Imaging of Ventricular Septal Tumor in an Asymptomatic Adolescent using Multiple Modalities

Primary cardiac tumors are rare at all ages, and especially so in childhood, where the most prevalent type of benign cardiac masses are rhabdomyomas followed by fibromas, both of which have a predilection for ventricular septum. We report an unusual case of a tumor involving the ventricular septum in an asymptomatic 17-year-old adolescent who has been known to have this tumor for 10 years. The use of multiple imaging included myocardial contrast two-dimensional echocardiography, real time three-dimensional echocardiography (with and without myocardial contrast), and magnetic resonance imaging supported the diagnosis of cardiac rhabdomyoma.     

Femoral nerve injury complicating continuous psoas compartment block

OBJECTIVES: The objective of this case report is to describe a femoral nerve injury after a psoas compartment block (PCB) and to discuss the probable mechanisms of injury and neuron regeneration. To date, this is the first report of severe femoral nerve injury after PCB. CASE REPORT: A 60-year-old, American Society of Anesthesiologists II woman underwent right total knee replacement under general anesthesia and continuous PCB for postoperative analgesia. Postoperatively, she showed signs of severe femoral nerve injury. A physical therapy program and muscle electrical stimulation were instituted and continued for 6 months. The patient recovered completely with no residual motor or sensory deficit and had no other complication. CONCLUSIONS: Severe nerve injuries after regional anesthesia techniques remain infrequent and probably unreported. Our case report suggests that severe femoral nerve injury should be added to the list of reported complications during PCB. This case report is also encouraging because it shows the possibility of a good recovery after such injury.     

Beta-blocker therapy for dynamic left-ventricular outflow tract obstruction

BACKGROUND: In a small but significant group of elderly patients who present with breathlessness, dynamic left-ventricular outflow tract obstruction (DLVOTO) may be responsible for symptom generation. The aim of our study was to investigate the effect of beta-blockade on ventricular physiology and symptoms in patients with DLVOTO. METHODS: We performed a pilot study in 15 patients (age 76+/-10 years, mean+/-S.D., 14 female) with symptoms of exercise intolerance (New York Heart Association, NYHA, class 2.7+/-0.5). All patients had normal resting left ventricular (LV) systolic function together with DLVOTO based on the presence of basal septal hypertrophy and the development of high outflow tract velocities on stress echocardiography. All were commenced on oral atenolol (mean dose 45+/-19 mg), but this could not be tolerated in four patients due to a deterioration in clinical status. RESULTS: In the remaining 11 patients who could tolerate atenolol therapy, the rate pressure product was significantly lower (23%, P=0.028) and there was a marked reduction in LV outflow tract velocity (23%, P=0.001) following beta-blockade. Patient symptoms improved significantly following atenolol therapy, with a reduction in mean NYHA class from 2.8+/-0.4 to 1.5+/-0.5 (P<0.0001). CONCLUSIONS: Beta-blockade may represent a beneficial therapeutic approach in selected patients with DLVOTO as identified by stress echocardiography.     

Haematological manifestations of childhood brucellosis

Summary Very few data on the frequency and diversity of haematological abnormalities occurring in brucellosis in children have been reported. In the present study 110 children (56 boys and 54 girls; age range, 2 months to 14 years) with proven brucellosis were investigated to determine the haematological changes during the active course of this infection. Anaemia was detected in 48 (44%) patients, of whom four had evidence of haemolysis. Leukopenia occurred in 33% of the cases, with neutropenia and/or lymphopenia being the most striking features encountered. Thrombocytopenia was found in six (5%) patients and pancytopenia in 15 (14%) patients, of whom one developed disseminated intravascular coagulation. Clinically detectable bleeding occurred in five (4.5%) patients whose platelet counts were significantly low. Hypersplenism, haemophagocytosis and granulomatous lesions of the bone marrow appear to play a fundamental role in producing these abnormalities of the peripheral blood. Brucellosis may be considered in patients whose blood picture reveals haemolytic anaemia, leukopenia, thrombocytopenia or pancytopenia, particularly when the disease is epidemiologically suspected.

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Hämatologische Manifestationen der Brucellose im Kindesalter

Zusammenfassung Zur Häufigkeit und Vielfalt pathologischer hämatologischer Befunde bei Brucellose im Kindesalter liegen nur wenige Berichte vor. Die folgende Studie umfaßt 110 Kinder (56 Knaben, 54 Mädchen im Alter von 2 Monaten bis 14 Jahren) mit gesicherter Brucellose, bei denen die hämatologischen Veränderungen während des akuten Krankheitsverlaufes verfolgt wurden. Bei 48 Kindern (44%) trat eine Anämie, in vier Fällen mit Zeichen der Hämolyse auf. Bei 33% der Patienten bestand eine Leukopenie mit Neutropenie und/oder Lymphopenie. Sechs Patienten (5%) hatten eine Thrombozytopenie und 15 (14%) eine Panzytopenie, in einem Fall mit diffuser intravaskulärer Gerinnung, entwickelt. Bei fünf Kindern mit niedrigen Thrombozytenzahlen traten Blutungen auf. Für die Entstehung der Veränderungen im peripheren Blut sind im wesentlichen Hypersplenismus, Hämophagozytose und granulomatöse Läsionen im Knochenmark verantwortlich. Bei Patienten mit hämolytischer Anämie, Leukopenie, Thrombozytopenie oder Panzytopenie sollte an eine Brucellose gedacht werden, vor allem wenn eine entsprechende epidemiologische Situation besteht.

     

Epidemiology of oral cancer in Arab countries

Objectives:

To review the oral cancer (OC) studies that were conducted in Arab countries with regard to epidemiology, risk factors, and prognosis.

Methods:

A computer-based PubMed literature search was performed to retrieve studies conducted in the Arab world on epidemiology of OC. After screening for exclusion criteria, cross-referencing, and searching local journals, a total of 19 articles were included.

Results:

Eight prevalence studies found an OC prevalence ranging from 1.8 to 2.13 per 100,000 persons. Oral cancer patients were mostly in their fifth to sixth decade of life, and the incidence in younger age was reported in some Arab countries. Yemenis have an alarming high prevalence of OC among people younger than 45 years. Eleven studies explored determinants or prognosis of OC. Behavioral determinants such as smokeless tobacco (Shamma and Qat), and cigarette smoking were strongly associated with OC. Alcohol drinking and solar radiation exposures were cited as possible risk factors. The most affected sites were tongue, floor of the mouth, and lower lip variations in the affected site were attributed to the socio-cultural behavior of the populations under study. Squamous cell carcinoma was the most frequently detected cancer, and usually patients were in late stages (III and IV) at the time of diagnosis.

Conclusion:

No solid evidence exists regarding the true OC prevalence/incidence in most Arab countries due to the lack of national cancer registries and population-based studies.Oral cancer (OC) is defined as a neoplasm involving the oral cavity, which begins at the lips and ends at the anterior pillars of the fauces.1 Globally, OC is reported to be the eighth most commonly diagnosed cancer with an annual incidence of >300,000 cases.2 Incidence and mortality of OC are higher in developing countries when compared with developed countries.2,3 Global prevalence of OC shows wide variation in the geographical distribution. For instance, OC prevalence in the Indian subcontinent was 25% of all new cancer cases.4 A noticeable increase in the prevalence of OC was noted in some industrial countries (namely, UK, Netherlands, and Denmark)5,6 whereas other industrial countries (namely, Germany, France, Italy, Hong Kong, and USA) reported a decrease in the prevalence of OC.7 In 2010, the World Health Organization (WHO) reported an OC mortality rate of approximately 2 per 100,000 in the Middle East, which is lower than that reported in India and the United States.8 Squamous cell carcinoma (SCC) comprises 90-95% of all OC malignancies. In oral squamous cell carcinoma (OSCC), regional metastasis is prevalent in at least 30% of cases.9 It develops mainly between the sixth and the seventh decades of life and occurrence in younger people (<40 years old) is rare.10,11 Oral squamous cell carcinoma accounts for 4 of all malignancies in male and 2% in female.12 Higher proportions of OSCC, in addition to an alarming rise in incidence among young people are being documented worldwide.5,13 The most frequently affected sites of OC in Western countries are ventro-lateral aspects of the tongue and floor of the mouth, accounting for more than 50% of cases.12 Conversely, in the southeastern part of the Asian continent, OC is significantly higher in buccal and commissural mucosa. This was attributed directly to the use of unrefined topical tobacco, being chewed or kept in the mouth for long periods.14 The etiology of OC is multi-factorial comprising genetic, social, behavioral, and environmental risk factors. The major etiologic factors in the genesis of OC are tobacco chewing and/or smoking, and alcohol consumption.15 Human papillomaviruses (HPVs) have been considered as etiologic agents, particularly in OC with no tobacco or alcohol association.16 Potentially malignant disorders often precedes OSCC, and those showing features of moderate or severe epithelial dysplasia carry the highest risk for malignant transformation.17The greatest challenge is that OC is not detected early enough for successful treatment, despite the fact that OC is mostly a visible lesion. Most dentists or general medical practitioners misdiagnose OC for more innocent lesions that show similar clinical appearance.18 The aim of this article is to summarize the OC studies that were conducted in the Arab countries in regard to epidemiology, risk factors, and prognosis.