Unusual sites of metastatic involvement: intracardiac metastasis from laryngeal carcinoma

Cardiac metastatic squamous cell laryngeal carcinoma is rare.We report the case of a 49-year-old man with recurrent squamouslaryngeal carcinoma presenting with right leg acute ischaemiaand large mobile right and left cardiac masses. The patienthas history of laryngeal squamous cell cancer surgically treatedwith total laryngectomy, thyroidectomy, and tracheostomy 2 yearsago. He was admitted to our intensive care unit with acute rightleg pain, left sided chest pain, hypotension 92/55, and tachycardia112 bpm. On physical exam, he had a faint pulse of his rightPosterior Tibial artery with a cold foot, but no discoloration.Heart sounds were normal with no murmur. Initial workup showeda Troponin of 0.27. An electrocardiogram showed sinus tachycardia,with inverted T waves in the Infero-lateral leads. Emergentsurgical thrombectomy was done on his right leg with restorationof arterial blood flow to the affected limb. An echocardiogramshowed a preserved left ventricular function with multiple areasof echogenic masses in all four cardiac chambers located atthe annulus of the tricuspid valve, the right ventricular freewall and along the inter-ventricular septum. No intracardiacshunt was detected by contrast study. Computed tomography scanof the heart confirmed the presence of multiple exophytic intracardiacmasses within the left atrium, the right ventricle, interventricularseptum, and lateral free wall of the left ventricle. Immunohistochemicalstaining with cytokeratin of the emboli was consistent withmalignant squamous cell carcinoma consistent with metastasesof his known laryngeal squamous cell cancer.     

Treatment of COVID‐19 with pentoxifylline: Could it be a potential adjuvant therapy?

The world is facing a viral pandemic of a new coronavirus called COVID‐19. Pentoxifylline is a methyl‐xanthine derivative and it inhibits the phosphodiesterase IV (PDE IV). This drug is known for its unique features as an immunomodulatory and anti‐inflammatory agent, also it could have antiviral affects. This is a scoping review, in which all related articles on COVID‐19 and the probable benefits of Pentoxifylline against COVID‐19 pathogenesis, in Medline, Scopus, Web of Sciences, and Google Scholar up to 20 March 2020 with proper keywords including: pentoxifylline, Pentoxil, COVID‐19, coronavirus, treatment, anti‐inflammatory, immunomodulatory, antifibrosis, oxygenation, circulation, bronchodilator, ARDS, and organ failure. We found many confirmatory data on proper efficacy of pentoxifylline on controlling COVID‐19 and its consequences. The antiviral, anti‐inflammatory, anti‐oxidative, immune‐modulatory, bronchodilator and respiratory supportive effects and protective roles in organ failures of PTX, along with its main functions means better circulation‐oxygenation properties, low price and safety, make it a promising drug to be considered for COVID‐19 treatment, especially as an adjuvant therapy in combination with other drugs.     

Clinical impact of circulating oncogenic MiRNA-221 and MiRNA-222 in glioblastoma multiform

Journal of Neuro-Oncology - Approach selection paradigm for tuberculum sellae meningiomas (TSMs) is still a point of discussion. The trans-eyebrow supraorbital keyhole approach (TSKA) is a...     

Identification of a region required for TSC1 stability by functional analysis of TSC1 missense mutations found in individuals with tuberous sclerosis complex

Background

Familial adenomatous polyposis (FAP) is an autosomal dominant-inherited colorectal cancer syndrome, caused by germline mutations in the APC gene. Recently, biallelic mutations in MUTYH have also been identified in patients with multiple colorectal adenomas and in APC-negative patients with FAP. The aim of this work is therefore to determine the frequency of APC and MUTYH mutations among FAP families from two Spanish populations.

Methods

Eighty-two unrelated patients with classical or attenuated FAP were screened for APC germline mutations. MUTYH analysis was then conducted in those APC-negative families and in 9 additional patients from a previous study. Direct sequencing, SSCP analysis and TaqMan genotyping were used to identify point and frameshift mutations, meanwhile large rearrangements in the APC gene were screened by multiplex ligation-dependent probe amplification (MLPA).

Results

APC germline mutations were found in 39% of the patients and, despite the great number of genetic variants described so far in this gene, seven new mutations were identified. The two hotspots at codons 1061 and 1309 of the APC gene accounted for 9,4% of the APC-positive families, although they were underrepresented in Galician samples. The deletion at codon 1061 was not found in 19 APC-positive Galician patients but represented 23% of the Catalonian positive families (p = 0,058). The same trend was observed at codon 1309, even though statistical analysis showed no significance between populations. Twenty-four percent of the APC-negative patients carried biallelic MUTYH germline mutations, and showed an attenuated polyposis phenotype generally without extracolonic manifestations. New genetic variants were found, as well as the two hotspots already reported (p.Tyr165Cys and p.Gly382Asp).

Conclusion

The results we present indicate that in Galician patients the frequency of the hotspot at codon 1061 in APC differs significantly from the Catalonian and also other Caucasian populations. Similar results had already been obtained in a previous study and could be due to the genetic isolation of the Galician population. MUTYH analysis is also recommended for all APC-negative families, even if a recessive inheritance is not confirmed.     

Fragmented QRS complex is an independent predictor of plaque burden in patients at intermediate risk of coronary artery disease

ObjectiveWe aimed to evaluate the relationship between fragmented QRS complex and plaque burden in patients presented with typical chest pain and deemed to have intermediate pretest probability of CAD using coronary computed tomography angiography (CCTA).MethodsWe studied electrocardiograms (ECGs) obtained from 172 subjects (47.5 ± 9.5 years, 125 were men) presented with chest pain and had intermediate pretest probability for CAD. The presence was found and evaluation of CAD was performed with CCTA.ResultsSeventy four (43%) of the study cohort had CCTA-documented CAD. Meanwhile the frequency of fQRS in our cohort was (57%). 70 (71.4%) patients with fQRS had CAD compared with only 4 (5.4%) patients without fQRS (p < 0.001). The number of leads with fQRs was correlated with the calcium score (p < 0.005), segment stenosis score, segment involvement score, total plaque score (TPS), and E/e ratio (p < 0.001, for all). Multivariate analysis demonstrated that fQRS was a strong independent predictor for CAD (or = 2.15, p < 0.001). ROC analysis showed that the number of leads ≥3 was the optimal number for predicting CAD (AUC = 0.89, sensitivity 88%, and specificity 83%, p < 0.001).ConclusionFragmented QRS was seen more often in patients with high plaque burden. We suggest that fQRS might provide a useful noninvasive prognosticator for subjects with intermediate pretest probability of CAD for further investigation.     

CLINICAL EFFECTIVENESS OF KINESIOLOGICAL TAPING ON PAIN AND PAIN‐FREE SHOULDER RANGE OF MOTION IN PATIENTS WITH SHOULDER IMPINGEMENT SYNDROME: A RANDOMIZED,DOUBLE BLINDED,PLACEBO‐CONTROLLED TRIAL

Background:

Kinesiological taping (KT) is commonly used to improve symptoms associated with musculoskeletal disorders. However, review of the literature revealed minimal evidence to support the use of KT in treatment of shoulder disorders and controversy exists regarding the effect of KT in patients with shoulder impingement syndrome (SIS).

Objective:

The purpose of this study was to investigate the effect of KT on pain intensity during movement, pain experienced during the night (nocturnal pain), and pain‐free shoulder range of motion (ROM) immediately after taping, after three days and after one week, in patients with SIS.

Design:

Randomized, Double blinded, Placebo‐controlled design.

Participants:

A total of 30 patients with SIS participated in this study. Patients were assigned randomly to a control (N = 15) and an experimental group (N = 15).

Methods:

The patients in the experimental group received a standardized therapeutic KT. The standardized, placebo neutral KT was applied for control group. KT was applied two times with a three day interval, remaining on during the 3 day interval. Both groups followed the same procedures. Pain‐free active ROM during shoulder abduction, flexion, and elevation in the scapular plane was measured. Visual analogue scale (VAS) for pain intensity during movement or nocturnal pain and was assessed at baseline, immediately after KT, after three days, and one week after KT.

Results:

The result of repeated measures ANOVA showed a significant change in pain level during movement, nocturnal pain, and pain‐free ROM (p = 0.000) after KT in the experimental group. In the ANCOVA, controlling for pre‐test scores, change in pain level at movement (p = 0.009) and nocturnal pain (p = 0.04) immediately after KT was significantly greater in the experimental group than in control group. There was no significant difference in ROM measures (p > 0.05) between groups immediately after KT. No significant differences were found between the two groups in the after one week measurements of pain intensity and shoulder ROM.

Conclusion:

The KT produces an immediate improvement in the pain intensity at movement and nocturnal pain in patients with SIS.

Level of Evidence:

1     

Balloon dilatation of critical stenosis of the pulmonary valve in neonates.

Percutaneous balloon dilatation was attempted in 15 consecutive neonates (mean age 7.3 (range 1-27) days and weight 3.2 (range 2.5-4.1) kg) with critical stenosis of the pulmonary valve. Dilatation was successful in 11 (73%) patients. The mean balloon to annulus ratio was 1.1 (range 0.6-1.77). The ratio of right ventricle to femoral artery systolic pressure decreased from a mean (1 SD) of 1.4 (0.32) before to 0.8 (0.24) after dilatation and the transvalvar gradient decreased from 81 (29.7) mm Hg before to 33 (27.7) mm Hg after dilatation. All four (27%) patients in whom dilatation was unsuccessful underwent surgical valvotomy. Complications of balloon dilatation occurred in three (20%) patients; these included retroperitoneal haematoma (one) and iliofemoral venous occlusion (two). In one (7%) patient severe hypoxia and hypotension developed when the valve was crossed with a guide wire and balloon catheter. Despite successful dilatation he died 7 days after the procedure. During a mean (1 SD) follow up of 2 (1.7) years, seven (64%) of the 11 patients remained free of important restenosis. One patient required repeat dilatation three weeks after the initial procedure. In three (27%) patients restenosis developed 4-9 months after dilatation and all three had surgical valvotomy. Of the four patients initially referred for surgery three required a second operation and one required balloon dilatation. Percutaneous balloon dilatation gave effective relief of critical pulmonary stenosis in most neonates but complications and restenosis requiring surgery were common.     

Dry Needling in myofascial tracks in Non-Relaxing Pelvic Floor Dysfunction: A case study

Objective

The aim of this case report is to describe the use of Dry Needling (DN) in myofascial tracks related to the pelvic floor (PF) in the management of a male with Non-Relaxing Pelvic Floor Dysfunction (NRPFD).