Epstein-Barr virus-associated smooth muscle tumors in immunocompromised patients: Six case reports

BACKGROUNDEpstein-Barr virus associated smooth muscle tumor (EBV-SMT) is a rare oncological entity. However, there is an increasing incidence of EBV-SMTs, as the frequency of organ transplantation and immunosuppression grows. EBV-SMT diagnosis relies on histopathology and immunochemical staining to distinguish it from post-transplant lymphoproliferative disorder (PTLD). There is no clear consensus on the treatment of EBV-SMTs. However, surgical resection, chemotherapy, radiation therapy, and immunosuppression reduction have been explored with varying degrees of success. CASE SUMMARYOur case series includes six cases of EBV-SMTs across different age groups, with different treatment modalities, adding to the limited existing literature on this rare tumor. The median latency time between immunosuppression and disease diagnosis is four years. EBV-SMTs present with variable degrees of aggressiveness and seem to have worse clinical outcomes in patients with tumor multiplicity and worse immunocompetency.CONCLUSIONIt is imperative to continue building on this knowledge and keeping EBV-SMTs on the differential in immunocompromised individuals.     

Degenerative scoliosis and stenosis—Surgical management

Adult degenerative scoliosis affects the growing elderly population and is an expanding challenge for spine surgeons. The etiology and natural history of this disease are imperfectly understood; however, it is accepted that degenerative spinal curvature is likely to progress. Severe deformity, particularly in the sagittal plane, is poorly tolerated. Treatment is complicated in this population where comorbid or mimicking diseases are the norm. Where appropriate, surgery is undertaken only after a thorough assessment of each patient’s spinal geometry. Guidelines aid in selecting among or combining surgical procedures. Increased potential for correction generally involves increased risk. Complications are common after surgery for adult degenerative scoliosis and their management should be anticipated.     

Isolated primary squamous cell carcinoma of the tympanic membrane

INTRODUCTIONPrimary squamous cell carcinoma (SCC) of the tympanic membrane is exceptionally rare. We describe the history, investigation and management of this disease.PRESENTATION OF CASEA 68-year-old woman presented with a three month history of intermittent otorrhoea and external ear canal (EAC) pruritus. Otoscopy revealed a polypoidal granular nodule, confined to the posterior aspect of the tympanic membrane. Examination under anaesthesia (EUA) confirmed that the lesion was confined to the tympanic membrane, with a surrounding rim of normal drum. Biopsies were consistent with well differentiated SCC.DISCUSSIONFollowing discussion at multi-disciplinary team meeting for treatment planning, the patient underwent lateral temporal bone resection with ipsilateral superficial parotidectomy and selective neck dissection. Post-operative histology confirmed an SCC confined to the tympanic membrane.CONCLUSIONSCC of the tympanic membrane is an extremely rare condition. As with early temporal bone SCC, surgical resection with adjacent structure clearance remains the primary treatment modality.     

Social Adjustment of Women With and Without a Substance-Abusing Partner

Little normative information is available about the psychosocial functioning of women who have a substance-abusing intimate partner. This study examined whether the social adjustment of women who indicate that they have a substance-abusing partner (n=69) is compromised relative to that of women who indicate that their partner does not abuse substances (n=68). Women with a substance-abusing partner reported compromised social adjustment relative to a comparison sample both overall and in five of six life domains (work, social/leisure, primary relationship, parental, family). Results suggest the potential benefit of expanding the focus of research and treatment to include effects and outcomes for these women and to influence treatment-related policy.     

Racquetball Injuries

It doesn't take a lot of skill to play racquetball and benefit from the excellent exercise it provides. Most of the injuries can be prevented if safety precautions are observed.     

The effect of glucosamine and/or chondroitin sulfate on the progression of knee osteoarthritis: a report from the glucosamine/chondroitin arthritis intervention trial

OBJECTIVE: Osteoarthritis (OA) of the knee causes significant morbidity and current medical treatment is limited to symptom relief, while therapies able to slow structural damage remain elusive. This study was undertaken to evaluate the effect of glucosamine and chondroitin sulfate (CS), alone or in combination, as well as celecoxib and placebo on progressive loss of joint space width (JSW) in patients with knee OA. METHODS: A 24-month, double-blind, placebo-controlled study, conducted at 9 sites in the United States as part of the Glucosamine/Chondroitin Arthritis Intervention Trial (GAIT), enrolled 572 patients with knee OA who satisfied radiographic criteria (Kellgren/Lawrence [K/L] grade 2 or grade 3 changes and JSW of at least 2 mm at baseline). Patients with primarily lateral compartment narrowing at any time point were excluded. Patients who had been randomized to 1 of the 5 groups in the GAIT continued to receive glucosamine 500 mg 3 times daily, CS 400 mg 3 times daily, the combination of glucosamine and CS, celecoxib 200 mg daily, or placebo over 24 months. The minimum medial tibiofemoral JSW was measured at baseline, 12 months, and 24 months. The primary outcome measure was the mean change in JSW from baseline. RESULTS: The mean JSW loss at 2 years in knees with OA in the placebo group, adjusted for design and clinical factors, was 0.166 mm. No statistically significant difference in mean JSW loss was observed in any treatment group compared with the placebo group. Treatment effects on K/L grade 2 knees, but not on K/L grade 3 knees, showed a trend toward improvement relative to the placebo group. The power of the study was diminished by the limited sample size, variance of JSW measurement, and a smaller than expected loss in JSW. CONCLUSION: At 2 years, no treatment achieved a predefined threshold of clinically important difference in JSW loss as compared with placebo. However, knees with K/L grade 2 radiographic OA appeared to have the greatest potential for modification by these treatments.