Grouped skin metastases from laryngeal squamous cell carcinoma and overview of similar cases

Cutaneous metastases from internal malignancies or primary skin cancers are uncommon, particularly in a grouped pattern. We report a 58-year-old man with a known case of laryngeal squamous cell carcinoma who underwent radiotherapy after surgical excision of the tumor. Unilateral, grouped, red-brown, vesicle-like nodules appeared on his shoulder 9 months after the laryngeal surgery. The pathologic diagnosis of an excised nodule was metastatic squamous cell carcinoma.     

IgG Avidity Test for Ocular Toxoplasmosis Diagnosis at a Tertiary Center,Northeast of Iran

Background: The diagnostic methods which are used for acute ocular toxoplasmosis are very important; if the treatment is delayed, it sometimes leads to loss of vision. Fewstudies have been performed to evaluate serological tests used in the diagnosis of acute ocular toxoplasmosis. Objective: To evaluate the immunoglobulin (Ig) M, G and IgG avidity tests for diagnosis of acute ocular toxoplasmosis in the northeast of Iran. Methods: A cross-sectional study was carried out from January 2014 to December 2016. After an opthalmic examination was conducted by a retina specialist, 16 typical acute and 34 typical chronic ocular toxoplasmosis cases were included in this study. Information on clinical manifestations, age and occupation was recorded. Anti-Toxoplasma IgG, IgM and IgG avidity tests were administered on serum samples using the ELISA method. Results: Blurring of vision in all patients was the most clinical presentation. The IgG avidity test could diagnose all acute and recent cases. However, three false positive and one false negative result occurred using the IgM test by ELISA. The false negative result in all likelihood occurred because the patient was at the beginning stage of the infection. Conclusion: The result of this study showed that IgM is not a reliable marker of acute disease. Repetition of the serology tests was proposed in cases with clinical manifestations without detectable antibody titer after approximately two weeks. IgG avidity testing results coincided with clinical diagnosis and it could therefore considered to be a reliable method to differentiate between recently acquired and chronic ocular toxoplasmosis.     

Complete supine percutaneous nephrolithotomy (csPCNL) in patients with and without a history of stone surgery: safety and effectiveness of csPCNL

To determine the effects of previous stone surgery on the results of complete supine percutaneous nephrolithotomy (csPCNL), we reviewed 81 patients undergoing csPCNL at our center between March 2008 and March 2009. The principal aim in our study was whether prior renal surgery affects the outcome of PCNL. The results of the study were analyzed using SPSS 11 software. Our patients were divided to in two groups. Group 1 consisted of patients with a previous history of renal stone surgery and group 2 consisted of patients without history of renal surgery. Mean operative time in group 1 was 98.75 ± 56.31 min, and in group 2 99.71 ± 45.9 min (p = 0.93). Bleeding requiring transfusion occurred in four (14.2%) patients in group 1, and in eight (15.09%) patients in group 2 (p = 0.826). Fever was detected in no patients in group 1, and in four (7.5%) patients in group 2 (p = 0.136). Postoperative hematoma was seen in one (3.5%) patient in group 1 and in no patient in group 2 (p = 0.166). Other major complications including extravasations, sepsis, pleural effusion, pelvis perforation, and visceral organ trauma were not seen in any groups. This is the first experience of csPCNL in patients with and without a previous history of renal surgery. We found that there was no difference in results between the two groups that underwent complete supine PCNL. So csPCNL in patients with a history of stone surgery can be safe and effective. csPCNL offers the potential advantages of less patient handling, easier access to the urethra, easier possibility of changing spinal or regional anesthesia to general anesthesia if needed, better airway control and less hazard, especially for patients with compromised cardiopulmonary function, morbid obesity, or those who require a prolonged procedure and easier access to upper calyx. Its popularity is still minimal in the field of urology as a whole, because of fear of colon injury and a lack of training in this position in educational centers.     

Is complete supine percutaneous nephrolithotripsy feasible in all patients?

Although complete supine percutaneous nephrolithotomy (csPCNL) is routine in some surgical centers throughout the world, its popularity in the field of urology due to a deficiency in its training in educational centers, as a whole, is still minimal. We evaluated the outcomes of tubeless csPCNL in this study. This study was a clinical trial, conducted by one surgical team from January 2009 to January 2010, on 117 patients in complete supine position. Percutaneous access was created under fluoroscopic or ultrasonographic guidance in complete supine position. All patients underwent csPCNL without nephrostomy tube (tubeless). Stone disintegration was performed with pneumatic lithotripsy. Pre- and post-operative data of patients were evaluated. The mean operative time was 98 min. The mean reduction in hemoglobin level was 1.5 g/dl. A total of 129 punctures (105 single and 12 double) was performed. The ureteral catheter was left for 1–3 days. The mean hospital stay was 3.7 days. The stone-free rate was 77.77%. Seventeen patients required blood transfusion. Eight patients had fever. Fistula, extravasation or wound infection did not occur. This study demonstrated that csPCNL is a good option for all patients. Furthermore, csPCNL offers potential advantages including better urethral access, less handling of patients, better control of the airway during procedures and reducing overall operative time, a surgeon seated more comfortably, no density overlap with vertebra, easier access to upper calyces, more rapid access to the airway with less hazard, especially in patients with compromised cardiopulmonary function and morbid obesity.     

Avascular necrosis of the femoral head in children with acute lymphoblastic leukemia: a 4- to 9-year follow-up study

Avascular necrosis of the femoral head is usually seen in children aged 1.5 to 10 years, reaching a peak incidence between the ages of 4 and 9. Avascular necrosis of the femoral head is a known complication of corticosteroid therapy in acute lymphoblastic leukemia. There are few reports in the literature regarding the natural history of this condition, and there is no consensus on its management. This study examined the natural history of avascular necrosis of the femoral head in children with leukemia. From 1993 to 2006, a total of 865 children with acute lymphoblastic leukemia were admitted to the hematology-oncology ward of a children's hospital. The diagnosis of acute lymphoblastic leukemia was established by bone marrow aspiration. Based on clinical and radiographic findings, avascular necrosis of the femoral head was found in 7 patients; these patients underwent follow-up for 4 to 9 years. Avascular necrosis of the femoral head was clinically symptomatic in all of the children, and they had advanced radiographic collapse of the femoral head. However, the head of the femur was not at risk in any patient based on clinical and radiographic findings. Patients received supportive treatment such as abduction brace and physiotherapy. After 4 to 9 years of follow-up, clinical and radiographic results were satisfactory. Provided that the head of the femur is not at risk, avascular necrosis of the femoral head in children with acute lymphoblastic leukemia may be successfully managed with nonoperative care.     

HLA class II allele and haplotype frequencies in Iranian patients with leukemia

Previous studies demonstrated significant differences in a number of HLA allele frequencies in leukemia patients and normal subjects. In this study, we have analyzed HLA class II alleles and haplotypes in 110 leukemia patients (60 acute myelogenous leukemia "AML", 50 chronic myelogenous leukemia"CML") and 180 unrelated normal subjects. Blood samples were collected from all of the patients and control subjects. DNA was extracted by salting out method and HLA typing was performed using PCR-SSP method. Significant positive association with AML was obtained for HLA-DRB1*11allele (35% vs. 24.7%, P=0.033). Two alleles including HLA-DRB4 and -DQB1*0303 were significantly less frequent in AML patients than in controls. HLA-DQB1*0303 allele was never observed in CML patients compared with allele frequency in controls (4.2%). According to haplotype analysis, HLA-DRB1*0101/DQA1*0104/-DQB1*0501 frequencies were significantly higher and -DRB1*16/-DQA1*01021/-DQB1*0501 frequencies were significantly lower in CML patients than in controls. In conclusion it is suggested that HLA-DRB1*16 allele and HLA-DRB1*15/-DQA1*0103/-DQB1*06011 and -DRB1*16/-DQA1*01021/-DQB1*0501 haplotypes predispose individuals to AML and HLA-DRB4 allele predispose to CML. Future studies are needed to confirm these results and establish the role of these associations in AML and CML.