Nonspecific Granulomas Research Articles

Utility of Keystone Flap in Armory of Dermatosurgeons

Abstract Purpose and Background: To create awareness among dermatosurgeons about the versality of keystone flaps in re-surfacing post-excisional small, medium and large skin defects. Aims and Objectives: Single-staged tension free re-surfacing of various sized skin defects using keystone flap and to have least donor site morbidity, primary healing and maximum functional outcome. Material and Methods: This retrospective study was conducted, between October 2021 – January 2023 in Department of Plastic Surgery, PGIMS Rohtak, on 15 males and 1 female aged between 18 - 65 years. Sixteen Keystone flaps (type IIA n=13, Omega cum Sydney melanoma unit modification n=3) were utilized for resurfacing skin defects arising after excision of basal cell carcinoma (n=3) and benign hairy nevus (n=2) on cheek, basal cell carcinoma forehead (n=1), electric burns on deltoid (n=2), giant neurofibroma back (n=1), tattoo forearm (n=3), chronic non-specific granuloma thumb (n=2) and pilonidal sinus disease (n=2). Skin with maximum expansibility was chosen as donor site with utmost care of facial lines and its aesthetic subunits. Flaps were dissected all around preserving maximum number of hand-held doppler-identified perforators in pedicular area. Sutures were removed on 10th to 15th post-operative day. Follow-ups ranged from 2 to 15 months. Results: None had wound dehiscence or loss of flap. Conclusion: Keystone flaps have defect-adaptive design, simple bio-geometry, technical simplicity, decreased downtime, cost effectivity and efficiency and can be designed to resurface post-excisional skin defect from head to toe with acceptable results, therefore should strongly be considered by dermatosurgeons while excising skin lesions.

Flexible Endoscopic Surgery for Benign Nonepithelial Lesions of the Larynx.

The traditional approach for the management of benign laryngeal lesions is transoral microsurgery. In cases of anatomic particularities, such as insufficient cervical extension, short mandible, temporomandibular joint ankylosis etc., and contraindications for general anesthesia, transoral microsurgery is not possible. In such cases transnasal flexible endoscopic surgery under local anesthesia can be a relevant alternative. The purpose of the study was to assess the possibilities of flexible endoscopic management of benign nonepithelial lesions of the larynx. Flexible endoscopic surgical interventions were performed on 315 patients with different benign nonepithelial lesions of the larynx. The larynx pathology was represented by following lesions: myxoid polyp, polypoid degeneration of vocal folds, fibrous polyp, angiofibrous polyp, angiomatous polyp, nonspecific granuloma, cyst, lipoma, neurofibroma and amyloidosis. In 97,8% of the cases interventions were performed under local anesthesia with spontaneous respiration. In 88,6% of the cases interventions were performed as outpatient procedures. In all the cases the expected result was obtained - complete ablation of the visible lesion. In 7 cases repeated interventions were performed for recurrent lesions. Flexible endoscopic surgery is an efficient method for the treatment of benign nonepithelial lesions of the larynx, that offers a relevant therapeutic alternative, especially for the patients who have contraindications for general anesthesia or transoral microsurgery. The advantages of the method, worthy of mentionning, are positive economic effect and time economy, the intervention being possible in an outpatient setting for the majority of patients. The online version contains supplementary material available at 10.1007/s12070-022-03444-z.

The experimental invasion of rats with Eustrongylides excisus (Nematoda, Dioctophymatidae) larvae during the acute course of infection

Ten laboratory rats were experimentally invaded per os with the Eustrongylides excisus (Jäegerskiold, 1909) nematode larvae (L3–L4) received from Perca fluviatialis (Linnaeus, 1758), caught in the water area of the Dnipro-Buh Estuary, Ukraine. The aim of the experimental study was to measure the pathogenic effect of the given parasite on the mammals’ organisms by means of the histological analysis of the affected organs of the infected rats. The researched animals were divided into two groups. The experiment lasted 15 days; the second group was a control group. The histological analysis showed purulent-serous and purulent-fibrinous peritonitis, acute circulatory disorders in brain tissues (signs of hypoxic-ischemic lesions of the brainstem in the form of neuronal changes) and the heart (partial spasm of arteries and edema of interstitial myocardial tissue); pathological changes in the lungs (acute interstitial purulent pneumonia, acute focal emphysema of the lungs), liver (acute exudative hepatitis), kidneys (signs of shock reaction) and intestines (acute serous-purulent enteritis). Formation of non-specific granulomas was noticed, which contained the fragments of the parasitic larvae. The acute course of the purulent-serous and purulent-fibrinous inflammatory processes in the organs of the invaded rats was noticed; signs of systemic inflammatory response syndrome with pronounced distributive vascular leukocytosis in the studied organs.

The role of endobronchial ultrasound-guided transbronchial needle aspiration in isolated intrathoracic lymphadenopathy in non-neoplastic patients: a common dilemma in clinical practice.

ABSTRACTObjective:To determine the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in non-neoplastic patients with isolated intrathoracic lymphadenopathy (IL). Methods:This was a retrospective study of patients with isolated IL referred for EBUS-TBNA. We calculated the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of EBUS-TBNA in the diagnosis of granulomatous, reactive, and neoplastic lymphadenopathy. In cases of nonspecific granulomas, reactive lymphadenopathy, or inconclusive results, a definitive diagnosis was established by other diagnostic procedures or during a follow-up period of at least 18 months. Results:Among the 58 patients included in the study, EBUS-TBNA established a diagnosis of granulomatous disease in 22 (38%), reactive lymphadenopathy in 15 (26%), cancer in 8 (14%), and other diseases in 3 (5%). Results were inconclusive in 10 (17%), the diagnosis being established by other bronchoscopic procedures in 2 (20%) and by surgical procedures in 8 (80%). A final diagnosis of reactive lymphadenopathy was established in 12. Of those, 11 (92%) had their diagnosis confirmed during follow-up and 1 (8%) had their diagnosis confirmed by mediastinoscopy. In another 3, a final diagnosis of sarcoidosis or neoplasm was established. For the diagnosis of granulomatous disease, neoplasms, and reactive lymphadenopathy, EBUS-TBNA was found to have a sensitivity of 73%, 68%, and 92%, respectively; a specificity of 100%, 100%, and 93%, respectively; an accuracy of 86%, 93%, and 93%, respectively; a PPV of 100%, 100%, and 80%, respectively; and an NPV of 78%, 92%, and 98%, respectively. Conclusions:In non-neoplastic patients, granulomatous disease and reactive lymphadenopathy appear to be common causes of isolated IL. EBUS-TBNA shows promising results as a first-line minimally invasive diagnostic procedure. The results obtained by EBUS-TBNA can be optimized by examining clinical and radiological findings during follow-up or by comparison with the results obtained with other bronchoscopic methods.

Peripheral Lymph Node Excisional Biopsy: Yield, Relevance, and Outcomes in a Remote Surgical Setup.

Objective To study the patient profile for symptomatic peripheral lymphadenopathy in terms of histopathological findings and demography and evaluate the yield, relevance, and outcomes of peripheral lymph node biopsy (PLNB) as a diagnostic step in a remote setup in the absence of less invasive options like fine-needle aspiration cytology (FNAC) or ultrasonogram- (USG-) guided FNAC. Methods A retrospective review of patients undergoing PLNB between 1 May 2011 and 30 April 2013 was done. Demographics, histopathological reports, and outcomes were studied. Results Of 132 patients, 51 (38.63%) were male and 81 (61.36%) were female. There were 48 (36.3%) patients in the age group less than 16 years, and 84 (63.6%) were beyond 16 years. The commonest site of biopsy was the neck in 114 (86.36%) patients. The histopathological diagnosis was tuberculosis (TB) in 60 (45.45%) patients, reactive lymphadenitis in 29 (21.9%), nonspecific granuloma in 18 (13.6%), lymphoma in 7 (5.3%), acute lymphadenitis in 7 (5.3%), metastatic secondary in 3 (2.2%), and other benign causes in 8 (6.06%). Conclusions PLNB is a procedure with good diagnostic yield in evaluation of peripheral lymphadenopathy. Its relevance is appreciable in a remote setup where less invasive options are unavailable. Its simplicity and lack of mortality/significant morbidity make it a valid option in rural surgical practice.

Does this sarcoidosis case triggered by typhoid fever? A rare case report

Sarcoidosis is a multisystemic disease that characterized by the presence of nonspecific noncaseating granuloma of undetermined etiology. Its peak incidence was found in patients &#6150 years old. Globally, the disease is more common among Scandinavians and African Americans. In Asia, it is rare and the highest incidence was found in Japan and India. In Iraq, sarcoidosis is a rare disease, but there are no accurate records of its incidence. Mycobacterium spp. and Propionibacterium acnes are the most common triggering infectious agent, and corticosteroids are the standard treatment of choice for symptomatic patients for not &#611 year. In particular, this report presents a rare case of sarcoidosis that developed in an elderly Iraqi female with an unusual presentation. In addition, it has been heralded exceptionally by an acute typhoid fever with a possible correlation. She treated effectively with prednisolone for only 2 months without any complaint for 1½-year duration.

MRI findings of cerebral schistosomiasis in acute stage：establishment of experimental model of acute cerebral schistosomiasis with rabbits

To establish an experimental model of acute cerebral schistosomiasis japonica and explore the MRI manifestations of acute cerebral schistosomiasis. Rabbits were divided into 3 groups with 10 rabbits in each group. The rabbits in the experimental group were directly injected with suspension fluid of Schistosoma japonicum eggs (0.9 mg, 1 ml) by the cranial drilling method, those in the negative control group were given saline (1 ml) by the same method above-mentioned, and those in the blank control group were not given any treatment. Antibiotic was given to the first two groups after the operation. The clinical manifestations of the 3 groups were observed, and the magnetic resonance imaging (MRI) was performed in 30 days post-operation, and then the brain tissues were taken for pathological examinations. All the rabbits in the experimental group exhibited inappetence, various neurological symptoms including hemiplegia, and weight loss after the operation; while those in the negative control group showed inappetence in 3 days after the operation, and 1 week later, the symptom disappeared; there were no adverse reactions in the blank control group. MRI of the experimental group showed nodular or patchy enhancement on T1WI enhancement, brain edema, abnormal ventricular dilatation, and needle augmentation. SWI displayed hypointense in the abnormal enhanced nodules and flaky hypointense on the operation brain. In the negative control group, 2 rabbits showed abnormal enhancement of the needle canal, and 1 showed mild dilatation of the ventricle. The blank control group showed normal manifestations. The pathological examinations showed abnormal appearances in 10 rabbits of the experimental group, including 6 with S. japonicum egg granuloma nodules, nonspecific granuloma nodules coexisted with perivascular inflammation; no granuloma nodules were found in the negative control group, but 2 rabbits showed vascular inflammation; the blank control group showed the normal brain tissue. An experimental model of acute cerebral schistosomiasis is successfully established in rabbits by intracranial injection of schistosome eggs. The MRI examination combined with the clinical manifestations can improve the accuracy of early diagnosis of cerebral schistosomiasis.

МІКРОФЛОРА СЛИЗОВОЇ ОБОЛОНКИ ГОРТАНІ У ХВОРИХ НА НЕСПЕЦИФІЧНУ ПОСТІНТУБАЦІЙНУ ГРАНУЛЬОМУ ГОРТАНІ

Актуальною проблемою сучасної медицини є профілактика і лікування неспецифічної постінтубаційної гранульоми гортані. Одним із факторів виникнення даної патології є запальний процес у гортані після проведеної інтубації, спричинений мікрофлорою. Остання у пацієнтів із неспецифічною гранульомою гортані не вивчена взагалі.Мета дослідження – порівняльне вивчення загального кількісного та якісного бактеріального й грибкового обсіменіння слизової оболонки гортані у здорових людей і хворих на неспецифічну гранульому гортані.Матеріали і методи. Кількісну та якісну характеристику мікробних асоціацій і видовий склад мікрофлори слизової оболонки гортані вивчали у 40 здорових людей і 72 хворих на неспецифічну гранульому гортані. Ідентифікацію мікроорганізмів проводили згідно з класифікаційними схемами Bergey, використовуючи тест-системи “API Staph”, “API Strep”, “API 20 E”, “API NH”, “API Caryne”, “API Candida”. Антибіотикочутливість кожного штаму досліджували відповідно до Інформаційного листа №189. При цьому використовували диски з бензилпеніциліном, амоксиклавом, стрептоміцином, гентаміцином, офлоксацином, левофлоксацином, еритроміцином, цефазоліном, цефуроксином, цефтриаксоном, цефпіромом.Результати досліджень та їх обговорення. Порівняльний аналіз отриманих результатів дозволяє констатувати, що у хворих на неспецифічну постінтубаційну гранульому гортані виявлено всі ті ж види аеробних мікроорганізмів, що й у здорових людей, однак висівались вони значно частіше. Загальна щільність мікробних популяцій на слизовій оболонці гортані у здорових осіб становила (2672±614) КУО/мл, у хворих на неспецифічну гранульому – (21514±2382) КУО/мл. В обох досліджуваних групах домінували представники кокової мікрофлори. У хворих на неспецифічну гранульому гортані стрептококи висівались у 56 (77,8 %), стафілококи – у 60 (83,3 %) і нейсерії – у 65 (90,3 %) пацієнтів. Аналіз антибіотикограм мікроорганізмів, виділених у хворих на неспецифічну гранульому гортані, показав підвищення їх резистентності до досліджуваних антибіотиків, порівняно з мікрофлорою, виділеною у здорових осіб.Висновки. У процесі лікування хворих на неспецифічну гранульому гортані антибіотиками вибору можуть бути представники цефалоспоринового (цефуроксин, цефтриаксон, цефпіром) і фторхінолонового (левофлоксацин) рядів.

Pathological effects of Curcuma zedoaria (shoti) flour feeding in growing broilers

Curcuma zedoaria (shoti), is one of the underexploited natural bounty which is considered as a good source of food and or feed for humans and as well as birds. In the present study, we investigated the effects of shoti meal as a primary source of carbohydrate in the growing broiler diet. The birds were fed with the shoti meal @ 10, 20, 40% raw and 20% autoclaved meal/Kg and fed for 19 days. The diet was estimated to have contributed to 83 g crude protein and 750 g starch/Kg dry flour. The results have shown that although there had been no deaths, however, broilers fed on different levels of flour grew slowly. Gross changes included lesions of necrotic enteritis and varying degrees of alterations in the gut and coxo-femoral joints. Entire articular cartilage was separated from the sub-chondral bone. The mesentery was depleted of fat, so was the abdominal and the fat pad from the thighs. The experimental birds appeared to be leaner than the corresponding control. The liver showed fatty changes and chronic inflammatory changes with non-specific granuloma in the parenchyma. The results suggested that more research should be carried out before considering Curcuma zedoaria as a feed source for the poultry.

Diagnosis of Abdominal Tuberculosis Needs Attention.

Dear Editor, We read with keen interest the article titled BStudy of surgical emergencies of tubercular abdomen in developing countries^ by Wani et al. published in the May–June 2015 issue of the Indian Journal of Surgery. The authors have presented 50 patients of tubercular abdomen. The inclusion criteria for patient selection and the diagnostic criteria used to label the patient as a case of abdominal tuberculosis (AT) has not been specified. The authors mentioned rates of positivity of PCR and IgM ELISA for blood and ascitic fluid and its sensitivity. The details of test-kit used for IgM ELISA have not been mentioned. Absolute number of tests on ascitic fluid is not mentioned; ascites was present in a small proportion of patients (n=8). It is not mentioned what gold standard was used for calculating sensitivity for these tests. The authors have not taken into consideration the specificity of these tests for diagnosis of AT. Histopathology test was reported to confirm the diagnosis in 97.8 % patients; however, the histopathological criteria for diagnosing AT have not been mentioned. The proportion of patients who required surgery on failure of initial conservative antituberculosis treatment (ATT) has not been mentioned. Clarification on these points will enhance the value of the observations. A number of tests are being used for confirming the clinical diagnosis of AT. AT being an infective disease, the demonstration of Mycobacterium tuberculosis (MT) from the abdominal lesions would be an ideal criterion for diagnosis; however, the yield ofMTon tissue sections is poor [1]. The demonstration of AFB on Ziehl-Nielsen staining or demonstration of caseating granulomas in abdominal specimen is the next acceptable level of evidence for diagnosis for AT. Diagnosis on the basis of nonspecific granulomas would be a matter of conjecture as several other diseases—notably Crohn’s disease, Ulcerative colitis, Salmonella, Yersinea, Histoplasma capsulatum, and Mycobacteriun capsulatum infection—can produce granulomas in the intestine, lymph nodes, and/or peritoneum. It is difficult to establish evidence-based diagnosis of AT due to difficulty in obtaining specimen for testing and low positivity of accepted criteria. The CT scan is a valuable adjunct in diagnosing ATas it can document typical lesions in intestine, lymph nodes, and omentum, and collections of exudates in abdomen. CT facilitates image guided FNAC and aspiration to collect specimen for cytological / microbiological tests . Demonstration of MT, AFB, caseating granulomas in specimens from other organ/systems like sputum, urine, and FNAC from extra-abdominal lymph nodes, and biopsy from endometrium may corroborate the CT and increase the level of confidence of the diagnosis of AT. Laparoscopy has an important role in demonstrating the typical abdominal lesions and facilitating collection of exudates/tissue specimen for testing. Commercial serological tests provide inconsistent and imprecise findings resulting in highly variable values for sensitivity and specificity. WHO has strongly recommended that these tests not be used for the diagnosis of pulmonary and extrapulmonary TB [2]. Reported high positivity of PCR from blood (72%) is an interesting finding, and its value in diagnosis of AT needs further evaluation. Empirical treatment with ATT should be prescribed only after due diligence, based on available * Bhupendra Kumar Jain bhupendrakjain@gmail.com

The Anxiety-depressive Spectrum Disorders in the Larynx Granuloma Patients: Interdisciplinary Study

The nonspecific larynx granuloma (LG) is a nonneoplastic inflammatory nodular polipoid lesion that most often develops in the vicinity of the posterior vocal cords. The significant provocative factors include gastroesophageal reflux, intubation trauma, vocal abuse. Mental disorders (MD) in LG are not investigated still. Objective The purpose of the study was to determine the occurrence rate and the variants of MD in LG outpatients in otorhinolaryngology practice. Methods 30 LG patients (26 men and 4 women, mean age 48±8) were included to the study. MD were diagnosed in accordance with ICD-10 criteria. The severity of depression and anxiety were measured with MADRS and HAM-A. Results The MD of anxiety-depressive spectrum were diagnosed in all investigated cases: depressive episode (mild/moderate; single/recurrent (n=13;43.4%); dysthymia (n=11;36.6%); generalized anxiety disorder (n=6;20%). The LG had manifested at the background of MD in most cases (n=26;86%). The chronic stress factors had preceded MD and LG in 90% and 36.6% accordingly. The profession and anxiety related vocal abuse has been revealed in 36.6%. Conclusion The preliminary results of the interdisciplinary study have shown close relation of LG with stress related MD of anxiety-depressive spectrum.

Comparison between endobronchial ultrasound-guided transbronchial needle aspiration and 18F-fluorodeoxyglucose positron emission tomography in the diagnosis of postoperative nodal recurrence in patients with lung cancer

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has a high diagnostic value for preoperative mediastinal staging in patients with lung cancer. In this study, the utility of EBUS-TBNA for the pathological diagnosis of postoperative lymph node recurrence was investigated and compared with that of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET). Patients who received both EBUS-TBNA and FDG-PET for the diagnosis of postoperative lymph node recurrence were retrospectively investigated. They underwent routine chest computed tomography (CT) follow-up after thoracotomy, and when hilar or mediastinal lymph nodes showed enlargement on CT compared with the previous chest CT, they were referred for FDG-PET and EBUS-TBNA. We compared the diagnostic performance of these two modalities. In addition, pathological findings of the biopsied sample were evaluated precisely and compared with the results of FDG-PET. Positivity for hypermetabolism on FDG-PET was defined as a standardized uptake value (SUV) greater than 2.5. A total of 40 patients were retrospectively reviewed. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of EBUS-TBNA were 100% for each parameter, whereas those of FDG-PET were 95.8, 12.5, 62.2, 66.7 and 62.5%, respectively. The SUV of true-positive nodes was significantly higher than that of false-positive nodes (P = 0.001). Twenty-two of 24 patients who were confirmed for recurrence by EBUS-TBNA underwent anticancer treatment. The pathological diagnoses of 14 false-positive cases by FDG-PET were chronic inflammation in 12 and non-specific granuloma in 2. The diagnostic yield of EBUS-TBNA is higher than that of FDG-PET when postoperative lymph node recurrence is suspected.

Open-lung biopsy in patients with undiagnosed lung lesions referred at a tertiary cancer center is safe and reveals noncancerous, noninfectious entities as the most common diagnoses

We evaluated the diagnostic yield of open-lung biopsies (OLBs) in a large tertiary cancer center to determine the role of infectious diseases as causes of undiagnosed pulmonary lesions. All consecutive adult patients with either single or multiple pulmonary nodules or masses who underwent a diagnostic OLB over a period of 10 years (1998-2007) were retrospectively identified. Their risk factors for malignancy and clinical and radiological characteristics were reviewed, and their postoperative complications were assessed. We evaluated 155 patients with a median age of 57 years (range, 19-83 years). We identified infectious etiologies in 29 patients (19 %). The most common diagnosis in this group was histoplasmosis (12 [41 %]), followed by nontuberculous mycobacterial infection (7 [24 %]) and aspergillosis (4 [14 %]). The majority of the 126 remaining patients had nonmalignant diagnoses, the most prevalent being nonspecific granuloma (26 %), whereas only 17 % had malignant diagnoses. We observed no significant differences among the patients with infectious, malignant, or both noninfectious and nonmalignant final diagnoses regarding their demographic, laboratory, and clinical characteristics. Six percent of the patients had at least one post-OLB complication, and the post-OLB mortality rate was 1 %. OLB is a safe diagnostic procedure which frequently identifies a wide variety of infectious and inflammatory diseases.

Histological Assessment of the Lobster (Homarus americanus) in the “100 Lobsters” Project

The emergence of epizootic shell disease in the American lobster (Homarus americanus) has been devastating to the industry in the coastal waters of southern New England. A comprehensive assessment of the disease syndrome, known as the “100 Lobsters” Project, was initiated to examine health and physiological parameters among laboratories involved in the research on lobster shell disease. A histological study of the 100 lobsters was undertaken as part of that assessment. Tissues from 90 lobsters from Rhode Island and 19 lobsters from Maine were examined as a general health assessment of the 100 lobsters. Approximately half the lobsters from Rhode Island were selected because they had frank epizootic shell disease, whereas none of the lobsters from Maine exhibited the syndrome. In addition to epizootic shell disease, the histological findings revealed 3 other idiopathic syndromes—necrotizing hepatopancreatitis, idiopathic blindness, and nonspecific granulomas—in higher prevalences in lobsters from Rhode Island compared with those from Maine. Necrotizing hepatopancreatitis, a newly described disease syndrome in lobsters, was observed in 15% of the lobsters from Rhode Island. Idiopathic blindness was present in 54% of the lobsters from Rhode Island, and 16% of the animals from Maine. This is the first report of the syndrome in lobsters from Maine. None of the idiopathic syndromes was associated with epizootic shell disease. The detection of multiple disease syndromes such as epizootic shell disease, necrotizing hepatopancreatitis, and idiopathic blindness may be indicative of exposure to environmental stressors in Narragansett Bay, RI.

Fulminant sepsis due to disseminated histoplasmosis in renal transplantation: A diagnostic challenge

Disseminated histoplasmosis can be extremely life threatening if not identified and treated promptly. Diagnosing fungal infections in patients receiving solid organ transplants and in those who are immunosuppressed is pivotal in prevention of fungal sepsis. These patients may present with subtle chronic symptoms prior to sepsis. The patient, a 77-year-old woman who had a kidney transplant from a living related donor about 26 years previously, presented with recurrent skin rash and muscle weakness for 4 months. Her skin biopsy showed nonspecific granulomas prior to admission. On presentation she remained critically ill, and her radiographic imaging or cultures did not show specific abnormalities throughout the disease course, except for a positive urine histoplasma antigen and serum histoplasma polymerase chain reaction. Her clinical status deteriorated eventually leading to death. This case highlights the importance of rapid diagnostic tests in the early diagnosis of disseminated histoplasmosis, which could potentially prevent fulminant sepsis.

Lymph Node Biopsies: A Hospital Based Retrospective Study

Lymphadenopathy is a common clinical finding at the outpatient setting that may be caused by a vast array of disease processes. A retrospective study to analyze the histopathological diagnosis of lymph node biopsies with respect to age, sex, and site was conducted. All the lymph nodes sent for histopathological examination from August 2003 to 2007 were included. Of all patients with enlarged lymph nodes, 49% were males (mean age: 34.52 years) and 51% were females (mean age: 38.1 years). The most common diagnosis was tubercular lymphadenitis (42%), followed by non-specific (reactive) lymphadenitis (23%), metastatic deposits (10%), non-specific granuloma (3%), NHL (2%), and lymphadenitis due to various other causes (7%). Thirteen percent of the biopsied lymph nodes were normal in morphology. Most common site of lymph node enlargement was neck (44%) followed by mesentery (19%) and axilla (16%). Most of the patients were in the age group of 21-30 years (20%). The neck lymph nodes were the most commonly sent nodes for histopathological examination and tuberculosis was the most common diagnosis.

Bilateral idiopathic orbital inflammation 3 years before systemic Wegener´s granulomatosis in a 7-year-old girl

Wegener's granulomatosis (WG) is a necrotizing granulomatous vasculitis characterized by the involvement of the upper or lower airways, lungs, and kidneys, but it can affect almost any organ including the orbit. WG is rare in childhood. This case report describes a 7-year-old girl who presented bilateral idiophatic orbital inflammation and antineutrophil cytoplasmic antibodies-negative titres. Computed tomography scan and magnetic resonance imaging showed enlargement of both lacrimal glands with infiltration. Treatment with corticosteroids achieved remission of the disease. Three years later, she developed a systemic affectation with tracheal stenosis, pulmonary affectation, renal failure, and respiratory tract mucosa inflammation. Lacrimal gland biopsy showed perivascular nonspecific granulomas and ANCA titres remain negative. Treatment with corticosteroids and cyclophosphamide was done. A relapse occurred 2 years later, with complete remission with antitumor necrosis factor-alpha. No other symptoms have appeared after 9 years of follow-up. Early diagnosis and treatment is crucial to increase the survival rate in these patients.

Pressure cutaneous ulcer over a pacemaker successfully treated with left subcostal transplantation in an extremely thin patient

Implantation of a permanent cardiac pacemaker is becoming common with the increase in the elderly population. A cutaneous ulcer over the pacemaker is a rare complication. Most such cases previously reported demonstrate non-specific granuloma histologically, negative patch testing of materials used in the device, and no growth in the bacterial culture taken from the generator pocket. To date, the conventional treatments often result in a disappointing outcome. We describe an extremely thin 79-year-old Japanese male with a pressure cutaneous ulcer caused by the presence of a pacemaker device. This patient was referred to us with a 1-month history of repeated cutaneous ulcer and exposure of the cardiac pacemaker in the left pectoral area. Conservative treatment was not effective. Treatment with left subcostal implantation of a new pacemaker, which was not wrapped, and disposition of the electrodes in the subcutaneous tissue of the thorax was successful. Cutaneous manifestations have not recurred for 5 years. Considering the poor condition of the patient, subcostal translocation of the pacemaker was a simple and acceptable treatment for pressure cutaneous ulcer over the pacemaker.

CT-guided transthoracic core biopsy for pulmonary tuberculosis: diagnostic value of the histopathological findings in the specimen.

We evaluated the value of CT-guided transthoracic core biopsy for the diagnosis of mycobacterial pulmonary nodules. The 30 subjects in this study had pulmonary nodules that had been either diagnosed histopathologically as tuberculosis or were suspected as tuberculosis based on a specimen obtained by CT-guided transthoracic core biopsy. The histopathological findings, the existence of acid-fast bacilli in the biopsy specimens, and the clinical course of the patients after the biopsy were reviewed retrospectively. Two of the three histological findings for tuberculosis that included epithelioid cells, multinucleated giant cells and caseous necrosis were observed in 21 of the nodules which were therefore diagnosed as histological tuberculosis. Six of these 21 nodules were positive for acid-fast bacilli, confirming the diagnosis of tuberculosis. Thirteen of the 21 nodules did not contain acid-fast bacilli but decreased in size in response to antituberculous treatment and were therefore diagnosed as clinical tuberculosis. Seven nodules with only caseous necrosis were diagnosed as suspected tuberculosis, with a final diagnosis of tuberculosis being made in 4 of the nodules and a diagnosis of old tuberculosis in 2 nodules. Two nodules with only multinucleated giant cells were diagnosed as suspected tuberculosis with 1 of these nodules being diagnosed finally as tuberculosis and the other nodule as a nonspecific granuloma. When any two of the three following histopathological findings--epithelioid cells, multinucleated giant cells or caseous necrosis--are observed in a specimen obtained by CT-guided transthoracic core biopsy, the diagnosis of tuberculosis can be established without the detection of acid-fast bacilli or Mycobacterium tuberculosis.

El tratamiento local esclerosante con etoxiesclerol en la patología orl: Enfermedad de rendu-osler, granulomas, angiomas…

In a previous report, we showed the efficacy of the submucous sclerosant therapy with Etoxiesclerol ® (Polidocanol) in two patients with Rendu-Osler-Weber disease. We confirm, in this present study, the advantages of Etoxiesclerol in the treatment of the epistaxis in the Rendu-Osler disease, in six patients, 3 males and 3 females and likewise in two patients with non-specific granuloma of nasal septum and another patient with cavernous hemangioma of soft palate.