Leukemoid reaction: a diagnostic clue in metastatic carcinoma mimicking classic Hodgkin lymphoma

We report on 2 patients who were initially suspected to have classic Hodgkin lymphoma because of lymphadenopathy and the presence of Reed-Sternberg-like cells. Both patients had an associated leukemoid reaction (using a threshold leukocyte count of 50 000/microL) and were eventually diagnosed with metastatic carcinoma. Disseminated carcinoma can mimic Hodgkin lymphoma clinically, radiologically, and histologically. Reed-Sternberg-like cells may be found in carcinomas, and they represent a particularly challenging diagnostic pitfall for the unwary. When these cells lead to a suspicion of Hodgkin lymphoma, the presence of a leukemoid reaction should prompt the pathologist to question the diagnosis. Misdiagnosis can be avoided by the use of cytokeratin whenever a leukemoid reaction is present in a suspected case of Hodgkin lymphoma.     

Growth rate and sister chromatid exchange (SCE) incidence of bone marrow cells in Acute Myeloblastic Leukemia (AML)

The sister chromatid exchange (SCE) incidence and growth kinetics have been studied by means of an in vitro bromodeoxyuridine (BrdU) chromosome labeling method in the bone marrow cells of 17 acute myeloblastic leukemia (AML) patients with only diploid cells at diagnosis, remission, and relapse of the disease. At diagnosis, the cells tended to exhibit a low SCE frequency as compared to that during remission. An increased SCE frequency was observed after chemotherapy during remission or relapse. At diagnosis and relapse, when leukemic blast cells predominated in the marrow, they were characterized by the predominance of cells that had undergone only one cell cycle after BrdU exposure. In contrast, the marrow cells during remission tended to resemble the control pattern of growth kinetics, with a predominance of cells undergoing second and third cell cycles in the presence of BrdU. These results suggest that the growth rate of leukemic and nonleukemic cells is different, and that chemotherapy can cause an increased SCE frequency in the marrow cells of AML patients irrespective of the state of the disease.     

Body Fat Moderates the Association of Olfactory Dysfunction with Dietary Intake in U.S. Middle-Aged and Older Adults: A Cross-Sectional Analysis of NHANES 2013–2014

Background: Obesity relates to impaired olfactory function. Abnormal olfactory function is also associated with poor diet; however, whether obesity-related markers shape this relationship is unknown. Methods: Cross-sectional analysis (n = 1415, age > 40 years) of NHANES 2013–2014 examined body fat percent (BF%) and waist circumference (WC) as moderators of the relationship between olfactory function and diet. The olfactory function test identified adults with olfactory dysfunction (OD) or normal olfaction (NO). Validated 24 h recall captured nutrient intake and Healthy Eating Index-2010 scores. BF% and WC were measured. We tested adjusted linear regression models, with an interaction term between olfactory function and BF%/WC, for each nutrient or HEI score, and reported coefficients (β), standard errors (SE), and p-values for significant interaction terms. Results: In OD (9.5%; mean age 50.9 years, 95% CI 49.6, 52.2) compared with NO (mean age 49.3 years, 95% CI 48.8, 49.9), higher BF% was associated with higher intake of saturated fat (β (SE): 0.2 (0.1) g; p = 0.06) and percent of total calories from total fat (0.2 (0.1); p = 0.07), saturated (0.1 (0.004); p = 0.02), and monounsaturated fat (0.1 (0.1); p = 0.08); lower percent of total calories from carbohydrates (−0.2 (0.1); p = 0.09) and mg of sodium (−17.8 (09.6); p = 0.08); and a higher (healthier) refined grain score (0.1 (0.1); p = 0.04). Higher WC was associated with higher refined grain scores (0.01 (0.02); p = 0.01) in OD. Conclusion: BF% may shape dietary intake and quality in OD. Longitudinal studies are needed to elucidate the directionality of these relationships and develop strategies to improve dietary intake among OD.     

MRI of female urethra and periurethral pathologies

Introduction and hypothesis

Accurate diagnosis of a wide spectrum of urethral/periurethral pathologies in women remains challenging due to its anatomical location and nonspecific clinical presentations. Magnetic resonance imaging (MRI) has emerged as the modality of choice for diagnosing female urethral and periurethral pathologies due to its multiplanar scanning capability, superior soft tissue differentiation, noninvasive nature, and overall excellent contrast resolution.

Methods

In this narrative review, we describe the use of MRI to visualize the female urethra and periurethral pathologies.

Results

MRI can confidently characterize lesions into cystic or solid, provide a more succinct differential diagnosis, and in some cases provide a specific and accurate diagnosis, enabling surgeons to prepare a roadmap before operative procedure. Moreover, functional MRI can be useful to assess dynamic disorders such as urethral hypermobility.

Conclusions

We provide a comprehensive review of normal MR anatomy of the female urethra, as well as the MR features of practically important urethral and periurethral lesions.

     

Chemotaxonomic Studies on Centella asiatica (L.) Urb. from Varied Phytogeographical Conditions of India for Its Industrial Prospection

Proceedings of the National Academy of Sciences, India Section B: Biological Sciences - Centella asiatica (L.) Urb. (Apiaceae) with high commercial value is an important herb in traditional Indian...     

Recalcitrant hypertrophic herpes genitalis in HIV‐infected patient successfully treated with topical imiquimod

Herpes Simplex Virus type 2 is the primary cause of genital ulceration worldwide. The presence of atypical features like deep ulcerations, hypertrophic, or pseudotumoural lesions or unusual location can be a marker for co‐infection with HIV. These immunocompromised patients are usually resistant to the conventional antiviral treatment. We present a case of an HIV‐infected patient with hypertrophic herpes genitalis, refractory to conventional oral antiviral therapy, who was successfully treated with a combination of oral valcyclovir and topical application of 5% imiquimod.     

Clinical study of the recurrent flaps of the arm for resurfacing of elbow defects

Defects around the elbow region are often irregular with exposed nerves, tendons, bones/joint, and implants. Skin grafts, though possible in some cases, must be avoided, as it requires prolonged splintage and physiotherapy to prevent recurrence and elbow stiffness. Distant flaps require multiple stages, and free flaps are rarely indicated for elbow defects. Muscle flaps are bulky. To overcome these problems, distally based fasciocutaneous flaps from medial and lateral sides of the arm based on posterior ulnar recurrent artery and radial recurrent artery, respectively, were used. Ten patients were studied. Age of the patients ranged from 10 to 40 years. Five were male, and five were female. Radial and ulnar recurrent flaps were used in five patients each. The largest flap size was 18 × 8 cm, and the smallest was 10 × 6 cm. The flaps were islanded in four cases, and in six cases, they were used as pedicled flaps. Skin grafts were used in 90% of the patients because large flaps were required for resurfacing; also, our patients had thinner arms with less girth. All flaps survived well. One island flap had venous congestion and marginal necrosis, which eventually healed. A significant improvement of mobility and elbow movement was noted in all patients. These flaps can be raised even from the previously burnt skin, as the pedicle is located deep. These flaps have the following advantages: The flap is reliable (deeply located consistent vascular pedicle), can cover both the flexor and extensor surface of the elbow joint, avoids prolonged splintage, elbow stiffness, and recurrence, good aesthetic, and has functional results.     

Platelets and antiplatelet therapy in patients with diabetes mellitus

Atherosclerotic heart disease is the leading cause of death in patients with diabetes mellitus. Platelets play a major role in the clinical manifestations of ischemic heart disease. Diabetic patients have hyperreactive platelets with exaggerated adhesion, aggregation and thrombin generation. Antiplatelet agents, including aspirin, clopidogrel, and glycoprotein IIb/IIIa inhibitors, have shown significant efficacy in reducing recurrent ischemic events in patients with diabetes. Treatment with glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention reduces mortality in diabetic patients.