Solitary fibrous tumor of the lung

Solitary fibrous tumors are mesenchymal entities integrated in a mixed group of hemangiopericytoma-like neoplasms. Although classically presented as a pleura-based mass, there are extrapleural sites including the lung. We present the clinical, imaging, and histological features of a solitary fibrous tumor of the lung.     

Gunshot and blast injuries of the extremities: a review of 45 cases

European Journal of Orthopaedic Surgery & Traumatology - Gunshot wounds and blast injuries constitute a major public health problem, as the increasing availability of firearms and explosives in...     

Outbreak Caused by an Ertapenem-Resistant,CTX-M-15-Producing Klebsiella pneumoniae Sequence Type 101 Clone Carrying an OmpK36 Porin Variant

Although numerous studies have documented outbreaks of carbapenem-resistant Klebsiella pneumoniae (CRKP) possessing various carbapenemases, reports on outbreaks due to CRKP possessing extended-spectrum β-lactamases (ESBLs) and/or AmpCs with porin lesions have been limited. Here, we describe an outbreak caused by an ertapenem-resistant, CTX-M-15-producing clonal K. pneumoniae strain expressing an OmpK36 porin variant. From May 2012 to November 2012, 37 ertapenem-resistant K. pneumoniae isolates phenotypically negative for carbapenemase production were recovered from 19 patients hospitalized in the intensive care unit of a Greek hospital. The isolates were either susceptible or intermediate to other carbapenems and resistant to all remaining β-lactams but cefotetan. Phenotypic and molecular analysis revealed the presence in all isolates of the bla_CTX-M-15 gene on a conjugative 100-kb plasmid, disruption in the expression of the ompK35 gene, and the production of an Ompk36 porin variant. The index case was a patient admitted from another hospital. Active surveillance upon admission and on a weekly basis was immediately initiated; environmental samples were also periodically tested. Molecular typing showed that all clinical isolates as well as two ertapenem-resistant environmental K. pneumoniae isolates belonged to the same clonal type and were assigned to multilocus sequence typing (MLST) sequence type 101 (ST101). As all colonized/infected patients were hospitalized during overlapping periods, cross-infection was considered the main route for the dissemination of the outbreak strain. Despite reinforcement of infection control measures and active surveillance, the outbreak lasted approximately 7 months. Identification of hidden carriers upon admission and by screening on a weekly basis was found valuable for early recognition and subsequent successful management of the outbreak.     

Volume matters: The influence of different botulinum toxin‐A dilutions for sialorrhea in amyotrophic lateral sclerosis

Introduction: We aimed to determine the effect of different botulinum toxin‐A (BTX‐A) dilutions on the treatment efficacy and side effects for amyotrophic lateral sclerosis (ALS) related sialorrhea. Methods: Ten patients were enrolled in the study. BTX‐A dilution for Group A was 100 U in 1 ml of saline, whereas the dilution for Group B was 100 U in 2 ml of saline. Both groups received 20 U of BTX‐A in each parotid gland, and assessments were made by means of the Drooling Impact Scale, items 1 and 3 of the ALS functional rating scale, and visual analog scales for drooling and swallowing function. Results: Although both groups exhibited a similar improvement in drooling, Group B had a mild but significant deterioration in bulbar function that was not evident in Group A. Conclusions: These results suggest that BTX‐A has a safer profile when reconstituted with 1 ml instead of 2 ml of saline. Muscle Nerve, 2013     

Multiple quantitative trait loci for blood pressure interacting epistatically and additively on Dahl rat chromosome 2

Our previous work demonstrated 2 quantitative trait loci (QTLs), C2QTL1 and C2QTL2, for blood pressure (BP) located on chromosome (Chr) 2 of Dahl salt-sensitive (DSS) rats. However, for a lack of markers, the 2 congenic strains delineating C2QTL1 and C2QTL2 could not be separated. The position of the C2QTL1 was only inferred by comparing 2 congenic strains, one having and another lacking a BP effect. Furthermore, it was not known how adjacent QTLs would interact with one another on Chr 2. In the current investigation, first, a critical chromosome marker was developed to separate 2 C2QTLs. Second, a congenic substrain was created to cover a chromosome fragment thought to harbor C2QTL1. Finally, a series of congenic strains was produced to systematically and comprehensively cover the entire Chr 2 segment containing C2QTL2 and other regions previously untested. Consequently, a total of 3 QTLs were discovered, with C2QTL3 located between C2QTL1 and C2QTL2. C2QTL1, C2QTL2, and C2QTL3 reside in chromosome segments of 5.7 centiMorgan (cM), 3.5 cM, and 1.5 cM, respectively. C2QTL1 interacted epistatically with either C2QTL2 or C2QTL3, whereas C2QTL2 and C2QTL3 showed additive effects to each other. These results suggest that BP QTLs closely linked in a segment interact epistatically and additively to one another on Chr 2.     

The clinical significance of non-malignant neutropenia in hospitalized children

Neutropenia in non-cancer patients is often discovered in the course of an evaluation for acute infection, and it is usually secondary to the infection itself rather than a predisposing factor of the infection. Although it is not a common finding in hospitalized pediatric patients, it causes a great concern to the treating physicians. The aim of this study was to determine the incidence, the etiology, and the clinical significance of neutropenia in previously healthy children admitted in a general pediatric ward. One thousand five hundred and forty-eight patients admitted during a period of 18 months were included in the study. The clinical characteristics, the complete blood count, and the sedimentation rate were recorded. A total of 143 (9.2%) pediatric patients were identified as neutropenic, with mean absolute neutrophilic count of 0.960 × 10⁹/l (SD 0.341 × 10⁹/l) and ranged from 0.200 to 1.499 × 10⁹/l. The neutropenic patients had lower hemoglobin of 11.2 mg/dl and ranged from 6.2 to 17.2 mg/dl compared to hemoglobin of 11.5 mg/dl, which ranged from 5.2 to 18.0 mg/dl of the individuals with normal neutrophils, p < 0.0001 and lower mean platelet count of 294 × 10⁹/l, which ranged from 122 to 929 × 10⁹/l compared to platelet count of 381 × 10⁹/l, which ranged from 90–165 × 10⁹/l of the individuals without neutropenia, p < 0.001. Additionally, those patients were significantly younger than the non-neutropenic ones. Infection was the most common cause of neutropenia, although none of them developed septicemia. The neutrophil count normalized in most of the patients before discharge. However, 12 (8.3%) of neutropenic patients were discharged with persistent findings. Two of those were finally diagnosed with autoimmune neutropenia. In conclusion, the acquired neutropenia in hospitalized patients without malignancy is mild to moderate. It has no influence on the clinical outcome. Importantly, it has short duration, and it is usually resolved before patient’s discharge.