The Diagnostic Value of 4D MRI at 3T for the Localization of Parathyroid Adenomas

Publication date: Available online 22 January 2019

Source: European Journal of Radiology

Author(s): Mesut Ozturk, Ahmet Veysel Polat, Cetin Celenk, Muzaffer Elmali, Seher Kir, Cafer Polat

Abstract

Purpose

The aim of this study was to assess the feasibility of four-dimensional magnetic resonance imaging (4D MRI) at 3 T for the localization of parathyroid adenomas.

Materials and Methods

Preoperative 4D MRI scans, encompassing dynamic contrast-enhanced (DCE) sequences and non-contrast enhanced (non-CE) sequences, including a T2-weighted multipoint Dixon (T2-mDixon) sequence, with in-phase, out-phase, and water-only images, were evaluated retrospectively in 41 patients with surgically proven parathyroid lesions. Two readers who were blinded to the surgical findings independently reviewed the images in two sessions (non-CE sequences alone and non-CE + DCE sequences). The MRI localization of the suspected adenoma in each session and the consensus interpretation of the MRI images, were compared with the surgical results and interobserver agreement was assessed.

Results

By interpreting the non-CE sequences alone, reader 1 correctly localized 34 parathyroid lesions (sensitivity 81.0%, positive predictive value (PPV) 87.2%), and reader 2 correctly localized 34 parathyroid lesions (sensitivity 81.0%, PPV 91.9%). With the addition of DCE sequences, reader 1 correctly identified 35 parathyroid lesions (sensitivity 83.3%, PPV 87.5%), while reader 2 correctly identified 36 parathyroid lesions (sensitivity 85.7%, PPV 92.3%). Overall, MRI detected 38 parathyroid lesions (sensitivity 90.5%, PPV 95.0%). Interobserver agreement was slightly superior in non-CE + DCE sequences compared to non-CE sequences alone (ĸ = 0.738 vs. ĸ = 0.796).

Conclusion

4D MRI with DCE sequencing is a reliable method for the localization of parathyroid adenomas.

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Development and Validation of a Radiomics Nomogram for Identifying Invasiveness of Pulmonary Adenocarcinomas Appearing as Subcentimeter Ground-glass Opacity Nodules

Publication date: Available online 22 January 2019

Source: European Journal of Radiology

Author(s): Wei Zhao, Ya'nan Xu, Zhiming Yang, Yingli Sun, Cheng Li, Liang Jin, Pan Gao, Wenjie He, Peijun Wang, Hongli Shi, Yanqing Hua, Ming Li

Abstract

The aim of the present study was to develop and validate a radiomics-based nomogram for differentiation of pre-invasive lesions from invasive lesions that appearing as ground-glass opacity nodules (GGNs) ≤10 mm (sub-centimeter) in diameter at CT. A total of 542 consecutive patients with 626 pathologically confirmed pulmonary subcentimeter GGNs were retrospectively studied from October 2011 to September 2017. All the GGNs were divided into a training set (n = 334) and a validation set (n = 292). Researchers extracted 475 radiomics features from the plain CT images; a radiomics signature was constructed with the least absolute shrinkage and selection operator (LASSO) based on multivariable regression in the training set. Based on the multivariable logistic regression model, a radiomics nomogram was developed in the training set. The performance of the nomogram was evaluated with respect to its calibration, discrimination, and clinical-utility and this was assessed in the validation set. The constructed radiomics signature, which consisted of 15 radiomics features, was significantly associated with the invasiveness of subcentimeter GGNs (P < 0.0001 for both training set and validation set). To build the nomogram model, radiomics signature and mean CT value were used. The nomogram model demonstrated good discrimination and calibration in both training set (C-index, 0.716 [95% CI, 0.632 to 0.801]) and validation set (C-index, 0.707 [95% CI, 0.625 to 0.788]). Decision curve analysis (DCA) indicated that radiomics-based nomogram was clinically useful. A radiomics-based nomogram that incorporates both radiomics signature and mean CT value is constructed in the study, which can be conveniently used to facilitate the preoperative individualized prediction of the invasiveness in patients with subcentimeter GGNs.

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Whole-tumor histogram analysis of apparent diffusion coefficient in differentiating intracranial solitary fibrous tumor/hemangiopericytoma from angiomatous meningioma

Publication date: Available online 22 January 2019

Source: European Journal of Radiology

Author(s): Wenle He, Xiang Xiao, Xiaodan Li, Yihao Guo, Liuji Guo, Xiaomin Liu, Yikai Xu, Jun Zhou, Yuankui Wu

Abstract

Purpose

To assess the role of histogram analysis of apparent diffusion coefficient (ADC) maps based on whole-tumor in differentiating intracranial solitary fibrous tumor/hemangiopericytoma (SFT/HPC) from angiomatous meningioma (AM).

Materials and methods

Pathologically confirmed intracranial SFT/HPC (n = 15) and AM (n = 20) were retrospectively collected and their clinical and conventional MRI features were analyzed. Diffusion-weighted (DW) images (b = 0 and 1000s/mm²) were processed with the mono-exponential model. Regions of interest covering the whole tumor were drawn on all slices of the ADC maps to obtain histogram parameters, including mean ADC (ADCmean), median ADC (ADCmedian), maximum ADC (ADCmax), minimum ADC (ADCmin), skewness and kurtosis, as well as the 5^th, 10^th, 25^th, 75^th, 90^th and 95^th percentile ADC (ADC5, ADC10, ADC25, ADC75, ADC90 and ADC95). Differences of histogram parameters between SFT/HPC and AM were compared using Mann-Whitney U test. Receiver operating characteristic (ROC) curves was used to determine the diagnostic performance.

Results

The ADCmin (P=0.001) and ADC5 (P = 0.045) were significantly lower in SFT/HPCs than in AMs, while no significant difference was found in sex, age, conventional MRI features or any other histogram parameters between the two entities (P=0.051-1.000). ADCmin showed the best diagnostic performance (area under curves [AUC], 0.86; sensitivity, 81.3%; specificity, 83.3%) in differentiating SFT/HPC from AM with optimal cutoff value being 569.00 × 10^-6  mm²/s, followed by ADC5 (AUC, 0.72; sensitivity, 68.8%; specificity, 75 %) with optimal cutoff value being 781.97 × 10^-6  mm²/s.

Conclusion

SFT/HPC and AM share similar conventional MR appearances. Whole-tumor histogram analysis of ADC maps may be a useful tool for differential diagnosis, with ADCmin and ADC5 being potential parameters.

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Effects of Vaginal Seeding on Infants' Body Mass Index and Allergy Risk for Caesarean-delivered Children

Conditions:   Overweight and Obesity;   Allergy Intervention:   Procedure: Vaginal seeding Sponsors:   Peking University;   National Natural Science Foundation of China;   Liuyang Maternal and Child Health Care Hospital Recruiting (Source: ClinicalTrials.gov)

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A Randomized Experiment of Malaria Diagnostic Testing and Conditional Subsidies to Target ACTs in the Retail Sector: the TESTsmART Trial Aim 1

Conditions:   Malaria;   Febrile Illness Interventions:   Other: Conditional ACT subsidy, Arm 1 levels;   Other: Conditional ACT subsidy, Arm 2 levels;   Other: Conditional ACT subsidy, Arm 3 levels;   Other: Conditional ACT subsidy, Arm 4 levels Sponsors:   Duke University;   National Institute of Allergy and Infectious Diseases (NIAID);   Moi University;   Clinton Health Access Initiative, Nigeria Not yet recruiting (Source: ClinicalTrials.gov)

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Hypereosinophilic syndrome presenting with bilateral ear fullness

Publication date: Available online 23 January 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): H.J. Jung, G.H. Yu, J.H. Park

Abstract

Introduction

Hypereosinophilic syndrome is a rare disease with hypereosinophilia resulting in end-organ dysfunction. Patients present with organ-associated symptoms, and the targets frequently affected are heart, lung, skin, or the nervous system, and the middle ear involvement is rare.

Case report

A 30-year-old female with left ear fullness and hearing loss, which persisted for 6 months, was finally diagnosed with hypereosinophilic syndrome (HES). After high dose systemic steroids treatment, all symptoms improved.

Conclusion

Eosinophilic otitis media and HES involving the middle ear share many clinical manifestations. Prompt and accurate differential diagnosis is required for these diseases to ameliorate symptoms and promote recovery.

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Hypereosinophilic syndrome presenting with bilateral ear fullness

Publication date: Available online 23 January 2019

Source: European Annals of Otorhinolaryngology, Head and Neck Diseases

Author(s): H.J. Jung, G.H. Yu, J.H. Park

Abstract

Introduction

Hypereosinophilic syndrome is a rare disease with hypereosinophilia resulting in end-organ dysfunction. Patients present with organ-associated symptoms, and the targets frequently affected are heart, lung, skin, or the nervous system, and the middle ear involvement is rare.

Case report

A 30-year-old female with left ear fullness and hearing loss, which persisted for 6 months, was finally diagnosed with hypereosinophilic syndrome (HES). After high dose systemic steroids treatment, all symptoms improved.

Conclusion

Eosinophilic otitis media and HES involving the middle ear share many clinical manifestations. Prompt and accurate differential diagnosis is required for these diseases to ameliorate symptoms and promote recovery.

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A comparison of treatment effectiveness between clear aligner and fixed appliance therapies

Abstract

Background

Align technology has developed greatly over past few years. Patients tended to prefer clear aligners over conventional brackets because of the superior comfort and esthetics, while the effectiveness of clear aligners was still controversial. The aim of this systematic review was to verify whether the treatment effectiveness of clear aligners was similar to the conventional fixed appliances.

Methods

A comprehensive search of the Pubmed, Web of Science, Embase, Scopus, and Cochrane Central Register of Controlled Clinical Trials Register databases for studies published through to August 20, 2018 was conducted. Comparative clinical studies assessing the effectiveness of clear aligners compared with braces were included.

Results

Eight papers were included in this study. Two of the included papers were randomized controlled trials and six were cohort studies. Clear aligners might not be as effective as braces in producing adequate occlusal contacts, controlling teeth torque, increasing transverse width and retention. While no statistically significant difference was found between two groups in Objective Grading System score (WMD = 8.38, 95% CI [− 0.17, 16.93]; P = 0.05). On the other hand, patients treated with clear aligners had a statistically significant shorter treatment duration than with braces (WMD = − 6.31, 95% CI [− 8.37, − 4.24]; P < 0.001).

Conclusion

Both clear aligners and braces were effective in treating malocclusion. Clear aligners had advantage in segmented movement of teeth and shortened treatment duration, but were not as effective as braces in producing adequate occlusal contacts, controlling teeth torque, and retention.

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A comparison of treatment effectiveness between clear aligner and fixed appliance therapies

Abstract

Background

Align technology has developed greatly over past few years. Patients tended to prefer clear aligners over conventional brackets because of the superior comfort and esthetics, while the effectiveness of clear aligners was still controversial. The aim of this systematic review was to verify whether the treatment effectiveness of clear aligners was similar to the conventional fixed appliances.

Methods

A comprehensive search of the Pubmed, Web of Science, Embase, Scopus, and Cochrane Central Register of Controlled Clinical Trials Register databases for studies published through to August 20, 2018 was conducted. Comparative clinical studies assessing the effectiveness of clear aligners compared with braces were included.

Results

Eight papers were included in this study. Two of the included papers were randomized controlled trials and six were cohort studies. Clear aligners might not be as effective as braces in producing adequate occlusal contacts, controlling teeth torque, increasing transverse width and retention. While no statistically significant difference was found between two groups in Objective Grading System score (WMD = 8.38, 95% CI [− 0.17, 16.93]; P = 0.05). On the other hand, patients treated with clear aligners had a statistically significant shorter treatment duration than with braces (WMD = − 6.31, 95% CI [− 8.37, − 4.24]; P < 0.001).

Conclusion

Both clear aligners and braces were effective in treating malocclusion. Clear aligners had advantage in segmented movement of teeth and shortened treatment duration, but were not as effective as braces in producing adequate occlusal contacts, controlling teeth torque, and retention.

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Decreased Treg-derived miR-181a and miR-155 correlated with reduced number and function of Treg cells in allergic rhinitis children

Abstract

Background

Regulatory cells (Tregs) have been proved to be deeply involved in allergic airway inflammation. This study aims to evaluate the expression of miRNA in children with AR and their association with Tregs as well as the severity of AR.

Methods

Twenty-five AR children and 20 healthy children were enrolled in this study. The Treg-cell percentage and expression of IL-10 and TGF-β were detected by flow cytometry and enzyme-linked immunosorbent assay. The microRNA microarray analysis in purified Tregs was performed and differentially expressed microRNAs were confirmed by quantitative polymerase chain reaction (qPCR).

Results

Children with AR had lower percentage of Tregs and expression of IL-10 and TGF-beta compared with control children. We found that significantly lower levels of miR-155 and miR-181a in Tregs from AR than healthy controls. Furthermore, intracellular miR-155 and miR-181a level were positively correlated with percentage of Tregs and expression of IL-10 and TGF-beta. Similarly, total nasal severity scores (TNSS) were found to be negatively correlated with miR-155 and miR-181a levels.

Conclusion

Decreased Treg-derived miR-181a and miR-155 were correlated with reduced number and function of Tregs in AR children. The intracellular miR-155 and miR-181a levels may serve as predictors of disease severity in childhood AR.

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Decreased Treg-derived miR-181a and miR-155 correlated with reduced number and function of Treg cells in allergic rhinitis children

Abstract

Background

Regulatory cells (Tregs) have been proved to be deeply involved in allergic airway inflammation. This study aims to evaluate the expression of miRNA in children with AR and their association with Tregs as well as the severity of AR.

Methods

Twenty-five AR children and 20 healthy children were enrolled in this study. The Treg-cell percentage and expression of IL-10 and TGF-β were detected by flow cytometry and enzyme-linked immunosorbent assay. The microRNA microarray analysis in purified Tregs was performed and differentially expressed microRNAs were confirmed by quantitative polymerase chain reaction (qPCR).

Results

Children with AR had lower percentage of Tregs and expression of IL-10 and TGF-beta compared with control children. We found that significantly lower levels of miR-155 and miR-181a in Tregs from AR than healthy controls. Furthermore, intracellular miR-155 and miR-181a level were positively correlated with percentage of Tregs and expression of IL-10 and TGF-beta. Similarly, total nasal severity scores (TNSS) were found to be negatively correlated with miR-155 and miR-181a levels.

Conclusion

Decreased Treg-derived miR-181a and miR-155 were correlated with reduced number and function of Tregs in AR children. The intracellular miR-155 and miR-181a levels may serve as predictors of disease severity in childhood AR.

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Unilateral mydriasis: a complication of spine surgery in prone position

Publication date: Available online 23 January 2019

Source: Brazilian Journal of Anesthesiology (English Edition)

Author(s): Priyanka Gupta, Vijay B. Adabala, Amiya K. Barik

Abstract

Prone position though a commonly used position for better access to surgical site but may be associated with a variety of complications. Perioperative Visual Disturbances/Loss is rare but devastating complication that is primarily associated with spine surgeries in prone position. In this case we report a 42 year old ASA-II patient who developed anisocoria with left pupillary dilatation following lumbar microdiscectomy in prone position. Following further evaluation of the patient, segmental pupillary palsy of the left pupillary muscles was found to be the possible cause of anisocoria. Anisocoria partially improved but persisted till follow up.

Resumo

O posicionamento em decúbito ventral, embora comumente usado para melhor o acesso ao local cirúrgico, pode estar associado a uma variedade de complicaç&otildees. O Distúrbio/Perda visual no Perioperatório é uma complicação rara, mas devastadora que está principalmente associada a cirurgias de coluna vertebral em decúbito ventral. Relatamos aqui o caso de um paciente de 42 anos de idade, ASA – II, que desenvolveu anisocoria com dilatação pupilar esquerda após microdiscetomia lombar em decúbito ventral. Após uma avaliação adicional do paciente, observamos que a paralisia segmentar dos músculos pupilares esquerdos seria a possível causa de anisocoria. A anisocoria melhorou parcialmente, mas persistiu até o acompanhamento.

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Unilateral mydriasis: a complication of spine surgery in prone position

Publication date: Available online 23 January 2019

Source: Brazilian Journal of Anesthesiology (English Edition)

Author(s): Priyanka Gupta, Vijay B. Adabala, Amiya K. Barik

Abstract

Prone position though a commonly used position for better access to surgical site but may be associated with a variety of complications. Perioperative Visual Disturbances/Loss is rare but devastating complication that is primarily associated with spine surgeries in prone position. In this case we report a 42 year old ASA-II patient who developed anisocoria with left pupillary dilatation following lumbar microdiscectomy in prone position. Following further evaluation of the patient, segmental pupillary palsy of the left pupillary muscles was found to be the possible cause of anisocoria. Anisocoria partially improved but persisted till follow up.

Resumo

O posicionamento em decúbito ventral, embora comumente usado para melhor o acesso ao local cirúrgico, pode estar associado a uma variedade de complicaç&otildees. O Distúrbio/Perda visual no Perioperatório é uma complicação rara, mas devastadora que está principalmente associada a cirurgias de coluna vertebral em decúbito ventral. Relatamos aqui o caso de um paciente de 42 anos de idade, ASA – II, que desenvolveu anisocoria com dilatação pupilar esquerda após microdiscetomia lombar em decúbito ventral. Após uma avaliação adicional do paciente, observamos que a paralisia segmentar dos músculos pupilares esquerdos seria a possível causa de anisocoria. A anisocoria melhorou parcialmente, mas persistiu até o acompanhamento.

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Analysis of the association of IL4 polymorphisms with orthodontic mini-implant loss

Publication date: Available online 23 January 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): T.F. Lopes, C.M. Souza, A.M. Reichow, A.C. Melo, P.C. Trevilatto

Abstract

The aim of this study was to investigate the association of clinical characteristics and IL4 tag single nucleotide polymorphisms (SNPs; rs2227284 and rs2243268) with orthodontic mini-implant (MI) failure. The sample included 135 subjects of both sexes, mean age 48.7 ± 10 years (range 20–76 years): 104 in the control group (patients without any MI loss) and 31 in the study group (patients presenting ≥1 MI loss). Genotypes were determined by real-time PCR. Bivariate and multivariate analyses were performed (P < 0.05). No association was found between the selected tag SNPs and MI loss. The C allele of the IL4 rs2243268 polymorphism in the recessive model was more frequent in patients who had fewer MIs installed (≤2 vs. >2; P = 0.043, odds ratio 0.65, 95% confidence interval 0.58–0.74). On multivariate analysis, smoking habit was significantly associated with the group with multiple MIs installed (P = 0.036), however the significance of the association with rs2243268 was not maintained. No association was found between the socio-demographic, smoking, or genetic factors studied and MI loss. This study supports the interaction between host and environmental factors and its influence on susceptibility to orthodontic MI failure.

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Analysis of the association of IL4 polymorphisms with orthodontic mini-implant loss

Publication date: Available online 23 January 2019

Source: International Journal of Oral and Maxillofacial Surgery

Author(s): T.F. Lopes, C.M. Souza, A.M. Reichow, A.C. Melo, P.C. Trevilatto

Abstract

The aim of this study was to investigate the association of clinical characteristics and IL4 tag single nucleotide polymorphisms (SNPs; rs2227284 and rs2243268) with orthodontic mini-implant (MI) failure. The sample included 135 subjects of both sexes, mean age 48.7 ± 10 years (range 20–76 years): 104 in the control group (patients without any MI loss) and 31 in the study group (patients presenting ≥1 MI loss). Genotypes were determined by real-time PCR. Bivariate and multivariate analyses were performed (P < 0.05). No association was found between the selected tag SNPs and MI loss. The C allele of the IL4 rs2243268 polymorphism in the recessive model was more frequent in patients who had fewer MIs installed (≤2 vs. >2; P = 0.043, odds ratio 0.65, 95% confidence interval 0.58–0.74). On multivariate analysis, smoking habit was significantly associated with the group with multiple MIs installed (P = 0.036), however the significance of the association with rs2243268 was not maintained. No association was found between the socio-demographic, smoking, or genetic factors studied and MI loss. This study supports the interaction between host and environmental factors and its influence on susceptibility to orthodontic MI failure.

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Global Analysis of Lysine Succinylome in the Periodontal Pathogen Porphyromonas gingivalis

Summary

The Gram‐negative anaerobe Porphyromonas gingivalis is not only a keystone periodontal pathogen, but also an emerging systemic pathogen. Although the newly discovered protein post‐translational modification (PTM), lysine succinylation (Ksuc), appears to play an important role in modulating metabolic processes in bacteria, this PTM has not been investigated in P. gingivalis. In this study, we used a highly sensitive proteomics approach combining affinity enrichment with high‐resolution liquid chromatography coupled with tandem mass spectrometry to examine Ksuc in P. gingivalis. In total, 345 Ksuc sites in 233 proteins were identified and determined to be involved in a variety of cellular processes. In the region surrounding Ksuc sites, lysine residues were drastically overrepresented and sequence motifs with succinyl‐lysine flanked by a lysine at the +3 or +6 positions appear to be unique to this pathogen. Additionally, our results suggest a crosstalk between Ksuc and glycosylation, but the overlap between Ksuc and acetylation in P. gingivalis is quite different from that observed in other organisms. Notably, Ksuc was observed in proteins associated with established virulence factors including gingipains, fimbriae, RagB and PorR. Moreover, products of the factors necessary for P. gingivalis in vitro survival (18.5%) were found to be succinylated at lysine sites and the same was observed in products of fitness factors for P. gingivalis survival in both abscess and epithelial cell colonization environments (12%). Collectively, these results suggest that Ksuc may be a new mechanism in modulating the virulence, adaptation, and fitness of P. gingivalis.

This article is protected by copyright. All rights reserved.

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Global Analysis of Lysine Succinylome in the Periodontal Pathogen Porphyromonas gingivalis

Summary

The Gram‐negative anaerobe Porphyromonas gingivalis is not only a keystone periodontal pathogen, but also an emerging systemic pathogen. Although the newly discovered protein post‐translational modification (PTM), lysine succinylation (Ksuc), appears to play an important role in modulating metabolic processes in bacteria, this PTM has not been investigated in P. gingivalis. In this study, we used a highly sensitive proteomics approach combining affinity enrichment with high‐resolution liquid chromatography coupled with tandem mass spectrometry to examine Ksuc in P. gingivalis. In total, 345 Ksuc sites in 233 proteins were identified and determined to be involved in a variety of cellular processes. In the region surrounding Ksuc sites, lysine residues were drastically overrepresented and sequence motifs with succinyl‐lysine flanked by a lysine at the +3 or +6 positions appear to be unique to this pathogen. Additionally, our results suggest a crosstalk between Ksuc and glycosylation, but the overlap between Ksuc and acetylation in P. gingivalis is quite different from that observed in other organisms. Notably, Ksuc was observed in proteins associated with established virulence factors including gingipains, fimbriae, RagB and PorR. Moreover, products of the factors necessary for P. gingivalis in vitro survival (18.5%) were found to be succinylated at lysine sites and the same was observed in products of fitness factors for P. gingivalis survival in both abscess and epithelial cell colonization environments (12%). Collectively, these results suggest that Ksuc may be a new mechanism in modulating the virulence, adaptation, and fitness of P. gingivalis.

This article is protected by copyright. All rights reserved.

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Primary Cutaneous Hodgkin‐like Polymorphic Post‐Transplant Lymphoproliferative Disorder

Post‐transplant lymphoproliferative disorder (PTLD) is an uncommon complication after solid organ transplants and hematopoietic stem cell transplants. Isolated involvement of the skin without systemic involvement in PTLD is extremely rare. Primary cutaneous PTLD is generally categorized as either cutaneous T‐cell lymphomas or cutaneous B‐cell lymphomas, with variable Epstein‐Barr virus (EBV) positivity. Herein, we describe an exceedingly uncommon case of a primary cutaneous Hodgkin‐like polymorphic PTLD. A man in his 60s, with a history of kidney transplant, presented with a 5‐week history of 2 indurated plaques. Clinical, histologic and immunohistochemical findings were consistent with primary cutaneous Hodgkin‐like polymorphic PTLD. Reduction in immunosuppression led to resolution of his lesions. This case highlights a rare case of primary cutaneous Hodgkin‐like PTLD and increases awareness of this uncommon post‐transplant complication. It also underscores the importance of collaboration between dermatology, hematology, dermatopathology and hematopathology in order to diagnose challenging cases.

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Primary Cutaneous Hodgkin‐like Polymorphic Post‐Transplant Lymphoproliferative Disorder

Post‐transplant lymphoproliferative disorder (PTLD) is an uncommon complication after solid organ transplants and hematopoietic stem cell transplants. Isolated involvement of the skin without systemic involvement in PTLD is extremely rare. Primary cutaneous PTLD is generally categorized as either cutaneous T‐cell lymphomas or cutaneous B‐cell lymphomas, with variable Epstein‐Barr virus (EBV) positivity. Herein, we describe an exceedingly uncommon case of a primary cutaneous Hodgkin‐like polymorphic PTLD. A man in his 60s, with a history of kidney transplant, presented with a 5‐week history of 2 indurated plaques. Clinical, histologic and immunohistochemical findings were consistent with primary cutaneous Hodgkin‐like polymorphic PTLD. Reduction in immunosuppression led to resolution of his lesions. This case highlights a rare case of primary cutaneous Hodgkin‐like PTLD and increases awareness of this uncommon post‐transplant complication. It also underscores the importance of collaboration between dermatology, hematology, dermatopathology and hematopathology in order to diagnose challenging cases.

This article is protected by copyright. All rights reserved.

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A cross-sectional evaluation of outcomes of pediatric branchial cleft cyst excision

Publication date: Available online 23 January 2019

Source: International Journal of Pediatric Otorhinolaryngology

Author(s): Jillian Mattioni, Sarah Azari, Travis Hoover, Daniel Weaver, Sri Kiran Chennupati

Abstract

Objective

To examine complications following pediatric branchial cleft cyst excision by surgical specialty, demographics, and comorbid conditions.

Methods

A retrospective review of the National Surgical Quality Improvement Program database was performed. Pediatric cases from January 1, 2015 through May 1, 2017 with a current procedural terminology code of 42810 (excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues) or 42815 (excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into the pharynx) were included. Statistical analysis was performed to assess associations between complications and surgical specialty, demographics, and comorbidities.

Results

Of the 895 cases that met inclusion criteria, the median age was two years and there was an approximately equal number of males (46.8%) and females (53.2%). Forty-five patients (5.0%) experienced at least one 30-day complication, the most predominant of which was superficial surgical site infection. There was no statistically significant difference between complications and surgical specialty, complications and patient demographics, or complications and depth of excision. There was a statistically significant difference (p = 0.05) in the percentage of patients with a past medical history of developmental delay between those with at least one complication (11.1%) compared to those without any complications (4.2%).

Conclusion and relevance

Branchial cleft excision is a generally safe procedure across surgical specialties and patient demographics. There is an association between a history of developmental delay and 30-day postoperative complications.

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