosteal enchondroma. Early identification of the initial lesion should be coupled with total surgical resection, as a definitive treatment, to prevent malignant transformation. Enchondromas grow in an expanding manner which makes easy total resection.

Background : Rare cases of neuromyelitis optica spectrum disorder (NMOSD) occur with only hypothalamic lesions as the initial lesion, and such cases can present with hypersomnia, endocrinopathy, and autonomic failure. However, orthostatic hypotension (OH) caused by hypothalamic lesions due to NMOSD has not been reported. Case report : We report the case of a patient with NMOSD who presented with severe OH due to hypothalamic lesions. Conclusion : We suggest that clinicians should be aware that NMOSD with hypothalamic lesions can present with OH.

The imaging definition of lacunar infarcts is variable, particularly regarding their size and the presence of cavitation. We investigated the changes of diameter and evolution pattern of acute lacunar infarcts, and the factors associated with the evolution pattern. Patients with acute single subcortical hemispheric or brainstem ischemic lesions of penetrating arterial territories were included. Maximal diameters on initial diffusion-weighted image (DWI) and follow-up fluid-attenuated inversion recovery image (FLAIR), which performed > 12 months after initial DWI, were semi-automatically measured. Clinical characteristics were compared according to evolution patterns on follow-up FLAIR, classified as cavitated, focal lesion without cavitation, and disappeared. Five hundred nine patients were included. Mean time to follow-up was 31.3 ± 13.7 months. Mean diameter of acute lacunar lesions decreased from 12.9 ± 4.4 to 8.5 ± 4.8 mm during follow-up. Lesions of 58.2% patients remained as cavitated, 18.3% as focal lesion without cavitation, and 23.6% disappeared. Initial NIHSS score (p = 0.005), diameter of initial lesion (p

Introduction: Recurrent cervical intraepithelial lesions (rCIN2/3) after treatment of CIN2/3 occur in 5–15% of cases. rCIN2/3 can result from incomplete resection of CIN2/3, where the same HPV type and variant remains present. rCIN2/3 could also occur following a new infection with a different HPV variant of the same HPV type as the initial lesion. This study investigates HPV16 consensus variants in paired HPV16 positive scrapes from baseline CIN2/3 and rCIN2/3 lesions. Methods: Paired HPV16 positive cervical scrapes of women with CIN2/3 at baseline and rCIN2/3 6 or 12 months after treatment were selected for whole-genome amplification and Illumina sequencing. Sequences were compared and nucleotide changes over time were characterized. Results: From 14 paired samples, 10 had identical consensus variants in baseline CIN2/3 and rCIN2/3. Four paired samples showed one to three nucleotide variations at recurrent disease compared to baseline. Conclusion: Identical or nearly identical HPV16 consensus variants were found in scrapes of paired HPV16 positive baseline CIN2/3 and rCIN2/3 lesions after treatment, suggesting no need for HPV variant analysis when the same HPV type is found in both lesions. These results argue for either incomplete excision of baseline CIN2/3 or inability of clearance of the original HPV infection. Keywords: Whole-genome sequencing, HPV16, HPV genome variants, CIN, rCIN, Recurrent infection

Vertebral angiomatosis in cats is a rare locally aggressive benign tumor-like lesion that has been reported to have a good prognosis if surgically treated. This case reports a 14-month-old Maine Coon cat, who had a successful surgery for vertebral angiomatosis at the age of seven months, and represented with hindlimb ambulatory paraparesis seven months after the surgery. The CT scan confirmed the recurrence of vertebral angiomatosis, seven months postsurgery, showing more aggressive characteristics than the initial lesion and a poorer prognosis.

Ameloblastic fibro-odontoma (AFO) is a rare benign odontogenic tumor with the histologic features of ameloblastic fibroma (AF) but also contains enamel and dentin. It is most commonly observed in the pediatric population. Distinction between AFO and AF becomes important as ameloblastic fibromas are associated with higher recurrence rates of up to 18%, and 35% of these recurrent lesions can undergo malignant transformation to ameloblastic fibrosarcoma. Hence, for amelobastic fibroma, conservative curettage is recommended for the initial lesion and marginal resection is considered for recurrent cases. In contrast, AFO can be treated with simple curettage and the recurrence rate is approximately seven percent. Malignant transformation of AFO is exceedingly rare. Therefore, the treatment and prognosis differs for these two histologically similar neoplasms. We present a case of a 17-year-old boy who was initially diagnosed with ameloblastic fibroma upon biopsy, with subsequent curettage specimen showing AFO, which carries a better prognosis.

Video Objective To demonstrate the rational use of shaving technique in the approach of endometriotic lesions of the recto-vaginal septum in selected cases. Setting Botucatu Medical School, Sao Paulo State University - FMB/UNESP. Tertiary public hospital, university teaching center. Interventions The procedure begins by characterizing the endometriotic lesion, by recognition of the pelvic anatomical structures and their relations with the disease. The physiological adherence of the sigmoid to the left pelvic wall is dissected, followed by identification of the ureters. Anatomic markers are used to guide dissection avoiding complications and inadvertent injury of noble structures. The retroperitoneal dissection begins on both sides from healthy tissue laterally towards the medial retro-uterine portion until it reaches the central portion of the lesion in the insertion of uterosacral ligaments. From this point on, the lesion is confined to the posterior portion of the uterus and anterior wall of the rectum. The endometriotic lesion is then isolated in the rectal wall using the reverse shaving technique. With the aid of a rectal probe, superficial resection of the endometriotic lesion is started, taking care not to deepen its dissection beyond the superficial sero-muscular layer. Finally, rigorous hemostasis is performed. When resection is very deep or very extensive it is advisable to check the integrity of the rectum-sigmoid wall with the aid of safety maneuvers. The vaginal touch is repeated at the end of the procedure to confirm that the entire initial lesion has been removed. Conclusion Despite its indication only for cases of superficial lesions the shaving technique presents as advantages: autonomy for the gynecologist, less tissue damage with preservation of the neuronal activity of the intestine, rapid recovery with early return of the daily life activity to the patient, being a great option for the treatment of rectum-vaginal endometriosis in duly selected cases.

We report on a 55-year-old man who developed a de novo DAVF in left ACC 5 years after curative transvenous embolization for DAVF in right ACC. Angiography revealed that the de novo lesion demonstrated more aggressive arteriovenous shunt flow than the initial lesion. Successful transvenous embolization was performed for also the second lesion. The authors describe the possible pathophysiological mechanisms and management strategies for this rare occurrence.

Key Clinical Message Renal lymphoma as an initial lesion is relatively rare. Bilateral renal lymphoma frequently presents as acute kidney injury. With systematic chemotherapy for the lymphoma, patients usually recover their kidney function. However, in the case we describe here, the patient's kidney function recovered greatly after an open renal biopsy. Here, we review and discuss this unique case.

A 66-year-old man presented to his previous physician with epigastric discomfort in 2014. He was then referred to our hospital due to suspected primary malignant melanoma of the esophagus (PMME). A biopsy showed atypical cells containing melanin granules. A diagnosis of PMME was thus made. We investigated the endoscopic findings of the previous physician, which revealed a black point-like pigmentation at the same site since 2009. In 2010, black pigmentation was also observed at the same site. Although esophageal melanosis was suspected, no biopsy was performed. This case demonstrates the process by which esophageal melanomas develop into malignant melanomas.

BACKGROUND: Eczema of the hands and feet is one of the commonest conditions encountered in dermatologic practice affecting 1% of adults. The patch test is the only scientific proof of contact allergy, a positive reaction to a correctly prepared and applied patch test confirms the person has allergic contact sensitivity. There are not much studies done on the patterns of lower leg and foot eczema's especially from India. Hence this study tries to determine the patterns of lower leg and foot eczema and also to evaluate the common allergens by patch testing. The aim of this study is: To determine the pattern of lower leg and foot eczema. Confirm the common allergens responsible by patch testing using Indian Standard Series. METHODS: A prospective clinical study was done comprising of 50 clinically suspected cases of lower leg and foot eczema for a period of 2 years from September 2008 to September 2010. The study included 32 males and 18 females. An informed consent was obtained from all the patients and detailed history with particular emphasis on age of onset, site of initial lesion, extent of dermatitis, seasonal variation, aggravating factors and association with atopy were noted. RESULTS: Mean age of 50 patients in this study was 44.52 years with a standard deviation of 15.8 (range 7 - 70 years). The most common age group affected was 46- 60 years (40%), followed by 31-45 years (30%). 32 cases (64%) were males and 18 cases (36%) were females with a male to female ratio of 1.78: 1.0. Out of 50 cases, 23 patients (46%) showed positive patch test result to at least a single allergen. To the 26 allergens in Indian standard series tested, around 19 allergens were found to be positive. Some were having positivity to multiple allergens, giving a total of 51 positive results. Out of which 46 were relevant (90.20%) against which only 5 cases were non-relevant (9.80%) according to the history.

A rare case of recurrent primary cutaneous nodular amyloidosis (PCNA) involving both sides of the face is being reported from India where the initial lesion on the right side of face was operated upon and recurred in 1 year. Around the same time the patient developed a similar lesion on the left side. The patient refused any treatment after being informed about the relatively innocuous nature of the disease. The importance of regular follow-up was explained to rule out systemic progression. This is the rarest form of primary cutaneous amyloidosis with a very low rate of progression to systemic amyloidosis. We propose that PCNA be included in the differential diagnosis of asymptomatic facial plaques and nodules.

Background. Since the preconisation presence of high-risk human papillomavirus (HR-HPV) is the main determinant of the risk of progression of preinvasive lesions; the state of the excision margins could be of less importance. Relatively little is known about the effect of human immunodeficiency virus (HIV) infection on the relation between the states of the excision margins. Methods. We compared 120 HIV-infected and 139 HIV-uninfected women who underwent a hysterectomy after large loop excision of the transformation zone (LLETZ) for abnormal Pap smear. Results. The excision margins had been reported negative in 21.7% of infected and 7.8% of uninfected cases (P=0.03). Three (11.5%) of 26 negative margins in HIV-infected and 2 (18.2) out of HIV-uninfected cases were falsely negative as evidenced on hysterectomy specimens (P=0.73). The persistence rate of the initial lesion was similar in both groups (P=0.20). The persistence rate with highly active antiretroviral treatment (HAART) was similar to untreated patients (P=0.20). The progression rate from low-grade to high-grade preinvasive lesions was higher in HIV-infected than HIV-uninfected women (P=0.027). Conclusion. HIV-infected women with incomplete excision margins after LLETZ are at higher risk of progression of residual preneoplastic lesions.

Endothelial dysfunction is regarded as the initial lesion in the development of atherosclerosis. Endocan, previously called endothelial cell–specific molecule 1 (ESM-1), is a new candidate immunoinflammatory marker that may be associated with cardiometabolic risk factors. Therefore, we assessed serum levels of endocan in newly diagnosed patients with untreated essential hypertension (HT). A total of 18 patients with HT and 23 normotensive control participants were included in the study. Serum endocan levels, carotid intima–media thickness (cIMT), and high-sensitivity C-reactive protein (hsCRP) were measured. Serum endocan levels were significantly higher in the HT group ( P < .001). In patients with HT, serum endocan levels correlated positively with cIMT and hsCRP ( r = .551, P < .001 and r = .644, P < .001, respectively). Our findings suggest that circulating endocan levels represent a new marker in patients with essential HT. Endocan may be a surrogate endothelial dysfunction marker and may have a functional role in endothelium-dependent pathological disorders.

One of hypotheses of atherosclerosis is based on a presumption that the zones prone to the development of atherosclerosis contain lysosomes which are characterized by enzyme deficiency and thus, are unable to dispose of lipoproteins. The present study was undertaken to investigate the characteristics and changes of lysosomes in the earliest stages of the development of atherosclerosis. Electron microscopic immunocytochemistry revealed that there were certain changes in the distribution of CD68 antigen in lysosomes along the ‘normal intima-initial lesion-fatty streak’ sequence. There were no significant changes found in the key mRNAs encoding for the components of endosome/lysosome compartment in initial atherosclerotic lesions, but in fatty streaks, the contents of EEA1 and Rab5a mRNAs were found to be diminished while the contents of CD68 and p62 mRNAs were increased, compared with the intact tissue. The study reinforces a view that changes occurring in lysosomes play a role in atherogenesis from the very earlier stages of the disease.

Teeth with periapical lesions can undergo successful orthodontic treatment, but conventional protocols indicate that such teeth should be endodontically stabilized prior to such treatment. A case report is presented where such endodontic stabilization was not possible, yet a chronic periapical lesion resolved as orthodontic treatment progressed. This paper will discuss the possible causes of the initial lesion, and reasons why it resolved without endodontic treatment. Clinical Relevance: This report illustrates the possible combined roles of trauma, occlusion and periodontal disease in the development of a perio-endo lesion, and how orthodontic treatment potentially relieved some of the exacerbating factors, thus enabling resolution of the infection without endodontic treatment.

Background Coarctation of aorta (CoA) patients present cardiovascular complications late after repair the causes of which are not fully understood. Our study investigates the neurohormonal and immune activation and the elastic properties of the aorta and peripheral vessels in adult patients with coarctation of aorta (CoA), late after repair. Methods Nineteen adult patients with repaired CoA and 29 matched healthy controls underwent aortic distensibility, stiffness index, a study of the elastic properties of peripheral vessels proximal to the coarctation site and measurement of plasma cytokine and neurohormone levels. Results Distensibility index was reduced (p=0.02) and stiffness index was increased (p=0.005) in CoA patients compared to control. Augmentation index (p=0.0007) and augmented pressure (p=0.001) were higher in CoA patients and Forearm Blood Flow (FBF) index was reduced (p=0.009). Plasma levels of sICAM-1 (p=0.01), sVCAM-1 (p=0.05), E-selectin (p=0.01), sFas-ligand (p=0.02) and IL-10 (p=0.01) were also elevated in CoA patients vs control. TNF-a, IL-6, Endothelin-1 and NT-pro-BNP levels were not. Conclusions Adults with repaired CoA seem to develop a late inflammatory reaction, which reflects a functional problem in all vessels, regardless of the initial lesion. This may explain the late complications of the disease despite early repair and improved surgical procedures.

To evaluate initial radiologic findings of symptomatic intracranial vertebrobasilar dissections (VBDs) as well as the results at follow-up imaging of dissections that are conservatively managed.The respective institutional review boards approved this retrospective study and waived the need for informed consent. The initial radiologic findings of 210 patients with 230 symptomatic intracranial VBDs were retrospectively evaluated (48 ruptured, 182 unruptured). Those patients had undergone conventional angiography as well as magnetic resonance imaging and/or computed tomographic angiography, so that angiographic shapes and pathognomonic findings (eg, intramural hematoma, intimal flap) could be reviewed. The primary angiographic shapes of the symptomatic intracranial VBDs were subdivided into three groups: (a) dilatation without stenosis, (b) pearl-and-string, and (c) stenosis without dilatation. Furthermore, the radiologic evolution of conservatively managed symptomatic intracranial VBDs was evaluated. The respective frequencies of the radiologic findings at initial and follow-up imaging studies were compared by using χ2 tests.Primary shape differed significantly between ruptured and unruptured symptomatic intracranial VBDs. Most ruptured dissections presented with one of two main structures: dilatation without stenosis or pearl-and-string appearance. The primary shape of unruptured dissections was evenly distributed among the three types of findings. Intramural hematomas were most frequently found in the stenosis-without-dilatation group (42 of 60 [70%]), followed by the pearl-and-string group (27 of 90 [30%]). Intimal flap was most frequently found in the pearl-and-string group (21 of 90 [23%]), followed by the stenosis-without-dilatation group (eight of 60 [13%]). Follow-up results significantly differed by initial VBD shapes: Seventy-four percent (25 of 34) of the dilatation-without-stenosis group showed no change, whereas improvement was observed in 91% (39 of 43) of the stenosis-without-dilatation group (P.05). Intracranial VBDs with intramural hematoma showed improvement in 63% (34 of 54) of cases, progression occurred in 20% (11 of 54), and only 17% (nine of 54) exhibited no change (P.05).Primary angiographic shapes of symptomatic intracranial VBDs differed between ruptured and unruptured lesions. The stenosis-without-dilatation lesions most frequently exhibited radiologic improvement at follow-up imaging, followed by pearl-and-string and dilatation-without-stenosis lesions.

In Brazil, increased leaf spot disease (Pyrenophora chaetomioides Speg.) frequency and intensity on cultivated spring oat (Avena sativa) requires that plant pathologists and breeders rapidly identify oat genotypes with greater resistance. Criteria are needed to compare and evaluate oat genotypes to screen large numbers of lines, quantification of resistance components under controlled conditions allowing year-long screening and the rejection of susceptible lines before lengthy field trials. There is a need to determine which resistance components are associated with leaf spot intensity in the field, as estimated from the area under the disease progress curve (AUDPC). We assessed various oat P. chaetomioides resistance components under controlled conditions in seedlings of 26 oat genotypes chosen from recommended varieties and elite breeding lines to determine the association of resistance components with the AUDPC, obtained by evaluating each genotype in the field. The resistance components estimated were: initial lesion size (ILS) and final lesion size (FLS); rate of lesion expansion (r); and area under the normalized and corrected lesion expansion curve (AULECc). All correlations were positive and significant at p = 0.01 and were distributed into moderate (0.5 < r < 0.8) and strong (0.8 ≤ r < 1) correlation classes. The strongest average correlations occurred with the AULECc (0.827), ILS (0.801) and FLS (0.801) components. These results indicate which components may be useful in resistance screening, with FLS possibly being the most useful criterion because it is less laborious to obtain and speeds up the selection process for leaf spot resistance.

Matrix metalloproteinases (MMPs) are a family of zinc metallo-endopeptidases secreted by cells and are responsible for much of the turnover of matrix components. Several studies have shown that MMPs are involved in all stages of the atherosclerotic process, from the initial lesion to plaque rupture. Recent evidence suggests that MMP activity may facilitate atherosclerosis, plaque destabilization, and platelet aggregation. In the heart, matrix metalloproteinases participate in vascular remodeling, plaque instability, and ventricular remodelling after cardiac injury. The aim of the present article is to review the structure, function, regulation of MMPs and to discuss their potential role in the pathogenesis of acute coronary syndromes, as well as their contribution and usefullness in the setting of the disease.

BACKGROUND AND OBJECTIVE Cryoablation is safe for the ablation of substrates in proximity to the AV node, because the initial lesion is reversible. We report our results of cryoablation in a transregional center for ablation in children and adolescents. PATIENTS AND METHODS Data on 39 children and adolescents (4 - 18 years of age) who had been treated with cryo energy were analyzed retrospectively. The diagnosis was AV nodal reentry tachycardia (AVNRT; n = 30), para-Hisian accessory pathway (AP; n = 6) and congenital junctional ectopic tachycardia (JET; n = 4). In addition to non-inducibility, the targeted endpoint for AP-ablation was a missing or decremental concentric retrograde conduction, for ablation of AVNRT the endpoint was no slow pathway, no AH jumps and no echo-beats. The median follow-up was 3 years (270 - 1919 days). RESULTS The targeted endpoint was reached in 35/39 patients (90 %), in four patients (10 %) RF energy had to be applied. A recurrence occurred in 7/35 (20 %) successfully treated patients. Two patients had a pre-excitation again after AP ablation, but no symptoms. Thus, 28/35 patients (80 %) remained asymptomatic after cryoablation, and 26/35 (74 %) are definitively cured, regarding all follow-up data. The subgroup of AVNRT patients does not differ from the entire group. There was no AV block in the cryoablation group. CONCLUSIONS Cryoablation is very safe and effective for the definitive treatment of arrhythmias in children and adolescents. The price for the high safety is a reduced efficacy and a higher recurrence rate.