Neurološke manifestacije hipereozinofilnog sindroma – pregled literature

Hypereosinophilic syndrome is a rare disorder of the hematopoietic system. The disease is characterized by continuously high number of eosinophils (>1.5x109/L) for more than six months. Other possible causes of hypereosinophilia, such as allergic and parasitic diseases, malignant disease, Churg-Strauss disease and infection should be eliminated. The most common manifestations of hypereosinophilic syndrome are pulmonary, skin, gastrointestinal, cardiac difficulties and neurologic lesions. Numerous neurologic lesions have been described, in particular of the central and peripheral nervous systems. Review of the literature revealed the following to have been recorded so far: mononeuritis multiplex, sensory polyneuropathy, radiculopathy, myalgia, myositis and perimyositis, neuropathy, ataxia, paraplegia, ophthalmologic abnormalities, optic neuritis, hemiplegia-hemiparesis, spasmodic quadriplegia, seizures, meningitis, cerebral infarction, organic psychosyndrome, other mental changes, stroke, temporal arteritis, leptomeningeal dissemination, memory deficits and dysarthria.Hipereozinofilni sindrom je rijetka bolest hematopoetskog sustava. Bolest je obilježena visokim brojem eozinofila (>1,5x109/L) duže od šest mjeseci, uz uvjet da su isključeni drugi mogući uzroci hipereozinofilije kao što su alergija i parazitne bolesti, maligne bolesti, Churg-Straussova bolest i druge infekcijske bolesti. Većina kliničkih manifestacija hipereozinofilnog sindroma obuhvaća oštećenja pluća, kože, probavnog sustava, srčane poremećaje i neurološka oštećenja. Opisana su brojna neurološka oštećenja središnjeg i perifernog živčanog sustava. Pretraživanjem literature nalaze se moguće neurološke manifestacije bolesti kao što su mononeuritis multiplex, senzorna polineuropatija, radikulopatija, mijalgija, miozitis i perimiozitis, neuropatija, ataksija, paraplegija, oftalmološki poremećaji, optički neuritis, hemiplegija-hemipareza, spastička tetraplegija, epileptični napadaji, meningitis, ishemijski moždani udar, psihoorganski sindrom i drugi mentalni poremećaji, temporalni arteritis, leptomeningealna diseminacija, poremećaji pamćenja i dizartrija

Recurrence of primary extramedullary plasmacytoma in breast both simulating primary breast carcinoma

BACKGROUND: Extramedullary myelomas (plasmacytoma) are malignant proliferations of plasma cells in the absence of bone involvement. When they occur in the soft tissue they usually involve the upper respiratory tract and oral cavity. Extramedullary plasmacytomas of breast are uncommon. CASE PRESENTATION: A 70 year-old woman with bilateral breast masses underwent excisional biopsy for suspected primary carcinoma that subsequently proved to be a recurrence from extramedullary plasmacytoma of the mediastinum. This was diagnosed and treated 5-years prior to appearance of breast lumps. CONCLUSION: Though uncommon, considering the possibility of metastatic carcinoma and primary, secondary or recurrent lymphoproliferative disease presenting as a breast mass may avoid unnecessary surgeries

Neurološke manifestacije hipereozinofilnog sindroma – pregled literature

Hypereosinophilic syndrome is a rare disorder of the hematopoietic system. The disease is characterized by continuously high number of eosinophils (>1.5x109/L) for more than six months. Other possible causes of hypereosinophilia, such as allergic and parasitic diseases, malignant disease, Churg-Strauss disease and infection should be eliminated. The most common manifestations of hypereosinophilic syndrome are pulmonary, skin, gastrointestinal, cardiac difficulties and neurologic lesions. Numerous neurologic lesions have been described, in particular of the central and peripheral nervous systems. Review of the literature revealed the following to have been recorded so far: mononeuritis multiplex, sensory polyneuropathy, radiculopathy, myalgia, myositis and perimyositis, neuropathy, ataxia, paraplegia, ophthalmologic abnormalities, optic neuritis, hemiplegia-hemiparesis, spasmodic quadriplegia, seizures, meningitis, cerebral infarction, organic psychosyndrome, other mental changes, stroke, temporal arteritis, leptomeningeal dissemination, memory deficits and dysarthria.Hipereozinofilni sindrom je rijetka bolest hematopoetskog sustava. Bolest je obilježena visokim brojem eozinofila (>1,5x109/L) duže od šest mjeseci, uz uvjet da su isključeni drugi mogući uzroci hipereozinofilije kao što su alergija i parazitne bolesti, maligne bolesti, Churg-Straussova bolest i druge infekcijske bolesti. Većina kliničkih manifestacija hipereozinofilnog sindroma obuhvaća oštećenja pluća, kože, probavnog sustava, srčane poremećaje i neurološka oštećenja. Opisana su brojna neurološka oštećenja središnjeg i perifernog živčanog sustava. Pretraživanjem literature nalaze se moguće neurološke manifestacije bolesti kao što su mononeuritis multiplex, senzorna polineuropatija, radikulopatija, mijalgija, miozitis i perimiozitis, neuropatija, ataksija, paraplegija, oftalmološki poremećaji, optički neuritis, hemiplegija-hemipareza, spastička tetraplegija, epileptični napadaji, meningitis, ishemijski moždani udar, psihoorganski sindrom i drugi mentalni poremećaji, temporalni arteritis, leptomeningealna diseminacija, poremećaji pamćenja i dizartrija

ACUTE EFFECT OF INSPIRATORY MUSCLE WARM-UP PROTOCOL ON KNEE FLEXION-EXTENSION ISOKINETIC STRENGTH

In this study, it was planned to investigate the acute effect of inspiratory muscle warm-up protocol on knee flexion-extension isokinetic strength. In our study, control and two different experimental applications were performed on sedentary individuals (n: 15, age: 22.25 ± 1.49 years). In the control application, the subjects participated in the 60os-1 180os-1 and 240os-1 knee flexion-extension isokinetic test, respectively, without general warm-up. Isokinetic tests performed after general warm-up in one of the experimental trials. In the other experimental trial, in addition to general warming, the same isokinetic tests were performed after performing 30 breaths of respiratory muscle twice at 40% maximal inspiratory pressure intensity. One-way analysis of variance and LSD tests were performed for repeated measurements to determine the difference between trials. There were significant differences in 60o PT H / Q Ratio, 60o WH / Q Ratio, 60o PTEx, 60o WEx, 60o PTFlx, 60o FIFlx and 60o WFlx 180o PT H / Q Ratio (%), 180o PTEx (nm), 180o APEx (watts), 180o PTFlx (nm), 180o FIFlx (nm), 180o WFlx (nm / repeat) 240o PTEx (nm), 240o WEx (nm / repeat), 240o PTFlx (nm), 240o FIFlx (nm) and 240o WFlx (nm / repeat) parameters in favor of experimental applications (p <0.05). There was no significant difference between applications in other parameters measured (p> 0.05). As a result, it can be said that inspiratory muscle warm-up exercise lowers the fatigue index and therefore increases the peak torque, average power and total workforce, and it affects the knee flexion-exudate isokinetic strength acutely.  Article visualizations

EFFECT OF CORE TRAINING PROGRAM ON RESPIRATORY FUNCTION AND INSPIRATORY MUSCLE STRENGTH IN SWIMMERS

The aim of this study is to examine the effect of core training program on respiratory functions and inspiratory muscle strength in swimmers. 22 male swimmers between the ages of 18 and 22, who do regular swimming training, participated in the study voluntarily. The subjects were divided into experimental (n: 11) and control (n: 11) groups. A core training program was applied to the experimental group 3 days a week for 8 weeks. Both groups continued their normal swimming training. Before and after core training, the subjects' maximal inspiratory muscle strength (MIP), vital capacity (VC), forced vital capacity (FVC), forced expiratory volume (FEV1) and forced expiration rate (FEV1 / FVC) were measured. The respiratory functions of the subjects were determined by using a Spirometer and the respiratory muscle strengths were determined by using the MicroRPM pressure gauge device. The obtained data were analyzed by the SPSS 22.0 program. The paired Samples T tests were used for within-group comparison and Independent Samples T tests were used for the group comparison. As a result of the statistical analysis, a statistically significant difference was found in the respiratory parameters and inspiratory muscle strength values of the experimental group (

Does low-molecular-weight heparin influence the antimyeloma effects of thalidomide? A retrospective analysis of data from the GIMEMA, nordic and turkish myeloma study groups

Background/Aim: Low-molecular-weight heparin (LMWH) has been shown to prolong survival among patients with solid tumors, but its role among myeloma patients is unknown. Patients: Data from the GIMEMA (Gruppo Italiano Malattie Ematologiche dell'Adulto), Nordic and Turkish myeloma study groups comparing melphalan and prednisolone with (MPT, n: 404) or without thalidomide (MP, n: 393) are analyzed for effects of LMWH. Forty percent (159/394) of the patients on MPT and 7.4% (29/390) in the MP arm received LMWH. Results: Thalidomide improved response and progression-free survival (PFS). Regardless of thalidomide treatment, response rate was higher among those receiving LMWH vs. none vs. other anticoagulants (58.1 vs. 44.9 vs. 50.4%, p = 0.01). PFS was significantly longer (median 32 vs. 21 and 17 vs. 17 months, p = 0.004) only among international scoring system (ISS) I patients receiving MPT +/- LMWH vs. MP +/- LMWH. The group of MPT patients who also received LMWH had a better OS compared to those who did not [45 months, 95% confidence interval (CI) 27.7-62.3, vs. 32 months, 95% CI 26.1-37.9; p = 0.034]. When multivariate analysis was repeated in subgroups, thalidomide was no longer a significant factor (response, PFS) among those receiving LMWH. Conclusion: Addition of LMWH to MPT, in particular in patients with low ISS, suggests additive effects, but the results are limited by the retrospective design of our study. (C) 2015 S. Karger AG, Base

Fournier's Gangrene after Open Hemorrhoidectomy without a Predisposing Factor: Report of a Case and Review of the Literature

Fournier's gangrene (FG) is a fatal synergistic infectious disease with necrotizing fasciitis of the perineum and abdominal wall along with the scrotum and penis in men and vulva in women. An unpredictable case of FG two weeks after open hemorrhoidectomy in a previously healthy 55-year-old male is described. Full-thickness patchy skin necrosis of the perianal, perineal and scrotal region associated with rectal perforation was detected on admission. Prompt radical debridement together with aggressive fluid resuscitation and broad-spectrum antibiotic administration was initiated. Because of rectal involvement, diverting sigmoid colostomy was fashioned. The patient survived after two additional local debridements. Nevertheless, loss of sphincter function due to massive muscle destruction led to permanent colostomy. Our case together with others reported in the literature illustrates that, although rare, FG after open hemorrhoidectomy represents a life-threatening complication to otherwise healthy patients. The development of fever and urinary retention should draw the attention of the surgeon, even if the presentation is delayed. The current literature only briefly mentions the potential risk of FG after such a common surgical procedure. However, devastating complications occur more often than anticipated. This disastrous complication without predisposing factor is discussed along with a literature review

IL-6 і TGF-β як маркери пошкодження аерогематичного бар’єру у дітей з гострою лімфобластною лейкемією: клінічні та прогностичні аспекти

Background. Damage markers of blood-air barrier are important for studding pathological process in lungs in children with acute lymphoblastic leukemia (ALL). Purpose is to analyses pulmonary complications and to assess IL-6 and TGF-β levels in the exhaled breath condensate (EBC) in children with ALL and its prognostic value. Materials and Methods. 40 children with ALL aged 6–17 years were examined. 1st group included newly diagnosed ALL (n = 18). 2nd group involved ALL survivors who had completed course of ALL IC BFM 2009 protocols (n = 22). The control group consisted of 15 healthy children. The levels of IL-6 and TGF- β in the EBC were analyzed by ELISA. Results and discussion. Pulmonary complications presented in 82.5% of children with ALL during chemotherapy and in 15.8% of ALL survivors. IL-6 and TGF-β levels in EBC were significantly higher in both ALL groups than control: IL-6 p1-C = 0,000001; p2-C = 0,000000; TGF-β p1-C = 0.000014; p2-C = 0.009364. 1st group had higher levels of IL-6 and TGF-β in the EBC than 2nd group: IL-6 p1-2 = 0,000000; TGF-β p1-2 = 0.000141. There was a positive correlation between IL-6 and TGF-β levels (r = 0.681176, p = 0.000001). According to ROC analysis, IL-6 level in EBC collected during Protocol 1 > 47.64 pg/ml can be prognostic for pulmonary complications during chemotherapy (AUC 0.875; Sensitivity 75.0%; Specificity 100,0%). Level of IL-6 > 49.96 pg/ml can predict pneumonia during chemotherapy (AUC 0,883; Sensitivity 100.00%; Specificity 81.82%). IL-6 level after the total course of chemotherapy > 23.64 pg/ml can predict pulmonary complications in ALL survivors (AUC 0.819; Sensitivity 75.00%; Specificity 81.82%). TGF-β level in EBC after the completion of chemotherapy > 19.93 pg/ml can be prognostic for pulmonary complications in ALL survivors (AUC 0.896; Sensitivity 100.00%; Specificity 77.78%). Conclusions. IL-6 and TGF-β levels in EBC can be prognostic for pulmonary complications in children with ALL.Актуальність. Вивчення маркерів пошкодження аерогематичного бар’єру має важливе значення для розуміння патологічного процесу в легенях дітей з гострою лімфобластною лейкемією (ГЛЛ). Мета роботи. Проаналізувати легеневі ускладнення та оцінити рівень IL-6 і TGF-β у конденсаті повітря, що видихається (КВП) та його прогностичне значення у дітей з ГЛЛ. Матеріали та методи. Обстежено 40 дітей з ГЛЛ віком 6–17 років. Перша група включала дітей з вперше діагностованою ГЛЛ (n = 18). Друга група включала дітей у ремісії, які пройшли повний курс протоколів ALL IC BFM 2009 (n = 22). Контрольну групу склали 15 здорових дітей. Рівні IL-6 і TGF-β в КВП аналізували методом ELISA. Результати та їх обговорення. Легеневі ускладнення спостерігалися у 82,5% дітей з ГЛЛ під час хіміотерапії та у 15,8% дітей у довгостроковій ремісії. Рівні IL-6 та TGF-β у КВП були значно вищими в обох групах з ГЛЛ, порівняно з контрольною групою: IL-6 p1-C = 0,000001; p2-C = 0,000000; TGF-β p1-C = 0,000014; p2-C = 0,009364. 1-ша група мала достовірно вищі рівні IL-6 та TGF-β в EBC, ніж 2-га група: IL-6 p1-2 = 0,000000; TGF-β p1-2 = 0,000141. Виявлена позитивна кореляція між рівнями IL-6 і TGF-β (r = 0,681176, p = 0,000001). Відповідно до ROC аналізу, рівень IL-6 у КВП, зібраний під час протоколу 1 > 47,64 пг/мл, може бути прогностичним для гострих легеневих ускладнень під час протоколів хіміотерапії (AUC 0,875; чутливість 75,0%; специфічність 100,0%). Рівень IL-6 > 49,96 пг/мл може прогнозувати пневмонію під час хіміотерапії (AUC 0,883; чутливість 100,0%; специфічність 81,82%). Рівень IL-6 після завершення курсу хіміотерапії > 23,64 пг/мл може прогнозувати легеневі ускладнення у дітей у довготривалій ремісії ГЛЛ (AUC 0,819; чутливість 75,00%; специфічність 81,82%). Рівень TGF-β у КВП після завершення протоколів хіміотерапії > 19,93 пг/мл може бути прогностичним для легеневих ускладнень у довготривалій ремісії ГЛЛ (AUC 0,896; чутливість 100,0%; специфічність 77,78%). Висновки. Рівні IL-6 і TGF-β у КВП можуть бути прогностичними для визначення розвитку легеневих ускладнень у дітей з ГЛЛ

Short- and long-term results of harmonic scalpel hemorrhoidectomy versus stapler hemorrhoidopexy in treatment of hemorrhoidal disease

SummaryPurposeIn this prospective randomized study, our aim is to compare the short- and long-term results of harmonic scalpel hemorrhoidectomy (HSH) and stapler hemorrhoidopexy (SH) methods in the surgical treatment of Grade III and Grade IV hemorrhoidal disease.MethodsNinety-nine consecutive patients diagnosed with Grade III or Grade IV internal hemorrhoidal disease were included in the study. Patients were randomized to HSH (n = 48) or SH (n = 51) treatments. Data on patient demographic and clinical characteristics, operative details, postoperative pain score on a visual analog scale, additional analgesic requirement, postoperative short- and long-term complications, and recurrence of hemorrhoidal disease were also recorded. Patients were regularly followed for a total period of 24 (6–36) months.ResultsThe patient demographic and clinical characteristics were similar in the two groups. The operative time was significantly shorter in the HSH group compared with the SH group. Overall pain scores were not significantly different between the groups, although severe pain was significantly more common in the HSH group. Recurrence was significantly lower in the HSH group compared with the SH group.ConclusionHSH and SH are both safe and effective methods for surgical treatment of Grade III and Grade IV hemorrhoidal disease. In our study, the HSH method was determined to be safer, easier, and faster to perform, and associated with fewer long-term recurrences than the SH method