Giant GIST of the Small Intestine in a Young Man

Gastrointestinal stromal tumors (GISTs) represent a rare group of neoplasms of the digestive tract deriving from the mesenchyme. Giant GISTs (over 10 cm in diameter) represent only 20 % of all cases and are associated with a high risk of malignancy. We present the case of a giant GIST of the jejunum successfully treated by surgical resection and adjuvant therapy with imatinib.     

Budesonide and formoterol inhibit inflammatory mediator production by bronchial epithelial cells infected with rhinovirus

Background Rhinoviruses (RVs) are responsible for the majority of acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations. RVs infect the lower airways and induce the production of pro-inflammatory and remodelling-associated mediators. Budesonide (BUD) and formoterol (FORM) synergize in controlling asthma and COPD exacerbations; however, their effects on virus-induced inflammation and remodelling are less known.
Objective We investigated whether BUD and FORM synergize in suppressing RV-induced inflammation and remodelling in the airways.
Methods In vitro models of RV infection of BEAS-2B and primary normal human bronchial epithelial (NHBE) cells were used. We assessed the effects of individual and combined drugs administered post-infection, at a clinically relevant concentration range (10⁻⁶–10⁻¹⁰  m ), on the production of CCL5, CXCL10, CXCL8, IL-6 and the remodelling-associated VEGF and bFGF, using ELISA and RT-PCR.
Results BUD effectively suppressed RV-mediated induction of all mediators studied, in a concentration-dependent manner. FORM alone suppressed the production of CXCL8 and bFGF. The combination of BUD and FORM had concentration-dependent, additive or synergistic effects in the suppression of RV-induced CCL5, CXCL8 and CXCL10 in both cell types as well as VEGF in NHBE only. Combination treatment also resulted in an enhanced suppression of RV-induced IL-6, and CCL5 at the mRNA level as compared with BUD or FORM alone.
Conclusion BUD and FORM suppress RV-induced chemokines and growth factors in bronchial epithelial cells in a concentration-dependent, synergistic or additive manner. These data further support the combined use of BUD and FORM in asthma and COPD and intensification of this therapy during exacerbations.     

Retained surgical sponges: what the practicing clinician should know

Retained surgical sponges (RSS) are an avoidable complication following surgical operations. RSS can elicit either an early exudative-type reaction or a late aseptic fibrous tissue reaction. They may remain asymptomatic for long time; when present, symptomatology varies substantially and includes septic complications (abscess formation, peritonitis) or fibrous reaction resulting in adhesion formation or fistulation into adjacent hollow organs or externally. Plain radiograph may be useful for the diagnosis; however, computed tomography is the method of choice to establish correct diagnosis preoperatively. Removal of RSS is always indicated to prevent further complications. This is usually accomplished by open surgery; rarely, endoscopic or laparoscopic removal may be successful. Prevention is of key importance to avoid not only morbidity and even mortality but also medicolegal consequences. Preventive measures include careful counting, use of sponges marked with a radiopaque marker, avoidance of use of small sponges during abdominal procedures, careful examination of the abdomen by the operating surgeon before closure, radiograph in the operating theater (either routinely or selectively), and recently, usage of barcode and radiofrequency identification technology.     

Prevalence of impacted teeth in a Greek population

Aim: Τo determine the prevalence of impacted teeth in an adult Greek population, according to type, sex, and age. Methods: The major source of data for this study was the orthopantomographic films and the physical examinations of 425 patients (202 males and 223 females) with impacted teeth. The elements that were examined and processed were relevant to the age, sex, total number of impacted teeth, and the type and frequency of impaction of each tooth. Moreover, the associated pathology, if any, of the impacted tooth was recorded. Results: A total of 152 patients (35.8%) had one impacted tooth, 134 patients (31.5%) had two impacted teeth, and 139 patients (32.7%) had three or more impacted teeth; 777 (82.7%) impacted teeth revealed associated pathology. Conclusions: The third molars revealed the highest frequency of impaction (P < 0.001); the number of impacted teeth of the mandible was larger than that of the maxilla (P < 0.001), and the number of impacted anterior teeth in the maxilla was larger than that in the mandible (P < 0.001). Cases of impacted posterior teeth were more numerous than anterior teeth (P < 0.001). The majority of patients revealed pathological signs, which dictated the surgical removal of the impacted tooth/teeth.     

Use of the excimer laser in stapes surgery and ossiculoplasty of middle ear ossicles: preliminary report of an experimental approach

Surgery of the stapes may cause a number of complications, including hearing deficits and balance disorders. This has made it necessary to look for improved techniques. Small-fenestra stapedotomy has recently been popularized. Lasers have been advocated for use in fenestrating the stapes footplate. On the other hand, sculpting the middle ear ossicles during tympanoplasty is often necessary for the reconstruction of the ossicular chain and the improvement of sound conduction. Using an excimer laser with a wavelength of 193 nm, fenestrations of the footplate and ossicular sculpting were performed on ossicles obtained during ear surgery and from human cadaver temporal bones. The results indicate that the excimer laser can be used effectively and accurately on an experimental basis and that further research is needed before this method can be used for clinical purposes.     

DNA testing for fragile X syndrome in schools for learning difficulties

Fragile X syndrome is the most common inherited cause of mental retardation. Early diagnosis is important not only for appropriate management of individuals but also to identify carriers who are unaware of their high risk of having an affected child. The disorder is associated with a cytogenetically visible fragile site (FRAXA) at Xq27.3, caused by amplification of a (CGG)n repeat sequence within the gene at this locus designated FMR1. Clinical and molecular studies have been undertaken to screen for fragile X syndrome in 154 children with moderate and severe learning difficulties of previously unknown origin. Southern blot analysis of peripheral blood showed the characteristic abnormally large (CGG)n repeat sequence associated with fragile X syndrome in four of the 154 children. The findings were confirmed by cytogenetic observation of the fragile site and by further molecular studies. The families of the affected children were offered genetic counselling and DNA tests to determine their carrier status. These findings show that there are still unrecognised cases of fragile X syndrome. Given the difficulty of making a clinical diagnosis and the implications for families when the diagnosis is missed, screening in high risk populations may be justified. The issues involved in screening all children in special schools for fragile X syndrome are discussed.     

Modified technique of percutaneous dilational tracheostomy in 600 cases

Tracheostomy is frequently required for the treatment of critically ill patients to prevent the complications with prolonged translaryngeal intubation. It may facilitate airway suctioning and improve patient comfort during the process of weaning. The purpose of the study was to introduce a new modified technique for percutaneous dilational tracheostomy (MPDT) and assess its advantages. From November 1997 through December 2000, a series of 600 patients (350 men, 250 women; mean age 44.5 years) underwent MPDT in our department. The technique we used is a combination of the Seldinger and Schachner techniques with an incision of 2 to 3 cm between the cricoid cartilage and the notch. Using a small automatic retractor, the thyroid muscles were dissected with the help of a curved mosquito clamp. This gave us the opportunity to control the isthmus and offered the possibility of ligation when the thyroid was large, providing a good operative field directly on the trachea. Hence we avoided traumatizing the isthmus, which is the main source of hemorrhage during this procedure. The mean operating time was 4.5 minutes. The morbidity rate was 0.04%. One patient developed a subcutaneous emphysema and in three cases we had to ligate the external jugular vein. The surgical incision was completely healed within 3 to 4 days after removing the tracheostoma. No tracheal stenoses were observed during the follow-up. MPDT is a safe, applicable technique that can be performed quickly even by a nonsurgeon in the intensive care unit and emergency department, with a low risk of complications because there is a direct view of the trachea and minimal trauma.