Large thoracic tumour without superior vena cava syndrome

A 62-year-old male with long-standing smoking history presented with haemoptysis. Plain chest X-ray showed abnormal findings proximate to the right pulmonary hilum. Bronchoscopy revealed a fragile exophytic tumour of the right wall of the lower third of the trachea, infiltrating the right main bronchus (75% stenosis) and the right upper lobar bronchus (near total occlusion). Contrast-enhanced chest computed tomography demonstrated a 7.2 × 4.9 cm tumour contiguous to the above-mentioned structures, mediastinal lymph node pathology, and a vessel coursing inferiorly to the left of the aortic arch and anterior to the left hilum. Despite the tumour constricting the right superior vena cava (SVC), no signs of SVC syndrome were present. In this case, the patient does not present with SVC syndrome, as expected due to the constriction of the (right) SVC caused by the tumour, since head and neck veins drain through the persistent left superior vena cava (PLSVC). PLSVC is the most common thoracic venous anomaly with an incidence of 0.3% to 0.5% of the general population and it is a congenital anomaly caused by the failure of the left anterior cardinal vein to regress and to consequently form the ligament of Marshall during foetal development. It is associated with absence of the left brachiocephalic vein and in 10% to 20% of cases the right SVC is absent. Two potential draining points of the PLSVC have been previously reported. In the majority of cases PLSVC drains directly into the coronary sinus, but less frequently it drains into the left atrium or the left superior pulmonary vein (LSPV). In cases where the PLSVC drains into the coronary sinus, congenital heart defects are rare. The patient usually remains asymptomatic and PLSVC is an incidental finding during radiographic imaging or medical procedures. When the PLSVC drains into the left atrium or the LSPV, a right-to-left shunt is formed; a condition usually asymptomatic. In some reported cases this PLSVC variant presents with persistent, unexplained hypoxia or cyanosis and embolisation causing recurrent transient ischaemic attacks and/or cerebral abscesses. This PLSVC variant is more often associated with absence of the right SVC and congenital heart abnormalities.

“Luck’s always to blame”: silent wounds of a penetrating gunshot trauma sustained 20 years ago

Gunshot tracheal injuries represent life-threatening events and usually necessitate emergent surgical intervention. We report a case of an exceptional finding of a patient with retained ballistic fragments in the soft tissues of the thorax, proximal to the right subclavian artery and the trachea, carrying silently his wounds for two decades without any medical or surgical intervention. The bullet pellet on the upper part of the trachea seen accidentally in the chest computed tomography, was also found during bronchoscopy. In short “luck’s always to blame”

Glycine insertion makes yellow fluorescent protein sensitive to hydrostatic pressure

Fluorescent protein-based indicators for intracellular environment conditions such as pH and ion concentrations are commonly used to study the status and dynamics of living cells. Despite being an important factor in many biological processes, the development of an indicator for the physicochemical state of water, such as pressure, viscosity and temperature, however, has been neglected. We here found a novel mutation that dramatically enhances the pressure dependency of the yellow fluorescent protein (YFP) by inserting several glycines into it. The crystal structure of the mutant showed that the tyrosine near the chromophore flipped toward the outside of the β-can structure, resulting in the entry of a few water molecules near the chromophore. In response to changes in hydrostatic pressure, a spectrum shift and an intensity change of the fluorescence were observed. By measuring the fluorescence of the YFP mutant, we succeeded in measuring the intracellular pressure change in living cell. This study shows a new strategy of design to engineer fluorescent protein indicators to sense hydrostatic pressure

Successful combined surgical approach in a rare case of retrotracheal goitre in a patient with anatomical impediments

Diving goitres can descend the cervical region expanding directly into the thoracic cavity. In most cases, diving goitres extend into the anterosuperior compartment, but they may also extend behind the trachea. We herein present a case of a male patient with retrotracheal goitre and history of left thyroid lobectomy and median sternotomy for thoracic aortic aneurysm repair with graft placement. After detailed preoperative evaluation, the patient underwent surgical resection of the mass through a combined approach; the existing cervical incision and a right posterolateral mini-thoracotomy. The postoperative course of the patient was uncomplicated. One year after surgery, the patient is asymptomatic and disease-free. (Folia Morphol 2018; 77, 1: 166–169

Diffuse Idiopathic Skeletal Hyperostosis (DISH) and non small cell lung cancer: case presentation and review of the literature

Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is a systemic non inflammatory disease of unknown cause. It is characterized by the presence of osteophytes due to calcification and ossification of spinal ligaments and entheses. Moreover, diffuse idiopathic skeletal hyperostosis has been associated with a variety of metabolic disorders. However, to the best of our knowledge no association with non small cell lung cancer (NSCLC) has been reported so far. In the present study we report a case of a patient with NSCLC and DISH.Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier’s disease, is a systemic non inflammatory disease of unknown cause. It is characterized by the presence of osteophytes due to calcification and ossification of spinal ligaments and entheses. Moreover, diffuse idiopathic skeletal hyperostosis has been associated with a variety of metabolic disorders. However, to the best of our knowledge no association with non small cell lung cancer (NSCLC) has been reported so far. In the present study we report a case of a patient with NSCLC and DISH

Equity in protection:bridging global data gaps for an EBV vaccine-a systematic review and meta-analysis

INTRODUCTION: Epstein-Barr virus (EBV) is linked to multiple malignancies and autoimmune conditions, with different disease burdens globally. Pharmaceutical companies and researchers are placing substantial investment in the development of EBV vaccines. To ensure optimal vaccine roll-out, particularly in resource-limited settings, it is essential to have data on the age at acquisition of EBV. This study aimed to systematically review and meta-analyse seroprevalence by age and country, WHO region and country income level, identify knowledge gaps, and determine an approach to bridge these gaps.METHODS: MEDLINE, Embase and Web of Science were searched on 22 March 2022 for studies that measured EBV seroprevalence by age. An updated search was conducted on 22 October 2022. There were no language restrictions. Papers were assessed for quality using an adapted version of the Downs and Black checklist. Seroprevalence by age was estimated using a fixed-effect (country) or random-effects (WHO region and income) meta-analysis. This review has been registered on PROSPERO (CRD42022349900).RESULTS: Only one country (USA) had enough data for a country meta-analysis. WHO regional analyses revealed the Western Pacific region to have a higher seroprevalence in younger age groups than other WHO regions. Country income level better explained seroprevalence trends per age. Middle-income countries displayed a quicker rise to balance seroprevalence than high-income countries, with a 30% absolute increase in 0- to 4-year-olds in middle-income than in high-income countries (59% [95% CI 28 to 91%, I2=99%] vs 29% [95% CI 16 to 41%, I2=99%]).CONCLUSION: This first meta-analysis producing estimates of EBV seroprevalence by age provides crucial information to guide governments when using a vaccine for EBV. However, data variability and limited consistency of methodologies and EBV seroprevalence measurements hindered comprehensive meta-analyses across all WHO regions and countries. This study provides an interim framework for the extrapolation of seroprevalence using country-specific income levels to aid vaccine roll-out decisions.PROSPERO REGISTRATION NUMBER: CRD42022349900.</p

Unilateral hypertransparency on chest radiograph: the congenital Poland Syndrome

  Unilateral hypertransparent hemithorax requires a particular diagnostic approach as it can be the result of diverse pulmonary diseases, including pneumothorax, large pulmonary embolus, unilateral large bullae, mucous plag, airway obstruction and contralateral pleural effusion. Congenital syndromes with chest wall abnormalities, are rare, but often underdiagnosed causes. Poland Syndrome consists of such a rare, congenital anomaly and is characterized by the absence of the pectoralis major muscle and upper limb ipsilateral abnormalities. We present a case of a patient with acute exacerbation of chronic obstructive pulmonary disease (COPD) and a unilateral hypertransparency on chest radiology, attributed to the underlying Poland Syndrome.  

Giant liposarcoma of the back with 4 types of histopathology: a case report

The incidence of soft tissue tumours, both malignant and benign, is very common. However, the coexistence of 4 types of histopathology is rare and the aim of this article is to present one treated in our Department. An 87-year-old Greek man was treated in our Department for a huge tumour on his back, under local anaesthesia. The pathology report of the specimen referred 4 types of neoplasia. This case represents this incidence in a giant liposarcoma of the back

A systematic investigation of the intrinsic flow properties of fractures using a combined 3D printing and micro-computed tomography approach

Geological storage operations spanning energy, nuclear material and carbon dioxide (CO2) storage, require meticulous understanding of the integrity of geological seals over a range of temporal and spatial scales. Fluid-conductive fault and fracture systems in otherwise low-permeability rocks may threaten seal performance and compromise subsurface storage projects. The understanding of these systems is complicated by the occurrence of anisotropic aperture distribution caused by inherent surface roughness. Difficulties predicting fluid flow through fractures stems from our limited understanding of the fundamental controls on their intrinsic permeabilities, and the prevalence, severity and complexity of hydromechanical responses arising from the coupling of multiphase flow, pore pressure and effective stress. In this study, we systematically investigated the effect of surface roughness on the transport properties of 3D-printed (Acrylonitrile Butadiene Styrene resin) fracture surfaces with micrometre surface roughness distributions. We printed 11 separate fractures, 7 of which are synthetically generated self-affine surfaces encompassing a range of fractal dimensions (Df = 1.2 to 2.4) observed in nature. The remaining 4 are acquired from micrometre-scale surface scans from natural fractures within the Carmel mudrock, a caprock from a natural CO2 leakage site in Utah, USA. Fluid flow experiments using single (brine) and multiple fluids (decane and brine) are undertaken to investigate the fluid pathways and interactions between each phase across a range of effective stresses (5 to 25 bar). We investigate the interplay between multiphase flow dynamics, surface roughness and hydraulic aperture distribution to gain insight into the intrinsic transport properties of fractures with different origins of roughness. Experiments are performed and imaged using a micro-computed tomography scanner (EMCT; (Bultreys et al., 2016)), where the results can be used to further the understanding of the governing parameters influencing fracture transmissivity, while also constraining surface roughness inputs for single- and multiphase fracture flow models