Bilateral central retinal vein occlusion with multiple intracerebral hemorrhage in a neonate

Central retinal vein occlusion and intracerebral hemorrhage are rare diseases during infancy and are both related to venous thrombosis. We present the case of a full-term male hydrops infant without specific neurologic symptoms initially but later demonstrating bilateral central retinal vein occlusion and intracerebral hemorrhage. We conclude that routine funduscopic examination in high-risk newborns should be seriously considered.     

UV-specific p53 and PTCH mutations in sporadic basal cell carcinoma of sun-exposed skin

UVB irradiation is known to produce DNA damage at mutation hotspots in the p53 tumor suppressor gene, leading to the development of skin cancers. Mutations in the PTCH tumor suppressor gene, which is known to be responsible for the development of nevoid basal cell carcinoma syndrome, have also been identified in sporadic basal cell carcinomas (BCCs). We describe the case of an 80-year-old welder in whom 3 novel p53 mutations, as well as UV-specific PTCH mutations, were detected in two BCC samples from sun-exposed skin. The simultaneous presence of UV-specific p53 and PTCH mutations in the same BCC sample has not previously been reported.     

Percutaneous pulsed radiofrequency in the treatment of cervical and lumbar radicular pain

BACKGROUND: Previous reports of the efficacy of percutaneous pulsed radiofrequency have been confounded by fewer case numbers, poor patient selection, and limited data on cervical or lumbar radicular pain. We used percutaneous pulsed radiofrequency for cervical and lumbar radicular pain, and the study has more than 100 cases for the analysis of the efficacy of percutaneous pulsed radiofrequency. METHODS: We collected 154 cases of patients with lumbar or cervical radicular pain due to a herniated intervertebral disk or previous failed surgery. They underwent pulsed radiofrequency therapy in 2 to 4 spinal levels unilaterally. Follow-up period was from 1 week to 1 year postoperatively. RESULTS: Twenty-six (53.06%) of 49 patients and 59 (50.86%) of 116 patients after cervical and lumbar pulsed radiofrequency stimulation, respectively, had an initial improvement of 50% or more in the first week of follow-up. Twenty-seven (55.10%) of 49 patients and 52 (44.83%) of 116 patients after cervical and lumbar pulsed radiofrequency stimulation, respectively, had pain relief of 50% or more at the follow-up period of 3 months. In the analysis of patients with pain relief of 50% or more for at least 1 month, the most effective period was during postoperation 1 month later. No complication was found among these patients. CONCLUSIONS: The results of this retrospective analysis showed that the application of pulsed radiofrequency is a safe and useful intervention for cervical and lumbar radicular pain. The satisfactory pain relief obtained by most of our patients justifies the start of this study for at least 6 months. Although pulsed radiofrequency appears to provide intermediate-term relief of pain, further studies with long-term follow-up are necessary.     

Ultrasonographic and cytologic findings of metastatic cancer in the thyroid gland.

BACKGROUND AND PURPOSE: Cancer metastasizing to the thyroid is not uncommon. Prompt diagnosis and aggressive treatment appear to contribute to better prognosis in some patients. The aim of this study was to determine the clinical manifestations, ultrasonographic and cytologic findings, and outcomes in patients with metastatic thyroid cancer. METHODS: We retrospectively reviewed the medical records, including clinical courses, ultrasonographic and cytologic findings, and outcomes, of 14 patients with metastatic thyroid cancer. RESULTS: There were various primary sites of cancer in our study population, with adenocarcinoma the most common. The sonographic images in five of 12 patients who underwent sonography showed diffusely heterogeneous hypoechoic abnormalities, while the remaining seven patients had nodular lesions. The cytologic appearances of metastatic lesions in the thyroid were characteristic of the primary malignancies. CONCLUSIONS: Most cancer metastatic to the thyroid presented as advanced metastases of primary malignancies. The sonographic appearance alone was not the ideal discriminator, and fine needle aspiration cytology helped define the diagnosis and management strategy.     

Transtracheal migration of an intravertebral Steinmann pin to the left bronchus

Foreign body aspiration only rarely occurs by migration into the lung from other sites in the body. This report describes the migration of an intracervical Steinmann pin through the posterior tracheal membrane into the left bronchus and its successful removal via the rigid bronchoscope.     

Laparoscopic Roux-en-Y Vs. Mini-gastric Bypass for the Treatment of Morbid Obesity: a 10-Year Experience

Background

Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered the gold standard for the treatment of morbid obesity but is technically challenging and results in significant perioperative complications. While laparoscopic mini-gastric bypass (LMGB) has been reported to be a simple and effective treatment for morbid obesity, controversy exists. Long-term follow-up data from a large number of patients comparing LMGB to LRYGB are lacking.

Methods

Between October 2001 and September 2010, 1,657 patients who received gastric bypass surgery (1,163 for LMGB and 494 for LRYGB) for their morbid obesity were recruited from our comprehensive obesity surgery center. Patients who received revision surgeries were excluded. Minimum follow-up was 1?year (mean 5.6?years, from 1 to 10?years). The operative time, estimated blood loss, length of hospital stay, and operative complications were assessed. Late complication, changes in body weight loss, BMI, quality of life, and comorbidities were determined at follow-up. Changes in quality of life were assessed using the Gastrointestinal Quality of Life Index.

Results

There was no difference in preoperative clinical parameters between the two groups. Surgical time was significantly longer for LRYGB (159.2 vs. 115.3?min for LMGB, p?<?0.001). The major complication rate was borderline higher for LRYGB (3.2 vs. 1.8?%, p?=?0.07). At 5?years after surgery, the mean BMI was lower in LMGB than LRYGB (27.7 vs. 29.2, p?<?0.05) and LMGB also had a higher excess weight loss than LRYGB (72.9 vs. 60.1?%, p?<?0.05). Postoperative gastrointestinal quality of life increased significantly after operation in both groups without any significant difference at 5?years. Obesity-related clinical parameters improved in both groups without significant difference, but LMGB had a lower hemoglobin level than LRYGB. Late revision rate was similar between LRYGB and LMGB (3.6 vs. 2.8?%, p?=?0.385).

Conclusions

This study demonstrates that LMGBP can be regarded as a simpler and safer alternative to LRYGB with similar efficacy at a 10-year experience.     

Community Outbreak of Adenovirus,Taiwan, 2011

In 2011, a large community outbreak of human adenovirus (HAdV) in Taiwan was detected by a nationwide surveillance system. The epidemic lasted from week 11 through week 41 of 2011 (March 14–October 16, 2011). Although HAdV-3 was the predominant strain detected (74%), an abrupt increase in the percentage of infections caused by HAdV-7 occurred, from 0.3% in 2008–2010 to 10% in 2011. Clinical information was collected for 202 inpatients infected with HAdV; 31 (15.2%) had severe infection that required intensive care, and 7 of those patients died. HAdV-7 accounted for 10%, 12%, and 41% of infections among outpatients, inpatients with nonsevere infection, and inpatients with severe infection, respectively (p<0.01). The HAdV-7 strain detected in this outbreak is identical to a strain recently reported in the People’s Republic of China (HAdV7-HZ/SHX/CHN/2009). Absence of circulating HAdV-7 in previous years and introduction of an emerging strain are 2 factors that caused this outbreak.     

Antigenic characterization of respiratory syncytial virus strains with monoclonal antibodies

To study the antigenic characteristics of respiratory syncytial virus (RSV), we developed and evaluated monoclonal antibodies (MAbs) to three strains of RSV: 11 to Long, 4 to 18537, and 9 to A2. Six of these MAbs immunoprecipitated the nucleoprotein, six the large glycoprotein, and 11 the fusion protein. By the pattern of the reactions of these MAbs to 16 strains of RSV in an indirect immunofluorescence assay or enzyme-linked immunosorbent assay, we were able to distinguish three subgroups. With a panel of 10 of these 24 MAbs, we tested 26 strains isolated between 1979 and 1982 in Boston and found that 22 belonged to group 1, 4 to group 2, and none to group 3. The pattern of the reactions of the MAbs against representative strains from the three groups identified nine epitopes by indirect immunofluorescence assay: three of each on the nucleoprotein, the large glycoprotein, and the fusion protein. These results, along with those of previous studies, suggest that groups 1 and 3 are antigenically similar and group 2 is antigenically more distinct.     

Life-threatening bacterial pneumonia in male homosexuals with laboratory features of the acquired immunodeficiency syndrome

Two male homosexuals with laboratory features of the acquired immunodeficiency syndrome developed fulminating pneumonia requiring mechanical ventilatory support despite antibiotic therapy. Pathology consistent with bacterial pneumonia without other opportunistic pathogens were found at open lung biopsy. Cultures from the open biopsy grew Hemophilus influenzae in one, and Streptococcus pneumoniae was seen on Gram stain and sputum culture prior to antimicrobial treatment in the other. Each recovered on continued single antibiotic therapy. Life-threatening bacterial pneumonia may be a feature of the acquired immunodeficiency syndrome, possibly due to B cell abnormalities.