Positive Delphian node in laryngeal cancer: Predictive of thyroid gland metastasis?

Introduction: Laryngeal carcinoma represents the 22nd most common cancer worldwide. Thyroid metastasis from laryngeal cancer is extremely rare. Overall, thyroid gland involvement by metastatic carcinoma represents about 1.1-2.1 % among thyroid malignant diseases.Presentation of case: A male in his 70s came to our Otolaryngology Unit with a laryngeal squamous cell carcinoma (cT3). Total laryngectomy , bilateral neck dissection were performed. Histological examination revealed a pT3 carcinoma with sub-massive metastasis of the Delphian node. The patient underwent close follow-up. After eight months, neck examination revealed a suspected nodule in the right thyroid lobe. A right thyroid lobectomy was performed , histological assessment revealed a nodule with squamous carcinoma metastasis in the superior pole of the thyroid lobe. The remaining thyroid tissue was affected by multinodular macrofollicular goitre. The patient underwent adjuvant therapy. One year after the second surgery, he showed no signs of recurrence. Discussion: Thyroid gland metastasis from laryngeal carcinoma is a very rare occurrence. In literature, we found only three articles that describes thyroid metastasis in overall 7 patients affected by laryngeal squamous cell carcinoma. Positive Delphian lymph node is usually related to poor prognosis: in 2007 a study reported tumour recurrence in 15 out of 25 patients with metastatic Delphian lymph node within the first two years of surgery.Conclusion: Thyroid gland metastasis from laryngeal carcinoma is rare; so close follow-up of oncologic patients is mandatory and, most of all, the positive Delphian node should not be underestimated for its predictive value

Reversible effect of magnetic fields on human lymphocyte activation patterns: different sensitivity of naive and memory lymphocyte subsets.

The aim of this study was to investigate the influence of 50 Hz magnetic or static magnetic fields of 0.5 mT on subsets of human CD4+ T cells in terms of cytokine release/content, cell proliferation and intracellular free calcium concentration. CD4+ T cells can be divided into different subsets on the basis of surface marker expression, such as CD45, and T cells can be divided into naive (CD45RA+) and memory (CD45RA2) cells. In this study, the effects of magnetic fields after 24 and 48 h of cell culture were analyzed. We found that the CD4+CD45RA2 T subset were more sensitive after 2 h of exposure. Decreases in the release/content of IFN-c, in cell proliferation and in intracellular free calcium concentrations were observed in exposed CD4+CD45RA2 T cells compared to CD4+CD45RA+ T cells. The results suggest that exposure to the magnetic fields induces a delay in the response to stimulants and that modifications are rapidly reversible, at least after a short exposure

Septate uterus: nosographic overview and endoscopic treatment

To comment on the prevalence, diagnosis, and treatment of the septate uterus, with special reference to hysteroscopic metroplasty and its effect on reproductive outcome, we searched publications in PubMed and Embase. Original articles, meta-analysis, reviews, and opinion articles were selected. The studies suggest that the prevalence of the septate uterus is increased in women with repeated pregnancy loss and infertility. Reliable diagnosis depends on accurate assessment of the uterine fundal contour and uterine cavity by means of magnetic resonance and three-dimensional ultrasound. Pertinent published data comparing pregnancy outcome before and after hysteroscopic metroplasty indicated a marked improvement after surgery. Magnetic resonance and three-dimensional ultrasound represent the gold standard for diagnosis of septate uterus. Hysteroscopic metroplasty with its simplicity, minimal postoperative sequelae, and improved reproductive outcome is the gold standard for treatment, not only in patients with recurrent pregnancy loss and premature labor but also in patients with infertility, especially if in vitro fertilization is being contemplated

SEMI-AUTOMATIC VOLUMETRIC SEGMENTATION OF THE UPPER AIRWAYS IN PATIENTS WITH PIERRE ROBIN SEQUENCE

Pierre Robin malformation is a rare craniofacial dysmorphism whose pathogenesis is multifactorial. Although there is some agreement in non-invasive treatment in less severe cases, the dispute is still open on cases with severe respiratory impairment. We present a semi-automatic novel diagnostic tool for calculating upper airway volume, in order to eventually address surgery in patients with Pierre Robin Sequence (PRS). Multidetector CT datasets of two patients and two controls were tested to assess the proposed method for ROI segmentation, upper airway volume computation and three-dimensional reconstructions. The experimental results show an irregular pattern and a severely reduced cross-sectional area (CSA) with a mean value of 8.3808 mm(2) in patients with PRS and a mean CSA value of 33.7692 mm(2) in controls (a ΔCSA of about -75%). Moreover, the similarity indexes and sensitivity/specificity values obtained showed a good segmentation performance. In particular, mean values of Jaccard and Dice similarity indexes were 91.69% and 94.07%, respectively, while the mean values of specificity and sensitivity were 96.69% and 98.03%, respectively. The proposed tool represents an easy way to perform a quantitative analysis of airway volume and useful 3D reconstructions

Artificial Intelligence for Classifying the Relationship between Impacted Third Molar and Mandibular Canal on Panoramic Radiographs

The purpose of this investigation was to evaluate the diagnostic performance of two convolutional neural networks (CNNs), namely ResNet-152 and VGG-19, in analyzing, on panoramic images, the rapport that exists between the lower third molar (MM3) and the mandibular canal (MC), and to compare this performance with that of an inexperienced observer (a sixth year dental student). Utilizing the k-fold cross-validation technique, 142 MM3 images, cropped from 83 panoramic images, were split into 80% as training and validation data and 20% as test data. They were subsequently labeled by an experienced radiologist as the gold standard. In order to compare the diagnostic capabilities of CNN algorithms and the inexperienced observer, the diagnostic accuracy, sensitivity, specificity, and positive predictive value (PPV) were determined. ResNet-152 achieved a mean sensitivity, specificity, PPV, and accuracy, of 84.09%, 94.11%, 92.11%, and 88.86%, respectively. VGG-19 achieved 71.82%, 93.33%, 92.26%, and 85.28% regarding the aforementioned characteristics. The dental student's diagnostic performance was respectively 69.60%, 53.00%, 64.85%, and 62.53%. This work demonstrated the potential use of deep CNN architecture for the identification and evaluation of the contact between MM3 and MC in panoramic pictures. In addition, CNNs could be a useful tool to assist inexperienced observers in more accurately identifying contact relationships between MM3 and MC on panoramic images

Osteoporosis risk factors in HIV positive women with osteoporosis: A retrospective analysis

Multifactorial risk factors such as HIV/HCV co-infection and antiretroviral therapy (ARV) have been associated with osteoporosis in HIV+ women. We retrospectively analysed which known risk factors were associated with the diagnosis of osteoporosis, according to the WHO definition, in HIV positive women who were followed-up at the AIDS Centre of the University of Palermo, Italy between January 2011 and December 2014. Twenty-one HIV+ women with osteoporosis (13 HIV+ mono-infected and 8 HIV/HCV co-infected females) who underwent dual-energy X-ray absorptiometry (DXA) and liver stiffness assessment were included in the study. No significant differences between the HIV and HIV/HCV group were found regarding liver stiffness and lumbar/femoral osteoporosis scores. In a univariate analysis, we observed a positive linear correlation between LBD score (Lumbar Bone Density) with pre-fractures (p-value = 0.0082), smoke (p-value = 0.0008), alcohol (p-value < 0.0001) and ARV exposure score (p-value = 0.0039), while there were no significant negative linear correlations. In multivariate analysis, pre-fractures, smoke and alcohol were positive predictors of LBD score, while previous antiretroviral therapy (ARV) (years) score was a negative predictor compared to others. Univariate analysis showed a positive linear correlation between FDB (Femoral Bone Density) with smoke (p-value = 0.0303) and alcohol (p-value = 0.0050), while there were no significant negative linear correlations. In multivariate analysis, alcohol was a positive predictor of FDB score compared to others, while ARV score was a negative predictor compared to others. This preliminary study suggests that other factors besides ARV score and liver fibrosis may affect the skeletal system in osteoporotic women with HIV infection. Some of these factors, such as alcohol and smoking, are modifiable. Additional research into impact on osteoporosis in HIV women with osteoporosis is required

Techniques, Tricks, and Stratagems of Oral Cavity Computed Tomography and Magnetic Resonance Imaging

The oral cavity constitutes a complex anatomical area that can be affected by many devel-opmental, inflammatory, and tumoural diseases. MultiSlice Computed Tomography (MSCT) and Magnetic Resonance Imaging (MRI) currently represent the essential and complementary imaging techniques for detecting oral cavity abnormalities. Advanced MRI with diffusion-weighted imaging (DWI) and dynamic contrast-enhanced perfusion-weighted imaging (DCE-PWI) has recently increased the ability to characterise oral lesions and distinguish disease recurrences from post therapy changes. The analysis of the oral cavity area via imaging techniques is also complicated both by mutual close appositions of different mucosal surfaces and metal artifacts from dental materials. Nevertheless, an exact identification of oral lesions is made possible thanks to dynamic manoeuvres and specific stratagems applicable on MSCT and MRI acquisitions. This study summarises the currently available imaging techniques for oral diseases, with particular attention to the role of DWI, DCE-PWI, and dynamic manoeuvres. We also propose MSCT and MRI acquisition protocols for an accurate study of the oral cavity area

The Videofluorographic Swallowing Study in Rheumatologic Diseases: A Comprehensive Review

Autoimmune connective tissue diseases are a heterogeneous group of pathologies that affect about 10% of world population with chronic evolution in 20%-80%. Inflammation in autoimmune diseases may lead to serious damage to other organs including the gastrointestinal tract. Gastrointestinal tract involvement in these patients may also due to both a direct action of antibodies against organs and pharmacological therapies. Dysphagia is one of the most important symptom, and it is caused by failure of the swallowing function and may lead to aspiration pneumonia, malnutrition, dehydration, weight loss, and airway obstruction. The videofluorographic swallowing study is a key diagnostic tool in the detection of swallowing disorders, allowing to make an early diagnosis and to reduce the risk of gastrointestinal and pulmonary complications. This technique helps to identify both functional and structural anomalies of the anatomic chain involved in swallowing function. The aim of this review is to systematically analyze the basis of the pathological involvement of the swallowing function for each rheumatological disease and to show the main features of the videofluorographic study that may be encountered in these patients