Epstein�CBarr virus-associated inflammatory pseudotumor of the spleen: report of two cases and review of the literature

We report two rare examples of Epstein–Barr virus (EBV)-associated inflammatory pseudotumor of the spleen. One patient presented with night sweats, abdominal pain, and weight loss and was found to have a splenic mass on CT scan suspected of lymphoma. The splenic mass in second patient was found incidentally at the time of work up for kidney stones. The pathologic examination of these splenectomy specimens showed similar histologic features. However, the spindle cells were composed of EBV-infected follicular dendritic cells in one case whereas the second case lacked significant follicular dendritic cell proliferation and showed only focal EBV-infected cells suggesting that these proliferations are heterogenous in nature.     

Zinner’s syndrome: report of two cases and review of the literature

Background

Congenital malformations of the seminal vesicle are uncommon, and most of them are cystic malformations. If an insult occurs between the 4th and the 13 h gestational week, the embryogenesis of the kidney, ureter, seminal vesicle, and vas deferens could be altered. Cysts of the seminal vesicle may appear with a mass effect, dysuria, epididymitis, or obstruction of the gastrointestinal and genitourinary tracts. Approximately two thirds of them are associated with ipsilateral renal agenesis, because both the ureteral buds and seminal vesicles originate from the mesonephric (Wolffian) duct. They were first described by Zinner in 1914, and 200 cases of seminal vesicle cysts associated with ipsilateral renal agenesis have been reported in the literature. Most patients with this anomaly are asymptomatic until the third or fourth decade of life. Some cases have nonspecific symptoms such as prostatism, urinary urgency, dysuria, painful ejaculation, and perineal discomfort. Transrectal ultrasonography provides good visualization of the pelvic structures and allows guidance for aspiration of the cysts.

Case presentation

We present two cases of seminal vesicle cyst. The first patient had dysuria, increased frequency of urination, and haematuria. He was operated and benefited from a removal of the cyst with right ureterectomy and left ureteral reimplantation. The second patient had disorder of the digestive transit and he benefited from a laparoscopic removal of the cyst.

Conclusions

Seminal vesicle cysts combined with ipsilateral renal agenesis are rare urological anomalies. Usual symptoms that are caused by the seminal vesicle cysts are bladder irritation and obstruction as well as pain in the perineum and scrotum. Epididymitis is frequently found. Treatment consists to removing the seminal vesicle cyst.

     

Central Mucoepidermoid carcinoma of mandible – A case report and review of the literature

BACKGROUND: Primary central mucoepidermoid carcinoma of jaws is a rare lesion comprising 2-3% of all mucoepidermoid carcinomas reported in literature. CASE PRESENTATION: The case presented here illustrates the hypothesis that its specific pathogenesis is unknown. CONCLUSIONS: Mucoepidermoid carcinoma of the jaw is a rare tumour of unknown aetiology. Although about a 100 cases has been reported in literature, the speculation on its aetiopathogenesis has mainly centred on the pluripotential capabilities of the epithelial lining of odontogenic cysts.     

Rate of complications in scoliosis surgery – a systematic review of the Pub Med literature

Background

Spinal fusion surgery is currently recommended when curve magnitude exceeds 40–45 degrees. Early attempts at spinal fusion surgery which were aimed to leave the patients with a mild residual deformity, failed to meet such expectations. These aims have since been revised to the more modest goals of preventing progression, restoring 'acceptability' of the clinical deformity and reducing curvature. In view of the fact that there is no evidence that health related signs and symptoms of scoliosis can be altered by spinal fusion in the long-term, a clear medical indication for this treatment cannot be derived. Knowledge concerning the rate of complications of scoliosis surgery may enable us to establish a cost/benefit relation of this intervention and to improve the standard of the information and advice given to patients. It is also hoped that this study will help to answer questions in relation to the limiting choice between the risks of surgery and the "wait and see – observation only until surgery might be recommended", strategy widely used. The purpose of this review is to present the actual data available on the rate of complications in scoliosis surgery.

Materials and methods

Search strategy for identification of studies; Pub Med and the SOSORT scoliosis library, limited to English language and bibliographies of all reviewed articles. The search strategy included the terms; 'scoliosis'; 'rate of complications'; 'spine surgery'; 'scoliosis surgery'; 'spondylodesis'; 'spinal instrumentation' and 'spine fusion'.

Results

The electronic search carried out on the 1^st February 2008 with the key words "scoliosis", "surgery", "complications" revealed 2590 titles, which not necessarily attributed to our quest for the term "rate of complications". 287 titles were found when the term "rate of complications" was used as a key word. Rates of complication varied between 0 and 89% depending on the aetiology of the entity investigated. Long-term rates of complications have not yet been reported upon.

Conclusion

Scoliosis surgery has a varying but high rate of complications. A medical indication for this treatment cannot be established in view of the lack of evidence. The rate of complications may even be higher than reported. Long-term risks of scoliosis surgery have not yet been reported upon in research. Mandatory reporting for all spinal implants in a standardized way using a spreadsheet list of all recognised complications to reveal a 2-year, 5-year, 10-year and 20-year rate of complications should be established. Trials with untreated control groups in the field of scoliosis raise ethical issues, as the control group could be exposed to the risks of undergoing such surgery.     

Usefulness of core needle biopsy for the diagnosis of thyroid Burkitt’s lymphoma: a case report and review of the literature

Background

Thyroid lymphomas are an exceptional finding in patients with thyroid nodules. Burkitt’s lymphoma is one of the rarest and most aggressive forms of thyroid lymphomas, and its prognosis depends on the earliness of medical treatment. Given the rarity of this disease, making a prompt diagnosis can be challenging. For instance, fine-needle aspiration (FNA) cytology, which is the first-line diagnostic test that is performed in patients with thyroid nodules, is often not diagnostic in cases of thyroid lymphomas, with subsequent delay of the start of therapy.

Case presentation

Here we report the case of a 52-year-old woman presenting with a rapidly enlarging thyroid mass. Thyroid ultrasonography demonstrated a solid hypoechoic nodule. FNA cytology was only suggestive of a lymphoproliferative disorder and did not provide a definitive diagnosis. It is core needle biopsy (CNB) that helped us to overcome the limitations of routine FNA cytology, showing the presence of thyroid Burkitt’s lymphoma. Subsequent staging demonstrated bone marrow involvement. The early start of an intensive multi-agent chemotherapy resulted in complete disease remission. At 60 months after the diagnosis, the patient is alive and has not had any recurrence.

Conclusions

Clinicians should be aware that thyroid Burkitt’s lymphoma is an aggressive disease that needs to be treated with multi-agent chemotherapy as soon as possible. To diagnose it promptly, they should consider to order/perform a CNB in any patient with a rapidly enlarging thyroid mass that is suspicious for lymphoma.

     

Physical examination of the potential tissue donor, what does literature tell us?

European Tissue Banks should carry out a physical examination as a part of the donor selection procedure. This is one of the obligations concerning donation and procurement mentioned in the European Commission directives on tissue banking. As the directives do not give any further specification on the content or on the procedure of the physical examination, a search of literature was done in order to find more information. Although data in literature generally remain quite vague, it was possible to set up a list of items which should be looked at during physical examination. This list can be used temporarily until further information is gathered from an international survey and from a risk assessment analysis.     

Exploring the influence of rural residence on uptake of organized cancer screening – A systematic review of international literature

Lower screening uptake could impact cancer survival in rural areas. This systematic review sought studies comparing rural/urban uptake of colorectal, cervical and breast cancer screening in high income countries. Relevant studies (n = 50) were identified systematically by searching Medline, EMBASE and CINAHL. Narrative synthesis found that screening uptake for all three cancers was generally lower in rural areas. In meta-analysis, colorectal cancer screening uptake (OR 0.66, 95 % CI = 0.50−0.87, I² = 85 %) was significantly lower for rural dwellers than their urban counterparts. The meta-analysis found no relationship between uptake of breast cancer screening and rural versus urban residency (OR 0.93, 95 % CI = 0.80–1.09, I² = 86 %). However, it is important to note the limitation of the significant statistical heterogeneity found which demonstrates the lack of consistency between the few studies eligible for inclusion in the meta-analyses. Cancer screening uptake is apparently lower for rural dwellers which may contribute to poorer survival. National screening programmes should consider geography in planning.     

Does conversion of forest to agricultural land change soil carbon and nitrogen? a review of the literature

Soil carbon is a large component of the global carbon cycle and its management can significantly affect the atmospheric CO₂ concentration. An important management issue is the extent of soil carbon (C) release when forest is converted to agricultural land. We reviewed the literature to assess changes in soil C upon conversion of forests to agricultural land. Analyses are confounded by changes in soil bulk density upon land‐use change, with agricultural soils on average having 13% higher bulk density. Consistent with earlier reviews, we found that conversion of forest to cultivated land led to an average loss of approximately 30% of soil C. When we restricted our analysis to studies that had used appropriate corrections for changes in bulk density, soil C loss was 22%. When, from all the studies compiled, we considered only studies reporting both soil C and nitrogen (N), average losses of C and N were 24% and 15%, respectively, hence showing a decrease in the average C : N ratio. The magnitude of these changes in the C : N ratio did not correlate with either C or N changes. When considering the transition from forest to pasture, there was no significant change in either soil C or N, even though reported changes in soil C ranged from ?50% to +160%. Among studies that reported changes in soil N as well as soil C, C : N ratios both increased and decreased, with trends depending on changes in system N. Systems with increasing soil N generally had decreased C : N ratios, whereas systems with decreasing soil N had increased C : N ratios. Our survey confirmed earlier findings that conversion of forest to cropland generally leads to a loss of soil carbon, although the magnitude of change might have been inflated in many studies by the confounding influence of bulk‐density changes. In contrast, conversion of forest to uncultivated grazing land did not, on average, lead to loss of soil carbon, although individual sites may lose or gain soil C, depending on specific circumstances, such as application of fertiliser or retention or removal of plant residues.     

Did the perils of abdominal obesity affect depiction of feminine beauty in the sixteenth to eighteenth century British literature? Exploring the health and beauty link

'Good gene' mate selection theory proposes that all individuals share evolved mental mechanisms that identify specific parts of a woman's body as indicators of fertility and health. Depiction of feminine beauty, across time and culture, should therefore emphasize the physical traits indicative of health and fertility. Abdominal obesity, as measured by waist size, is reliably linked to decreased oestrogen, reduced fecundity and increased risk for major diseases. Systematic searches of British literature across the sixteenth, seventeenth and eighteenth centuries reveal that a narrow waist is consistently described as beautiful. Works in ancient Indian and Chinese literature similarly associate feminine attractiveness with a narrow waist. Even without the benefit of modern medical knowledge, both British and Asian writers knew intuitively the biological link between health and beauty.     

A literature review of type I SLCA—making the logic underlying methodological choices explicit

Purpose

The Social Life Cycle Assessment guidelines (UNEP-SETAC 2009) distinguish two different SLCA approaches, type I and type II. Few comprehensive and analytical reviews have been undertaken to examine the multiplicity of approaches that have been developed within type I SLCA. This paper takes on the task of exploring the evaluation methods used in type I SLCA methods.

Methods

In order to tackle this work, a critical literature review was undertaken, covering a total of 32 reviewed articles, ranging from 2006 to 2015. Those articles have been selected for they make explicit reference to type I, performance reference points (PRPs), corporate behavior assessment, and social performance assessment or if their assessment methods generated a result located at the same point as the inventory data, with regards to the impact pathway. The selected articles were analyzed with a focus on the inventory data used, the aggregation of inventory data on the functional unit, and the type of characterization and weighting methods used. This analysis allowed to make explicit the often implicit logic underlying the evaluation methods and to identify the common denominators of type I SLCA.

Results and discussion

The analysis highlighted the multiplicity of approaches that are comprised within type I SLCA today, both in terms of the data collected (in particular, its positioning along the impact pathway); the presence of some optional steps, such as the scaling of inventory data on the functional unit (FU); and in terms of the different characterization and weighting steps. With regards to data collection, this review has highlighted that the furthest indicators are positioned along the impact pathway, the hardest it is to justify the link between them and the activities of companies in the product system. The analysis also suggested that an important differentiating factor among type I SLCA methods lies in “what the inventory data is assessed against” at the characterization step and how it is ultimately weighted. To illustrate this, a typology of six characterization methods and five types of weighting methods was presented.

Conclusions

It is interesting to identify which approaches are most appropriate to respond to the various questions that SLCA aims to respond to. A question that arises is what approaches are most likely to tell us anything about the impact of a product system on social well-being? This question is particularly relevant in the absence of well-documented impact pathways between activities within product systems and impact on social well-being.

     

Cerebral blood flow during cardiopulmonary bypass in pediatric cardiac surgery: the role of transcranial Doppler – a systematic review of the literature

Background

Transcranial Doppler Ultrasound (TCD) is a sensitive, real time tool for monitoring cerebral blood flow velocity (CBFV). This technique is fast, accurate, reproducible and noninvasive. In the setting of congenital heart surgery, TCD finds application in the evaluation of cerebral blood flow variations during cardiopulmonary bypass (CPB).

Methodology

We performed a search on human studies published on the MEDLINE using the keyword "trans cranial Doppler" crossed with "pediatric cardiac surgery" AND "cardio pulmonary by pass", OR deep hypothermic cardiac arrest", OR "neurological monitoring".

Discussion

Current scientific evidence suggests a good correlation between changes in cbral blood flow and mean cerebral artery (MCA) blood flow velocity. The introduction of Doppler technology has allowed an accurate monitorization of cerebral blood flow (CBF) during circulatory arrest and low-flow CPB. TCD has also been utilized in detecting cerebral emboli, improper cannulation or cross clamping of aortic arch vessels. Limitations of TCD routine utilization are represented by the need of a learning curve and some experience by the operators, as well as the need of implementing CBF informations with, for example, data on brain tissue oxygen delivery and consumption.

Conclusion

In this light, TCD plays an essential role in multimodal neurological monitorization during CPB (Near Infrared Spectroscopy, TCD, processed electro encephalography) that, according to recent studies, can help to significantly improve neurological outcome after cardiac surgery in neonates and pediatric patients.     

Does the implementation of environmental flows improve wetland ecosystem services and biodiversity? A literature review

Environmental flow releases are a tool for wetland restoration, but there has been no systematic evaluation of their success. We systematically assessed 102 published studies from a wide range of wetland ecosystems across the globe to determine whether releasing environmental flows could maintain or promote biodiversity and increase ecosystem services, and which strategies were most effective. We found that environmental flow releases remarkably increased regulating services (sediment regulation and water purification) and supporting services (primary production and habitat maintenance), and maintained biodiversity and provisioning services. Biodiversity responses were positive only in river wetlands, and were negative in coastal, lake, and marsh wetlands; the overall delivery of ecosystem services responded positively in all ecosystem types except artificial wetlands. The effects were positive for ecosystem services under all environmental flow regimes, and seasonal minimum flow releases could maintain biodiversity and improve ecosystem services. We also found that long‐term environmental flow releases (years to decades) maintained biodiversity. Values of a change‐in‐flow parameter (D) ranging from 0 to 10% improved both biodiversity and ecosystem services. In summary, long‐term implementation, a high‐flow regime, and D ranging from 0 to 10% for the environmental flows promoted biodiversity and improved ecosystem services around the world, particularly in river wetlands. Regional‐level conclusions might be applicable to guide the implementation of environmental flow releases, but small sample sizes reduce their reliability. We also found that the effect sizes of environmental flow release projects for biodiversity and ecosystem services were significantly and positively correlated in rivers, but not in other wetlands.     

Cancer stem cells – the current status of an old concept: literature review and clinical approaches

As regards their morphology and biology, tumours consist of heterogeneous cell populations. The cancer stem cell (CSC) hypothesis assumes that a tumour is hierarchically organized and not all of the cells are equally capable of generating descendants, similarly to normal tissue. The only cells being able to self-renew and produce a heterogeneous tumour cell population are cancer stem cells. CSCs probably derive from normal stem cells, although progenitor cells may be taken into consideration as the source of cancer stem cells. CSCs reside in the niche defined as the microenvironment formed by stromal cells, vasculature and extracellular matrix. The CSC assays include FACS sorting, xenotransplantation to immunodeficient mice (SCID), incubation with Hoechst 33342 dye, cell culture in non-adherent conditions, cell culture with bromodeoxyuridine. CSCs have certain properties that make them resistant to anticancer therapy, which suggests they may be the target for potential therapeutic strategies.     

Primary mucosal sinonasal melanoma—Case report and review of the literature. The role of complex treatment-surgery and adjuvant radiotherapy

Aim

The place of adjuvant radiotherapy in the treatment of sinonasal melanoma.

Background

Sinonasal mucosal melanoma is a rare disease with poor prognosis and requires a complex treatment. Elective neck dissection in patients with N0 and adjuvant radiotherapy has been a source of controversy. High late regional recurrence rates rise questions about elective irradiation of the neck nodes in patients with N0 stage disease.

Methods

We present our two years’ follow up in a case of locally advanced sinonasal melanoma and literature review of the treatment options for mucosal melanoma.

Results

In locally advanced sinonasal melanoma treated with surgical resection, postoperative radiotherapy and chemotherapy we had local tumor control. Two years later, a regional contralateral recurrence without distant metastasis occurred.

Conclusions

Literature data for frequent neck lymph nodes recurrences justify elective neck dissection. Postoperative elective neck radiotherapy for patients with locally advanced sinonasal melanoma and clinically N0 appears to decrease the rate of late regional recurrences.     

Treatment of acute hepatitis C virus infection with interferon-α 2b and ribavirin: Case report and review of the literature

   

Hepatitis C virus (HCV) infection becomes chronic in about 85 % of individuals as demonstrated by the persistence of HCV. It is necesseray to treat acute hepatitis C infection. Interferon-α is generally used for the treatment of acute HCV infection.