Life-threatening Capillary Leak Syndrome in an Adult with Refractory Acute Myeloid Leukemia during Allogeneic Transplantation

A 27-year-old male was first admitted to our hospital in August 2014 with complaints of chills and fever. He exhibited obvious pain and swelling of gastrocnemius and activity abstacle. Peripheral blood counts revealed white cell counts of 29.9 × 109/L, hemoglobin lever of 89g/L, platelet counts of 179 × 109/L.

Bone marrow was hypercellular exhibiting infiltration with 30% blast cells comprising myeloblasts and promonocytes. Immunophenotype analysis showed 54% abnormal cells which were positive for CD13, HLA-DR, CD11b, CD11c, CD33, CD14, CD64 and CD15, and weakly positive for CD34 and MPO. The overall findings were consistent with acute myeloid leukemia.

G-banding revealed 46, XY. Moreover, genetic testing revealed positive for dupMLL fusion. He did not respond to “HA”(HHT 4 mg/d × 7d, Ara-c 0.2 g/d × 7d) and subsequent “IA” (IDA 30 mg d1, 20 mg d2-3, Ara-c 0.2 g/d × 7d) induction chemotherapy.Salvage therapy consisted of DAC (decitabine) (20 mg/m2/d × 5d), Ara-c (cytarabine) (10 mg/m2/d × 2d) and Ara-c (10 mg/m2 every 12 h × 3d) was planned.

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Portal Hypertension Model in Pigs

Every year in western countries millions of people are diagnosed with portal hypertension (PHT) which rapidly complicates hepatic cirrhosis and causes esophageal varices, ascites and encephalopathy. This determines higher risk of morbidity and mortality and contributes to elevate costs for the Health Care System.

PHT is defined as the elevation of the portal vein pressure gradient over 5-10 mmHg. Common causes are: Pre-hepatic such as portal vein thrombosis or congenital atresia; intra-hepatic as liver cirrhosis, hepatic fibrosis and less commonly non-cirrhotic causes such as schistosomiasis, massive fatty change and granulomatous diseases; post-hepatic including obstruction that occurs at any level between liver and right heart (i.e., Budd Chiari syndrome and veno-occlusive disease VOD).

The pathophysiology of portal hypertension is explained by the increasing of vascular resistance into the blood flow of the liver; as consequence the hepatic micro vasculature is compressed by regenerative nodules and fibrotic scars of the cirrhosis.

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Genitourinary Hydatid Disease

The most important parasitic diseases involving the genitourinary system in humans are helminthic, where schistosomiasis is the commonest followed by hydatid disease (HD) and filariasis [1]. HD is a parasitic infestation, caused by tape worms of the genus Echinococcus, that usually involves the liver and lungs, although no organ is spared.

The varied presentations and complications of HD present routine surgical problems in endemic areas, although HD of the urinary tract is uncommon, comprising 2–4% of all cases. This article reviews the epidemiology, etiopathogenesis, clinical features and presentations, medical and surgical treatment of genitourinary and pelvic echinococcosiswith special reference to individual organs.

In addition our own experience at our hospital in the last 4 years that we treated 4 cases of hydatid cysts of which 3 were renal HD and one was primary pelvic HD.

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Complete Sciatic Nerve Transection Associated with a Closed Femoral Shaft Fracture

Femoral shaft fractures are usually the result of a high-energy injuries. It is estimated that annually between 1.0 and 2.9 million femoral shaft fractures occur worldwide. In high-income countries the annual incidence of femoral shaft fractures ranges between 8.2 and 23.9 per 100,000 people.

Due to the high-energy mechanism, associated injuries are common in this patient population and the inhospital mortality has been reported to be approximately 1.4%. In particular, musculoskeletal injuries to the ipsilateral limb, such as hip fractures, patella fractures, tibial plateau fractures, and ligamentous knee injuries have been reported to commonly occur in conjunction with high-energy femoral shaft fracture.

However, reports on peripheral nerve injuries as a result of a femoral shaft fracture are limited in the orthopaedic literature. Rodriguez-Merchan et al. reported on 150 femoral shaft fractures and observed temporary neurologic deficits in 10 patients. A few case reports have reported on injuries to the sciatic nerve associated with femoral shaft fractures.

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Secondary Augmentation Mastopexy to Correct Malpositioned Nipple Areola Complex (NAC) and Baker's Grade III Capsular Contracture 15 Years Later

Augmentation mastopexy is a complex procedure that combines two surgical procedures in a single operation. Augmentation mastopexy attempts to correct both mammary volume loss or depletion and ptosis.

Some surgeons have suggested performing both procedures in a separate setting- performing the mastopexy first if the primary problem is one of ptosis and performing augmentation mammaplasty as a second procedure. If the primary problem is of volume loss or deflation, augmentation mammaplasty is carried out first followed by mastopexy in another setting.

Splitting the surgery into two stages have both economical and social drawbacks to the patient and surgeon. The patient now has to pay for and undergo two separate surgeries as well as be subjected to two separate postoperative recovery periods.Augmentation mastopexy does have its advantages that it allows the surgeon to pick an appropriate implant volume for the breast while accurately determining how much skin or tissue needs to be resected thereafter.

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Thoracic Wall Siliconoma after Silicone Leaking from a Defective Breast Implant in Patient with Poland Syndrome

Silicone breast implants are widely used in both aesthetic and reconstructive breast surgery. Within the rare complications that can appear in patients with this type of implant there is the formation of local and peripheral siliconomas, due to the diffusion of the silicone gel contained within the implant, that can appear in case of both damaged and intact implants.

The use of new generation breast implants (double lumen envelope and content of cohesive gel) has considerably lowered, but not eliminated, the risk of rupture and the possible formation of siliconomas.

The reported case regards a patient who, affected by Poland Syndrome, underwent breast augmentation surgery in order to correct the defect at the age of 18. A P.I.P. implant (Poly Implant Prothese, France) was positioned and, after 10 years, at the diagnostic exams revealed a nodular mass of the thoracic wall compatible with siliconoma without evident rupture of the implant.

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Complete Sciatic Nerve Transection Associated with a Closed Femoral Shaft Fracture

Femoral shaft fractures are usually the result of a high-energy injuries. It is estimated that annually between 1.0 and 2.9 million femoral shaft fractures occur worldwide. In high-income countries the annual incidence of femoral shaft fractures ranges between 8.2 and 23.9 per 100,000 people.

In particular, musculoskeletal injuries to the ipsilateral limb, such as hip fractures, patella fractures, tibial plateau fractures, and ligamentous knee injuries have been reported to commonly occur in conjunction with high-energy femoral shaft fracture.

Rodriguez-Merchan et al. reported on 150 femoral shaft fractures and observed temporary neurologic deficits in 10 patients. A few case reports have reported on injuries to the sciatic nerve associated with femoral shaft fractures.

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A Strange Evolution of Rheumatoid Arthritis

Rheumatoid arthritis is an autoimmune and a chronic disease that causes pain, stiffness, swelling and limited motion and function of many joints. While rheumatoid arthritis can affect any joint, the small joints in the hands and feet tend to be involved most often. Inflammation sometimes can affect organs as well, for instance, the eyes or lungs.

It is characterized by synovial proliferation and a symmetric erosive arthritis of peripheral joints. For the Romanian geographic particularity, it is appreciated that rheumatoid arthritis affects around 1% from general population, so the total number of suffering people are estimated to be up to 180,000. One of the gold standard in treating rheumatoid arthritis are the biologicals one, they are new class of drugs that have been used since 1998. Currently available biologic agents act as inhibitors of the cytokines IL-1 or TNF.

The tumor necrosis factor-alpha (TNF-alpha) blockers and the recombinant interleukin 1 (IL-1) receptor antagonist are effective in patients with active rheumatoid arthritis, they have been associated with reactivation of tuberculosis and possibly development of other opportunistic infections (histoplasmosis, listeriosis. and pneumocystis).

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Aspasia and Cleopatra Metrodora, Two Majestic Female Physician Surgeons in the Early Byzantine Era

Female physicians in antiquity were doomed to oblivion, pushed aside by their male colleagues. Aspasia and Metrodora have accomplished to leave their stigma and ameliorated the surgical techniques of the era.

The objective of this review is to provide all available knowledge concerning to those two significant female historical medical figures. A thorough search in the digital library of the Greek literature TLG (Thesaurus Linguae Graecae) was performed combined with a search in electronic databases such as Google Scholar, Scopus and PubMed. The key terms that have been used during the review were Aspasia, Metrodora, surgery, gynaecology, and Byzantium.

Both Aspasia and Metrodora performed a series of innovative surgical operations during their era. Aspasia's venesection, shemorrhoidectomy, hysterectomy, open subinguinal varicelectomy and hydrocelectomy and Metrodora's breast and face reconstruction, re-suturing of the vaginal hymen and breast and uterus cancer excisions, present great similarities to modern surgery.

Pilot Study of Alternative Therapy with Minerals in Patients of Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common endocrine system disorder among women of reproductive age. Women with PCOS may have enlarged ovaries that contain small collections of fluid (Follicles). Alternative therapy including natural minerals has been emerging in addition to established medical and surgical treatment for PCOS.

In present non-randomized, open label pilot study, we have studied safety and effectiveness of exclusive natural mineral solution with use of reserve wellness wrapping technique in PCOS patients. Methods: A total of 20 females (10 married and 10 unmarried) who had with PCOS were enrolled in present study. Natural Mineral powder used for study consist of mixture of Bentonite Clay, Magnesium Chloride, Magnesium Sulphate, Sodium Chloride and Zinc Oxide 2%. Patients were underwent standard study procedure.

Changes in hormonal level (AMH, LH, FSH, Prolactin, TSH, Insulin resistance) measured on 3rd day of menstrual cycle pre-treatment and post treatment was evaluated to assess the efficacy of study treatment. Safety was evaluated throughout study procedure by observing adverse events. Compliance to study treatment was documented on individual case report form of the patient.

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Role of Minimally Invasive Surgery in Gallbladder Carcinoma

The diagnosis of gallbladder cancer is made in two distinct clinical fashions: Preoperatively, those patients who have suspicious lesions found with laboratory work or imaging based on history and physical. And incidental, (most common) those patients in whom diagnosis is made by pathology after laparoscopic cholecystectomy or those with gallbladder features concerning for carcinoma intraoperatively. Due to the relative low incidence of gallbladder cancer and lack of distinct symptoms, gallbladder cancer can be found at advanced stages and diagnosis is still usually made postoperatively.

For lesions found incidentally, a laparoscopic approach was thought to be a disadvantage primarily because of increased biliary leak rates, delay in the ability to perform an unexpected extended resection, and port site metastasis. Early laparoscopic intraoperative biliary leak rates reached 26-36% potentially transforming early lesions to T4 disease with major impact on survival: 75% 5 year survival rate in T1a/ T1b to 10% 3 year survival in T4. Furthermore, early publications on laparoscopic cholecystectomy even for localized disease showed generalized worse outcomes.

Adding to the concern was the argument that an initial laparoscopic approaches found to have unexpected, advanced tumors upon entry into the abdomen or gallbladders with concerning appearance (thickened or infiltrated gallbladder walls) would require extended resection. Thus, these patients would require referral to a center where extended resection could be performed, resulting in treatment delay and potential disease advancement.

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Long-term Psychological Support for Women

In the near future, three years will have passed since the Great East Japan Earthquake. Despite the passage of time, several residents living off the Pacific coast of Tohoku continue to suffer from mental and physical repercussions of the event. In other words, numerous survivors of the Great East Japan Earthquake continue to live with emotional trauma and stress. Previous studies suggest that mental health problems among natural disaster survivors are most pronounced within a specified period after the event.

Although recovery among survivors is progressing incrementally in the disaster area of Tohoku, one may argue that availability of medium- to long-term psychological care for these people is important. Immediately following the earthquake, our research team provided horticultural therapy as a medium- to longterm psychological support to the survivors. The motivation behind this study is based on previous research suggesting that women are more susceptible to experiencing anxiety in post-disaster environments than men, that women are more likely to be diagnosed with Post- Traumatic Stress Disorder (PTSD) than men after experiencing natural disasters, and that weak social support is associated with a higher susceptibility to PTSD.

Horticultural Therapy (HT) is a psychological care method for treating PTSD that was developed in the United States for psychological care and social rehabilitation of disabled soldiers and war veterans diagnosed with PTSD following World War II. Previous studies have suggested that HT and exposure to nature can have cognitive, psychological, social, and physical benefits. Since the earthquake, our research group has reported psychological effects of horticultural therapy on women living in the disaster areas. 

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Meta-Analysis of Heart Rate Variability as a Psychophysiological Indicator of Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is a com¬mon mental health problem among combat veterans. PTSD is a psychiatric condition that can develop after exposure to extremely stressful life events. It is characterized by more than 1 month of re-experiencing, avoidance, and hyper-arousal symptoms. The current combat operations in Iraq and Afghanistann have resulted in a considerably large number of veterans with mental health problems.

Diagnoses of mental health conditions among active duty service members due to the psychological toll of exposure to violent conflict have increased substantially, due in part to increased and improved screening methods as well as Department of Defense (DOD) efforts to reduce the stigma associated with seeking mental health treatment that in the past might have dissuaded service members from reporting mental health concerns or accessing care. PTSD is not limited to veterans who experience combat trauma.

PTSD is considered the fourth most common psychiatric diagnosis, affecting 10% of all men and 18% of all women.Studies of psychophysiological correlates of PTSD in the past have typically involves facial electromyography (EMG; muscle contractions), heart rate (HR; cardiac activity), skin conductance (SC; sweat gland activity), systolic blood pressure (SBP; the force of blood in the circulatory system when the heart contracts), and diastolic blood pressure (DBP; the force of blood in the circulatory system when the heart is at rest). Heart rate variability (HRV) is a relatively new psychophysiological measure.

Modular Hip Hemiarthroplasty Stem

Hip fracture is a significant public health issue, with up to 75,000 cases presenting per year at an annual cost of approximately £2 billion in the UK. Globally there are over 1.5 million femoral neck fractures with 740,000 deaths, with this figure rising to 3.9 million by 2050. The increasing ageing population dictates that the burden of this condition is only set to rise to 100,000 in the UK annually by 2033, risk stratification and operative planning will be essential to avoid the burden of complications from unsuitable patient selection, the revision rate from hip hemiarthroplasty has been reported to be as high as 20% at 9 years follow up.

There are various types of hip hemiarthroplasty prostheses available for the treatment of femoral neck fractures. Recent developments have favoured the smooth stem prosthesis inserted with cement, which is supported by NICE (National institute of clinical excellence CG124. This design of prosthesis has commonly been used for total hip replacement in the elective setting with good long term survivorship. A Cochrane review in 2006 reported that patients with cemented prostheses have less pain and a tendency to better mobility than those with uncemented prostheses.

Previous studies assessing the common cemented implants, the ETS and Thompson hemiarthroplasty, have found these prostheses to be equivalent in radiographic outcomes and surgical complications. Although the ETS has been found surgical easier to insert than the Thompson counterpart, due to the tapered smooth stem nature. To date there has been no research comparing the ETS to a modular cemented equivalent in the treatment of intra-capsular neck of femur fractures.

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