Posterior Cervical Region Research Articles

A Unique Anatomical Variant of the Levator Scapulae Muscle: A Case Report

Musculature variations in the head and neck are typically observed in cadaveric dissections. Some of these variations could involve the levator scapulae muscle, which may lead to cervical and postural misalignment. The levator scapulae function to elevate the scapula and rotate it downward. In this case report, we present an 88-year-old male cadaver diagnosed with thoracic kyphosis having a double-bellied levator scapulae, originating from the transverse processes of C1-C4 and the mastoid process. This abnormality, not found elsewhere in our search of literature, can give physicians insight into upper back pain management and surgical navigation of the posterior cervical and upper back regions.

Spindle cell lipoma of the jejunal mesentery

Abstract 3-year-old girl with diarrhea was found to have an abdominal mass when she visited a hospital. The mass had a smooth margin and clear boundary, with an irregular internal echogenicity, showing patches and streaks. The mass showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, and the images were disturbed by the fat component inside the mass. The origin of the tumor was the mesentery. The tumor had a wide base and was contiguous with the small intestine. The tumor, including one side of the mesentery, was resected while the intestinal tract was kept intact. Fibroblast-like spindle cells were arranged in characteristic parallel arrays, with highly variable amounts of mature adipocytes in a background of collagen bundles, myxoid stroma. On immunohistochemical analysis, the spindle cells were strongly positive for CD34 but were negative for S100. Spindle cell lipoma (SCL) is a benign soft tumor, and distinguishing SCLs from liposarcomas is sometimes difficult. SCLs commonly occur in the posterior cervical region and shoulders of old and middle-aged men. Only three cases of SCLs in children have been reported.

Medical Device-Related Pressure Injuries: an integrative literature review.

To identify and analyze the scientific evidence regarding the occurrence of Medical Device-Related Pressure Injuries, considering the development sites; and to describe the devices of risk and the measures of prevention and treatment. Integrative, search-based review: CINAHL, PubMed, Wiley InterScience, Scopus, and Web Of Science. The terms "pressure ulcer" and "medical devices" were used, including original articles and case studies published between 2010 and 2015. Nine studies were selected. Posterior cervical region and nose had the highest injury frequencies, respectively, 66.0% and 40.0%. Eleven risk devices were identified, with emphasis on Non-Invasive Ventilation masks and orotracheal tube. For prevention and treatment emerged recommendations specific to the device employed and general measures. Medical Device-Related Pressure Injuries are frequent problems, however, they can be prevented and treated based on the recommendations of the articles raised in this review.

Fibroma tipo nucal laterocervical. Descripción de un caso

Introduction: Nuchal-type fibroma is a rare proliferation of soft tissues of a benign nature. It appears more frequently in middle-aged men, usually as a solitary mass and less than 6 cm, poorly circumscribed, not encapsulated, dense and whitish in color. Its etiopathogenesis is unknown and is usually asymptomatic. Its diagnosis is histological, and its treatment the complete resection. Case description: We present the case of a 72-year-old patient who came to our hospital due to the chance finding of a right laterocervical tumor 5 days ago. She does not treat dysphonia, odynophagia, otalgia, dyspnea, fever or constitutional syndrome. After the exploration and the necessary imaging tests, it is surgically intervened with good results, the result is a type of fibroma of laterocervical localization. Conclusions: The clinical evaluation of a solitary neck mass can be difficult, so the nuchal fibroid should include the possible differential diagnoses of tumors in the posterior cervical region.

Double fenestration of the ipsilateral internal jugular vein

To the editor, Internal Juguler vein (IJV) is the largest venous structure in the neck and drains venous blood from cranium, facial region, and the neck. IJV is an important anatomical landmark during surgical and interventional radiological procedures, and a thorough knowledge of its anatomical variations and neighborhood relationships is of paramount significance. Fenestration is a rare malformation of IJV (1-3). A 3-year-old female child was referred by an outside center to our center for computed tomography examination for further evaluation of a mass lesion in her neck. Her physical examination was not remarkable for any abnormality. The laboratory studies (including blood cell count, hemoglobin concentration, and hematocrit) were all normal. A contrast-enhanced multislice computed tomography (MSCT) examination was performed using a 16-slice computed tomography device (Brilliance, Philips, Amsterdam, Netherlands). The tomographic sections showed a tortuous and dilated IJV on the right side of the neck; three dimensional (3D) volumetric images were reconstructed using the axial plane images stored on the workstation. A 3D MSCT angiography showed double fenestration in the right IJV, and dilation and tortuosity in its terminal segment ( Figures. 1A, B ). Additionally, multiple conglomerated lymph nodes were present in bilateral posterior cervical region. The patient was informed about her vascular anomaly and discharged. Fenestrations and duplications of IJV are rare congenital vascular anomalies of neck. However, there is an important difference between fenestration and duplication. The main difference between these two clinical entities is that in duplication IJV originates as a single vessel from the cranium, branches off into two superiorly, and converges distally with the subclavian vein as two separate vessels, whereas in separation the two veins converge with each other before they converge with the subclavian artery, as in our patient (2, 4-5). The incidence of duplication is 0.4% while fenestration has an incidence of less than 1%. These two variations may co-occur with aneurysm and flebectasia. Our patient also had flebectasia and tortuosity in the terminal part of the right IJV. The embryological origin of IJV fenestration is unclear. Vascular, neural, and bony hypotheses have been put forth to explain this variation. Whereas it has been suggested that it occurs at 3-6. gestational weeks, it has also been reported to occur due to clinical causes such as interventional procedures (2-4). IJV fenestrations are usually asymptomatic and usually detected incidentally, as is the case for our patient. However, it is important to show the anatomy of IJV and the accessory nerve during neck dissection in patients with head-neck tumor. The relationship between the accessory nerve and IJV should be clarified in order to protect both structures during neck dissection (1, 3-5). Modern MSCT technology currently allows the visualization of the supra-aortic arterial and venous structures with a high image quality. The obtained images are reformatted and reconstructed in different planes and used to guide planning of endovascular and surgical treatment (3-5). In conclusion, it is of particular importance to have knowledge of this type of anomaly before contemplating surgical and interventional procedures involving the neck region.

Direction of commissural axon projections in different regions of the spinal cord during chicken embryonic development

Few researchers have investigated the direction of commissural axon projections on the contralateral side of the vertebrate embryonic spinal cord, especially for comparison between its different regions. In this study, pCAGGS-GFP plasmid expression was limited to different regions of the chicken embryonic spinal cord (cervical, anterior limb, anterior thorax, posterior thorax and posterior limb) at E3 using in ovo electroporation with modified electrodes and optimal electroporation conditions. Then open-book technique was performed at E6 to analyze the direction of axon projections in different spinal cord regions. The results show that in the five investigated regions, most axons projected rostrally after crossing the floor plate while a minority projected caudally. And there was a significant difference between the rostral and caudal projection quantities (P<0.01). The ratio of rostral and caudal projections was significantly different between the five investigated regions (P<0.05), except between the cervical region and the anterior limb (P>0.05). The projections were most likely to be rostral for the posterior limb followed by the posterior thorax, cervical region, anterior limb and anterior thorax. Our data for the direction of the commissural axon projections will be helpful in the future analyses of axon projection mechanisms and spinal cord-brain circuit formation.

An analysis on muscle tone and stiffness of posterior cervical region during sling and plinth on static prone position.

[Purpose] The purpose of this study was to quantitatively analyze changes in muscle tone and stiffness in the posterior cervical region of individuals in a static prone position in a sling or on a plinth. [Subjects and Methods] Twenty-four men in their 20s were divided into a sling group and a plinth group, and their changes in muscle tone and stiffness over time in the upper cervical region, lower cervical region, and upper trapezius muscles during a static prone position were measured. [Results] The sling group showed increases in the mean values of muscle tone and stiffness in the upper cervical region immediately after the suspension. In addition, this group exhibited statistically significant declines in the muscle tone and stiffness of the upper cervical region and a statistically significant decline in the muscle tone of the upper trapezius region. [Conclusion] The findings of this study suggest that for the treatment of the posterior upper cervical region after sling suspension in a static prone position, the time required to reduce the muscle tone and stiffness of this region should be taken into account.

Treatment Options for Odontoid Fractures. A Comparasion between Anterior and Posterior Approaches

Introduction Odontoid fractures account for 9% to 15% of adult, cervical spine fractures, and are the most common fractures in the geriatric cervical spine. The mechanism of injury generally results from hyperflexion or hyperextension of the cervical spine during low-energy impacts in the elderly or high-energy impacts in the young and middle aged. No consensus exists on the optimal treatment (surgical or conservative) and the most relevant outcome parameter (osseous union, fracture stability or clinical outcome). Neurologic injuries associated with these fractures are rare. Material and Methods This study was a retrospective chart review of 13 patients who were treated for odontoid process fractures between November 2010 and May 2015. Inclusion criteria: Patients with odontoid fractures submitted to surgical treatment. Data were obtained from medical charts and spinal column imaging reports. Medical charts, imaging studies and the patient's outcomes were submitted to descriptive analysis in the pre-operative and post-operative period. The data submitted to descriptive analysis were: Fracture gaps; the direction and degree of odontoid process displacement; the odontoid fracture line anatomy; the degrees of the atlantoaxial instability; and the contact between the fractured odontoid and the axis vertebrae. We used conventional radiographs, three-dimensional computed tomographic (3D-CT) scans, and magnetic resonance images. We used the Grauer Algorithm for defining the surgical treatment modality. We identified the solid bone union through the presence of bony bridges and the definite continuity of cortical bone. Results A total of 13 patients who underwent surgical treatment for odontoid fracture were identified. The patients were 76.9% men, the mean age = 32.92 years. Traffic accidents (69,2%) were the most common cause of trauma. The main symptom was pain (84.6%) in the posterior cervical region. The elapsed median time from accident to surgery was 30 days. Mean follow-up was 20 months. Odontoid screw technics (38,4%) and Harms posterior technic (38,4%) were the most common surgical treatment adopted as primary surgical treatment. The most common Grauer's line fracture type was type B on 8 cases. 2 patients referred chronic cervical pain after surgery, 1(20%) were submitted to anterior technic and 1 (12,5%) posterior technic. We had 2 cases with complications, all submitted to posterior technic, 1 with CSF leak and 1 with vertebral artery lesion. No mortality was observed. Conclusion There was no difference between anterior or posterior approach when analyzing the cervical chronic pain and mortality. However, there were more complications in cases covered by the posterior approach. A well-designed prospective study with a larger number of cases is needed to better elucidate optimal treatment algorithms from both an outcomes and cost-effectiveness perspective.

Topographic analysis of the skull vibration-induced nystagmus test with piezoelectric accelerometers and force sensors.

Vibration-induced nystagmus is elicited by skull or posterior cervical muscle stimulations in patients with vestibular diseases. Skull vibrations delivered by the skull vibration-induced nystagmus test are known to stimulate the inner ear structures directly. This study aimed to measure the vibration transfer at different cranium locations and posterior cervical regions to contribute toward stimulus topographic optimization (experiment 1) and to determine the force applied on the skull with a hand-held vibrator to study the test reproducibility and provide recommendations for good clinical practices (experiment 2). In experiment 1, a 100 Hz hand-held vibrator was applied on the skull (vertex, mastoids) and posterior cervical muscles in 11 healthy participants. Vibration transfer was measured by piezoelectric sensors. In experiment 2, the vibrator was applied 30 times by two experimenters with dominant and nondominant hands on a mannequin equipped to measure the force. Experiment 1 showed that after unilateral mastoid vibratory stimulation, the signal transfer was higher when recorded on the contralateral mastoid than on the vertex or posterior cervical muscles (P<0.001). No difference was observed between the different vibratory locations when vibration transfer was measured on vertex and posterior cervical muscles. Experiment 2 showed that the force applied to the mannequin varied according to the experimenters and the handedness, higher forces being observed with the most experienced experimenter and with the dominant hand (10.3 ± 1.0 and 7.8 ± 2.9 N, respectively). The variation ranged from 9.8 to 29.4% within the same experimenter. Bone transcranial vibration transfer is more efficient from one mastoid to the other mastoid than other anatomical sites. The mastoid is therefore the optimal site for skull vibration-induced nystagmus test in patients with unilateral vestibular lesions and enables a stronger stimulation of the healthy side. In clinical practice, the vibrator should be placed on the mastoid and should be held by the clinician's dominant hand.

Primary cutaneous nocardiosis: case report and review

Background: Infection caused by Nocardia species are uncommon and primary cutaneous nocardiosis is relatively rare. The lymphocutaneous pattern of the disease is the rarest type and commonly occurs in otherwise healthy individuals1. Clinically it can present as superficial acute skin and soft tissue infection (abcess or cellulitis), a lymphocutaneous infection and a deeper infection, mycetoma9. Mycetoma is commoner than other two variants. Here we report an interesting case of primary cutaneous nocardiosis (PCN) in posterior auricular, ear pinna and cervical region, progressing to lymphocutaneus nocardiosis which is a rare site. Keywords: Nocardiosis, Children, Pedal edema, Bikaner Case history: The child presented with bilateral pedal edema, loose motions, vomiting and a pustule behind right ear pinna and redness of inner aspect of pinna. The patient was diagnosed as PCN caused by Nocardia species grown on pus culture. Patient was a severe acute malnourished child and approximately treated according to sensitivity of antibiotics and drainage of abscess done

Cervical sympathetic chain schwannoma associated with parathyroid adenoma

Abstract Background Schwannoma is a rare benign tumour derived from nerve sheaths. When derived from the cervical sympathetic chain, it usually presents itself as an asymptomatic mass located in the posterior cervical region, at paravertebral level. Its diagnosis is not easy, usually requiring multiple imaging tests. Its differential diagnosis includes parathyroid adenoma. Clinical case A new case of schwannoma of the cervical sympathetic chain in a patient with a synchronous overactive parathyroid adenoma is reported. This case adds to the 60 described in the literature, although to our knowledge no association between schwannoma and parathyroid adenoma has been reported to date. Conclusions Despite being a benign tumour, its treatment is a complete surgical resection. The most common complication after the surgery needed for these tumours is ipsilateral Horner syndrome.

Trends in Epidemiology and Management of Traumatic Type II Odontoid Fracture: Experience in Latin America

Introduction Odontoid fractures (OF) are frequent in the trauma population, and there is no universally accepted single method of management. The objective of this study was to evaluate the epidemiology and management of type II OF in Latin America treated either with rigid cervical orthosis or surgery. Patients and Methods A total of 83 patients treated conservatively or by surgery were enrolled in this retrospective study. Medical charts, imaging studies, and outcomes of patients were analyzed in the pretreatment period and at the last medical evaluation. The fractures were assessed using conventional radiographs, three-dimensional computed tomographic (3D-CT) scans, and magnetic resonance images. Fracture gaps, the direction and the degree of displacement of the odontoid process, the fracture line anatomy, the degrees of atlantoaxial instability, the comminuted fracture, and the surface contact area were analyzed. The decision for operative or nonoperative treatment was based on anesthesia risk, and patient's choice of the nonoperative treatment. The nonoperative management generally consisted of a rigid cervical orthosis for 3 months. The type of surgery to be performed was chosen by the surgeon. The solid bony union was defined as the presence of bony bridges and the definite continuity of cortical bone. Fibrous union was considered present when no degree of motion was evident in dynamic radiographs despite persistent cortical bone discontinuity within a fracture gap on 3D CT scans. Nonunion was defined as a definite fracture gap with abnormal motion of the fractured dens on dynamic radiographs and on a 3D CT scan. Results A total of 83 patients were included in this study. The patients were 78.3% men, the mean age = 44.98 ( ± 23.20 years) years. Traffic accidents (66.3%) were the most common cause of trauma. The main symptom was pain (85.5%) in the posterior cervical region. The median time elapsed from accident to surgery was 7 days (P25: 2/P75: 27.5). Median follow-up was 23.66 ( ± 25.43 months) months. Conservative treatment with cervical orthosis, for example, Miami J collar or halo-vest was used in 20.5% of the cases. Odontoid screw technics (57.6%) were the most common surgical treatment adopted as primary surgical treatment. Symptomatic nonunion was observed in two cases with conservative treatment and three cases after odontoid screw fixation. All the patients were referred to posterior C1–C2 fixation. The posterior fixation tended to be used after conservative failed therapy, after nonunion anterior screw surgery, and in fractures with greater displacement. The most common radiological feature was no displacement of the odontoid process in relation to the body of C2, horizontal fracture line, gap fracture &lt; 2 mm, no subluxation across each C1–C2 facet joint and no comminuted fracture. Conclusion The patients treated nonoperatively with a rigid collar may have an overall favorable outcome compared with surgical treatment. A well-designed prospective study is needed to better elucidate optimal treatment algorithms from both an outcomes and cost-effectiveness perspective.

An Uncommon Cause for Polyuria

Diabetes Insipidus (DI) is characterized by passing of large volume of urine secondary to deficient secretion of antidiuretic hormone (Central DI) or renal resistance to its action (nephrogenic DI). Central DI is secondary to the destruction of neurons arising in the supraoptic and paraventricular nuclei [1]. The known causes include inflammatory or autoimmune diseases (e.g. sarcoidosis and Wegener’s granulomatosis), Langerhans cell histiocytosis, craniopharyngiomas, cranial injury resulting from surgery or an accident, metastases and rarely genetic defects in antidiuretic hormone synthesis. Nephrogenic DI may result from a genetic cause (e.g.: X-linked NDI is secondary to Arginine Vasopressin (AVP) receptor 2 mutations leading to a loss of function resulting in renal resistance) or an acquired cause (e.g: hypercalcaemia and medications like lithium and cisplatin) [2]. Herewith we report on a patient who presented to us with the features of diabetes insipidus. which had an abrupt onset secondary to a metastatic disease. A 31-year-old gentleman presented to Emergency Department with altered sensorium of 4 days duration. He was feeling unwell over 4 weeks prior to this presentation with an abrupt onset of polydipsia and polyuria (about 5-6 liters of urine/24 hours) along with a weight loss of 6 kg. There was no history of trauma, headache, fever, addictions, chronic illness or any long term medication use. On examination, his Glasgow Coma Scale (GCS) was 11 over 15. There was a group of matted lymph nodes (4X6 cm) in the right lower posterior cervical region. There were no signs of meningeal irritation and optic fundi examination and systemic examination were unremarkable. His haemogram and blood glucose levels were normal. The serum sodium level was 165mmol/l (135-145) with urine osmolarity of 105 mmol/kg (126-502). Other biochemical results are as follows: TSH-0.6μIU/ml (0.3 - 4.5); T4 (Total Thyroxine) -9.3ug/dL (4.5 - 12.5); FT4C (Free thyroxine)-1.3 ng/dL (0.8 - 2.0); FSH -0.7mIU/ml (0.7 – 11.1); LH -0.1 mIU/ml (0.8 – 7.6); Testosterone-20.0ng/dL (270-1030); Cortisol (8 AM) -11.6 ug/dL (7-25). The Computed Tomography [Table/Fig-1a] and MRI [Table/Fig-1b] of the brain are shown below. Histopathology from cervical lymph node biopsy and CT of the chest are shown in [Table/Fig-2,​,3]3] respectively. Both CT and the MRI brain showed a sellar-suprasellar mass lesion. The biopsy of the lymph node showed signet ring cells which were positive for CK7(Cytokeratin-7) and focally for TTF1(Transthyretin Factor-1) suggestive of an adenocarcinoma probably of the pulmonary origin (Signet Ring Cell Type). A subsequent CT of the chest showed a mass in the left lung. Thus the patient was diagnosed to have Diabetes Insipidus (DI) due to metastasis of the adenocarcinoma of the lung (signet ring cell type) with partial hypopituitarism. He was initiated on desomopressin with which his sensorium improved along with normalization of sodium and urine output. He was referred to medical oncology for further management. [Table/Fig-1]: CT and MRI Brain showing a well-defined 3.4x3.2 sized heterogeneously enhancing lesion in sellar suprasellar region [Table/Fig-2]: Histopathology (H&E) of lymph node –Signet ring cells along with increased mitotic figures suggestive of an adenocarcinoma (Signet Ring Cell Type) [Table/Fig-3]: CT Thorax–A Hypodense lobulated mass lesion in the posterior basal segment of the left lower lobe of the lung measuring 3.4 x 3.1 cm Malignancies from breast, lung, colon and prostate are the most commonest to have metastases in the pituitary gland. While most of pituitary metastases remain asymptomatic, common clinical presentation in symptomatic subjects is DI indicating preference of metastases to the posterior lobe. A CT scan usually shows a hyperdense or isodense mass which may enhance homogeneously or non-homogeneously with contrast, whereas MRI scan commonly demonstrates a high-intensity signal on T2 weighted images and the definitive diagnosis of metastatic involvement is always based on histological evaluation [2]. Management is usually palliative which includes medical treatment of diabetes insipidus and surgical debulking with or without radiotherapy especially when there is compromise of vision secondary to compression [3].

P08.16 * NECK PAIN DUE TO UNDETECTED METASTATIC LUNG ADENOCARCINOMA

PURPOSE: Computed tomography (CT) and magnetic resonance imaging (MRI) have contributed greatly to the ability to identify metastases in head and neck cancer. However the deficiencies in the assessment of lymphadenopathy still exist. The aim of this case report is to emphasize the importance of adequate knowledge of the patient's medical history, physical examination and a detailed analysis of imaging studies. METHODS: A 62-year-old man in whom the first manifestation of a metastatic lung adenocarcinoma was advanced severe and incapacitating neck pain of approximately 4 months of progression attributed to a degenerative disc disease of the cervical spine based in the cervical MRI results. During physical exploration showed no neurological deficit, just a pain in the back of the neck and limitation of the cervical spine motion. After detailed analysis of cervical MRI images, in which we observe the presence of a small nodule in the posterior cervical region surgery was recommended to get a sample, and then perform the corresponding histopathological study. RESULTS: After radical excision, the histopathological study has referred metastases in soft tissue of lung adenocarcinoma, infiltrating fibroadipose tissue and skeletal muscle. Immunohistochemically was positive for cytokeratin 7 (CK7+), thyroid transcription factor-1 (TTF-1+) and negative for cytokeratin 20 (CK20-). CONCLUSIONS: Don et al. (1995), in 36 neck dissections from patients with squamous cell cancer found a large number of malignant nodes having diameters of less than 10 mm. Since the current radiological criteria for assessing the status of the cervical lymph nodes are based largely on size, the findings indicate the major limitations in the detection capabilities of metastatic disease. For this reason it is important the history, the physical examination and a detailed analysis of imaging studies. Because, of this depends that patients receive an adequate treatment for their condition and needs.

Sympathetic ganglion transcutaneous electrical nerve stimulation after coronary artery bypass graft surgery improves femoral blood flow and exercise tolerance.

We tested the hypothesis that transcutaneous electrical nerve stimulation (TENS) over the stellate ganglion region would reduce sympathetic overstimulation and improve femoral blood flow (FBF) after coronary artery bypass graft surgery. Thirty-eight patients (20 men, 24 New York Heart Association class III-IV) were randomized to 5-day postoperative TENS (n = 20; 4 times/day; 30 min/session) or sham TENS (n = 18) applied to the posterior cervical region (C7-T4). Sympathetic nervous system was stimulated by the cold pressor test, with FBF being measured by ultrasound Doppler. Femoral vascular conductance (FVC) was calculated as FBF/mean arterial pressure (MAP). Six-min walking distance established patients' functional capacity. Before and after the intervention periods, pain scores, opiate requirements, and circulating β-endorphin levels were determined. As expected, preoperative MAP increased and FBF and FVC decreased during the cold pressor test. Sham TENS had no significant effect on these variables (P > 0.05). In contrast, MAP decreased in the TENS group (125 ± 12 vs. 112 ± 10 mmHg). This finding, in association with a consistent increase in FBF (95 ± 5 vs. 145 ± 14 ml/min), led to significant improvements in FVC (P < 0.01). Moreover, 6-min walking distance improved only with TENS (postsurgery-presurgery = 35 ± 12 vs. 6 ± 10 m; P < 0.01). TENS was associated with lesser postoperative pain and opiate requirements but greater circulating β-endorphin levels (P < 0.05). In conclusion, stellate ganglion TENS after coronary artery bypass graft surgery positively impacted on limb blood flow during a sympathetic stimulation maneuver, a beneficial effect associated with improved clinical and functional outcomes.

Giant lipoma of posterior cervical region.

Lipomas are the slow growing soft tissue tumors of benign nature. They commonly grow on torso and extremities but may also develop in head and neck region. Rarely lipomas can grow to acquire gigantic proportions, turning into an entity termed as giant lipoma. Such lipomas are entitled to immediate attention as they have a relatively high malignant potential. We report a rare case of giant cervical lipoma in an elderly gentleman, followed by a brief discussion on diagnosis and management of the disorder.

Facial Dermatitis to Mercaptobenzothiazole

Introduction: Allergic contact dermatitis to mercaptobenzothiazole and its derivatives has been increasingly recognized in industrialized countries because of their widespread use in polymerization of synthetic rubber. Case report: A 61 years old non atopic man, woodworker, with a 12-month history of itching, erythema, infiltration of genius region of face and extension to posterior cervical region. Epicutaneous tests were performed with enlarged Basic series, Rubber series, wood series, cosmetics series, plastics series from Portuguese Contact Dermatitis group series and fragments of the work protection mask. It was found positive for mercaptobenzothiazole (++), mercapto mix (++) and elastic band of mask (++) in evaluation at 96 h and 7 days. Conclusions: Despite being well known allergens, mercaptobenzothiazole and its derivatives are still widely used in the rubber industry. We emphasize this case as an example of important occupational disability caused by allergic contact dermatitis.

Colgajo miocutáneo de trapecio bilateral para reconstrucción de región cervical posterior

Reconstructive surgery for the resolution of defects in posterior cervical and occipital region can often be a challenge for plastic surgeons. The trapezius ...

A rapidly growing neck mass in childhood: Castleman’s disease concomitant with cavernous lymphangioma in the posterior cervical region

In this article, we present a 12-year-old girl case with a painless mass in the left posterior region of the neck for two weeks. Two masses were detected during surgery. Histopathologic examination revealed the hyaline vascular type of Castleman's disease for the bigger mass and cavernous lymphangioma for the smaller mass. In the light of literature data, our case was the third childhood cervical posterior triangle Castleman's disease and was the first case reported due to its concomitance with cavernous lymphangioma.

Maladie de Kikuchi-Fujimoto : une présentation atypique

IntroductionHistiocytic necrotizing lymphadenitis (Kikuchi-Fujimoto disease) is a rare clinical entity characterized by the association of enlarged lymph nodes in the posterior cervical region and fever. The disease is more frequent in young women. Case reportWe report a 41-year-old African patient who presented with atypical features of Kikuchi's disease including cutaneous lupus, haemophagocytosis, and lymphocytic meningitis. The ethnic origin and the clinical presentation were initially suggestive of tuberculous meningitis. However, microbiological analyses remained negative, histological findings were suggestive of Kikuchi's disease and HHV6 DNA integration was documented in our patient. ConclusionKikuchi's disease should be suspected in an African patient when lymphocytic meningitis is associated with enlarged cervical lymph nodes, hemophagocytosis and HHV6 DNA integration.