Friday, 20 July 2018

6 Year Old Boy with a Right Posterior Thoracic Mass


                                         http://austinpublishinggroup.com/surgical-oncology/




Bronchogenic cysts result from the abnormal or late budding of the ventral lung bud or the tracheobronchial tree during the process of the development. Primary Bronchogenic cysts of cardiac origin or extension are rare. Bronchogenic cysts can be detected in fetus or in stillbirths and it is well recognized in babies or infants. Bronchogenic cysts are rare lesions which originate from primitive tracheobronchial tree. They are primarily located in the thorax. Extrathoracic locations may be either in the immediate vicinity of the thoracic cage or more remote periscapular location which is extremely rare. The clinical presentations are usually releated to trancheal and tracheobronchial compressions. Typical localization of bronchial cysts has been reported for esophageal, pericardial, dermal cervical, diaphragmatic or intradural spaces, but such localizations are very rare.

A 6-years old male with presented with chest typical chest pain, discomfort, paroxysmalpalpitations continuing, for one month, cough, fever was admitted in our department with bronchogenin cyst extending to the right atrial wall. Physical examination, chest radiography, and blood analysis were found to be normal. The computed tomography (CT) confirmed giant cystic mass with a diameter of 6,5 x 5,5 x 5,5cm. Following standard a right posterolateral thoracotomy, we performed tumor enucleation and managed to resect the cyst from the atrial wall with the use of a side-biting clamp on the right atrial wall, which was repaired with continuous 4-0 polypropylene sutures (Ethicon, Somerville, NJ, USA). The patient was taken to the intensive care unit and weaned off mechanical ventilation in 6 hours. He was taken to the ward next day and discharged from the hospital on the postoperative 5th day. Microbiologic examination ended sterile and Bronchogenic cyst diagnosis was confirmed with detailed histopathologic examination. Grossly, the excised tumor measured 6,5 x 5,5 x 5,5cm and had multi-cystic features with turbid contents. Microscopically the tumor consisted of thin-walled multiple cysts attached to the respected myocardium. The inner cavities were lined with pseudo-stratified ciliated columnar epithelium and cartilages, which are characteristic features similar to those of normal bronchi and confirm a pathologic diagnosis of Bronchogenic cyst.

Thursday, 19 July 2018

Relationship between Total Percurred Distances in High Intensity with Physical Weariness on Soccer Athletes

                                        http://austinpublishinggroup.com/sports-medicine/



There are several http://austinpublishinggroup.com/sports-medicine/eccentric muscle actions during the match, such as jumping and sudden stops. According  the eccentric actions cause increased muscle damage and an increased number of micro lesions, complicating the recovery. It should also be considered different workloads due the positions and roles in the field (goalkeepers, center backs, full backs, holding midfielders, midfielders and strikers), respecting the training specificity principle.

It important being able to assess and identify the variables: Intensity, volume, effectiveness and frequency of competitive actions, individually (biological individuality), contribute on making technical, tactical and strategic decisions for soccer players in training and in competitive actions. Specifically in the competitive actions, knowing the covered distance in each position and their different intensities, contribute on building adequate and specific training models, consequently improving performance during game play.

For this purpose, various methods are investigated over time in order to minimize training mistakes, such as the use of lactate analysis, electromyography and Mechanomyography (MMG), with the intend of evaluate variations that occur in muscle before and during fatigue installation. Recently the plasma concentrations of Creatine Kinase (CK) has been described and used as a marker for muscular fatigue due the low cost and peak release that occurs between 24 and 48 hours after physical exercise session.

Wednesday, 18 July 2018

Inflammatory Stenosis of Ascending Colon: Differential Diagnosis between Granulomatous Disorders

                                           http://austinpublishinggroup.com/surgery-case-reports/



We present a case of 36 years old woman investigated in the emergency department because of intermittent abdominal pain in Right Iliac Fossa (RIF) associated with distension of the abdomen and nausea. The clinical report reveals a history of diarrhea, weight loss in the last six months and appendectomy performed 3 months before. Histological exam of appendix resulted suspicious for Crohn’s disease (Figure 1-2). In addition the patient reported close contact with TB affected patient (her mother) in the last year. The blood tests reveal poorly inflammatory index (CRP 2.11mg/dl) and a mild impairment of liver tests (AST 53 UI/L, ALT 60UI/L, ALP 279 U/L, ϒ-GT 129 UI/L). Furthermore serology reveals a positive QuantiFERON-Tb Gold test that confirmed the positivity of Mantoux reaction. Coproculture and urinoculture were negative for BK.

Colonoscopy characterized stenosis of right colon with severe inflammatory response suggestive for Crohn’s Disease (Figure 3-4). A total-body CT scan performed has shown thickness and oedema of the last tract of ascending colon that involved part of ileum. In addiction paracolic and lateral neckcaseous lymphadenitis is described (Figure 5-6). We perform Fine Needle Aspiration Cytology (FNAC) on lateral neck nodes (Figure 7) but Ziehl-Neelsen staining methods and RT-PCR resulted negative.

definitive histopathological examination revealed the presence of granulomatous inflammation with typical granulomas with localized caseous necrosis properties of TB (Figure 8-9). The Lowenstein-Jensen culture was positive for KB after 8th week. The patient underwent anti-TB therapy with resolution of symptoms. The endoscopic control after 4 months describes normal results of right hemicolectomy without any sign of inflammation.

Tuesday, 17 July 2018

Study of Biological Parameters of Schizophrinics During 6 Months of Different Anti Psychotics Treatment

                                               http://austinpublishinggroup.com/stem-cells/



Objective: The aim is to study the impact of antipsychotics on schizophrenic’s metabolic parameters in 6 months.

Methods: Blood glucose, lipid profile, liver enzymes weight & waist circumference were assessed for 160 schizophrenia patients; at the beginning and after 6 months of continuous use of antipsychotics. Patients with who used antipsychotics in the past 3 months or have family history of diabetes or obesity were excluded.

Results: Except for white blood count and High-Density Lipoproteins (HDL); all the studied parameters showed significant elevation after 6 months of antipsychotic treatment. The relation between the type of antipsychotic and the studied parameters showed that the lipid profile was the only parameter of significance in relation to drug type. Because not only the lipid profile but also other parameters increased after six months we used analysis of covariance [ANCOVA] which showed that the value of any studied parameters at the beginning of the study was significantly determine the values at the end of the study, in addition, the type of drug used in treatment is significantly influences the triglyceride level and interaction of sex, drug used, and the history of drug treatment could significantly determine the serum cholesterol and LDL levels.

Conclusion: The study demonstrated elevated metabolic parameters in patients with schizophrenia treated with antipsychotics. The burden of each antipsychotic was explored. More research is needed to confirm our findings which are limited by the short duration of the study, the fewer number of studied antipsychotics and sample size

Keywords: Antipsychotics; Schizophrenia; Metabolic

Monday, 16 July 2018

Study of Biological Parameters of Schizophrinics During 6 Months of Different Anti Psychotics Treatment


                              http://austinpublishinggroup.com/schizophrenia/index.php




Objective: The aim is to study the impact of antipsychotics on schizophrenic’s metabolic parameters in 6 months.

Methods: Blood glucose, lipid profile, liver enzymes weight & waist circumference were assessed for 160 schizophrenia patients; at the beginning and after 6 months of continuous use of antipsychotics. Patients with who used antipsychotics in the past 3 months or have family history of diabetes or obesity were excluded.

Results: Except for white blood count and High-Density Lipoproteins (HDL); all the studied parameters showed significant elevation after 6 months of antipsychotic treatment. The relation between the type of antipsychotic and the studied parameters showed that the lipid profile was the only parameter of significance in relation to drug type. Because not only the lipid profile but also other parameters increased after six months we used analysis of covariance [ANCOVA] which showed that the value of any studied parameters at the beginning of the study was significantly determine the values at the end of the study, in addition, the type of drug used in treatment is significantly influences the triglyceride level and interaction of sex, drug used, and the history of drug treatment could significantly determine the serum cholesterol and LDL levels.

Conclusion: The study demonstrated elevated metabolic parameters in patients with schizophrenia treated with antipsychotics. The burden of each antipsychotic was explored. More research is needed to confirm our findings which are limited by the short duration of the study, the fewer number of studied antipsychotics and sample size

Keywords: Antipsychotics; Schizophrenia; Metabolic

Friday, 13 July 2018

Verschraegen C*, Rehman H, Kalof A, Lemos D, Anker CJ, Leavitt B and Lisle J

                                              http://austinpublishinggroup.com/sarcoma/


Soft Tissue Sarcomas (STS) represent a very heterogeneous family of tumors derived from mesenchymal cells. Despite a variety of cells of origin, most STS are treated with the same chemotherapy regimens, although there are some exceptions. For example alveolar, soft part sarcoma is now treated with tyrosine kinase inhibitor in first line. Treatment of sarcomas is multidisciplinary, but the approach to the management of high risk primary STS remains controversial. While the combination of surgery and radiotherapy prevents local recurrence, the role of adjuvant or neoadjuvant chemotherapy to reduce the risk of metastatic disease or to reduce tumor size to facilitate an R0 resection is not established. Over 50% of patients with very high risk STS will eventually develop metastatic disease. Additional curative options must be identified in appropriate patients. The definition of high risk STS is also somewhat controversial. For the purpose of this clinical trial, we considered any high grade STS greater than 5cm in the greatest dimension, for which chemotherapy could be indicated in the first line setting. Although doxorubicinbased regimens are favored in first line for metastatic disease, the new combination of docetaxel and gemcitabine might have greater activity in some STS subtypes with less long term toxicity especially when administered on an every two-week schedule.
VascularEndothelial Growth Factor (VEGF) is a potent tumorproduced angiogenic factor whose overexpression is usually associated with an adverse outcome in most STS. Median pretreatment serum VEGF levels are significantly raised in patients with grade 2 and grade 3 sarcomas compared with concentrations in patients with benign lesions. Serum VEGF expression correlates with grade in soft tissue sarcoma and reflects response to treatment. The tyrosine kinase inhibitor, pazopanib, is now approved for recurrent or metastatic STS, with good clinical benefit. Health-related quality of life does not improve with pazopanib, but the improvement in progressionfree survival without impairment of quality of life was considered meaningful. When administered as a single agent, side effects are manageable and include hypertension, diarrhea, nausea, liver inflammation, mild myelosuppression, and hair de-pigmentation. In combination with chemotherapy, however, there is a synergistic effect on the toxicity profile and combination with multi-agent chemotherapy is not tolerable (Table 1). This study proposes to combine the least toxic chemotherapy regimen with intermittent pazopanib administration to avoid pharmacokinetics synergy, to be tested in the neoadjuvant setting for patients with high risk STS.

Thursday, 12 July 2018

Perioperative Pulmonary Embolism Prevention and Treatment

                                                       http://austinpublishinggroup.com/spine/



Massiveperioperative Pulmonary Embolism (PE) is an uncommon event but significant cause of morbidity and mortality. It is estimated that PE is responsible for between 150,000 and 200,000 deaths per year in the United States. 30% of the deaths from PE take place during the perioperative period. PE is the third most common cardiovascular disease after myocardial infarction and cerebrovascular accident (stroke). Several studies have reported mortality rates ranging from 15% to 30%, while mortality rates in a massive PE can reach 30% to 50%. A recent review of more than 3000 massive intraoperative thromboembolic events revealed an overall mortality of 41%.

Surgery increases the risks for perioperative PE. Healthcare providers, including anesthesiologists, are responsible for the diagnosis and treatment of perioperative PE. During surgery, PE often first presents with hemodynamic instability and if progressing quickly, can lead to death. It is important that healthcare providers recognize perioperative PE and know prevention and treatment options. Prompt diagnosis and treatment can save patient lives. In this review, we will focus on perioperative acute PE treatment and prevention.

Diagnosis of a PE in the perioperative period can be a challenge, but early detection can reduce morbidity. The American Heart Association (AHA) classified and defined PE into three classes: massive PE, submassive PE, and low-risk PE. Acute PE with sustained hypotension (systolic blood pressure <90 mm Hg for at least 15 minutes or requiring isotropic support, not due to a cause other than PE, such as arrhythmia, hypovolemia, sepsis, or Left Ventricular (LV) dysfunction), pulselessness, or persistent profound bradycardia (heart rate<40 bpm with signs or symptoms of shock).

6 Year Old Boy with a Right Posterior Thoracic Mass

                                          http://austinpublishinggroup.com/surgical-oncology/ Bronchogenic cysts result from...