Prepubertal Unilateral Gynecomastia: Report of 2 Cases

Prepubertal unilateral gynecomastia is an extremely rare condition. At present, its etiology and management strategy are not well known. Two unrelated prepubertal boys of ages 8 and 9 who presented with complaints of unilateral enlargement of breast tissue are reported. Physical examination, biochemical, hormonal and oncologic work-up findings were normal. Both patients were treated with peripheral liposuction successfully. Histopathological and immunohistochemical examinations showed benign fibroglandular gynecomastia and intensive (3+) estrogen receptor expression in 100% of periductal epithelial cells. Although an extremely rare and generally benign condition, patients with prepubertal unilateral gynecomastia should have a full endocrine and oncologic work-up.     

Endocrine disrupting chemicals: exposure,effects on human health,mechanism of action,models for testing and strategies for prevention

Reviews in Endocrine and Metabolic Disorders - Endocrine Disrupting Chemicals (EDCs) are a global problem for environmental and human health. They are defined as “an exogenous chemical, or...     

Social Support From the Athletic Trainer and Symptoms of Depression and Anxiety at Return to Play

Context:

Few empirical studies have examined social support from athletic trainers (ATs) and its buffering effect during injury recovery.

Objective:

To examine the effect of social support received from ATs during injury recovery on reported symptoms of depression and anxiety at return to play among a cohort of collegiate athletes.

Design:

Cohort study.

Setting:

Two Big 10 Conference universities.

Patients or Other Participants:

A total of 594 injuries sustained by 387 collegiate athletes (397 injuries by 256 males, 197 injuries by 131 females) on 9 sports teams.

Main Outcome Measure(s):

Data were collected during the 2007–2011 seasons. Social support was measured using the 6-item Social Support Questionnaire. Symptoms of depression were assessed using the Center for Epidemiological Studies Depression Scale. Anxiety was measured by the State-Trait Anxiety Inventory. We used generalized estimation equation regression models to examine the effect of the social support from ATs on the odds of symptoms of depression and anxiety at return to play.

Results:

In 84.3% (n = 501) of injury events, injured athletes received social support from ATs during their recovery. Of these, 264 (53.1%) athletes reported being very satisfied with this social support. Whether or not athletes received social support from ATs during recovery did not affect the symptoms of depression or anxiety experienced at return to play. However, compared with athletes who were dissatisfied with the social support received from ATs, athletes who were very satisfied or satisfied with this social support were 87% (95% confidence interval = 0.06, 0.30) and 70% (95% confidence interval = 0.13, 0.70) less likely to report symptoms of depression at return to play, respectively. Similar results were observed for anxiety.

Conclusions:

Our findings support the buffering effect of social support from ATs and have important implications for successful recovery in both the physical and psychological aspects for injured athletes.Key Words: collegiate athletes, psychological distress, coping, injury recovery

Key Points

• More than 80% of injured athletes in this study relied on social support from their athletic trainers during their recovery.
• Athletes who reported higher levels of satisfaction with the social support from their athletic trainers during recovery were less likely to experience symptoms of depression and anxiety at return to play.
• However, whether or not injured athletes received social support from athletic trainers during their injury recovery did not correlate with psychological outcomes at return to play.

Approximately 40% to 50% of collegiate athletes sustain at least 1 injury requiring medical attention or restricting participation for 1 day or more (or both) during their athletic careers.¹ In addition to negative physical consequences, these injuries often cause psychological disturbances among injured athletes, including depression and anxiety, which in turn play a role in their injury recovery.^2–4 Results from previous studies show that social support is an important coping resource for athletes dealing with psychological recovery from an injury.^5–9 Social support could “buffer” the effect of stress on injured athletes and thus indirectly influence their emotional wellbeing. In other words, social support could first help an injured athlete interpret an injury event as less stressful than he or she otherwise would, thus helping to reduce distress after an injury. Second, social support could help an injured athlete cope with the injury and improve motivation during rehabilitation.^8,9 Growing evidence also suggests that emotional social support, defined as expressions of empathy, love, trust, and caring,^10,11 may be crucial to recovery for injured collegiate athletes; other types of social support, including instrumental support (ie, provision of tangible aid and services) and informational support (ie, provision of advice, suggestions, and information), may be available to injured collegiate athletes as part of injury treatment.^10,11 However, although many universities provide psychological services to their students, including injured student–athletes, the psychologists are not always specially trained in the areas of sport and exercise and may not fulfill the injured athletes'' needs. Thus, certified athletic trainers (ATs), who are active in the day-to-day tasks of prevention, recognition, management, and rehabilitation of injuries among athletes, become an important source of emotional social support for injured athletes.¹¹Advances in sport medicine have reduced the average time required for physical healing from an athletic injury, yet a rapid physical recovery may not provide sufficient time for psychological recovery. Current practices in evaluation and management of injuries address the physical problems underlying an injury and return athletes to full participation as soon as possible, but psychological assessment or care is not usually included.^12,13 The potential discrepancy between physical healing and psychological recovery necessitates that more attention be given to the latter.¹³ We need to better understand how athletes respond to athletic injury and how external factors, such as social support, may affect athletes'' postinjury psychological status and facilitate their injury recovery. Yet relatively few empirical studies have directly examined social support from ATs and its buffering effect during injury recovery among competitive collegiate athletes.^11,12The aim of our study was 2-fold: (1) to describe the social support that injured collegiate athletes received from their ATs during their injury recovery and their satisfaction with such support and (2) to examine the effect of this social support from ATs during the recovery on reported symptoms of depression and anxiety at return to play.     

Fracture resistance of roots filled with three different obturation techniques

Objectives: The aim of this study was to compare in vitro root fracture resistance following root canal filling with AH 26 using lateral condensation, BeeFill, and Thermafil techniques. Study Design: Eighty extracted human mandibular premolars with similar dimensions were selected. In order to standardize the roots, measurements were taken in two separate regions of the teeth—at the cemento-enamel junction and 8 mm apically from the junction—buccolingual as well as mesiodistal for every tooth. Teeth were then randomly divided into five groups (n=16). With the exception of the non-prepared group (Group 1), instrumentation was done in all groups. In group 2, instrumentation but no filling was performed; in group 3, the obturation was done with AH 26 + gutta-percha; in group 4, with AH 26 + BeeFill and in group 5, AH 26 + a Thermafil obturator was used. All the roots were mounted vertically in copper rings and filled with acrylic resin, exposing 8 mm of the coronal part. A universal testing machine was used for the strength test. Results: The results were analyzed using the one-way ANOVA test. The significance between the groups was tested with Temhane’s T2 test. The results indicate that instrumentation of root canals had a significant effect on fracture resistance (p<0.05). In addition, there were no differences between the root canal obturation techniques; furthermore, these techniques did not create a statistically important resistance to vertical fracture (p>0.05). Conclusions: The results suggest that instrumentation of root canals significantly weakens the tooth structure to fracture and the root canal obturation techniques that are used are not able to form reinforcement. Key words:AH 26, obturation technique, vertical fracture.     

Falcine venous plexus within the falx cerebri: anatomical and scanning electron microscopic findings and clinical significance

Background

Only limited attention has been paid to the anatomy and clinical importance of the falcine venous plexus. The aim of this study was to evaluate the falcine venous plexus anatomically using scanning electron microscopy (SEM), and to provide guidance for neurosurgical approaches.

Methods

Latex or ink was injected into the superior and inferior sagittal sinus. The falcine venous plexus lying within the connective tissue of the falx cerebri was observed by dividing the falx into thirds (anterior, middle and posterior). Further, the SEM appearance of the falcine venous plexus was evaluated.

Results

The anterior third of the falx cerebri consisted of small diameter falcine venous vessels. These vessels were localized close to either the superior or inferior sagittal sinus, and none extended as far as mid-falx cerebri levels in any of the 16 cases. They communicated with either superior or inferior sagittal sinuses, but not with both of these sinuses. In the middle third of the falx cerebri, the majority of the vessels of the falcine venous plexus had larger diameter compared to those of the anterior third. These vessels extended the length of the falx cerebri levels. They communicated with both superior and inferior sagittal sinuses. In the posterior third of the falx cerebri, the vessels of the falcine venous plexuses had the largest diameter and were located at the junction of the inferior sagittal sinus and the straight sinus. They were localized at the lower two-thirds of the falx cerebri. In all cases, the dense venous networks communicated with the inferior sagittal sinus but not with the superior sagittal sinus. The falcine venous plexus observed in the posterior third of the falx cerebri was denser than in the anterior and middle portions. The SEM revealed small vessels whose diameter ranged between 42 and 138 μm. The vessels of the falcine venous plexus in the anterior third had a mean diameter of 0.42?±?0.1 mm, in the middle third a mean diameter of 0.87?±?0.17 mm, and in the posterior third, 1.38?±?0.21 mm.

Conclusion

The falcine venous plexus is a network of venous channels that exists within the connective tissue of the falx; the sizes and patterns of communication of these structures showed regional differences. Neurosurgeons should be aware of the regional differences when making an incision or puncturing the falx during a surgical approach.     

Choroidal and macular thickness changes in type 1 diabetes mellitus patients without diabetic retinopathy

Objectives: To explore choroidal thickness (ChT) and retinal thickness (RT) changes in patients with type 1 diabetes mellitus (DM).

Methods: Sixty patients with Type 1 DM and 60 age- and sex-matched healthy controls were included in this prospective case–control clinical study. All patients underwent a complete ophthalmological examination. ChT of each participant was measured at the fovea and horizontal nasal and temporal quadrants at 500-µm intervals to 1500 µm from the foveola using spectral-domain optical coherence tomography (SD-OCT). Age, gender, disease duration, serum glycosylated hemoglobin (HbA1c), fasting glucose level, axial length (AL) and refractive error were noted and analyzed.

Results: Mean disease duration, mean HbA1c and mean fasting blood glucose in diabetic patients were 6.1±2.8 years, (8.9±0.9)% and 287.5±69.1 mg/dl, respectively. Age, gender, AL, spherical equivalent differences between the patients and subjects were insignificant (p>0.05). Subfoveal ChT, nasal quadrant ChT measurements, temporal 1500 µm and mean nasal ChT were significantly lower in diabetic patients (p<0.05 for all). Temporal 500 µm and 1000 µm ChT measurements, mean temporal ChT, average ChT, central macular thickness and average macular thickness did not differ significantly between the groups (p>0.05 for all).

Conclusion: This study showed that there is choroidal thinning in young Type 1 diabetic patients with early period of disease duration without diabetic retinopathy nor any other systemic diseases. Choroidal changes in type 1 DM seem to begin at nasal and distal temporal retina. These results need to be verified by larger and longitudinal studies.     

Surgical treatment of giant liver hydatid cysts: comparison of cystojejunostomy and partial cystectomy

Purpose

The aim of this study was to compare partial cystectomy and internal drainage of the cyst cavity with cystojejunostomy for the surgical treatment of giant hepatic hydatid cysts.

Methods

Patients who underwent any type of surgical treatment between March 2009 and May 2013 for giant hepatic hydatid cysts were retrospectively evaluated. The data collected included demographic variables, diagnostic methods, surgical procedures, morbidity and mortality rates.

Results

Twenty-eight patients who underwent surgery for giant hepatic hydatid cysts were included. There were 16 (57 %) female patients, with a mean age of 32.8 years. The diagnostic methods primarily included abdominal ultrasonography and computed tomography, which were performed in 62 % of the patients. The patients were divided into two groups with respect to the treatment modality: Group A (n = 13) treated with cystojejunostomy and Group B (n = 15) treated with partial cystectomy. The overall rate of cavity-related complications was 25 % in Group B, whereas none of the patients in Group A had a cavity-related complication during the follow-up period (p < 0.05).

Conclusion

Cystojejunostomy is an effective and safe surgical approach for the treatment of giant hepatic hydatid cysts, with a lower rate of morbidity than partial cystectomy, and thus may be the surgical treatment of choice for giant hepatic hydatid cysts.     

Improvement of right ventricular function with transcatheter aortic valve implantation

Background and aim. It has been demonstrated that right ventricular systolic dysfunction develops soon after surgical aortic valve replacement (s-AVR). While the impact of s-AVR or TAVI on the function of the left ventricle has been studied with various imaging modalities, little is known about the impact on right ventricular function (RVF). In the current study, we evaluated the impact of TAVI on RVF using conventional echocardiography parameters. Methods and results. Echocardiography was performed prior to 24 h, 1 month and 6 months after TAVI. RVF was assessed using (1) tricuspid annular plane systolic excursion (TAPSE); (2) RV Tissue Doppler Imaging (S’); (3) right ventricular systolic pressure (RVSP); (4) Fractional area change (FAC); and (5) RV ejection fraction (RVEF). TAVI was performed through the subclavian artery in two patients and femoral artery in 48 patients with an Edwards Sapien XT valve. TAVI was performed on 50 patients between the dates of December 2012 and June 2013. After TAVI, a statistically significant improvement was observed for all parameters related to RVF (RVSP, RVEF, TAPSE, FAC, RVTDI S’). During the 1st and 6th months this statistically significant improvement continued in TAPSE and FAC, and there was no deterioration in RVSP, RVEF, and RVTDI S during the 1st month but a statistically significant improvement continued in the 6th month. Conclusion. RVF assessed by conventional echocardiography did not deteriorate after TAVI in early and midterm follow-up. Further, TAVI provides improvement of RVF and can safely and efficiently be performed in patients with impaired RVF.