Grisel’s syndrome, a rare cause of anomalous head posture in children: a case report

BACKGROUND: Anomalous head posture (AHP) or torticollis is a relatively common condition in children. Torticollis is not a diagnosis, but it is a sign of underlying disease. Grisel’s syndrome (GS) is a rare condition of uncertain etiology characterized by a nontraumatic atlanto-axial subluxation (AAS), secondary to an infection in the head and neck region. It has not been considered, in ophthalmological papers, as a possible cause of AHP. CASE PRESENTATION: A case of AAS secondary to an otitis media is studied. The children showed neck pain, head tilt, and reduction in neck mobility. The patient had complete remission with antibiotic and anti-inflammatory therapy and muscle relaxants. Signs of GS should always be taken into account during ophthalmological examination (recent history of upper airway infections and/or head and neck surgeries associated to a new onset of sudden, painful AHP with normal ocular exam). In such cases it is necessary to require quick execution of radiological examinations (computer tomography and/or nuclear magnetic resonance), which are essential to confirm the diagnosis. CONCLUSION: GS is a multidisciplinary disease. We underline the importance of an accurate orthoptic and ophthalmological examination. Indeed, early detection and diagnosis are fundamental to achieve proper management, avoid neurological complications and lead to a good prognosis

Joint Practice Guidelines for Radionuclide Lymphoscintigraphy for Sentinel Node Localization in Oral/Oropharyngeal Squamous Cell Carcinoma

Involvement of the cervical lymph nodes is the most important prognostic factor for patients with oral/oropharyngeal squamous cell carcinoma (OSCC), and the decision of whether to electively treat patients with clinically negative necks remains a controversial topic. Sentinel node biopsy (SNB) provides a minimally invasive method for determining the disease status of the cervical node basin, without the need for a formal neck dissection. This technique potentially improves the accuracy of histologic nodal staging and avoids overtreating three-quarters of this patient population, minimizing associated morbidity. The technique has been validated for patients with OSCC, and larger-scale studies are in progress to determine its exact role in the management of this patient population. This document is designed to outline the current best practice guidelines for the provision of SNB in patients with early-stage OSCC, and to provide a framework for the currently evolving recommendations for its use. Preparation of this guideline was carried out by a multidisciplinary surgical/nuclear medicine/pathology expert panel under the joint auspices of the European Association of Nuclear Medicine (EANM) Oncology Committee and the Sentinel European Node Trial (SENT) Committee

Joint practice guidelines for radionuclide lymphoscintigraphy for sentinel node localization in oral/oropharyngeal squamous cell carcinoma

Involvement of the cervical lymph nodes is the most important prognostic factor for patients with oral/oropharyngeal squamous cell carcinoma (OSCC), and the decision whether to electively treat patients with clinically negative necks remains a controversial topic. Sentinel node biopsy (SNB) provides a minimally invasive method of determining the disease status of the cervical node basin, without the need for a formal neck dissection. This technique potentially improves the accuracy of histological nodal staging and avoids over-treating three-quarters of this patient population, minimizing associated morbidity. The technique has been validated for patients with OSCC, and larger-scale studies are in progress to determine its exact role in the management of this patient population. This article was designed to outline the current best practice guidelines for the provision of SNB in patients with early-stage OSCC, and to provide a framework for the currently evolving recommendations for its use. These guidelines were prepared by a multidisciplinary surgical/nuclear medicine/pathology expert panel under the joint auspices of the European Association of Nuclear Medicine (EANM) Oncology Committee and the Sentinel European Node Trial Committee

Treatment with Hizentra in patients with primary and secondary ă immunodeficiencies: a real-life, non-interventional trial

International audienceBackground: Although Hizentra is indicated for immunoglobulin ă replacement therapy in patients with primary and secondary ă immunodeficiencies, phase III trials have focused on patients with ă primary immunodeficiencies. In this 9-month, real-life, prospective, ă non-interventional, longitudinal, multicenter study of patients with ă primary and secondary immunodeficiencies in France, treatment modalities ă (primary endpoint), efficacy, safety, tolerability, quality of life, and ă treatment satisfaction were evaluated using descriptive statistics. ă Results: Starting in January 2012, 117 patients were enrolled (99 ă adults, 18 children). Secondary immunodeficiencies were present in 48.7 ă % of patients. At follow-up, injections were administered every 7 days ă in 92.2 % of patients. Nine patients (7.8 %) were taking Hizentra ă every 10-14 days. The median dose of Hizentra administered was 0.1 ă g/kg/injection. Fifty-six patients were administered doses 0.2 ă g/kg/injection. Mean trough IgG titers were 9.0 +/- 3.3 g/L (median 8.3 ă g/L). The mean yearly rate of infection was 1.2 +/- 1.9. Mean scores on ă the Short Form-36 physical and mental component summaries were 46.3 +/- ă 10.0 and 46.6 +/- 9.3, respectively. Scores on the Treatment ă Satisfaction Questionnaire for Medication ranged from 69.9 +/- 19.9 to ă 88.3 +/- 21.2 depending on the domain. Treatment with Hizentra was well ă tolerated. No single drug-related systemic reaction occurred in more ă than one patient and few local reactions were reported (n = 5). ă Conclusions: Under real-life conditions and in a cohort that included ă patients with primary and secondary immunodeficiencies, treatment with ă Hizentra was effective and well tolerated and patients were generally ă satisfied with the treatment