A 3-year-old child with alternate convergent squint and abnormal movements of eyes since 1 year

ONE MINUTE OPHTHALMOLOGY

Year : 2019  |  Volume : 67  |  Issue : 1  |  Page : 7

Hypopigmented fundus in a young male

Nawazish Fatma Shaikh, Vinod Kumar
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication

21-Dec-2018

Correspondence Address:
Dr. Vinod Kumar
Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi - 110 029 
India

Source of Support: None, Conflict of Interest: None

Check

DOI: 10.4103/ijo.IJO_1834_18

 

How to cite this article: Shaikh NF, Kumar V. Hypopigmented fundus in a young male. Indian J Ophthalmol 2019;67:7

How to cite this URL: Shaikh NF, Kumar V. Hypopigmented fundus in a young male. Indian J Ophthalmol [serial online] 2019 [cited 2018 Dec 22];67:7. Available from: http://www.ijo.in/text.asp?2019/67/1/7/248137

Case

A 3-year-old boy presented with alternate convergent squint and abnormal movements of eyes since 1 year. Family and systemic history was unremarkable. The child had a best-corrected visual acuity of 20/100 in both eyes (OU). Ocular examination revealed pendular nystagmus and normal anterior segments in OU. Iris OU was brown-colored. Dilated fundus examination revealed a hypopigmented fundus with prominent choroidal vessels [Figure 1]a, [Figure 1]b. Macular pigments and foveal avascular zone (FAZ) were lacking in OU.

Figure 1: Dilated fundus examination revealed a hypopigmented fundus with prominent choroidal vessels (a and b). Macular pigments and foveal avascular zone (FAZ) were lacking in OU. Swept-source optical coherence tomography revealed an absent foveal contour and preservation of retinal layers in the foveal area (c and d) Click here to view

What is Your Next Step?

1. Refraction and optical coherence tomography (OCT)
2. Magnetic resonance imaging
3. Genetic analysis
4. Visual evoked potentials and electroretinogram

Findings

The child had a refractive error of + 3D in OU. Color vision was found to be normal for the child. Swept-source OCT revealed an absent foveal contour and preservation of retinal layers in the foveal area [Figure 1]c, [Figure 1]d. A diagnosis of ocular albinism and foveal hypoplasia was made, and the parents were explained about the prognosis. The child was prescribed glasses and was advised regular follow-up in addition to a strabismic evaluation.

Diagnosis

Ocular albinism with foveal hypoplasia

Correct Answer: A.

Discussion

Ocular albinism is an X-linked disorder in contrast to oculocutaneous albinism, which is inherited in a autosomal recessive manner.^[1],[2] Patients usually present with a variable decrease in visual acuity (visual acuity ranging from 20/60 to 20/400), nystagmus, strabismus, and photophobia. While oculocutaneous albinism is an easy diagnosis, ocular albinism may pose a diagnostic challenge as iris may not be hypopigmented.^[1],[2] The patients are frequently mistaken as having myopia as the fundus is lightly pigmented. Foveal hypoplasia is a frequent association and can be easily missed. Absent foveal reflex, FAZ, and macular pigments indicate foveal hypoplasia, which can be confirmed on OCT (preservation of retinal layers at fovea) or fundus fluorescein angiography (absent FAZ).

Ocular albinism is characterized by mutation in the GPR143 gene leading to dysfunctional melanosome ultimately resulting in macromelanosomes.^[1],[2] Melanin acts as an inducer and organizer of the formation of the fovea, optic nerves, optic tracts, and visual cortex. Absence or deficiency of melanin leads to ocular structure malformation and optic tract misrouting.

To conclude, high index of suspicion is required to diagnose ocular albinism as the fundus in these cases is easily confused with myopia.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 

References

1.	Federico JR, Krishnamurthy K. Albinism. [Updated 2018 Jul 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018.
2.	De Filippo E, Schiedel AC, Manga P. Interaction between G protein-coupled receptor 143 and tyrosinase: Implications for understanding ocular albinism type 1.J InvestDermatol2017;137:457-65.

The Scientific Journal of Al-Azhar Medical Faculty, Girls : Subarachnoid versus intravenous dexmedetomidine and fentanyl for minimizing stress response in laparoscopic cholecystectomy Mofeed Abdalla The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):137-143 Background The magnitude of stress response depends on several factors such as duration and intensity of surgical trauma, patient’s age, surgical method, anesthetic technique, blood loss, and postoperative pain. Aim of the work The aim of this work was to study the effect of intravenous versus intrathecal dexmedetomidine and fentanyl on stress response during laparoscopic cholecystectomy. Patients and methods Sixty patients fulfilling the inclusion criteria who were undergoing laparoscopic cholecystectomies were randomly assigned to receive either intravenous fentanyl and dexmedetomidine (group I) or intrathecal fentanyl and dexmedetomidine (group II). Mean arterial blood pressure and heart rate were recor

http://www.sjamf.eg.net/currentissue.asp?sabs=n

Subarachnoid versus intravenous dexmedetomidine and fentanyl for minimizing stress response in laparoscopic cholecystectomy Mofeed Abdalla The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):137-143 Background The magnitude of stress response depends on several factors such as duration and intensity of surgical trauma, patient’s age, surgical method, anesthetic technique, blood loss, and postoperative pain. Aim of the work The aim of this work was to study the effect of intravenous versus intrathecal dexmedetomidine and fentanyl on stress response during laparoscopic cholecystectomy. Patients and methods Sixty patients fulfilling the inclusion criteria who were undergoing laparoscopic cholecystectomies were randomly assigned to receive either intravenous fentanyl and dexmedetomidine (group I) or intrathecal fentanyl and dexmedetomidine (group II). Mean arterial blood pressure and heart rate were recorded before induction of anesthesia (T0), 5 min after intubation (T1), 30 min after start of surgery (T2), at skin closure (T3), 6 h postoperatively (T4), and 24 h postoperatively (T5). The number of patients who required intraoperative intravenous fentanyl and total intraoperative fentanyl consumption (µg), and the number of patients who required intravenous morphine at the end of surgery were recorded. Visual analogue scale and total postoperative morphine consumption (mg) at the end of surgery (M0), and at 6, 12, 18, and 24 h (M1, M2, M3, and M4, respectively) were recorded. Blood interleukin-6, cortisol, and glucose were measured before anesthesia (F0) and after recovery (F1). Postoperative complications were recorded. Results Heart rate and mean arterial blood pressure were statistically lower in group II at T2 and T3. The number of patients requiring intraoperative intravenous fentanyl and total intraoperative fentanyl consumption (µg), and the number of patients requiring intravenous morphine at the end of surgery were statistically lower in group II. Visual analogue scale and postoperative morphine consumption (mg) were statistically lower in group II at M0 and M1. Blood cortisol and blood glucose level were statistically lower in group II at F1. There were no statistical differences as regards complications. Conclusion Apart from lowering heart rate and BP, intrathecal dexmedetomidine and fentanyl was superior to intravenous dexmedetomidine and fentanyl, wherein it lowered pain score and analgesic consumption with attenuation of stress response.

Comparison between subtenon block and extraconal block during cataract surgery Ahmed M Abd El-Galeel, Osama I.A Badr, Khaled G Mohamed The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):144-149 Background Most ophthalmic procedures are performed under local anesthesia, and cataract extraction is the most frequently performed surgery in elderly patients. The aim of this study is to compare the intraoperative hemodynamic variables, efficacy, and efficiency of extraconal block versus subtenon block with low concentration of local anesthetic during cataract surgery. Patients and methods This prospective, randomized, and single-blind study was done on 80 patients American Society of anesthesiologists status I–III undergoing cataract surgery, of which 40 patients underwent subtenon block (group S) and 40 patients underwent extraconal block (group E). Five minutes after the start of anesthetic monitoring care, 5-ml mixture of lidocaine 1% and bupivacaine 0.25% containing 100 IU hyalorunidase, in a mixture ratio of 1 : 1, was injected intraocular slowly. Patients were monitored for intraoperative hemodynamics, ocular movement during surgery, and intraoperative pain sensation as primary outcome, and onset of blockade, pain assessment within 30 min postoperatively, number of patients need rescue dose, surgeon discomfort, and postoperative complications as secondary outcomes. Results Mean arterial blood pressure and heart rate in group S were significantly lower than those in group E but within safety margin. No significant difference was found between the two groups regarding full range of eye movement, surgeon’s discomfort grade during cataract surgery, and also, intraoperative pain sensation. The onset of blockade was significantly faster in group S than group E. Although group S had better postoperative analgesic effect than group E, postoperative rescue dose was of insignificant value. Conclusion Subtenon block seems to be a better local anesthetic technique than extraconal for cataract surgery, as it is faster, has less surgeon discomfort grading, and better postoperative analgesia. However, on the contrary, both subtenon and extraconal blocks are equally effective in pain control during surgery and also have good ocular akinesia during operation.

Endometrial hyperplasia versus carcinoma: does phosphatase and tensin homolog immunohistochemical expression differentiate between them Marwa A El Kholy, Eman A El Kholy The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):150-155 Context Phosphatase and tensin homolog (PTEN) is a protein that acts as a tumor suppressor by dephosphorylating the lipid second messenger phosphatidylinositol 3,4,5-trisphosphate. Loss of PTEN function and mutation in PTEN gene have been implicated in the pathogenesis of endometrial carcinoma (EC). Objective The aim was to evaluate the immunohistochemical expression of PTEN in endometrial hyperplasia and EC and to evaluate the relationship between its expression and tumor grade in EC. Materials and methods Specimens included 16 cases of endometrial hyperplasia without atypia, six cases of atypical endometrial hyperplasia, and 18 EC specimens. Immunohistochemical staining for PTEN was performed using diaminobenzidine detection kit on formalin-fixed and paraffin-embedded tissue samples. Tumor tissue blocks and clinical data were collected from the files of the Pathology Department of Al-Zahraa University Hospital during the period 2010–2014. Results Immunohistochemistry showed that PTEN was positive for nuclei and cytoplasm of glandular endometrial cells. The PTEN expression was decreased significantly in atypical hyperplasia or EC compared with simple or complex hyperplasia (P0.041). In EC, we proved that PTEN expression is downregulated in high-grade tumors. Conclusion A positive PTEN expression correlates significantly with hyperplasia without atypia and well-differentiated tumors. The downregulation of PTEN indicates a more malignant phenotype.

Brain natriuretic peptide for prediction of mortality in patients with sepsis Amani K Mohamed, Nagwa Abd El-Ghaffar Mohamed, Nalgaa Abou-Elfattah Tawfik, Marwa Yahia Mohamed The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):156-162 Introduction Worldwide, sepsis is one of the leading causes of morbidity and mortality. Patients are at high risk for irreversible organ failure and a lethal course. About 60 000 individuals die from sepsis annually, and survivors have a reduced quality of life. In addition, sepsis places a considerable economic burden on the society. Early and comprehensive treatment improves outcome significantly. Brain natriuretic peptides (BNPs) are powerful predictors of death and major events in patients with stable coronary disease and pulmonary embolism. Several prospective studies have been carried out to investigate the potential role of BNPs in predicting mortality in septic patients in ICUs. The aim of this prospective study was to evaluate BNP for the prediction of mortality and myocardial dysfunction in severe sepsis and septic shock. Patients and methods This prospective study was carried out on 50 patients including group I, patients with sepsis, group (II), patients with severe sepsis, and group III, patients with septic shock. This study was carried out in the ICU of the Internal Medicine Department, Al-Zahraa University Hospital, in the period between January 2013 and March 2014 with written consents from our patients according to the ethical committee of the university. BNPs were determined by enzyme-linked immunosorbent assay. Results There was a highly statistical difference in the mean±SD of the BNP levels in group III (901.77±259.6) compared with group II (610.84±102.46), P value less than 0.01; also, there was a statistical difference in the BNP levels in group III (901.77±259.6) compared with group I (217.4±81.16), P value less than 0.01, whereas there was a statistically significant difference in group II (610.84±102.46) compared with group I (217.4±81.16), P value less than 0.05. In terms of the correlation between the BNP levels and other parameters of the patient groups, there was a highly positive significant correlation between BNP levels and the acute physiology and chronic health evaluation (APACHE II) score, the Sequential Organ Failure Assessment score, and white blood cells count. A significant positive correlation was found between BNP levels and prothrombin concentration (PC). There was a nonsignificant correlation between BNP and age, creatine phosphokinase, creatine kinase-MB, serum glutamic oxaloacetic transaminase, serum glutamic pyruvic transaminase, prothrombin time, international normalized ratio, and length of stay. Conclusion Our results suggested that an elevated BNP level may prove to be a powerful predictor of mortality in patients with sepsis. Future larger and more adequately powered prospective studies are warranted to clarify the prognostic value of BNPs in conjunction with other biomarkers.

Expression of TWIST1 and CD44 as diagnostic and prognostic biomarkers in patients with gastric cancer Marwa A El Kholy, Hala A El Sayed, Eman M Ahmed The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):163-170 Objective The aim of this study was to investigate the association of TWIST1 and CD44 in gastric cancer (GC) with clinical parameters and their relation to prognosis, which may be beneficial for targeted therapeutic strategies in the future. Materials and methods The material of this work consisted of 40 primary GC specimens from patients who underwent radical gastrectomy. Patients who received neoadjuvant chemotherapy or chemoradiotherapy, those who presented with other cancers at the same time, or the patients with incomplete clinical data were excluded from the study. Hematoxylin and eosin-stained sections from all cases were re-evaluated and further stained immunohistochemically using antibodies against TWIST1 and CD44. Results TWIST1 and CD44-positive expressions were significantly increased in GC cases of diffuse type (P=0.019 and 0.002, respectively). Moreover, there was a statistically significant correlation between both markers and tumor grade, stage, and lymphovascular invasion (P=0.027 and 0.010, P=0.002 and 0.012, and P=0.001 and 0.005, respectively). A statistically significant correlation was found between TWIST1 and CD44 expressions in GCs (P=0.000). Conclusion The presence of TWIST1-positive carcinoma cells and CD44-positive cancer stem-like cells in GC tissue can be used as a diagnostic tool for GC and regarded as a marker of poor prognosis in patients with GC, which may provide potential targets for GC therapy.

Homocysteinemia in relation to anemia in hypothyroid patients Samia Souka, Hanaa Kandil, Soheir Korraa, Aida A Abdel Hameed, Marwa Hassan The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):171-180 Background Anemia and hypothyroidism are both common diseases in the community. Homocysteine (HCY) levels are increased in patients with hypothyroidism and methylenetetrahydrofolate reductase (MTHFR) deficiency is the most common genetic cause of hyperhomocysteinemia. The aim of the present study was to evaluate the level of serum HCY in patients with hypothyroidism and to study the relation of associated anemia with the serum level of HCY and MTHFR gene in patients with hypothyroidism. Patients and methods The study was conducted on 60 adult women attending the Endocrinology Outpatient Clinic of Al-Zahraa Hospital between September 2014 and June 2015 for proper diagnosis and management. Individuals of the study were divided into two main groups: group I (GI) with 30 hypothyroid patients, where 13 of them were postsurgical cases, and group II (GII) with 30 euthyroid individuals as a control group. Diagnosis was based on thyroid-stimulating hormone level reference values. Patients in GI were further classified into two subgroups: mild hypothyroid (subgroup I) and overt hypothyroid (subgroup II). Patient and control groups also were classified into anemic and nonanemic subgroups according to hemoglobin levels. The selected hypothyroid patients were women under thyroid hormone replacement therapy. Blood sample was obtained for proper investigations. Complete blood count, routine blood chemistry, serum iron level, thyroid function tests, vitamin B12 level, serum homocysteine (HCY), and MTHFR were performed. We performed a pilot study on MTHFR gene polymorphism. The C677T MTHFR gene mutation was detected in three of 10 patients and in two of 10 controls. No evidence of TT MTHFR gene mutation was observed in both patient and control groups. IBM SPSS statistics (version 23.0, USA, 2015) was used for data analysis. Results revealed the presence of anemia according to hemoglobin level (<12 g/dl). In patients group (GI), 50% (15/30) as compared with 13.3% (4/30) in the control group (GII) had anemia. Serum iron level in patients group (GI) was deficient in 40% (11/30), whereas deficient in 16.7% (5/30) in control group (GII). Vitamin B12 deficiency was found to be 44% (11/25) in patients group (GI), whereas in the control group (GII) was 6.7% (2/30). Analysis by Wilcoxon’s rank sum test, homocysteine (HCY) serum level showed a highly significant increase among patients (GI) as compared with control (GII). Ranked Spearman’s correlation test for the patients (GI) and control (GII) showed a significant negative correlation between homocysteine (HCY) and MTHFR serum levels, whereas the correlation with red cell indices parameters was insignificant. Serum iron and B12 levels were significantly correlated in patient group (GI). Pearson χ2 tests were done between both patients and control groups for the presence of anemia, iron deficiency, and elevated serum homocysteine (HCY) level and all revealed statistically significant results. Conclusion There is no significant correlation between homocysteinemia and anemia. However, the strong association between anemia and hypothyroidism is attributed mainly owing to combined iron and vitamin B12 deficiencies. This might explain the decreased response to treatment among the selected hypothyroid patients.

Impact of direct-acting antiviral therapy in Egyptian patients with chronic hepatitis C and liver cirrhosis Mohammed H Elnadry, Sherif A Abdel-Aziz, Mohammed Ghareb, Ali A Ahamad, Nagah M Abu-Mohammed, Marwan M Tayel The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):181-188 Background and aims In Egypt, ∼14.7% of the population has hepatitis C infection and genotype 4 infection accounts for more than 90% of the hepatitis C virus infections. Available data with newer all-oral regimens in the treatment of genotype 4 infection suggest that sustained virological response (SVR) 12 rates in treatment-naïve cirrhotic and noncirrhotic patients are greater than 95%. The study aimed to evaluate the virological response 12 weeks after treatment (SVR12), change in the model for end-stage liver disease score, and adverse clinical events during the study period. Patients and methods This prospective study included 451 patients with chronic hepatitis C and liver cirrhosis over a 3-month period started at January 2017. And the study was ethically approved by the Medical Research Ethics Committee, Faculty of Medicine, Al-Azhar University. The enrolled patients were classified into three groups: group I included 162 patients with chronic hepatitis C and liver cirrhosis subjected to direct-acting antivirals (DAAs) therapy (100/162 compensated cirrhosis and 62/162 decompensated cirrhosis), group II included 234 patients known to have chronic hepatitis C without liver cirrhosis subjected to DAAs therapy, and group III included 55 patients with chronic hepatitis C and liver cirrhosis not subjected to DAAs therapy according to the national protocol of therapy (as a control group). Treatment was administered for 12 weeks that included variable regimens of DAAs according to the Egyptian Ministry of Health protocol. Results We included 451 patients with chronic hepatitis C infection and liver cirrhosis; 47.8% of the patients were male, 84.4% were treatment naive, and 54.9% had cirrhosis. Of the study participants, 150 patients in group I and 53 patients in group II received sofosbuvir+daclatasvir+ribavirin, 183 patients received daclatasvir+sofosbuvir (group II), seven patients in group II received sofosbuvir+ledipasvir, five patients received sofosbuvir+ledipasvir+ribavirin (in group I), and seven patients in group I and nine patients in group II received ombitasvir/paritaprevir/ritonavir+ribavirin. Twelve weeks after end of treatment (SVR12) were 91.3% and 96.5% observed in group I and group II, respectively irrespective of the regimen of therapy. Treated patients in group I had a mean negative change in model for end-stage liver disease (−0.722; SD, 2.603) representing an improvement in liver function, whereas untreated patients in group III showed a minimal mean positive change (0.00; SD, 2.92) representing a deterioration in liver function (P<0.001). Improvements were observed in the Child-score (Child–Pugh–Turcotte) in group I versus untreated patients in group III. Hepatic encephalopathy was evident in 6.1% of patients in group I after treatment versus 38.1% in untreated patients (group III), and ascites developed in 30.2% of patients after treatment (group I) versus 65.4% in untreated patients (group III). Conclusion Oral regimens of DAAs are effective in the treatment of hepatitis C virus infection even in patients with liver cirrhosis, leading to improvements in liver functions.

Studying the changes of ocular wavefront aberrations after neodymium : yttrium aluminum garnet laser capsulotomy Nermeen M Badawi The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):189-193 Aimof the study The aim of this study is to evaluate the changes of wavefront aberrations after performing neodymium : yttrium aluminum garnet (Nd : YAG) laser posterior capsulotomy for the management of posterior capsular opacifications. Patients and methods This study is a prospective study that was performed on 100 eyes of 87 patients with posterior capsule opacification following phacoemulsification, in the period from March 2017 to October 2017. A complete ophthalmic examination and optical wavefront imaging were performed to every patient. Patients underwent posterior capsulotomy using Nd : YAG laser with a follow-up period of 6 months. Results There were no significant changes in postoperative refraction at P value more than 0.05 still the best-corrected visual acuity showed a clinically significant at P value less than 0.05. The intraocular pressure was statistically significantly increased on the first postoperative day (P<0.05) but not in other postoperative visits. Regarding higher order aberrations there was a statistically significant improvement in total third-order aberrations (P<0.05), coma aberration (P<0.05), total fourth-order aberrations (P<0.05), spherical aberration (P<0.05), and total higher order aberrations (P<0.05) while quadrafoil and fifth-order aberrations showed no statistically significant changes. Conclusion Nd : YAG laser posterior capsulotomy causes a significantly decrease in wavefront aberrations in patients with posterior capsule opacification.

Bone mineral density in relation to polycystic ovary syndrome: an insight into irisin and insulin Olfat Fawzy, Nagwa A Elghaffar, Eman Mahmoud, Abeer Helmy The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):194-204 Background and aim Polycystic ovary syndrome (PCOS) is a complex metabolic and endocrine disorder. The influence of different metabolic and endocrine changes in women with PCOS and their relevance to bone status remains to be documented. Irisin is a newly identified adipo-myokine, which may play a role in the etiopathogenesis of PCOS as well as bone metabolism. The aim of the study was to assess bone mineral density (BMD) and serum irisin level in women with PCOS and to determine BMD relationship with irisin and other hormonal parameters. Patients and methods The study enrolled 80 women of reproductive age having PCOS and 15 age-matched and BMI-matched healthy women to serve as controls. A metabolic panel, reproductive hormones, and serum irisin level were measured. In addition, BMD of the spine and femur was also assessed using dual-energy X-ray absorptiometry. Results Serum irisin level, fasting insulin, and homeostatic model assessment of insulin resistance were significantly higher in the PCOS group compared with the control group. Receiver operating characteristic curve for serum irisin was done for the PCOS group and the control group and demonstrated that the cut-off value for serum irisin was 0.161 μg /dl. There was also a statistically significant difference between the PCOS group and the control group in BMD of spine and femur, being higher in the PCOS group. Logistic regression analysis has shown that serum irisin level, waist circumference, and fasting serum insulin were predictors for the z-score of spine in the PCOS group. Conclusion Serum irisin level may be considered as a novel biomarker for PCOS diagnosis. Circulating irisin in PCOS is strongly related to BMD. This suggests that irisin as an adipo-myokine may also be associated with bone metabolism.

Occult hepatitis B virus among patients with chronic hepatitis and hepatocellular carcinoma Khodeir A Naeima, Abd-El-Samae M Eman, Aly R Dina, El-Moatassem M Ola The Scientific Journal of Al-Azhar Medical Faculty, Girls 2018 2(3):205-211 Background Hepatitis B virus (HBV) infection is diagnosed when the circulating HBV surface antigen (HBsAg) is serologically detected. Occult HBV infection is defined as the infection state negative for HBsAg serology, but it has shown viral genome persistence in infected individuals. The aim of the study is to determine the prevalence of occult HBV among patients with chronic hepatitis negative to HBsAg in the presence or absence of hepatitis C virus (HCV) infection. Patients and methods This study was conducted on a total number of 55 patients with chronic hepatitis (liver cirrhosis in 44 cases, nonalcoholic fatty liver in six cases) and hepatocellular carcinoma in five cases. All studied cases were subjected to routine liver function tests, HBsAg, HBsAb, hepatitis c virus immunoglobulin G (HbcIgG), α-fetoprotein, HCV RNA, and HBV DNA detection. Result All cases were negative to HBsAg and HBsAb in the presence or absence of HCV infection. HBV DNA detection by real-time RT-PCR confirmed the positivity of HBV infection [occult hepatitis b infection (OBI)] in two (4.5%) out of 44 cases of cirrhotic liver and represented 3.6% of the total cases studied with a viral DNA of 116 and 159 copies/ml, respectively. One case of OBI had a high level of α-fetoprotein (392 Iu/ml) and the second case had high copies of HCV RNA 127 000 copies/ml, that is coinfection. HbcIgG was positive in 31.8% in cirrhotic patients (including one out of the two positive OBI). HCV RNA was negative in 100.0% of nonalcoholic fatty liver, positive in 39 (one was positive OBI) cases with cirrhosis with a median value of 45 000 copies and in four out of the five hepatocellular carcinoma cases with a median value of 1.85E+08. This is statistically significant (P=0.01). We come to the conclusion that occult HBV do exist in our community. The diagnosis of OBI should be based on high sensitivity of HBsAg and HBV DNA testing.

Non‐syndromic cleft lip with or without palate susceptible loci are associated with tooth agenesis

Abstract

Objective

Non‐syndromic tooth agenesis (NSTA) may share common genetic factors with non‐syndromic cleft lip with or without cleft palate (NSCL/P). Single nucleotide polymorphisms (SNPs) were associated with individual's susceptibility to these anomalies. We selected five NSCL/P‐associated SNPs from our previous genome‐wide association study (GWAS) to test for the associations with NSTA.

Materials and methods

677 NSTA cases and 1,144 healthy controls were recruited in this case‐control study. Five genome‐wide NSCL/P‐associated SNPs (rs2235371, rs7078160, rs8049367, rs4791774 and rs13041247) were genotyped by TaqMan platform and evaluated for the associations with NSTA using PLINK software.

Results

No significant associations between these SNPs and risk of NSTA were observed in the overall analysis and subgroup analysis with the number of missing teeth. However, in the subgroup analysis by tooth position, rs8049367 was nominally associated with mandibular premolar agenesis (Dominant model: OR_dom=0.66, 95% CI_dom=0.47‐0.93, P _dom=0.016; Heterozygote model: OR_het=0.60, 95% CI_het=0.41‐0.88, P _het=0.008). Rs4791774 showed a nominal association with congenitally missing maxillary canine (Dominant model: OR_dom=0.53, 95% CI_dom=0.28‐0.98, P _dom=0.041; Heterozygote model: OR_het=0.50, 95% CI_het=0.26‐0.97, P _het=0.041) and premolar (Additive model: OR=0.59, 95% CI=0.36‐0.96, P=0.035).

Conclusion

This study showed that NSCL/P susceptible loci rs8049367 and rs4791774 were probably associated with risk of NSTA.

This article is protected by copyright. All rights reserved.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2GzLyxh

Unsteadiness in gait, profuse sweating, exanthematous vesicular rash.Acute cerebellar ataxia due to varicella zoster virus

A rare neurological sequelae of chicken pox in an adult p. 268
Kandan Balamurugesan, Prem Davis, Rajangam Ponprabha, Malaimala Sarasveni
DOI:10.4103/2221-6189.248032  
Chicken pox is a disease of childhood caused by varicella zoster virus belonging to the α-herpesvirus-3 family. But the clinical presentation in adults is uncommon and is usually associated with complications. The complications are more commonly seen in immunocompromised individuals and in people who get infected at the later age group. Since the varicella zoster virus rarely causes cerebellar disease in adults, hence here we report a non-immunized, immune-competent adult patient presented to the emergency department with unsteadiness in gait, profuse sweating, exanthematous vesicular rash. We made a diagnosis of acute cerebellar ataxia due to varicella zoster virus and treated accordingly.
http://www.jadweb.org/currentissue.asp?sabs=y

Atypical case of severe preeclampsia complicated by generalized convulsions (eclampsia) and hemolysis, elevated liver enzymes, and low platelet count syndrome in an 18 weeks pregnant patient with chronic hypertension

Severe eclampsia and HELLP syndrome at 18 weeks of pregnancy in a patient with chronic hypertension p. 265
Tomasz Wojewoda, Edyta Unkiewicz, Ewa Wojewoda-Chmiel, Piotr Bijak, Michal Bogusiewicz
DOI:10.4103/2221-6189.248031  
Preeclampsia is a pregnancy specific disease characterized by hypertension and proteinuria, by definition, developing after 20 weeks of pregnancy. Here we present an atypical case of severe preeclampsia complicated by generalized convulsions (eclampsia) and hemolysis, elevated liver enzymes, and low platelet count syndrome in an 18 weeks pregnant patient with chronic hypertension. Occurrence of these complications was preceded by upper right quadrant abdominal pain and severe hypertension. In this case no evidence of autoimmunity disorders or molar pregnancy was found.
http://www.jadweb.org/currentissue.asp?sabs=y

Acute dengue hypokalemic paralysis complicated by hypomagensemia

 p. 262
Durgesh Pushkar, Bidyut Roy, Hirdesh Chawla, Tauhid Ahmad
DOI:10.4103/2221-6189.248030  
Endemic to over 100 countries dengue virus infection has now become the most rapidly spreading mosquito-borne disease in the world. Dengue symptoms range from minor flu-like symptoms to major complications like bleeding, shock, and rarely death due to organ failure. Atypical manifestations of neurological, cardiovascular, gastrointestinal origin are collectively grouped into the expanded dengue syndrome. Acute motor quadriparesis have been reported in several cases of dengue infection. We report a rare and non-fatal case of motor quadriparesis due to hypokalemia complicated by associated hypomagnesemia in a dengue positive patient.
http://www.jadweb.org/currentissue.asp?sabs=y

The changes of cognitive function after brain-blast injury

Changes of inflammatory factors, reactive oxygen species and cognitive function in mice after brain-blast injury p. 258
Ying Liu, Yun-En Liu, Chang-Ci Tong, Hong-Xu Jin
DOI:10.4103/2221-6189.248025  
Objective: To study the changes of cognitive function in mouse after brain-blast injury. Methods: Fourty healthy male C57BL/6 mice were randomly divided into model group and control group. After 24 h of injury, histopathological changesc and reactive oxygen species changes were observed under microscope; while changes of inflammatory cytokines content were determined by Western-blot. Four weeks later, Morris water maze method was used to detect the cognition impairment. Results: HE staining showed blast induced brain injury in C57BL/6 mice. Compared with normal control group, the expression of IL-1β,IL-4, IL-6 were significantly increased in brain tissue of model group whereas IL-10 was significantly decreased (P<0.05); ROS expression in the hippocampus of model group mice was significantly increased compared with that in the control group. Morris water maze showed cognition impairment in mice after brain-blast injury. Conclusions: Brain-blast injury causes cognition impairment in mice, which may be related to the occur of inflammatory change and oxidative stress in the early stage.
http://www.jadweb.org/currentissue.asp?sabs=y

The role of regulatory T cells (Tregs) at late stages of stroke

Effect of partial depletion of CD25+ T cells on neurological deficit and tissue damage in acute cerebral ischemia rat models p. 247
Ana L Rodriguez-Perea, Johanna Gutierrez-Vargas, Mauricio Rojas, Gloria P Cardona-Gomez, Paula A Velilla
DOI:10.4103/2221-6189.248029  
Objective: To evaluate the role of regulatory T cells (Tregs) at late stages of stroke. Methods: Anti-CD25 antibody (or PBS as a control) was injected to reduce the pool of Tregs in Wistar rats; then, ischemia was induced transiently by middle cerebral artery occlusion during 60 min and reperfusion was allowed for 7 d. Then, Treg frequency was analyzed in peripheral blood, spleen and lymph nodes. Neurological score (0-6) and infarct volume were also determined. Results: Nine days after injection, the CD4+CD25+ T cells were reduced by 70.4%, 44.8% and 57.9% in peripheral blood, spleen and lymph nodes, respectively compared to PBS-treated rats. In contrast, the reduction of CD4+FOXP3+ T cells was lower in the same compartments (38.6%, 12.5%, and 29.5%, respectively). The strongest reduction of CD25+CD4+ T cells was observed in those FOXP3-negative cells in blood, spleen and lymph nodes (77.8%, 52.8%, and 60.7%, respectively), most likely corresponding to activated T cells. Anti-CD25-treated transient middle cerebral artery occlusion rats had a lower neurological deficit and did not develop tissue damage compared with PBS-treated animals. Conclusions: These findings suggest that treatment with anti-CD25 in our model preferentially reduce the T cell population with an activated phenotype, rather than the Treg population, leading to neuroprotection by suppressing the pathogenic response of effector T cells.
http://www.jadweb.org/currentissue.asp?sabs=y

Intranasal ketamine as an analgesic agent for acute pain management in emergency department

: A literature review p. 241
Abdolghader Pakniyat, Morteza Qaribi, Dorin Rahnama Hezaveh, Ali Abdolrazaghnejad
DOI:10.4103/2221-6189.248028  
Ketamine is a well-known dissociative anesthetic agent, and has been used over 50 years. Intranasal pathway is a mucosal way for absorbing agents to directly affect in brain via olfactory sheets, bypassing first pass metabolism and the blood brain barrier. The current uses of intranasal ketamine as an analgesic agent for acute pain management in emergency department are discussed in this review article. Using "ketamine", "pain or analgesia", and "intranasal" as keywords, a search of google scholar, Pubmed, web of science, and Medline database from 1970 until 2017 was performed. Finally, from 1 204 papers extracted via primary search, 1 088 papers were omitted and finally 10 studies were considered for further assessment. There were four observational studies, one case series and report and 5 clinical trials. Ketamine was used for acute pain control due to musculoskeletal trauma, burns, and painful procedures. A total of 390 cases were included in these studies. The studies used ketamine with doses ranging 0.45-1.25 mg/kg via intranasal pathway. Intranasal ketamine provides relatively rapid, well tolerated, and clinically significant analgesia for emergency department patients. Considering the lack of adequate studies and undetermined intranasal dose, it is better to conduct further high quality investigation in both adults and pediatrics.
http://www.jadweb.org/currentissue.asp?sabs=y

Endogenous endophthalmitis secondary to melioidosis in paediatric patients

Endogenous endophthalmitis secondary to melioidosis in paediatric patients: Case series and review article p. 234
Wendy Ong Chin Feng, Wee Min Teh, Wan-Hazabbah Wan Hitam, Haslina Mohammad Ali
DOI:10.4103/2221-6189.248027  
Endogenous endophthalmitis is a devastating infection of the eye which can lead to permanent blindness. We report two rare cases of paediatric endogenous endophthalmitis secondary to melioidosis with contrasting visual outcomes. Both patients presented with acute painful visual loss with poor vision on presentation after exposure to open water sources (swimming at two separate locations with waterfalls). Both were diagnosed to have melioidosis endogenous endophthalmitis based on the ocular features clinically and via positive melioidosis serology. They otherwise did not exhibit any symptoms and signs suggestive of systemic melioidosis infection. Even though the two children demonstrated severe ocular involvement, ocular culture from vitreous and aqueous sampling taken from one of the patients did not yield any positive results. No ocular sampling was taken from the other patient. After standard antimicrobial treatment, the first patient responded well with good visual recovery without requiring any surgical intervention for the endophthalmitis. In contrast, our second patient ended up with poor visual outcome despite undergoing multiple intravitreal antibiotic injections and early pars plana vitrectomy. This is because he developed extensive retinal detachment due to the aggressive ocular infection. The diagnosis of endogenous endophthalmitis due to ocular melioidosis remains challenging and requires a high index of suspicion in areas endemic for the causative organism. Early empirical antibiotic treatment should be initiated in suspicious cases, even though the treatment outcomes may vary greatly
http://www.jadweb.org/currentissue.asp?sabs=y

Short- and long-term mortality and causes of death after reconstruction of cancers of the head and neck with free flaps

The use of free flaps to reconstruct cancers of the head and neck is accompanied by appreciable postoperative morbidity and high long-term mortality, but the causes of death and the impact of postoperative complications on survival have not been well studied. We have therefore analysed retrospectively the causes of death and survival of 146 such patients operated on between 2008 and 2016 of whom a total of 62 (43%) had died by the end of 2016. The cause of death was the primary disease in 45 of the 62.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2LwynvU

There are increasing numbers of clinicians, predominantly plastic surgeons, who are offering surgical...

There are increasing numbers of clinicians, predominantly plastic surgeons, who are offering surgical treatment to patients with migraine. This concept reached the public media arena over a decade ago, when the London Evening Standard published a review of the topic in 2008. The US news network CNN produced a documentary on it in 2016, but the technique is still regarded as controversial, and an option of last resort by its opponents.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2rPlxzL

The TIG fellowship: why are trainees not seizing the opportunity?

Introduction: Training Interface Groups (TIG) fellowships provide special interest surgical training by combining curricular elements of at least two specialties; four are open to OMFS applicants. There is a perception applicant numbers are declining, especially from OMFS. We explored this by seeking trainee perspectives.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2Lvj7PV

The use of interlocking1 PEEK patient specific facial implants (PSI) in the treatment of facial deformities, an outcome study

Introduction: Polyetheretherketone (PEEK) is a semi- crystalline linear aromatic polymer used increasingly in the correction of craniofacial deformity. PEEK is biocompatible, non-allergenic, strong, lightweight, resistant to fatigue and can be sterilized repeatedly without the degradation of its mechanical properties. PEEK can be contoured with high speed burs and fixed to bone with the use of a conventional plating system. Access, stability and soft tissue coverage are important factors for successful treatment.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2rOVOHG

Intra-oral anastomosis as possible approach for mid-face free flap reconstruction

Introduction: Craniofacial resection with adjuvant therapy is usually undertaken for locally advanced sinonasal malignancies. Elective management of the neck differs compared with oral cavity tumours of similar stage, as neck dissection is not mandated. Free tissue transfer is integral in Head and Neck reconstruction, which requires access to vessels for microvascular anastomosis. We describe a series of intra-oral anastomosis in place of conventional cervical access to reduce scarring, facial nerve and parotid morbidity and overcome difficulties related to pedicle length.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2Lt1EYc

Withdrawn 31/05/2018

from OroFacial via a.sfakia on Inoreader http://bit.ly/2rOW2P2

A five year retrospective study to examine the outcome of mandibular fractures that presented late to the maxillofacial services at a DGH

Introduction: It is current practice at many maxillofacial units to commence antibiotics for open mandibular fractures when presented in the acute setting. However, currently there is very little evidence to support this is custom. This five year retrospective study will examine all mandibular fractures that have presented to our unit and ascertain whether those presenting late, after 48hours, developed unfavourable outcomes.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2LzLn40

Transoral robotic-assisted oro-pharyngeal reconstruction

Transoral robotic surgery (TORS) has gained a place in the management of primary and recurrent oro-pharyngeal malignancy. Whilst the oncologic and functional outcomes of TORS are comparable to traditional open surgical approaches it offers a number of advantages, not least of which is the obviation of in line of site surgery. As such not only is resective surgery possible without resorting to access procedures such as mandibulotomy but robotically-assisted inset of free flaps is also feasible.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2rOVFE8

Penetrating Maxillofacial Trauma – epidemiology and injury characteristics in terror-related violence, interpersonal violence and deliberate self-harm at a Level 1 Trauma Centre

Introduction: Penetrating trauma to the head and neck presents specific diagnostic and therapeutic challenges. Aetiologies includes interpersonal violence (IPV), deliberate self-harm (DSH) and terror-related violence (TRV). Data from a Major Trauma Centre which straddles the two boroughs with the highest incidence of violent knife crime in the country will be presented, including data of victims of a major terrorist attack in 2017.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2LwgZYj

The management of Penetrating Neck Injury at a London Major Trauma Centre – a one-year survey

Introduction: Our level 1 trauma centre serves an intercity area where interpersonal violence (IPV) and deliberate self-harm (DSH) are rife. Our centre also treated patients from a major terrorist attack in 2017. The maxillofacial surgery team manages injuries to the neck which are both self-inflicted and sustained through violence. These injuries pose specific challenges. We have reviewed the demographics and management of these patients, including the use of CT angiogram.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2rP2Xrp

Grave's Orbitopathy -Setting up an Orbital MDT and the Role of the Maxillofacial Surgeon

Background: Grave's Orbitopathy (GO) presents major clinical and therapeutic challenges. Clinically significant GO develops in 50% of patients with Grave's, with 3-5% being severe. The management pathway is based on the guidelines from the European Group on Grave's Orbitopathy (EUGOGO). In our unit, patients undergo multidisciplinary management with input from Endocrinology, Ophthalmology, Orthoptics, Radiology, ENT and in symptomatic cases Oral and Maxillofacial surgery, when orbital decompression is indicated.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2Lvwpf9

Unscheduled Return to the Operating Theatre after Major Head and Neck Surgery and Free Flap Repair

Introduction: Quality improvement in surgery is a healthcare policy priority. Benchmark metrics of importance to the patient experience and/or healthcare expenditure are key criterion. Unscheduled return to the operating theatre (URTT) is associated with increased healthcare costs, disrupts the efficient delivery of care to other patient groups, and is a poor patient experience. The aims of this study are to measure the incidence and preoperative predictors of URTT and to establish the clinical reasons for URTT so that care practices designed to reduce their occurrence can be targeted.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2rOVgS8

Global Health Partnerships - Could They Benefit UK Maxillofacial Trainees?

Introduction/Aims: The Lancet Commission on Global Surgery has stimulated interest in embedding surgery within the global health agenda. The global burden of surgical disease is substantial and growing. Our maxillofacial department has been involved in a partnership with the maxillofacial department in Gaborone, Botswana for the past 10 years. These partnerships are mutually beneficial to both parties involved. Feedback has demonstrated that 75% of volunteers felt they developed an understanding of areas and systems outside of their usual scope of activity.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2Lvwlfp

Always the Bridesmaid.... OMFS in the UK missing out NHS Digital representation

The authors have previously pointed out NHS coding inconsistencies and inaccurate clinical work coding which has been to the detriment of the specialty of OMFS. (BAOMS ASM 2016, 2017).

from OroFacial via a.sfakia on Inoreader http://bit.ly/2rYS1rD

An audit on Oral and Maxillofacial Surgery outpatient utilisation - A comparison with guidelines and potential impact on training

Introduction: The increasing numbers, diversity and complexity of patients seen in OMFS outpatient clinics (OPC) have a potentially adverse effect on patient safety and a detrimental impact on surgical training. The authors prospectively collected data from clinics in one busy UK unit to establish the workload - and compare our findings - with the current BAOMS guidelines (2015).

from OroFacial via a.sfakia on Inoreader http://bit.ly/2Lv2Fiy

Surgical Management of Zygomatic Maxillary Complex Fractures as Day-Case Procedures

Introduction: Fractures of the zygomatic maxillary complex (ZMC) may require surgical management (ORIF) if they are significantly displaced, cause functional problems or involve the orbit (causing diplopia, restriction or enophthalmos). Patients are routinely kept in overnight for observations due to the perceived risk of post operative retrobulbar haemorrhage/orbital compartment syndrome (RBH/OCS). In-patient beds are the most in demand resource in the NHS and by utilizing a day-case enhanced recovery pathway, we are able to implement same day discharge with a minimal post operative observation time of 6hours.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2rLsbXU

Regional implementation of a new international facial trauma course in Europe

Purpose: An international planning committee defined a curriculum for an accepted standard of facial fracture care worldwide using backward planning to identify patient problems and surgeon gaps. A competency-based course was designed with standard objectives to deliver through lectures, small group discussions, and practical exercises. Educational outcomes in Europe were compared to those worldwide.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2LtHrS9

A “Real Time” screening tool to aid management of Post-Traumatic Stress Disorder in facial trauma patients for use in the Oral and Maxillofacial outpatient setting

Background: Post-Traumatic Stress Disorder (PTSD) is a serious condition linked to an increased suicide risk and reduced quality of life. It encompasses symptoms of re-experiencing the trauma, hyper-arousal, emotional numbing and avoidance. The prevalence of PTSD after facial trauma can range from 25-41% so the importance of identifying at risk patients by the Oral and Maxillofacial Surgery team cannot be over-emphasised. Prompt identification and management of mental health disorders optimises both mental and physical recovery, however surgeons often have low confidence in making psychological diagnoses.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2rPwRft

Giving the smile back to patients - Validation of a new Quality of Life Questionnaire for Facial Palsy Patients

Introduction: Facial palsies create significant challenges for patients because of the psycho-social, aesthetic and functional impacts. Despite this, there is no comprehensive tool measuring quality of life (QoL) in these patients. Sheffield Teaching Hospitals is one of a few regional centres that have established a multi-disciplinary approach in treating such patients. We have created a comprehensive questionnaire (Sheffield Teaching Hospitals Quality of Life - STHQoL) assessing all levels of disability relating to facial palsy.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2LuopLl

Wound Infusion Catheters in Free Flap Head and Neck Cancer Patients

Our tertiary centre performs 120 free flap reconstructions per annum for people with head and neck cancer. Following flap anastomosis prevention of vasoconstriction is essential to promote blood flow through the transferred tissue and ensure flap survival. Inadequate pain management with accompanying vasoconstriction/tachycardia can have a detrimental effect on the free flap. In select free-flaps we use a Pajunk Infiltralong wound infusion catheter (WIC) and Fuser pump to administer 0.125% L-bupivicaine 8ml/hr to the flap donor site.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2rQTujy

Urachal Anomaly: Case Reports

Presenting two case reports of urachal anomalies. 

Submitted by Dr MGK Murthy, Dr  GA Prasad 

Case 1(MRI)

14 yrs boy with h/o periumbilical pain, swelling & discharge with periumbilical sinus in USG presents for MRI which show- An ill defined irregular subtle fluid signal intensity focus suggested in the infraumbilical region with a long thin linear low signal intensity on all pulse sequences properitoneal track identified extending to the superior aspect of urinary bladder with no definite fluid contents/ bladder diverticulum/secondary tracks/intraperitoneal extension/ presence of air /air fluid levels – likely represents urachal  anomaly in the form urachal umbilical sinus track with no significant cyst formation /vesicourachal  diverticulum.

Case 2 ( CT scan)

58 yrs female presents with pain abdomen for  CT scan shows thin cord like nonenhancing hypodense track from urinary bladder dome upto the umbilicus with small speck of calcification at the bladder end with no sinus or cyst or bladder diverticulum suggesting  urachus without any complications.

Urachal anomalies result from abnormal persistence of embryologic communication between umbilicus & urinary bladder. During normal gestational development, the urachus involutes and its lumen is obliterated, becoming the median umbilical ligament. Urachal anomalies are  – Patent urachus or urachal fistula–  patent connection between umbilicus & urinary bladder. Umbilical urachal sinus – blind focal dilatation at umbilical end. Vesicourachal  diverticulum – focal outpouching at bladder end. Urachal cysts – midline cysts near the bladder end usually.

Common complications of urachal remnants are infection & tumors of urachus. Treatment – surgical excision of urachal remnant.

Famous Radiology Blog http://bit.ly/1MM2hKr TeleRad Providers at http://bit.ly/1NgppuI Mail us at sales@teleradproviders.com

from Imaging via a.sfakia on Inoreader http://bit.ly/2Sftjib

Risk of high‐grade malignancy in parotid gland tumors as classified by the Milan System for Reporting Salivary Gland Cytopathology

Abstract

Background

The Milan System for Reporting Salivary Gland Cytopathology (Milan System) has previously shown its diagnostic utility by categorizing the seven cytology findings in salivary gland lesions. However, there has been lack of study about the risk of high‐grade malignancy in the cytology diagnosis based on the Milan System. Thus, we tried to identify the diagnostic ability of the Milan System for high‐grade malignancy and to suggest an improved diagnostic approach for preoperative estimation of high‐grade malignancy using the Milan System.

Methods

A total of 413 patients with parotid gland tumors, who had undergone surgical resection from 2011 to 2015 were included in the present study retrospectively. Cytopathology was reclassified according to the Milan System by two independent reviewers. The outcomes were risk of malignancy and risk of high‐grade malignancy. The diagnostic performance of the Milan System category [Malignant] for detecting high‐grade malignancy was calculated.

Results

The risk of malignancy was 83.3% and 100% in the Milan System categories [Suspicious for Malignancy] and [Malignant], respectively. Meanwhile, the risk of high‐grade malignancy was 16.7% and 55.9% in these two categories. Disease‐free survival of patients with high‐grade malignancy was significantly worse than those with low‐ and intermediate‐grade malignancy. Union‐combining the Milan System category [Malignant] with the presence of nodal metastasis suggested high‐grade malignancy with an acceptable diagnostic sensitivity (0.889‐0.963) and negative predictive value (0.900‐0.966).

Conclusions

The Milan System category [Malignant] with the presence of nodal metastasis suggested parotid gland tumors as high‐grade malignancy in a pretreatment setting.

This article is protected by copyright. All rights reserved.

from OroFacial via a.sfakia on Inoreader http://bit.ly/2R9L7Ob