Radiological evaluation of Hyperostosis frontalis interna: is it of clinical importance?

Hyperostosis frontalis interna (HFI) presents irregular thickening of the frontal bone. Even though HFI is frequently seen during routine radiological imaging, it usually remains unrecorded owing to a common belief that it just represents an incidental finding or anatomical variant. Recent studies implied that HFI may be clinically relevant. Etiology of HFI is still debated, while presumptions are mainly based on altered sex steroids impact on skull bone growth. Some authors implied that frontal bone might be particularly affected by this condition due to specificity of its underlying dura. In this paper we present a 27-years old female patient with a treatment resistant headache. Head CT showed massive, irregular bony mass, with lobulated contours arising from the right frontal bone, but did not cross the fronto-parietal suture, spearing the superior sagittal sinus and skull midline. After surgery, histopathological analysis of the frontal bone sample in our patient showed thickening pattern similar to those described in micro-CT studies of HFI. Furthermore, in an attempt to test speculation of the possible role of estrogen in pathogenesis of HFI, we investigated the expression of a-estrogen receptors on dura of the frontal region. These analyses confirmed nuclear expression of estrogen on frontal region dural tissue, supporting previous speculation of the development mechanisms of HFI and contributing to a better understanding of this common condition of the frontal bone. Additionally, the presence of HFI may result in severe symptomatology, which could be misinterpreted and related to other disorders if HFI is not radiologicaly recognized and reported

BRAF V600E MUTATIONS IN METASTATIC MELANOMA - CASE REPORT

The treatment of metastatic melanoma represents a challenge. Vemurafenib, a selective BRAF kinase inhibitor, is a new medicine against carcinoma. Recently, it has been shown that it raises the survival rate among patients with metastatic melanoma who have BRAFV600mutation. This work will discuss new approaches to the treatment of patients with metastatic melanoma, who have been proved to have BRAF V600 mutation and we will present the case of a female patient with whom the clinical study with Vemurafenib has been started

Bleeding in trauma: Current diagnostic and therapeutic approach

Recognising shock due to haemorrhage in trauma patients is about constructing a synthesis of trauma mechanism, injuries, vital signs and the therapeutic response of the patient. The treatment of bleeding patients who have exsanguinating injuries is aimed at two major goals: stopping the bleeding and restoration of the blood volume with correct coagulation. Abdominal ultrasound has replaced diagnostic peritoneal lavage for detection of haemoperitoneum. With the development of multi-sliding computer tomography, rapid evaluation by CT-scanning of the trauma patient is possible during resuscitation. The concept of damage control surgery with 'blind' transfusion or 'damage control resuscitation' in treatment of severe trauma, has proven to be of vital importance in the treatment of exsanguinating trauma patients and is adopted worldwide. Pharmacotherapeutic interventions may be a promising concept to limit blood loss after trauma. The role of thromboelastography as point-of-care test for coagulation in massive blood loss is emerging, providing information about actual clot formation and clot stability, shortly after the blood sample is taken