Myoepithelial Carcinoma of the Parotid Gland

Rare malignant tumor of the salivary gland, a myoepithelial carcinoma, arose de novo in the right parotid gland. The initial tumor was composed predominantly of myoepithelial cells. Subsequently the tumor recurred three times, with infiltration of the bones of the cranial base. Histological examination showed sarcomatoid neoplasm composed of malignant spindle cells with high mitotic rate and perineural invasion. There was no involvement of cervical lymph nodes. Immunohistochemistry demonstrated myoepithelial differentiation: tumor cells were positively stained with vimentin, alpha smooth muscle actin and S-100 protein antibodies, and focal positively was noticed with cytokeratin (AE1/AE3) antibody. Large number of tumor cells nuclei was reactive with the monoclonal anti-p63 antibody, clone 4A4. Myoepithelial carcinomas exhibit a wide spectrum of morphological heterogeneity and for that reason could be confused with many tumors. Cytoarchitectural patterns and immunohistochemical profile are crucial for identification. These tumors are malignant neoplasms with diverse clinical outcomes, sometimes very aggressive

Sindrom spontane otekline vrata - prikaz slučaja

U prošlosti je korišteno više izraza za označavanje bolesnika sa spontanom, atraumatskom oteklinom lijeve supraklavikularne jame, uključujući \u27benignu supraklavikularnu tumorsku limfangiektaziju\u27 i \u27rekurentnu limfagiektaziju lijeve supraklavikularne jame\u27. Patogeneza još uvijek nije u potpunosti razjašnjena ali se sumnja da je uzrok prolazna opstrukcija duktusa toracikusa. U ovom prikazu izvještavamo o epidemiologiji, kliničkoj slici i radiološkim nalazima u sindromu spontane otekline vrata (SCSS). Bolesnica (55) se javila u hitni objedinjeni prijam zbog otekline vrata s lijeve strane za koju navodi da se naglo pojavila toga jutra. Žali se na osjećaj stezanja u području otekline, te ima dojam gušenja. Pokreti vrata su joj ograničeni. Palpacijski oteklina zauzima lijevu supraklavikularnu jamu u cijelosti, sprijeda seže do prednjeg ruba m. SCM, prema dolje seže do klavikule, straga se širi do trapezoidnog mišića, a prema gore do regije II. Učinjena je laboratorijska obrada, UZV vrata, MSCT vrata i prsišta. Oteklina se gotovo u potpunosti spontano povukla nakon četiri dana. Devet dana od početka simptoma učinjena je kontrolna radiološka obrada koja je pokazala značajnu regresiju ranije opisanih promjena. Zaključno, SCSS je neuobičajen i relativno nepoznat entitet koji uglavnom pogađa žene u perimenopauzi i uzrokuje akutnu, samoograničavajuću oteklinu lijeve supraklavikularne regije. Tjelesna aktivnost i topli vremenski uvjeti mogući su precipitirajući čimbenici. SCSS se može ponoviti i nije povezan s laboratorijskim abnormalnostima, no međutim, i dalje je nužno isključiti druge moguće uzroke akutne otekline vrata

Šum u uhu - sadašnje stanje i terapija privikavanjem

Tinnitus is an abnormal noise in the ear. About six percent of the general population suffers from what they consider to be "severe" tinnitus. Tinnitus can come and go, or be continuous. It can sound like a low roar, or a high-pitched ring. Tinnitus may be bilateral or unilateral. The causes of tinnitus are various, e.g., inner ear injury, 8th nerve lesion, injury of the brainstem, and rarely of the brain. There also are many extracranial causes of tinnitus. Upon making the diagnosis of tinnitus, medical therapy may occasionally help lessen the noise even though the cause has not been identified. Current therapy for tinnitus, so-called tinnitus retraining therapy, first includes learning about what does actually cause the tinnitus. This process is called habituation of reaction. Tinnitus then becomes quieter for long period of time and may eventually disappear, or becomes part of the background .sound of silence (habituation of perception). In some cases, changes in the inner ear function may be important in triggering the occurrence of tinnitus (e.g., Meniere\u27s disease or acute acoustic trauma); however, the retraining approach works independently of the triggering factor. Despite the importance of hearing loss, a recent study in tinnitus patients showed that there was no significant difference in hearing between the tinnitus group and control group of healthy subjects.Šum u uhu je pojava nenormalne buke u uhu. Otprilike 6% populacije pati od tzv. jakog šuma u uhu. Šum se može pojaviti i nestati, ali može biti i trajan. Može zvučati poput duboke tutnjave ili zvonjave visokih tonova. Može nastati u oba uha ili samo u jednom. Uzroci šuma mogu biti različiti, npr. oštećenje unutarnjeg uha, ozljeda osmog moždanog živca ili moždanog debla, ili pak rjeđe ozljeda mozga. Ekstrakranijski uzroci šuma također su brojni. Nakon postavljanja dijagnoze osjet buke u uhu može se ublažiti upotrebom lijekova, iako uzrok šuma jo. nije utvrđen. U suvremenom načinu liječenja šuma, tzv. liječenju metodom privikavanja (tinnitus retraining therapy), najprije treba utvrditi što je zapravo prouzročilo nastanak šuma. Taj se proces zove "privikavanje na nastalu situaciju". Šum se tako može ublažiti na dulje vrijeme, a na kraju može i sasvim nestati ili se stopiti sa zvučnom pozadinom (habituacija percepcije). Promjene u unutarnjem uhu u nekim slučajevima mogu potaknuti naglu pojavu šuma u uhu (npr. Meniereova bolest ili akutna akustička trauma), ali valja naglasiti da liječenje metodom privikavanja daje dobre rezultate bez obzira na to što je u osnovi nastanka šuma. Unatoč važnosti gubitka sluha najnovija ispitivanja u bolesnika sa šumom pokazuju da nema značajnih razlika u sluhu između bolesnika sa šumom i skupine zdravih ispitanika

Diagnostic Value of MPO in Patients Admitted for Suspected Acute Coronary Syndrome- A Study of Adult in Mostar, Bosnia AND Herzegovina

We assessed the diagnostic efficacy of plasma Myeloperoxidasis (MPO) alone or in combination with cardiac troponin I (cTnI) for detecting ACS in patients presenting with chest pain initiating within 24 h before the hospital admission. In this prospective cohort study were included all respondents who have visited outpatient clinic of internal diseases, University Hospital Mostar because of chest pain and suspected acute coronary syndrome within 24 h of the onset of the period of 6 months and the total sample consisted of 114 patients. Troponin and myeloperoxidase were significantly positively correlated at the beginning of treatment, myeloperoxidase was significantly positively associated with adverse cardiovascular events during hospitalization and myocardial infarction (P0.05). Sensitivity of myeloperoxidase as a valid test detection of myocardial infarction at baseline was 0.15 and specificity was 0.85, suggesting good diagnostic value usable in the clinical practice

Benign Paroxysmal Vertigo in Childhood

The aim of the paper is to describe the clinical picture of benign paroxysmal vertigo (BPV) in childhood. BPV in childhood often goes unrecognized in spite of the fact that vertigo and balance disorders are not uncommon in children. Four cases are described with clinical examination findings between the attacks