Nasopharyngeal carcinoma with extensive nodular skin metastases: a case report

Skin metastasis from nasopharyngeal carcinoma is a rare clinical finding. The most common form of appearance is a few solitary skin nodules. However, massive and extensive nodular dissemination or diffuse dermal lymphatic infiltration is extremely rare. We here present a case of a 40-year-old man with widespread nodular skin metastases from undifferentiated nasopharyngeal carcinoma.     

Pseudarthrose des kindlichen Condylus radialis humeri mit posttraumatischem Cubitus valgus

Non-union of the pediatric lateral humeral condyle following post-traumatic cubitus valgus is a severe complication after inadequate treatment. We report on a then 14-year-old male patient who developed an increasingly defective position in terms of cubitus valgus after conservative treatment of a lateral humeral condyle fracture. After performing screw osteosynthesis and achieving consolidation, a successful supracondylar dome osteotomy was performed which led to relief from pain and free range of motion of the elbow joint.     

ORIGINAL ARTICLE: A Prospective Case–Control Study Analyzes 12 Thrombophilic Gene Mutations in Turkish Couples with Recurrent Pregnancy Loss

Citation Yenicesu GI, Cetin M, Ozdemir O, Cetin A, Ozen F, Yenicesu C, Yildiz C, Kocak N. A prospective case–control study analyzes 12 thrombophilic gene mutations in Turkish couples with recurrent pregnancy loss. Am J Reprod Immunol 2010; 63: 126–136 Problem Recurrent pregnancy loss (RPL) is a heterogeneous disorder. The contribution of specific thrombophilic genes to the pathophysiology of RPL has remained controversial. We evaluated the prevalences of 12 thrombophilic gene mutations among homogenous Caucasian couples with RPL and fertiles. Method of study This was a prospective case–control study evaluating 272 women with RPL and 152 of their male partners, and a control group of 56 fertile couples. We investigated mutations including FV Leiden, factor V H1299R, factor II prothrombin G20210A, F XIII V34L, β‐fibrinogen ?455G>A, plasminogen activator inhibitor‐1, GPIIIa L33P (HPA‐1 a/b L33P), MTHFR C677T, MTHFR A1298C, ACE I/D, Apo B R3500Q, and Apo E. Results Overall, heterozygous mutations of FV Leiden, FXIII V34L, GPIIIa L33P, Apo E4, and prothrombin G20210A and homozygous mutations of PAI‐1and MTHFR C677T were associated with RPL. There was no meaningful association between RPL and other studied genes. Conclusion In contrast to the other mutations and polymorphisms, FV Leiden, FXIII V34L, GPIIIa L33P, Apo E, prothrombin G20210A, PAI‐1 and MTHFR C677T gene mutations may help to identify the couples at risk for recurrent pregnancy loss.     

Continual Reassessment Method vs. Traditional Empirically Based Design: Modifications Motivated by Phase I Trials in Pediatric Oncology by the Pediatric Brain Tumor Consortium

In this article we provide additional support for the use of a model-based design in pediatric Phase I trials and present our modifications to the continual reassessment method (CRM), which were largely motivated by specific challenges we encountered in the context of the Pediatric Brain Tumor Consortium trials. We also summarize the results of our extensive simulations studying the operating characteristics of our modified approach and contrasting it to the empirically based traditional method (TM). Compared to the TM, our simulations indicate that the modified version of CRM is more accurate, exposes fewer patients to potentially toxic doses, and tends to require fewer patients. Further, the CRM-based MTD has a consistent definition across trials, which is important, especially in a consortium setting where multiple agents are being tested in studies that are often running simultaneously and accruing from the same patient population.     

Surgical management of spontaneous in-the-bag intraocular lens and capsular tension ring complex dislocation

We describe a technique to manage late spontaneous intraocular lens (IOL) and capsular tension ring (CTR) dislocation within the intact capsular bag. The subluxated IOL and CTR complex can be positioned in a closed chamber and fixed to the pars plana at both 3 and 9 o’clock quadrants with the presented ab externo direct scleral suturation technique which provides an easy, safe and effective surgical option for such cases.     

Bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis

X-linked juvenile retinoschisis is a rare hereditary retinal disease characterized by a tangential splitting of the neurosensory retina which may cause early-onset visual impairment. Existence of the retinal neurosensory layer splitting on cross-sectional images of optical coherance tomography (OCT) and the absence of leakage on fluorescein angiography (FA) help confirming the diagnosis. Such diagnostic tests are also helpful in determining the management of the disease. However, most of the retinoschisis cavities remain stable and rarely extend to the posterior pole, many authors suggest laser prophylaxis to avoid the potential risk of retinal detachment due to holes in the outer retinal layer. Herein, we report a case with bilateral foveal retinoschisis accompanying unilateral peripheral retinoschisis who was evaluated with detailed ophthalmologic examination. Visual acuity, fundoscopy, OCT, and FA remained stable in the second year of follow-up after prophylactic argon laser treatment.