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Secondary Mesenteric Panniculitis as a Paraneoplastic Syndrome: An Updated Review
Mónica García-Fernández,
María Dolores Jover-Ríos,
Pedro Esteve-Atiénzar,
Juan Méndez-Mora,
Alex Méndez-Jover,
Sonia Cascant-Pérez,
Francisco Caparrós-Hernández,
Carmen Seguí-Pérez,
Marc Seguí-Pérez,
Lidia Ramírez-Utrero,
Carles García-Cervera,
Juan Manuel Núñez-Cruz,
David Bonet-Tur,
Sara Bañón-Escandell,
Pablo Roig-Rico,
Jorge Peris-García,
Asunción Pérez-Fullana,
José Miguel Seguí-Ripoll
Issue:
Volume 7, Issue 6, November 2019
Pages:
141-146
Received:
12 August 2019
Accepted:
6 September 2019
Published:
24 October 2019
Abstract: In response to the case of a patient with mesenteric panniculitis (MP) and proliferative disease, we reviewed the literature on their possible association and associations with other neoplasms. MP is a non-specific chronic inflammation of the mesenteric fat, with low prevalence and unknown etiology; patients may be asymptomatic or present predominantly gastrointestinal complaints. The disease can be either primary or secondary to other pathologies, including neoplastic ones. Diagnosis is made via computed tomography (CT) and confirmed by biopsy. Currently, there is no established treatment for MP. The literature contains series of variable sample sizes, case reports, reviews of other published studies, and some series after a 5-year follow-up. Papers tend to be relatively consistent when it comes to prevalence data and clinical manifestations. However, there is still controversy regarding the role that secondary MP could play in a paraneoplastic picture. From the diagnostic point of view, the incorporation and use of positron emission tomography (PET), together with CT, has been helpful for the approach and the diagnostic focus in this field. Nevertheless, its usage and the discrimination cut point between inflammatory pathology and tumor pathology (maximum standard uptake value: SUVmax) are not clearly defined in neoplastic cases.
Abstract: In response to the case of a patient with mesenteric panniculitis (MP) and proliferative disease, we reviewed the literature on their possible association and associations with other neoplasms. MP is a non-specific chronic inflammation of the mesenteric fat, with low prevalence and unknown etiology; patients may be asymptomatic or present predomina...
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The Adjunct of Voice Recognition to Medical Transcriptionist in Asian Countries–The Pros and Cons
Amjad Sattar,
Mahnoor Hafeez
Issue:
Volume 7, Issue 6, November 2019
Pages:
147-150
Received:
14 July 2019
Accepted:
19 August 2019
Published:
26 October 2019
Abstract: Voice recognition software (VRS) is a form of Artificial intelligence; it’s a phenomenon of converting or transcribing acoustic human speech (i.e. sound waves) into a symbolic form of a human language such as English whereas Dictaphone (DP) is an electronic voice recorder analogous to cell phone that saves and records voice files. The Radiologists believe that Report generation in Radiology is a daunting task, including reading scans, requiring analytical and observational skills, interpretation of findings, dictating cases, proof reading, re analyzing cases and signing off after corrections, especially when the case list is long. In solving this multi-step process, VRS and DP have emerged as handy tech savvy equipments for “automatic typing” of scans, with the involvement of Medical transcriptionist (MT) for timely generation of reports. In the past few decades, there has been considerable transition from manual hand signed reports to electronically generated reports. MT has been a closed companion of Radiologist, even in manually generated reports. There has been a threat to MT being replaced by VRS at tertiary care hospitals, because of its low economic impact. The pros and cons of tool are elaborated in this article with the survey of Radiology Institutes of Pakistan.
Abstract: Voice recognition software (VRS) is a form of Artificial intelligence; it’s a phenomenon of converting or transcribing acoustic human speech (i.e. sound waves) into a symbolic form of a human language such as English whereas Dictaphone (DP) is an electronic voice recorder analogous to cell phone that saves and records voice files. The Radiologists ...
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Central Diabetes Insipidus in a Patient with Stiff Person Syndrome
Fatima Zarzour,
Abir Bou Khalil,
Sami Toufic Azar
Issue:
Volume 7, Issue 6, November 2019
Pages:
151-153
Received:
14 August 2019
Accepted:
6 September 2019
Published:
19 November 2019
Abstract: Background: Central diabetes insipidus (CDI) is a rare hypothalamic-pituitary disease due to the deficiency of arginine vasopressin (AVP) synthesis of which more than one third of etiologies are unidentified. Autoimmunity is associated with one third of patients with apparently idiopathic CDI. The most common antibody detected in auto immune CDI is autoantibodies to AVP-secreting cells (AVPcAb). Stiff-person syndrome (SPS) is a rare neurological disorder with features of an autoimmune disease. It is characterized by fluctuating muscle rigidity in the trunk and limbs and a heightened sensitivity to stimuli. It is well known that SPS is associated with multiple auto immune endocrinopathy including auto immune diabetes and auto immune thyroid disease. The association between SPS and CDI is not well documented in the literature. Case information: We report a case of 51 year old female who developed CDI while being treated for SPS unmasked by high dose steroids. Result: Anti amphiphysin is the only antibody detected in our patient. Animal studies showed a high expression of amphiphysin in anterior and posterior pituitary gland, data in human are still vague .One theory is that anti-amphiphysin antibodies attack the amphiphysin molecules in the AVP secreting cells and inhibit release of AVP. Conclusion: This antibody could hint towards the autoimmune cause of CDI.
Abstract: Background: Central diabetes insipidus (CDI) is a rare hypothalamic-pituitary disease due to the deficiency of arginine vasopressin (AVP) synthesis of which more than one third of etiologies are unidentified. Autoimmunity is associated with one third of patients with apparently idiopathic CDI. The most common antibody detected in auto immune CDI is...
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Genito Urinary Syndrome of Menopause (GSM) or Vulvo-vaginal Atrophy (VVA) an Unspoken Sorrow
Shaikh Zinnat Ara Nasreen,
Safinaz Shahreen,
Saleheen Huq,
Sabereen Huq
Issue:
Volume 7, Issue 6, November 2019
Pages:
154-162
Received:
19 August 2019
Accepted:
26 September 2019
Published:
2 December 2019
Abstract: GSM includes wide spectrum of vulvovaginal Symptoms and urinary troubles replacing the term vulvovaginal atrophy (VVA). It is a silent epidemic condition affecting 50-60% postmenopausal women. Estrogen withdrawal causes thinning, narrowing, tissue loss & reduced blood supply in vulvo-vaginal area, which results GSM. GSM causes burning in vagina, dyspareunia, urinary urgency, repeated UTI. Dyspareunia affects all the domain of sexual function and deteriorates the quality of life. Irony is, women are oblivious to share and doctors are reluctant to discuss. So women keep continue suffering without knowing the restorative treatment. Repercussion of GSM/VVA intensifies the sorrows, distress and sufferings. It has profound effect on relationship and psychology and quality of life of women. Good history taking and clinical examination do diagnosis. Investigations are done to exclude other causes. Treatment is challenging. Maintenance of optimum body weight, exercise, regular coitus, quitting smoking & excessive alcohol intake are the key factors. Vaginal moisturizers are recommended as 1st line therapy for mild to moderate VVA or women who can’t take estrogen. Ideal moisturizers should have similarity with vaginal secretion of osmolality, pH and composition. Meta analysis shows local estrogen therapy is effective. It restores vaginal pH and maturation index. Systemic absorption is minimal so progesterone needs not to be added. Testosterone improves dyspareunia, sexual desire, lubrication and satisfaction. DHEA (Prasterone) penetrates vaginal wall better. It increases elasticity and vascularity of vagina. RCTs have not shown benefits of it’s systemic therapy. But local daily administration of DHEA reduces dyspareunia and GSM so improves the quality of life. Ospemifene is well tolerated. It’s agonist effect on vaginal mucosa and antagonist effect on endometrium and breast, makes it promising. Lasofoxifene, third generation SERM, is also very effective but it needs FDA approval. Laser is widely being used and very effective. It is simple, faster, painless procedure. It activates dominant fibroblasts, proteoglycans, hyaluronic acid, thereby improves GSM & sexuality. Black cohosh, Botox, G-shot, probiotics, gabapentin are not yet evidence based. Still there is significant unmet need for medical treatment. Women reports GSM but that is only tip of iceberg. Good communication and optimum treatment only can break the sorrows GSM/VVA.
Abstract: GSM includes wide spectrum of vulvovaginal Symptoms and urinary troubles replacing the term vulvovaginal atrophy (VVA). It is a silent epidemic condition affecting 50-60% postmenopausal women. Estrogen withdrawal causes thinning, narrowing, tissue loss & reduced blood supply in vulvo-vaginal area, which results GSM. GSM causes burning in vagina, dy...
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Clinical Characteristics of Mineral Bone Disease Among Patients with Chronic Kidney Disease in Southern, Nigeria
Ndu Victor Onyebuchi,
Oko-Jaja Richard I.,
Emem-Chioma Pedro,
Wokoma Friday
Issue:
Volume 7, Issue 6, November 2019
Pages:
163-168
Received:
4 October 2019
Accepted:
21 October 2019
Published:
6 December 2019
Abstract: Mineral bone disease (MBD) is a common complication in patients with chronic kidney disease (CKD). The objective of this study is to determine the characteristics of CKD-MBD among adult patients with CKD in South-South, Nigeria. One hundred and fifty consecutive consenting chronic kidney disease patients who fulfilled the inclusion criteria for this study were recruited. Patients had a detailed clinical assessment, biochemical and radiological evaluations for CKD-MBD. Biochemical investigations included serum calcium, phosphate, parathyroid hormone (PTH) and alkaline phosphatase while the radiological investigations included X-ray of the skull, spine, wrist and phalanges. The age range of the patients was 22-80 years, with a mean of 45.1 (±11.9) years. There were 90 males and 60 females with male to female ratio of 1.5:1. Symptoms suggestive of CKD-MBD in the study population were bone pain and pruritus occuring in 34.9% and 12.0% of the CKD-MBD patients. Other symptoms presented by the patients included leg swelling in 126 (84%), frothiness of urine in 123 (82%), vomiting in 109 (72.7%), facial puffiness in 102 (68%), haematuria in 18 (12%) and chest pain in 73 (48.7%) of the patients. The mean values for serum PTH, serum calcium, serum phosphate, alkaline phosphatase and caxpo4 product among the CKD-MBD patients were 205.06±112.6 pg/ml, 2.56±0.73mmol/l, 1.63±0.63mmol/l, 109.26±65.57IU/L and 4.07±1.28mmol2/l2 respectively. There was hypercalcaemia in 44.6%, hypocalcaemia in 26.0%, hypophosphataemia in 12.0% and hyperphosphataemia in 29.3% of the patients. High alkaline phosphatase was observed in 36.0% while 8.7% had low alkaline phosphatase. There was high calcium x phosphate product in 34.0% of the patients. Radiological features in keeping with CKD-MBD was present in only 6% of those with CKD-MBD. Hypercalcemia is the major biochemical abnormalilty in patients with CKD-MBD in our environment.
Abstract: Mineral bone disease (MBD) is a common complication in patients with chronic kidney disease (CKD). The objective of this study is to determine the characteristics of CKD-MBD among adult patients with CKD in South-South, Nigeria. One hundred and fifty consecutive consenting chronic kidney disease patients who fulfilled the inclusion criteria for thi...
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A Radiomics Model in Predicting Recurrence Time of Small Hepatocellular Carcinoma After Hepatectomy Base on MR by ANN
Weiwei Wang,
Weimin An,
Jinghui Dong,
Jianzeng Zhang,
Peng Li,
Zhenjie Wu,
Fangfang Shi,
Mengmeng Zhang
Issue:
Volume 7, Issue 6, November 2019
Pages:
169-174
Received:
28 October 2019
Accepted:
22 November 2019
Published:
11 December 2019
Abstract: Objective: The recurrence time of small hepatocellular carcinoma (sHCC) after resection are heterogeneous. Prediction the recurrence time of sHCC after resection is propitious to the fine management and individualized treatment of patients with sHCC, especially preoperative noninvasive. Methods: Collected the patients who with SHCC resection, and performed MR before operation one month long, cases with complete follow-up data in the Fifth Medical Center of the Chinese PLA General Hospital during January 2010 to January 2017. Abstract radiographic features of MR LAVA sequence Mask images by pyradiomics and input ANN. Results: A total of 179 cases were enroll into the study, of which 89 were early recurrence (≤24 months) cases and 90 were non-early recurrence (>24 months) cases. Abstract 121 radiographic features of MR LAVA sequence Mask images. Input ANN model into training group (150 cases) and test group (29 cases), the AUC value is 0. 64. The correlation factors of AFP and tumor size were 0.03 and 0.06 respectively. Conclusion: the ANN model of Mask features of MR T1 LAVA sequence can be used to predict the recurrence time of sHCC after resection before the operation, to establish the operative strategy and determine the Image examination frequency of postoperative follow-up.
Abstract: Objective: The recurrence time of small hepatocellular carcinoma (sHCC) after resection are heterogeneous. Prediction the recurrence time of sHCC after resection is propitious to the fine management and individualized treatment of patients with sHCC, especially preoperative noninvasive. Methods: Collected the patients who with SHCC resection, and p...
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Kawasaki Disease with Rare Presentation Masquerading as Severe Infection in Children: A 10-year Retrospective Review in a Tertiary Hospital in Hong Kong SAR
Au Dennis Chi-yu,
Fong Nai-chung,
Kwan Yat-wah
Issue:
Volume 7, Issue 6, November 2019
Pages:
175-183
Received:
13 October 2019
Accepted:
19 December 2019
Published:
31 December 2019
Abstract: Kawasaki disease (KD) with uncommon presentations can lead to diagnostic confusion mimicking severe infections: particularly KD shock syndrome (KDSS) mimicking toxic shock syndrome; and retropharyngeal edema (RPE) mimicking retropharyngeal neck abscess according to our local experience. High vigilance is needed for early diagnosis and timely treatment to minimize unnecessary operations and development of complications. A 10-year (2007-2016) retrospective review was performed for KD presented with features of KDSS/RPE. 120 KD cases were recruited. M:F was 1.2: 1, age 3.5 months to 12 years old. Sixteen had RPE mimicking neck abscess (13.3%) presenting as fever with neck complaints: swelling, pain or refusal to rotation/extension. None of them fulfilled sufficient diagnostic criteria for KD initially, some even with absent KD signs. They responded poorly to administration of antibiotics. Neck X-ray showed thickened retropharyngeal space suspicious of abscess. Computed tomography (CT) showed retropharyngeal fluid collection with no definite rim-enhancement. One case in doubt of early abscess underwent fine needle aspiration yielding 1.5ml necrotic material, sterile for bacterial culture. Signs of KD emerged as clinical course progressed, and all patients responded well to treatment with immunoglobulin (IVIG) and aspirin. Four presented as KDSS mimicking toxic shock (3.3%) with systolic hypotension requiring inotropic support and had ventricular dysfunction, mitral regurgitation on echocardiogram. Three had coronary ectasia on presentation. All were IVIG resistant and had severe hypoalbuminemia, probably contributing to shock. Two required pulse methylprednisolone and two responded to second dose IVIG.
Abstract: Kawasaki disease (KD) with uncommon presentations can lead to diagnostic confusion mimicking severe infections: particularly KD shock syndrome (KDSS) mimicking toxic shock syndrome; and retropharyngeal edema (RPE) mimicking retropharyngeal neck abscess according to our local experience. High vigilance is needed for early diagnosis and timely treatm...
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