The Cystic Sponge Anus

Introduction: A peculiar spongy appearance of the perianal skin was observed in a patient who underwent wide excision surgery for inguinal and gluteal hidradenitis suppurativa (HS). Case Presentation:This peculiar appearance was observed in a 62-year-old male patient. It included multiple orifices and cavities forming the spongy aspect of the perianal skin with multiple cysts and giant comedones. The perianal lesions were asymptomatic and the patient had never received any perianal treatment for the comedones or cysts. Histopathology was performed and demonstrated dilated hair follicles with flaky keratin and loose hair shafts in the center. The spongy appearance was most likely the result of spontaneous shedding of the cystic contents. Conclusion: We suspect that the "cystic sponge anus"might be associated with HS, smoking, the male gender, and may yet be another expression of an occlusive follicular disease. Future studies will be needed to clarify the prevalence and comorbidities of the "cystic sponge anus."</p

Discontinuities without discontinuity: The Weakly-enforced Slip Method

Tectonic faults are commonly modelled as Volterra or Somigliana dislocations in an elastic medium. Various solution methods exist for this problem. However, the methods used in practice are often limiting, motivated by reasons of computational efficiency rather than geophysical accuracy. A typical geophysical application involves inverse problems for which many different fault configurations need to be examined, each adding to the computational load. In practice, this precludes conventional finite-element methods, which suffer a large computational overhead on account of geometric changes. This paper presents a new non-conforming finite-element method based on weak imposition of the displacement discontinuity. The weak imposition of the discontinuity enables the application of approximation spaces that are independent of the dislocation geometry, thus enabling optimal reuse of computational components. Such reuse of computational components renders finite-element modeling a viable option for inverse problems in geophysical applications. A detailed analysis of the approximation properties of the new formulation is provided. The analysis is supported by numerical experiments in 2D and 3D.Comment: Submitted for publication in CMAM

Pathogenic bacteria and indicator organisms for anti-microbial resistance in pork meat at retail level in The Netherlands.

Slaughter pigs and pork carcasses are often contaminated with pathogenic bacteria. Consequently raw meat on sale in retail stores may also contain these bacteria. In The Netherlands the calculated contribution by pigs to the relative occurrence of human salmonellosis in the period 1994-1998 was 25.2 % (van Pelt, 2001). Survey and monitoring data on the contamination of raw products with pathogens like Salmonella, Campylobacter, Listeria monocytogenes and Escherichia coli O157 are essential for making risk estimates, and the results of surveys carried out in 1990/2000 and 2002 are presented here. In 2002 also a surveillance of anti-microbial resistance among indicator bacteria (Escherichia coli, Enterococcus faecium/faecalis) isolated from pork meat was started. The results show that pork meat was contaminated with Salmonella in levels between 6.2 - 10.5 %, S. Typhimurium being the predominant serotype, and to a lesser extent with Campylobacter, Listeria and E. coli O157

The Role of Pathology in Small Renal Mass Laparoscopic Cryoablation

Objective. We evaluated histological outcome of intraoperative biopsies at laparoscopic renal mass cryoablation (LCA), prevalence of peritumoral fat tissue invasion, and risk of tract seeding. Methods. Patients were biopsied 3–5 times (16-gauge). Histology was analyzed by general pathologists and reviewed. Peritumoral fat was histologically examined. The trocar used for biopsy-guidance was examined by cytology. Records were studied for reporting tract metastasis. Results. 77 biopsied renal masses with mean ± SD diameter 30 ± 7.4 mm were histologically classified by primary and review pathology revealing 64 and 62 malignancies, 13 and 15 benign lesions, respectively. In 30/34, the fat covered a carcinoma but revealed no malignancy. Cytology showed no malignant cells but was inconclusive in 1 case. No tract metastasis occurred. Conclusions. The use of an intraoperative biopsy protocol provides histological diagnosis of all renal masses. No existence of peritumoral fat tissue invasion or tract seeding was found

Hidradenitis suppurativa tarda:defining an understudied elderly population

Background Hidradenitis suppurativa (HS) is a chronic, devastating, multifactorial skin disease. Patients generally develop HS after puberty and the prevalence of the disease is assumed to decrease with higher age. Data outside the usual age range are limited, especially for elderly patients. ObjectivesTo investigate the prevalence, clinical characteristics and associated comorbidities among the elderly HS population. Methods Data were collected through a population-wide survey-based study within the Lifelines Cohort Study in the Netherlands. The clinical characteristics of elderly patients with HS (≥ 60 years) were compared with an adult population (&lt; 60 years) with HS. The comorbidities in elderly patients with HS were compared with those of a non-HS sex- and age-matched elderly population in a 1: 4 ratio. HS in the elderly was defined as active HS in patients aged 60 years and older. Within the HS elderly group, two subgroups were defined, late-onset HS (HS developed after 60 years of age) and persistent HS (HS developed from a younger age but continuing after 60 years of age). Results Within the Lifelines cohort 209 elderly patients with HS were identified as well as an adult (&lt; 60 years) group with HS (n=793) and a non-HS sex- and age-matched control elderly group (n=810). The prevalence of HS among the elderly bootstrap analysis population was 0.8% [95% confidence interval (CI) 0.4–1.2]. A significantly higher age of HS symptom onset was found compared with the adult HS group: respectively, 40 vs. 23 years (odds ratio 1.056, 95% CI 1.05–1.07). Among the elderly HS cohort (in the Discussion, the HS tarda cohort) a female: male ratio of 1.7: 1.0 and a higher family history for HS were found. Moreover, elderly patients with HS had a significantly higher risk of having HS-associated comorbidities compared with the sex- and age-matched controls. Conclusions The prevalence of HS in the elderly is not rare. Among the elderly a shift from female predominance towards a lower female: male ratio in HS is observed. In addition, HS in the elderly showed significant variation in age of onset and involved body areas. Moreover, elderly patients with HS were more susceptible to multimorbidity. Finally, we propose defining HS in the elderly as ‘HS tarda’ and subdividing it as late-onset and persistent HS tarda.</p

Contribution of Genetics to the Susceptibility to Hidradenitis Suppurativa in a Large, Cross-Sectional Dutch Twin Cohort

IMPORTANCE Hidradenitis suppurativa is a chronic, inflammatory skin disease in which genetic factors are considered to play a role, with up to 38% of patients reporting a family history. Variations in the γ-secretase genes are found mainly in familial cases with an autosomal dominant pattern of inheritance. These variations are rare in the general population with hidradenitis suppurativa, even in patients who report a family history of the disease. OBJECTIVE To assess the heritability of hidradenitis suppurativa in a nationwide Dutch twin cohort. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study on self-reported hidradenitis suppurativa conducted from 2011 to 2016, data were collected from twins participating in the surveys of the nationwide Netherlands Twin Register. All complete twin pairs answering the question on hidradenitis suppurativa in the survey were included: 978 female monozygotic twin pairs and 344 male monozygotic twin pairs and 426 female dizygotic twin pairs, 167 male dizygotic twin pairs, and 428 dizygotic twin pairs of the opposite sex. Statistical analysis was performed from July to November 2019. MAIN OUTCOMES AND MEASURES The main outcome is the proportion of susceptibility to hidradenitis suppurativa due to additive genetic factors (narrow-sense heritability), dominant genetic factors, common or shared environmental factors, or unshared or unique environmental factors. The main outcome was evaluated prior to data collection. RESULTS The prevalence of hidradenitis suppurativa among twin pairs was 1.2% (58 of 4686); the mean (SD) age was 32.7 (15.4) years. The narrow-sense heritability of hidradenitis suppurativa was 77% (95% CI, 54%-90%), with the remainder of the variance due to unshared or unique environmental factors based on an age-adjusted model combining additive genetic factors and unshared or unique environmental factors. CONCLUSIONS AND RELEVANCE The high heritability found in this study suggests a stronger than previously assumed genetic basis of hidradenitis suppurativa. Environmental factors were also shown to contribute to the susceptibility to hidradenitis suppurativa, supporting a multifactorial cause of the disease. Moreover, the results of this study strongly support the need for a global genome-wide association study in the general population of patients with hidradenitis suppurativa