Primary intrathoracic goiter -a rare mediastinal tumor

Primary intrathoracic goiter is a rare presentation of thyroid disease. Its removal usually necessitates thoracotomy or sternotomy. This patient having a primary intrathoracic goiter presented with posterior mediastinal mass that was removed through a right lateral thoracotomy.     

Imaging of total knee arthroplasty

Painful total knee arthroplasty (TKA) represents a diagnostic challenge for the clinician and radiologist, as there is a wide variety of potential etiologies, with a broad range of clinical presentations, and the abnormalities on imaging studies are often subtle, absent, or nonspecific. Imaging findings of normal TKA are reviewed, in addition to a variety of complications such as loosening, infection, instability, osteolysis, heterotopic ossification, extensor mechanism disruption, and fracture. Although imaging evaluation of painful TKA is usually limited to conventional radiographs and nuclear imaging, examples of the utility of computed tomography are also illustrated, and suggested imaging strategies and algorithms are discussed.     

A novel device for removal of the retained intrauterine device

OBJECTIVE: To evaluate the efficacy and acceptability of the Macaluso stent removal forceps for removal of retained intrauterine devices (IUDs) under direct vision using a hysteroscope in an outpatient setting. METHODS: Nineteen consecutive patients with a retained IUD who had been referred from primary care to the gynaecologists at the Conquest Hospital, Hastings, UK were included in the study. Attempts were made to remove the IUDs under direct vision using the Gynecare Versascope and Macaluso forceps. RESULTS: The procedure was successful in 18/19 (94.7%) patients. The patients tolerated the procedure well and none of them complained of severe pain. CONCLUSION: This device is simple, safe, effective and acceptable for the removal of IUDs with lost threads.     

Epidemiologic shift in the prevalence of Hepatitis A virus in Saudi Arabia: a case for routine Hepatitis A vaccination

This study aims to determine the seroprevalence of Hepatitis A among a selected group of Saudi children and thus, identify the best immunization strategy. A school-based seroprevalence study in children 4-18 years of age attending the National Guard schools was done. Of the 25,531 children attending the National Guard schools, 2399 (10%) were randomly selected through a stratified one-stage cluster survey. The overall prevalence of HAV-IgG was 28.9%. The prevalence was almost the same in male and female (28.2% versus 29.5%, respectively). There was a gradual increase in the HAV-IgG with 7% in children (< 8 years), 14% (8-11 years), 30% (12-15 years), and 52% (> 16 years) of age. Since a substantial proportion of this pediatric population confirms a continuing decrease in anti-HAV seroconversion rates, we recommend including Hepatitis A in the schedule of routine childhood vaccinations.     

Diterpenes from "Pini Resina" and their preferential cytotoxic activity under nutrient-deprived condition

In the course of our search for anticancer agents based on a novel anti-austerity strategy, we found that the 70 % EtOH extract of "Pini Resina" showed 100 % preferential cytotoxicity at the concentration of 50 microg/mL. Further bioassay-guided fractionation and purification led to the isolation of 15 compounds including one new compound 7-oxo-13 alpha-hydroxyabiet-8(14)-en-18-oic acid (1). Their structures were elucidated on the basis of spectroscopic analysis. Among the isolated compounds, methyl abieta-8,11,13-trien-18-oate (7) showed the most potent preferential cytotoxicity at 10 microg/mL under nutrient-deprived condition.     

Predicting the outcome of patients with unexplained syncope undergoing prolonged monitoring

Patients with unexplained syncope are often considered candidates for prolonged monitoring or empiric pacing when noninvasive and invasive investigations fail to provide a diagnosis. Identifying the outcome of patients undergoing prolonged monitoring that would ultimately benefit from empiric pacing may permit a cost-effective approach to resolution of syncope. Two hundred and six patients (age 57 +/- 18 years, 57% male) underwent prolonged monitoring with an implanted loop recorder for syncope of unknown origin. The median number of previous syncopal episodes was four (mean 29 +/- 133). Prior tilt testing was performed in 63% of patients, and electrophysiological testing in 46%. Symptoms recurred during follow-up in 142 patients (69%). Recurrence was associated with bradycardia leading to pacemaker implantation in 35 patients (17.0%), tachycardia in 12 (5.8%), sinus rhythm in 63 (30.6%), neurally mediated syncope based on rhythm and clinical assessment in 22 (11%), and failed activation in 10 (5%). Logistic regression analysis of baseline variables found that age was the only independent variable that predicted the need for pacing, associated with a 3% increase in risk per advancing year of age (odds ratio 1.027, P = 0.026). Despite this finding, no age group could be identified in which the likelihood of requiring pacing exceeded 30%. Logistic regression also found that patients with structural heart disease were less likely to experience recurrent symptoms during monitoring (49% vs 78%, P = 0.001) and that advancing age was associated with earlier recurrence of symptoms (P = 0.01). The etiology of recurrent syncope is diverse and cannot be predicted by baseline clinical variables. Empiric pacing appears to have little role in the management of this patient population.     

Gene Therapy Strategies to Exploit TRIM Derived Restriction Factors against HIV-1

Restriction factors are a collection of antiviral proteins that form an important aspect of the innate immune system. Their constitutive expression allows immediate response to viral infection, ahead of other innate or adaptive immune responses. We review the molecular mechanism of restriction for four categories of restriction factors; TRIM5, tetherin, APOBEC3G and SAMHD1 and go on to consider how the TRIM5 and TRIMCyp proteins in particular, show promise for exploitation using gene therapy strategies. Such approaches could form an important alternative to current anti-HIV-1 drug regimens, especially if combined with strategies to eradicate HIV reservoirs. Autologous CD4⁺ T cells or their haematopoietic stem cell precursors engineered to express TRIMCyp restriction factors, and provided in a single therapeutic intervention could then be used to restore functional immunity with a pool of cells protected against HIV. We consider the challenges ahead and consider how early clinical phase testing may best be achieved.