The role of human leucocyte antigens in children with hydatid disease: their association with clinical condition and prognosis

Hydatid disease (HD) is a parasitosis caused by Echinococcus granulosus, which is still an important health problem worldwide, and our country is an endemic region for HD. There is little information regarding the role of human leucocyte antigen (HLA) in genetic susceptibility or resistance to HD. In this study, we aimed to investigate the HLA profile of Turkish children with HD and to compare them with healthy individuals. We also planned to investigate whether HLAs have a potential role in the predisposition to or prevention of the occurrence of HD and to study the relationship between the clinical features of HD and the HLA profile of the patients. The study included 81 children (25 boys, 56 girls) with HD aged between 3 and 18 years. All the patients’ and control subjects’ HLA class I and II antigens were examined, antigen allele frequencies were calculated, and clinical characteristics were also evaluated. The frequency of HLA-B18, -DR1, and -DR15 alleles were significantly different between the patients and healthy groups; HLA-DR15 antigen might be associated with HD occurrence, and the presence of HLA-B18 and HLA-DR1 antigens might be associated with HD resistance. Compared with the healthy group, patients with lung HD had a significant increase in HLA-B44 frequency, and liver HD patients had a significant increase in HLA-DR15 antigen frequency. Furthermore, presence of HLA-DR11 was found to be a significant factor associated with cure of the disease. We concluded that HLA types have significant impact on the development of HD and clinical course of disease.     

Successful Treatment of Aortic Rupture with Endovascular Stent Grafting in a Patient with Mantle Cell Lymphoma

Purpose

To present a case of spontaneous aortic rupture in the course of mantle cell lymphoma and successful management with endovascular repair.

Case Report

A 69-year-old woman presented with a cervical mass. The patient was found to have stage IIIA and Mantle Cell Lymphoma International Prognostic Index (MIPI) 4. She was placed in an intermediate-risk group. The patient received an initial cycle of systemic chemotherapy consisting of rituximab, anthracycline, vincristine and methyl prednisolone. During follow-up, she developed abdominal aortic rupture secondary to intramural hematoma which was successfully managed with endovascular exclusion.

Conclusion

Hemodynamic changes can be seen during the course of lymphoma subsequent to systemic chemotherapy. These changes might be related to the spontaneous rupture of the main vessels. Endovascular repair may be a more appropriate treatment option than open surgery, especially in a patient with multiple comorbidities.Key Words: Systemic chemotherapy, Abdominal aortic rupture, Lymphoma, Endovascular stent-graft repair     

Adapalene gel 0.1% in the treatment of infantile acne: an open clinical study

Abstract:  Infantile acne is an uncommon condition in pediatric age. We determined the efficacy and safety of adapalene gel 0.1% in the treatment of infantile acne. Twelve patients were enrolled for adapalene gel 0.1% application once daily over a 16-week treatment period. Efficacy evaluation included counting the inflammatory and noninflammatory lesions by the physician and global evaluation of the improvement. After 16 weeks all patients were followed up for a 1-year period. The time of clearance of the infantile acne lesions was 3 months in four (33%) patients and 4 months in eight (67%) patients (median 3.4 months). Adapalene gel produced reductions in noninflammatory and inflammatory lesions counts. Limited side effects were observed and none of them required stopping the therapy. No patient was left with scarring. Three patients were showed mild lesions in the 1-year follow-up period. Adapalene gel 0.1% was found to be a highly effective and safe drug in the treatment of mild-to-moderate infantile acne.     

Accuracy of Plusoptix S04 in children and teens

Objective: To compare refraction measurements of young patients obtained using Plusoptix S04 with those obtained using cycloplegic retinoscopy.Design: Cohort study.Participants: Data were collected from 64 patients (128 eyes), aged 2–19 years.Methods: All eyes underwent photorefraction using Plusoptix S04 with or without cycloplegia and cycloplegic retinoscopy. Eyes with a maximum spherical and cylinder range of −7.00 to +5.00 were excluded from the study.Results: The difference in spherical equivalents between Plusoptix S04 without cycloplegia and cycloplegic retinoscopy was more than ± 0.50 D in 70.2% of the eyes. In 100 eyes (78.1%), photorefraction underestimated the hyperopic refractive error. The cylinder powers determined by Plusoptix S04 and cycloplegic retinoscopy were similar. The difference in the spherical equivalents between Plusoptix S04 with cycloplegia and cycloplegic retinoscopy was + 0.50 D in 89.8% of the eyes. In 96 eyes (75%), photorefraction with cycloplegia overestimated the hyperopic refractive error. The difference in cylindrical power determined using Plusoptix S04 with cycloplegia and cycloplegic retinoscopy was statistically significant (paired ttest, p = 0.009).Conclusions: The statistically significant difference in spherical equivalent values obtained using Plusoptix S04 with or without cycloplegia and cycloplegic retinoscopy suggests that Plusoptix S04 is more in evaluating the cylinder power and axis in young patients. Our results also suggest that Plusoptix S04 is not an accurate tool to estimate the refraction in children.     

Do we really need radiographic assessment for the diagnosis of non-specific heel pain (calcaneal apophysitis) in children?

Objective

Non-specific heel pain (calcaneal apophysitis) is a common disorder, particularly in physically active growing children. Foot radiographs are usually obtained as part of the clinical evaluation in routine orthopaedic practice. However, there is still controversy about the specific findings on radiographs, and it is unclear what information is present on radiographs that may alter the diagnosis and management. The purpose of this study was to review a consecutive series of patients with the diagnosis of calcaneal apophysitis to assess the yield of routine radiographs of the foot.

Material and methods

A prospective study was performed on 61 consecutive patients with a diagnosis of calcaneal apophysitis in a single-surgeon practice. Standard anteroposterior and lateral weight-bearing foot radiographs were obtained for each patient. Seventy-one sets of foot radiographs were reviewed to determine whether radiographs had an impact on diagnosis and management. Patients with antecedent trauma, penetrating injury, foot deformity, achilles tendonitis, bursitis and infections were excluded from the study.

Results

Seventy foot radiographs were considered to be normal. The radiographs changed the diagnosis in only one patient, in whom a simple bone cyst of the calcaneous was seen.

Conclusion

Calcaneal apophysitis is a self-limiting disease, and patients can be treated conservatively. Neither the sclerosis nor the fragmentation of the apophysis could be used to establish the diagnosis of calcaneal apophysitis. Therefore, obtaining radiographs as an initial step in their evaluation does not seem to be justified.     

Rapidly Progressing Malignant Insulinoma Presented with Multiple Liver Metastases: A Case Report

Introduction

A 51-year-old female was admitted to emergency unit with sudden loss of consciousness. Her blood glucose level from fingertip was 33 mg/dl, and insulin level was 55 (normal range, 4–17 IU). Abdominal ultrasonography revealed pancreatic mass with diffuse liver metastases. Biopsy of liver metastases showed differentiated neuroendocrine carcinoma.

Methods and Results

Diazoxide and chemotherapy stabilized her glucose level for more than 4 months. However, the disease showed progression, and death occurred 8 months later.

Conclusion

In conclusion, this case may suggest that biologic behavior may differ from histological behavior in insulinoma and platin-based systemic chemotherapy may provide some benefit in patients those who had diazoxide- and octreotide-resistant tumors.     

Accuracy of frozen sections for intraoperative diagnosis of complex atypical endometrial hyperplasia

Objective: The purpose of this study was to correlate the histological diagnosis made during intraoperativefrozen section (FS) examination of hysterectomy samples with complex atypical endometrial hyperplasia (CAEH)diagnosed with definitive paraffin block histology. Methods: FS pathology results of 125 patients with a preoperativebiopsy showing CAEH were compared retrospectively with paraffin block pathology findings. Results:Paraffin block results were consistent with FS in 78 of 125 patients (62.4%). The FS sensitivity and specificityof detecting cancer were 81.1% and 97.9%, with negative and positive predictive values of 76.7%, and 98.4%,respectively. Paraffin block results were reported as endometrial cancer in 77 of 125 (61.6%) patients. Finalpathology was endometrial cancer in 45.3% patients diagnosed at our center and 76.9% for patients who hadtheir diagnosis at other clinics (p=0.018). Paraffin block results were consistent with FS in 62.4% of all casesConsistence was 98.4% in patients who had endometrial cancer in FS. Conclusion: FS does not exclude thepossibility of endometrial cancer in patients with the preoperative diagnosis of CAEH. In addition, sufficientendometrial sampling is important for an accurate diagnosis