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Kimura’s Disease: A Rare Clinical Entity for A Head & Neck Surgeon
Get PDFBackground: Kimura’s disease, previously known as a variant of angiolymphoid hyperplasia with eiosinophilia (ALHE), is now considered a distinct clinical entity. In contrast to ALHE, it presents with exuberant systemic autoimmune response involving lymphoid system more readily and at times salivary glands. Disease typically presents with a head and neck region mass associated with peripheral eiosinophilia and raised IgE levels with occasional but concurrent renal or pulmonary involvement in advanced cases. Association of this disease to allergic rhinitis has not been reported in the previous medical literature.Case Presentation: Young Asian male was referred to us with suspicion of primary parotid tumor. He had typical symptom complex of allergic rhinitis with recurrent frontal and parotid region swelling associated with peripheral eiosinophilia (25%) and elevated IgE levels (1703 IU/mL). FNAC of the lesions was inconclusive and hence underwent US- guided core biopsy, which revealed a diagnosis of Kimura’s disease. Superficial parotidectomy and excision of frontal lesion were performed and histopathology of the lesion confirmed Kimura’s disease with involvement of parotid gland. Now the patient is on oral corticosteroids and mast cell stabilizers without recurrence for last 3 months since operative intervention.Conclusions: Kimura’s disease rarely involves parotid gland and its association with allergic rhinitis is being reported first time in medical literature to best of our knowledge. Kimura’s disease should include in the differential diagnosis of a parotid region mass
Donor Site Morbidity Associated with Cancellous Bone Harvest from the Anterior Iliac Crest: Using a Mini-Access Approach and Literature Review
Get PDFIntroduction: The anterior iliac crest is a popular donor sites for cancellous bone in alveolar cleft reconstruction. Potential problems such as donor site pain, restricted ambulation, and sensory nerve injury, are common drawbacks. We developed a mini-access approach to harvest cancellous bone graft from the iliac crest and reviewed the donor site morbidity in the literature.Methods: We reviewed the previously-collected data from patients who underwent alveolar bone grafting using the mini-access approach from the iliac crest in 2005, which was the second year in which we used this method. Donor site morbidity was recorded and analyzed. Data from a total of 40 patients were reviewed.Results: 28 patients were male and 12 were female with a mean age of 10. Thirty-three patients had a unilateral cleft, and 7 patients had bilateral clefts. The average bone graft volume was 5.35 ml, while the average length of hospitalization was 4.55 days. Suspected lateral femoral cutaneous nerve injury occurred in 10% of the cases.Conclusion: Compared to the literature, although we could not conclude that the mini-access approach is absolutely better than the other methods, it provides an easy, alternative way without special equipments to decrease the donor site morbidity
Crystal Engineering: A Powerful Tool towards Designing Pharmaceutical Solids with Desirable Physicochemical Properties
Get PDFNowadays various techniques have been applied for the improvement of physicochemical properties such as solubility, bioavailability, stability and hygroscopic nature of pharmaceutical solids without effecting the biochemical composition of the active pharmaceutical ingredients (API). Supramolecular approach specially the crystal engineering technique is one of the best techniques which play an important role to improve the physico-chemical, thermal and mechanical properties of drug molecules. Crystal engineering approach offers a number of routes such as co-crystallization, polymorphism, hydrate and salt formation with the help of which drug molecules with good physico-chemical behavior can be prepared. This article covers the concept of supramolecular chemistry and crystal engineering approach for the preparation of co-crystals and their application in pharmaceutical industries
The Effect of Adoptive Immunotherapy after Percutaneous Microwave Ablation in Recurrent Hepatocellular Carcinoma Patients with Hepatitis B: A Preliminary Study
Get PDFTo observe the influence of adoptive immunotherapy combination with percutaneous microwave ablation (PMWA) on peripheral blood examination, hepatic function examination and serum alpha fetoprotein (AFP) in recurrent hepatocellular carcinoma (HCC) patients with hepatitis B. Fourteen recurrent HCC patients with 31 lesions (D≤6.0cm, fewer than four tumors) were treated with radical PMWA and continuous four courses of adoptive immunotherapy, which were administrated at 1, 2, 3 and 4 months after PMWA, respectively. Under sonographic guidance, tumor lysate-pulsed DCs (1ml) were injected into bilateral groin lymph nodes at 9th day, while CTL (25ml) were injected into the abdominal cavity at 11th day and CIK (100ml) was infused intravenously at 14th day after hemospasis in one course of treatment, respectively. Peripheral blood examination, serum AFP and hepatic function were reviewed 1, 3, 6 months after adoptive immunotherapy. The number of white blood cell (WBC), lymphocyte (LYM), serum albumin (ALB) and cholinesterase (CHE) were detected increase significantly at 3 and 6 months after therapy compared to pre-therapy (p0.05). Platelet (PLT) was detected increased significantly at 6 months after therapy (p0.05) compared to pre-therapy. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were detected decreased significantly at 1, 3 and 6 months after therapy (p0.05). As to serum AFP, it was detected decreased gradually, while there was no difference during the follow-up (6-16 months). No severe adverse effects were observed. Adoptive immunotherapy prescribed soon after PMWA was safe and ameliorated the laboratory examination and the immunity status of recurrent HCC patients, which may improve the prognosis
Neoadjuvant Chemotherapy Followed By Conformal Hypofractionated Radiotherapy with Concurrent Gemcitabine in Muscle - Invasive Bladder Cancer
Get PDFPurpose: The aim of this prospective, phase II trial was to determine the response of muscle-invasive bladder cancer (MIBC) to concurrent chemoradiotherapy (CRT) of weekly gemcitabine with conformal hypofractionated radiotherapy after neoadjuvant chemotherapy.Patients and Methods: Forty patients with transitional cell carcinoma, stage T2-4a, N0, M0 after magnetic resonance imaging were recruited. Transurethral resection was done and neoadjuvant chemotherapy with gemcitabine 1250 mg/m² on days 1 and 8 with cisplatin 100 mg/m2 on day1 repeated every three weeks was given. CRT phase included gemcitabine at 100 mg/m2 on days 1, 8, 15, and 22 of a 28-day RT schedule that delivered 52.5 Gy in 20 fractions. The end points were tumor response, toxicity, and survival.Results: Thirty three patients (82.5%) completed treatment protocol. Twenty five patients (75.8%) achieved a complete endoscopic response. The remaining 8 patients (24.2%) had residual disease. At a median follow-up of 23.5 months (range, 11 to 33 months), 19 patients (57.6%) had a functional and intact bladder. Four patients (12.1%) had a loco regional recurrences and 2 patients (6.1%) developed distant metastasis. By using Kaplan-Meier analysis, 2-year disease free survival was 64%, and overall survival was 77.5%. Out of the 33 patients who entered the CCRT phase, only 6 patients (18.2%) had grade 3 acute rectal or bladder toxicity. No one developed G3 late toxicity. Overall, side effects were tolerable and manageable.Conclusion: Concurrent gemcitabine-based CRT after neoadjuvant chemotherapy and TURBT is effective with high response rate, durable local control and acceptable toxicity, which allows patients to preserve their own bladder. However further investigations is needed to confirm these results in larger number in a phase III trial
Tumor Shrinkage in Response to Vitamin K2 in Hepatocellular Carcinoma with Multiple Lung Metastases: A Case Report
Get PDFIntroduction: Advanced or metastatic hepatocellular carcinoma (HCC) can be lethal because of the limited therapeutic approach such as sorafenib. Recently, Vitamin K2 (VK2) has been increasingly recognized to have anti-cancer effects for HCC in vitro and vivo. However, the direct anti-cancer effect of VK2 to HCC has not been established yet in human.Presentation of Case: We presented here a 88-year-HCC patient displayed a tumor shrinkage in response to VK2 in multiple lung metastases, indicating the possibility of VK2 as an anti-cancer agent in human. Menatetrenone, a VK2 analogue, was introduced for multiple lung metastases as a palliative treatment, and thereafter multiple lung metastases, except one lung lesion, displayed tumor shrinkage and disappeared within five months after VK2 intake. The residual one lesion continued to grow up during the intake of VK2, suggesting that the residual tumor was insensitive to VK2 represented by tumor heterogeneity. Consequently, after a radiation therapy for the residual lesion, the elevated tumor markers of all were finally decreased into normal levels, and he is still alive for 18 months after VK2 intake without elevated tumor marker levels and toxic adverse effects.Conclusion:VK2 may be a therapeutic option for advanced and metastatic HCCs without any toxic adverse
Allotriophagia of A Bundle of Dried Reeds, Sudden Death, and Colon Cancer: A Case Report
Get PDFIntroduction: Epilepsy patients sometimes exhibit abnormal behavior, such as allotriophagia. We experienced a case of allotriophagia of dried reeds, which resulted in massive vomitings and sudden death.Presentation of case: A 69-year-old man died after vomitings of a large amount of bloody solution. Autopsy revealed that sharp edge of a piece of dried reeds penetrated the whole layer of the colon at the oral edge of the colon cancer.Conclusion: A bundle of dried reeds stuck in the cancerous ulcer in the colon and induced massive bleeding
CAM5.2 Expression in Metastatic Tumours of CNS: A Diagnostic Tool
Get PDFIntroduction: Secondary tumours or metastases account for more than half of all brain tumours in adults. Central nervous system is most commonly a target of metastatic dissemination. The judicious use of selected immunostains is unquestionably helpful in diagnostically challenging cases. CAM 5.2 being highly specific, is emerging as a specific marker to diagnose metastatic carcinoma.Presentation of case: Total six metastatic tumours were studied using CAM5.2. Histopathological sections of brain tissue were stained by routine hematoxylin and eosin (HE) as per standard technique. Representative sections were subjected to immunohistochemical staining with CAM 5.2. Skin biopsy act as a positive control for cytokeratin.All of the 6 cases showed positivity for CAM 5.2. CAM5.2 expression in metastatic tumours was statistically significant (sensitivity 100% 100% specificity).Conclusion: We conclude in our study that CAM5.2 was significantly associated with metastatic tumours, as they were positive using this specific marker
Co-cultivation of Curcuma longa with Piriformospora indica Enhances the Yield and Active Ingredients
Get PDFThe rhizome of Curcuma longa is used in the traditional medicinal system. Its secondary metabolites curcumin and the volatile oil possess wound-healing properties and inhibitory activities against certain pathogenic fungi and bacteria. Piriformospora indica is a root endophytic fungus that colonizes many plant roots and promotes the growth. P. indica was cultivated in the 5 litre capacity fermentor under standard conditions. The filtered biomass was then mixed with raw talcum powder. The propagative buds were treated with this formulation containing both sterile and inoculated fungus. We demonstrated that co- cultivation of C. longa and P. indica resulted in pronounced productivity and enhanced secondary metabolites- curcumin and volatile oil in farmers’ field. To the authors best of knowledge this is the first report where symbiotic fungus has added value to this medicinal plant in the agricultural field
Rosai Dorfman Disease of the Orbit
Get PDF Introduction: Rosai-Dorfman disease or Sinus Histiocytosis with massive lymphadenopathy (SHML) is a rare, benign and self-limited histiocytic proliferative disorder which affects mainly lymph nodes and very rarely extranodal sites.Presentation of case: A 60 year old lady with SHML of orbit is described. She underwent excision of the mass, received steroids for 6 weeks and is in remission at 2 years.Conclusion: Though the orbit is a rare site for SHML, the disease should be considered in the differential diagnosis of orbital swellings.