Head and Neck Medicine by Alexandros G.Sfakianakis

Gliome stellen in Bezug auf Diagnostik, Einteilung und Therapie eine Besonderheit im Vergleich zu anderen soliden Tumoren dar. Insbesondere die Vulnerabilität des betroffenen Organs Gehirn erfordert eine sorgfältige Planung von operativer, strahlentherapeutischer und medikamentöser Therapie sowie die sorgsame Begleitung und Therapieberatung der Betroffenen.

Methode

Eine selektive Literaturrecherche wurde durchgeführt.

Ergebnisse

Ohne integrierte Diagnose von histomorphologischen und molekularen Kriterien ist eine differenzierte Therapie nicht möglich. Aufgrund des meist diffus infiltrierenden Charakters kommt der medikamentösen Therapie ein entscheidender Stellenwert sowohl in der Erstbehandlung als auch beim Rezidiv oder Progress zu. Der rasante Zuwachs der Kenntnis von zugrunde liegenden molekularen und genetischen Veränderungen, die zur Tumorentstehung führen, lässt für die Zukunft eine weitere Diversifizierung in verschiedene Entitäten erwarten, welche die Therapiemöglichkeiten erweitern kann.

Schlussfolgerungen

Dogmen, wie eine immunprivilegierte Stellung des ZNS und fehlende ZNS-Gängigkeit von Medikamenten aufgrund der Besonderheit der Bluthirnschranke rücken im Zusammenhang mit modernen Therapiemöglichkeiten wie „small molecules", Antikörpern sowie immunonkologischen Therapieverfahren in den Hintergrund. Weitere sowohl klinische als auch präklinische Forschung ist dringend erforderlich, um die für viele Gliome immer noch schlechte Prognose zu verbessern.

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Πέμπτη 22 Νοεμβρίου 2018

Self-esteem following maxillofacial and orthopedic injuries: preliminary observations in sub-Saharan Africans

Abstract

Background

The face is a vital component of one's personality and body image while extremities are important in function (mobility, routine daily activities). Recovery and rehabilitation from acquired maxillofacial and orthopedic traumas are psychological in nature.

Methods

This was a prospective study of recruited subjects in a Nigerian University teaching hospital. A total of 160 participants (80 with maxillofacial injuries and 80 with orthopedic injuries) had repeated review assessments within 1 week of arrival in the hospital (time 1), 4–8 weeks after initial contact (time 2), and 10–12 weeks thereafter (time 3), using Rosenberg's Self-Esteem Questionnaire.

Results

Thirty-three (41.3%) participants in the maxillofacial injured and 12 (15.0%) in the orthopedic injured subjects scored between 0 and 14 at time 1. At time 2, 39 (51.3%) subjects in the maxillofacial fracture group and 20 (29.0%) in the orthopedic injured group scored between 0 and 14, while at time 3, 7 (9.2%) in the maxillofacial fracture group and 1 (1.5%) in the orthopedic injured group scored between 0 and 14. There was a statistical significant difference between the two groups when compared at times 1, 2, and 3 with p < 0.001, p = 0.006, and p = 0.041 respectively. Subjects with maxillofacial fracture consistently had lower self-esteem compared to subjects with orthopedic injured for times 1, 2, and 3.

Conclusions

Self-esteem may be reduced following maxillofacial injuries; therefore, measures should be taken by surgeons to minimize the risk of facial scarring by careful handling of tissues. Also, management of these injuries should integrate multidisciplinary care that will address psychological needs of patients.

Trial registration

Not applicable.

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Radiotherapy for breast cancer associated with a cutaneous presentation of systemic mastocytosis—a case report and literature review

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Abstract

Ionizing radiation therapy is a common adjuvant therapy for individuals undergoing surgery for breast cancer. There are many well-recognized acute and chronic cutaneous reactions that can vary in severity, course and duration. We present a rare cutaneous manifestation of systemic mastocystosis, in a 59-year-old female who underwent adjuvant radiotherapy following local excision of ductal carcinoma in situ.

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Transmesenteric hernia with two mesenteric defects in an adult

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Abstract

Transmesenteric hernia is a rare cause of small bowel strangulation in adults and, to our knowledge, no one has reported the existence of two mesenteric defects in an adult. Our patient was a 73-year-old Japanese woman who presented to our emergency department complaining of abdominal pain and nausea. Computed tomography with contrast enhancement revealed a closed loop obstruction in the pelvis, suggesting small bowel strangulation due to an internal hernia. The emergency exploratory laparotomy indicated a small bowel strangulation caused by a transmesenteric hernia. With the examination across whole parts of the mesentery, we identified another small defect. Both defects were closed by suture intraoperatively, and the patient's postoperative course was satisfactory. Searching for whole parts of the mesentery after the reduction of a hernia can help prevent the recurrence of internal hernias.

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Intracystic papillary breast carcinoma in a male patient: a case report and review of literature

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Abstract

Intracystic papillary carcinoma of the breast is a rare subtype of breast cancer accounting for approximately 0.5–1% of all breast carcinomas. To the best of our knowledge, the occurrence of this rare subtype of breast cancer in the male is even lower with less than 20 cases reported in the English literature over the past 30 years. We report a case of an elderly Asian male with intracystic papillary breast carcinoma who initially presented with a right sided breast lump for 4 months duration and his subsequent management. In addition, a review of similar cases in the English literature is included.

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