Search

The purpose of this report is to highlight the early clinical signs and management of ocular surface neoplasia following penetrating keratoplasty in xeroderma pigmentosa. A 14-year-old girl reported increased conjunctival hyperemia, tearing, photophobia in the right eye at 6 months after penetrating keratoplasty that worsened rapidly over the subsequent 2 weeks. Slit lamp examination showed increased vascularity, epithelial haze and raised whitish lesions at the graft–host junction. Alcohol keratoepithelectomy was performed for confirming the diagnosis. Histology of the sample revealed severe dysplasia. The lesion resolved after surface plaque brachytherapy. The graft clarity was restored and maintained until the last follow-up of 15 months following brachytherapy. Exacerbated symptoms and clinical signs of increased vascularisation and epithelial lesions should arouse the suspicion of ocular surface neoplasia in grafted eyes. Early diagnosis and management can salvage the graft clarity.

Introduction Narrowband imaging (NBI) is a special endoscopic optical enhancement setting allowing better visualization of mucosal microvasculature compared to white light endoscopy. This study evaluates the validity of NBI using the Ni classification in the detection and differentiation of severe dysplasia (SD) and glottic squamous cell carcinoma (SCC). Methods Patients with suspicious vocal cord lesions underwent conventional white light endoscopy followed by clinically indicated biopsy. At the same time, NBI images were obtained and graded independently. Lesions were graded from I to V according to the Ni classification and compared to histopathological findings. Results Fifty‐two patients were included in this study (40 SCC and 12 SD). The sensitivity and specificity of NBI in diagnosing laryngeal cancer was 95.0% (CI, 83.9%‐99.4%) and 83.3% (CI, 51.6%‐97.9%), respectively. The negative likelihood ratio was 0.06. Higher Ni grades correlated very strongly with more advanced disease. Conclusions NBI using the Ni classification is a sensitive diagnostic tool for the detection and differentiation of early neoplastic and preneoplastic glottic lesions. As higher Ni classification correlates strongly with advanced disease, it serves as a useful adjunct to white light endoscopy in the diagnosis of laryngeal cancer. Level of Evidence: Level IV.

Precancer cervix lesion High Grade Squamous Intraepithelial Lesion (HSIL) or moderate and severe Dysplasia (CIN II and III) is cervical Intraepithelial Neoplasia (CIN) which changes cervix epithelial cells without invasive to basalis membrane cells. This change step cervical epithelial cells through high-risk Human Papilloma Virus (HPV) infection such are HPV 16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70. Precancer cervix lesion HSIL could cause erosion of the cervix and cause post coital bleeding disorders. Loop Electrosurgical Excision Procedure (LEEP) treatment could cure HSIL or moderate and severe dysplasia (CIN II and III). Therefore, it relieves post coital bleeding disorders to the patients. Cervical precancerous lesions High Grade Squamous Intraepithelial Lesion (HSIL) or moderate and severe dysplasia (CIN II and III) are Cervical Intraepithelial Neoplasia (NIS) or Cervical Intraepithelial Neoplasia (CIN) where changes in cervical epithelial cells occur without penetrating the basement membrane. The stages of normal cervical epithelial changes begin with high-risk Human Papilloma Virus (HPV) infection, namely HPV 16, 18, 31, 33, 34, 35, 39, 45, 51, 52, 56, 58, 59, 66, 68, and 70 The HSIL cervical precancerous lesion could cause erosion of the cervix and cause complaints of post-coital bleeding disorders. Loop Electrosurgical Excision Procedure (LEEP) therapy could cure HSIL or moderate and severe dysplasia (CIN II and III) which could eliminate post-coitus bleeding disorders that suffered by patients.

OBJECTIVE: The aim of this study was to determine the center-edge angle (CEA) values according to age, gender and side in healthy children between 5 and 14 years old in Turkey and to find out the angular limit values for mild and severe dysplasia. METHODS: The data pool that was gathered to investigate the frequency of hip dislocation in children between 6 months and 14 years old in Turkey was used. The data pool consists of pelvis and lower abdomen radiographs obtained for reasons other than hip dysplasia. Lower abdomen/pelvis radiographies of children between 5 and 14 years old were extracted from the data pool and were evaluated. Distribution of CEA values according to age, gender and side was examined. Measurements were performed by a single investigator on computer by using a standard method. Reliability of the measurements was tested by three different investigators on randomly selected films by using the standard method. RESULTS: CEA values of 3192 hips of 1596 children, who had no hip pathology, were measured. Mean CEA value was found as 26.2°±5.5°. The mean CEA was 26.2°±5.3° in males (%54) and 26.2°±5.7° in females (%46) (p=0.224). Mean values for the right and left hips were 25.7°±5.4° and 26.6°±5.6°, respectively. CEA value of 449 (14%) hips of 333 (20.8%) children was at the limit of mild dysplasia and CEA value of 70 (2.2%) hips of 58 (3.6%) children was at the limit of severe dysplasia. CEA values had increased by age and mild and severe dysplasia limits were determined for every age group. CONCLUSION: The mild and severe dysplasia values that are defined according to ages in Turkish population will guide the investigators in the diagnosis, follow-up and treatment planning of developmental dysplasia. LEVEL OF EVIDENCE: Level IV, Diagnostic Study

AimsActinic keratosis (AK) is a precursor of cutaneous squamous cell carcinoma (SCC). No validated parameters can predict which AKs will progress into SCCs, but especially thick AKs are under suspicion. The clinical and histopathological thickness of AKs is strongly correlated. This study aimed to investigate the thicknesses and degree of dysplasia of AKs contiguous with SCCs assuming these AKs represent the AKs that have undergone malignant transformation.MethodsFiles of the Pathology Department, Hospital of Southern Jutland, Denmark, were reviewed. 111 cases met the inclusion criteria: a skin biopsy containing an invasive SCC. All SCCs merged with an AK at the edge. Degree of dysplasia, epidermal thickness and stratum corneum thicknesses of AKs were measured.ResultsAll AKs showed severe dysplasia. Most AKs had a stratum corneum thickness under 0.1 mm and an epidermal thickness under 0.5 mm, corresponding to clinically thin and non-hyperkeratotic AKs.ConclusionsOur result suggests malignant progression potential of AKs regardless of thickness.

Randomized clinical trials using human papillomavirus (HPV) DNA testing have found increased protection against cervical cancer and HPV-based screening is globally recommended for women ≥30 years of age. HPV-mRNA is a promising alternative target for cervical screening tests, but assessing equivalence requires longitudinal evaluation over at least the length of a screening interval. Our aim is to analyze the longitudinal sensitivity of HPV-mRNA and HPV-DNA in cervical samples taken up to 7 years before severe cervical intraepithelial neoplasia or worse (CIN3+). From a population-based cohort of 95,023 women in Sweden, cervical samples were frozen at -80°C between May 2007 and January 2012. Registry linkages identified that 1,204 of these women had CIN3+ 4 months to 7 years after enrolment. Baseline samples were analyzed for HPV-mRNA (Aptima, Hologic) and for HPV-DNA (Cobas 4800, Roche) and results from both tests obtained for 1,172 women. For both women

Objective To provide a reference for classification and treatment of vocal cords leukoplakia. Methods 640 cases of patients with vocal cords leukoplakia were divided into three groups based on the appearances. There were respectively 81 smooth flat lesions, 155 smooth hypertrophy lesions and 13 rough lesions were treated with conservative methods and 26, 153 and 212 cases were resected surgically for biopsy. Results A majority of smooth flat leukoplakia lesions were cured by non-operational methods and no atypical hyperplasia. Most of rough lesions were invalid and even progressed treated with conservative therapy and were severe dysplasia or canceration. Although 67.6% smooth hypertrophy lesions were cured or improved by conservative methods and 47% lesions had no or mild dysplasia, over 30% of lesions were still invalid or progressed and over 50% had moderate, severe dysplasia and canceration. By statistical analysis, the appearance of leukoplakia was concordant with pathological changes. Conclusions It is suggested that smooth flat vocal cords leukoplakia could be treated with conservative methods and rough lesions should be resected operationally, while for smooth hypertrophy vocal cords leukoplakia could be first followed-up and then adopt measures based on the appearance changes.

The objective of the present study was to investigate whether deep learning could be applied successfully to the classification of images from colposcopy. For this purpose, a total of 158 patients who underwent conization were enrolled, and medical records and data from the gynecological oncology database were retrospectively reviewed. Deep learning was performed with the Keras neural network and TensorFlow libraries. Using preoperative images from colposcopy as the input data and deep learning technology, the patients were classified into three groups [severe dysplasia, carcinoma in situ (CIS) and invasive cancer (IC)]. A total of 485 images were obtained for the analysis, of which 142 images were of severe dysplasia (2.9 images/patient), 257 were of CIS (3.3 images/patient), and 86 were of IC (4.1 images/patient). Of these, 233 images were captured with a green filter, and the remaining 252 were captured without a green filter. Following the application of L2 regularization, L1 regularization, dropout and data augmentation, the accuracy of the validation dataset was ~50%. Although the present study is preliminary, the results indicated that deep learning may be applied to classify colposcopy images.

Background According to recent estimates, 500 000 women have or are at risk of Female Genital Mutilation (FGM) in Europe and 14 700 in Switzerland.In Geneva, 6% of the population are asylum seekers, mainly from African countries where FGM is prevalent. No study exists on cervical dysplasia prevalence after FGM. Prevalence of severe dysplasia (HSIL+) in sub-Sahara African countries is estimated at 2.5%–3%; in Switzerland it's 0.58%. Objective To assess the prevalence of HSIL+ among women with FGM at at the Department of Gynecology of the Geneva University Hospitals. Methods Retrospective review of 619 consecutive medical files of the outpatients' clinic for women with FGM between 2010 and 2016. FGM type were recorded after gynecological exam and cervical screening performed. Results 368 women were included, average age 34.3 years old, mainly from Eritrea and Somalia (n=225, 61.14%). Most have FGM type 3 (n=205, 55,87 %). The prevalence of (HSIL+) was 2.98%. Conclusions Migrant women with FGM, who are known to be at risk of long term urogynecological, sexual and obstetric negative consequences, seem also to have a significant high prevalence of cervical dysplasia HSIL.

While most patients with signs of mild hip instability in the first weeks of life resolve spontaneously, those with more severe dysplasia will have significantly worse outcomes if not diagnosed and treated early. This creates a dilemma for the clinician who must depend on physical findings, aided by imaging studies that are relatively nonspecific in their ability to detect hip dysplasia. This chapter will present an approach to the newborn with abnormal hip findings or significant risk factors.

Background:In patients with patellar instability and severe trochlear dysplasia, trochleoplasty has become increasingly used as part of its surgical management.Hypothesis:Deepening trochleoplasty for severe dysplasia in patellofemoral instability improves function and increases sports participation.Study Design:Case series; Level of evidence, 4.Methods:Between 1995 and 2010, deepening trochleoplasty with a thick flap was performed in 90 patients (107 knees) with severe trochlear dysplasia. Data were collected prospectively preoperatively, at 6 weeks, and at 1-year follow-up. The patients were surveyed retrospectively to determine the clinical and functional outcomes including sports and exercise participation at a minimum of 2 years, with complete data available in 92%.Results:The average follow-up was 6 years (range, 2-19 years). The median Kujala score was 63 (interquartile range [IQR], 47-75) preoperatively, rising to 79 (IQR, 68-91) at 1-year follow-up and 84 (IQR, 73-92) at final follow-up ( P < .05). Seventy-two percent were satisfied with their knee function at 1-year follow-up, rising to 83% at final follow-up ( P < .0001). Sports and exercise participation increased from 36 patients (40%) preoperatively to 60 (67%) at final follow-up. The number of patients involved in competitions increased slightly from 10 (11%) to 11 (12%). Of those sports that involved twisting (eg, soccer, cricket, badminton), the number of patients participating increased from 16 (18%) to 22 (24%), whereas in nontwisting sports (eg, running, swimming, cycling), it increased from 24 (27%) to 47 (52%), of whom 12 (16%) used walking as exercise. Two patients who had undergone medial patellofemoral ligament (MPFL) reconstruction as the index operation needed the MPFL revised, and a further 8 patients needed MPFL reconstruction subsequently for instability symptoms and a mediolateral glide in extension of more than 2 quadrants’ displacement. At final follow-up, no patient had mechanical patellofemoral instability.Conclusion:Deepening trochleoplasty with a thick flap improves clinical and functional outcomes for patients with symptomatic patellar instability with severe trochlear dysplasia. These results improve over time and beyond 1-year clinical follow-up. However, trochleoplasty does not lead to a significant improvement in sports participation at a competitive level. It does improve patient participation in sports and exercise, principally in nontwisting sports activities.

Se recomienda para una mejor correlación en los diagnósticos citológicos e histológicos agrupar las diferentes formas de enfermedad neoplásica cervical entre categorías: a) Displasia leve moderada. b) Displasia severa carcinoma in-situ y c) Carcinoma Infiltrante. Se hace un análisis de la incidencia y distribución por edades de la enfermedad neoplásica cervical en 3,000 mujeres sometidas al estudio citológico cérvico-vaginal. Los hallazgos demuestran una edad promedio y una distribución coincidente con lo observado en otros países, reafirmándose el carácter potencialmente progresivo de las lesiones atípicas menores. Llama la atención la menor edad promedio del carcinoma invasivo cervical en Lima en relación con lo observado en otros países.