Myxoid fibroblastic tumor of the maxillary sinus in a 21-month-old child: an unusual diagnosis

Myxoid tumors of the soft tissue are a heterogeneous group of lesions with significant differences in behavior, from being totally harmless to malignant tumors with metastasizing potential. We describe the unusual case of a 21-month-old boy who developed a paranasal low-grade myxoid neoplasm with recurrent potential. The histological findings showed a proliferation of spindle cells within a vascular and myxoid background. The immunohistochemistry had the features of myofibroblasts and fibroblasts with strong Vimentin and light Smooth Muscle Actin reactivity. Close collaboration between clinician and pathologist is necessary to deal with these unusual lesions to predict their local aggressiveness and long-term behavior. Most of these cellular myxomas have been described in adults, involving primarily the limbs, but this case shows that any localization is possibl

First and second branchial arch syndromes: multimodality approach

First and second branchial arch syndromes (BAS) manifest as combined tissue deficiencies and hypoplasias of the face, external ear, middle ear and maxillary and mandibular arches. They represent the second most common craniofacial malformation after cleft lip and palate. Extended knowledge of the embryology and anatomy of each branchial arch derivative is mandatory for the diagnosis and grading of different BAS lesions and in the follow-up of postoperative patients. In recent years, many new complex surgical approaches and procedures have been designed by maxillofacial surgeons to treat extensive maxillary, mandibular and external and internal ear deformations. The purpose of this review is to evaluate the role of different imaging modalities (orthopantomogram (OPG), lateral and posteroanterior cephalometric radiographs, CT and MRI) in the diagnosis of a wide spectrum of first and second BAS, including hemifacial microsomia, mandibulofacial dysostosis, branchio-oto-renal syndrome, Pierre Robin sequence and Nager acrofacial dysostosis. Additionally, we aim to emphasize the importance of the systematic use of a multimodality imaging approach to facilitate the precise grading of these syndromes, as well as the preoperative planning of different reconstructive surgical procedures and their follow-up during treatmen

T regulatory cells disrupt the CCL20-CCR6 axis driving Th17 homing to the gut

Background: During HIV-1 infection, the integrity of the intestinal immune barrier is disrupted due to a deep depletion of CD4 + T cells in the gut. The translocation of microbial products from the gut lumen into the bloodstream has been linked with systemic inflammation. Despite long-term effective cART, CD4 + T cells in the lamina propria are incompletely restored in most individuals. Aims: Among the chemotactic axes involved in CD4 + T cell homing to the gut, we focused on the CCR6-CCL20 axis as it governs Th17 cells homing, a T cell subset exerting a major role in antimicrobial immunity. We aimed to assess the factors regulating the expression of CCL20 by the enterocytes, and notably the role of the cytokines produced by Treg and Th17 cells. Methods: Small bowel biopsies were obtained by endoscopy in 20 HIV-1 + and 10 HIV-1-individuals. Intestinal lymphocytes phenotype was analyzed by flow cytometry. CCL20 mRNA was quantified by qRT-PCR. The effect of PRR ligands and cytokines on CCL20 expression was explored using an ex-vivosystem of human primary enterocytes. A coculture was done between the enterocytes and Th17/Treg cells. The expression of CCL20 by the enterocytes was evaluated by qRT-PCR and ELISA

Tectonic events, continental intraplate volcanism, and mantle plume activity in northern Arabia: constraints form geochemistry and Ar-Ar dating of Syrian lavas

New (40)Ar/(39)Ar ages combined with chemical and Sr, Nd, and Pb isotope data for volcanic rocks from Syria along with published data of Syrian and Arabian lavas constrain the spatiotemporal evolution of volcanism, melting regime, and magmatic sources contributing to the volcanic activity in northern Arabia. Several volcanic phases occurred in different parts of Syria in the last 20 Ma that partly correlate with different tectonic events like displacements along the Dead Sea Fault system or slab break-off beneath the Bitlis suture zone, although the large volume of magmas and their composition suggest that hot mantle material caused volcanism. Low Ce/Pb (<20), Nb/Th (<10), and Sr, Nd, and Pb isotope variations of Syrian lavas indicate the role of crustal contamination in magma genesis, and contamination of magmas with up to 30% of continental crustal material can explain their (87)Sr/(86)Sr. Fractionation-corrected major element compositions and REE ratios of uncontaminated lavas suggest a pressure-controlled melting regime in western Arabia that varies from shallow and high-degree melt formation in the south to increasingly deeper regions and lower extents of the beginning melting process northward. Temperature estimates of calculated primary, crustally uncontaminated Arabian lavas indicate their formation at elevated mantle temperatures (T(excess) similar to 100-200 degrees C) being characteristic for their generation in a plume mantle region. The Sr, Nd, and Pb isotope systematic of crustally uncontaminated Syrian lavas reveal a sublithospheric and a mantle plume source involvement in their formation, whereas a (hydrous) lithospheric origin of lavas can be excluded on the basis of negative correlations between Ba/La and K/La. The characteristically high (206)Pb/(204)Pb (similar to 19.5) of the mantle plume source can be explained by material entrainment associated with the Afar mantle plume. The Syrian volcanic rocks are generally younger than lavas from the southern Afro-Arabian region, indicating a northward progression of the commencing volcanism since the arrival of the Afar mantle plume beneath Ethiopia/Djibouti some 30 Ma ago. The distribution of crustally uncontaminated high (206)Pb/(204)Pb lavas in Arabia indicates a spatial influence of the Afar plume of similar to 2600 km in northward direction with an estimated flow velocity of plume material on the order of 22 cm/a

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Treatment of linear mandibular fractures using a single 2.0-mm AO locking reconstruction plate: is a second plate necessary?

PURPOSE: To prospectively evaluate the use of a single Arbeitsgemeinschaft fur Osteosynthesefragen (AO) 2.0-mm locking reconstruction plate for linear noncomminuted mandibular fractures without the use of a second plate. PATIENTS AND METHODS: We analyzed the clinical and radiologic data of 45 patients with 74 fractures (21 single fractures, 22 double fractures, and 2 triple fractures). Fracture locations were the symphysis (n = 35, 47.3%), body (n = 15, 20.3%), and angle (n = 24, 32.4%). We recorded the mechanism of injury, time between admission to the hospital and surgery, gender and age, temporary maxillomandibular fixation and its duration, and the surgical approach. Postsurgical complications that were recorded as minor did not require surgical intervention, whereas major complications required further surgical intervention. RESULTS: All patients had satisfactory fracture reduction and a successful treatment outcome without major complications. Ten patients (22.2%) developed minor complications. CONCLUSION: The present study has demonstrated that treating linear noncomminuted mandibular fractures with a single AO 2.0-mm locking reconstruction plates is associated with no major complications and sound bone healing in all patients

Successful Treatment of a Postpolio Tinnitus with Type A Botulinum Toxin

Objectives/hypothesis: Objective tinnitus is a symptom often observed in patients with chronic hyperactivity of masticatory muscles. Methods: We report here the unusual case of a 63-year-old woman who developed a distressing tinnitus related to contractions of reinnervated masticatory muscles. This reinnervation process was caused by a postpolio syndrome that gave rise to an acoustic resonance phenomenon transmitted to the middle ear as an audible sound. Results: The tinnitus was successfully treated with electromyography-guided intramuscular injections of type A botulinum toxin. Conclusion: The intramuscular injection of botulinum toxin was found to be effective in relieving severe and disabling postpolio tinnitus

Influence of the primary cleft palate closure on the future need for orthognathic surgery in unilateral cleft lip and palate patients.

The aim of the study was to determine the influence of the dissection of the palate during primary surgery and the type of orthognathic surgery needed in cases of unilateral total cleft. The review concerns 58 children born with a complete unilateral cleft lip and palate and treated between 1994 and 2008 at the appropriate age for orthognathic surgery. This is a retrospective mixed-longitudinal study. Patients with syndromes or associated anomalies were excluded. All children were treated by the same orthodontist and by the same surgical team. Children are divided into 2 groups: the first group includes children who had conventional primary cleft palate repair during their first year of life, with extensive mucoperiosteal undermining. The second group includes children operated on according to the Malek surgical protocol. The soft palate is closed at the age of 3 months, and the hard palate at 6 months with minimal mucoperiosteal undermining. Lateral cephalograms at ages 9 and 16 years and surgical records were compared. The need for orthognathic surgery was more frequent in the first than in the second group (60% vs 47.8%). Concerning the type of orthognathic surgery performed, 2- or 3-piece Le Fort I or bimaxillary osteotomies were also less required in the first group. Palate surgery following the Malek procedure results in an improved and simplified craniofacial outcome. With a minimal undermining of palatal mucosa, we managed to reduce the amount of patients who required an orthognathic procedure. When this procedure was indicated, the surgical intervention was also greatly simplified