ACV isquémico debido a embolia paradojal a través de malformación arteriovenosa pulmonar en paciente joven / Ischemic stroke due to paradoxical embolism through pulmonary arteriovenous malformation in a young patient

Resumen La embolia paradojal debido a una malformación arteriovenosa pulmonar (MAVP) aislada es una causa in frecuente de accidente cerebrovascular (ACV) isquémico. Las MAVP son conductos anómalos de alta circulación entre arterias y venas pulmonares, desviando sangre desoxigenada hacia la circulación sistémica y represen tan una fuente menos común de embolias paradojales, especialmente en personas jóvenes. La embolización endovascular es el tratamiento preferido para MAVP clínicamente significativas. Presentamos el caso de una mujer de 34 años con ACV isquémico talámico izquierdo. Se detectó pasaje de burbujas "en cortina" en arterias cerebrales mediante Doppler transcraneal. En ecografía intracardíaca no se encontró foramen oval permeable, motivo por el cual se avanzó con realización de angiotomografía pulmonar, la cual confirmó la presencia de MAVP. La paciente recibió tratamiento endovascular exitoso. Es esencial considerar la MAVP en el diagnóstico etio lógico del ACV isquémico, especialmente en pacientes jóvenes con signos de comunicación anormal de derecha a izquierda. Se recomienda un seguimiento periódico mediante imágenes para evaluar la posible recurrencia o cambios en la MAVP, resaltando la importancia del manejo adecuado de estas malformaciones.

Abstract Paradoxical embolism due to an isolated pulmonary arteriovenous malformation (PAVM) is a rare cause of ischemic stroke. PAVMs are abnormal high-flow connec tions between pulmonary arteries and veins, diverting deoxygenated blood into the systemic circulation and they represent a less common source of paradoxical embolisms, especially in young individuals. Endovascular embolization is the preferred treatment for clinically significant PAVMs. We present the case of a 34-year-old woman with a left thalamic ischemic stroke. Severe contrast passage was detected in cerebral arteries through transcranial Doppler. Intracardiac ultrasound did not reveal a patent foramen ovale, prompting further investigation with pulmonary CT angiography, confirming the presence of PAVM. The patient underwent successful endovascular treatment. It is essential to consider PAVM in the etiological di agnosis of ischemic stroke, especially in young patients with signs of abnormal right-to-left communication. Periodic follow-up imaging is recommended to assess potential recurrence or changes in PAVM, emphasizing the importance of appropriate management of these malformations.

Effect of foot progression angle on lower extremity kinetics of knee osteoarthritis patients of different ages:a systematic review and meta-analysis / 中国组织工程研究

OBJECTIVE:Knee adduction moment and knee adduction angular impulse enlargement is the main biomechanical risk factor of knee osteoarthritis.According to the survey,a change in the foot progression angle could effectively change the motion mode of patients with knee osteoarthritis.However,the impact of toe-in and toe-out on knee adduction moment and knee adduction angular impulse in young and elderly patients did not reach a consensus.Therefore,this study comprehensively discussed the effect of foot progression angle on knee adduction moment and knee adduction angular impulse in different populations through meta-analysis and provided a reference for the treatment of knee osteoarthritis. METHODS:By June 2022,searches were conducted on Web of Science,EBSCO,PubMed and CNKI databases using"foot progression angle,knee adduction moment,knee adduction angular impulse,gait"as Chinese and English search terms.Self-controlled randomized controlled studies analyzing the effects of toe-in and toe-out on knee adduction moment bimodality and knee adduction angular impulse were included.The cochrane bias risk assessment tool was utilized to make a quality evaluation of the literature.Stata 15.1 software was used for subgroup analysis to determine the effect of foot progression angle on knee adduction moment and knee adduction angular impulse.Meta-regression analysis was used to further determine characteristics of outcome indicators(knee adduction moment,knee adduction angular impulse)changing with foot progression angle. RESULTS:(1)A total of 15 self-control trials and 2 randomized controlled trials(455 subjects)were included in the meta-analysis.All of the included articles were of medium to high quality.(2)The meta-analysis results showed that the toe-in gait could reduce the first peak of knee adduction moment(SMD=-0.380,95%CI:-0.710 to-0.060,P=0.022)and knee adduction angular impulse(SMD=-1.470,95%CI:-2.160 to-0.770,P<0.001)in young patients.The toe-out gait reduced the second peak of knee adduction moment(SMD=-0.720,95%CI:-1.010 to-1.440,P<0.001)in young patients.In addition,toe-in gait could reduce the first peak of knee adduction moment in elder patients(SMD=-0.550,95%CI:-0.800 to-0.300,P<0.001),but increase the second peak knee adduction moment of elderly(SMD=0.280,95%CI:-0.010 to 0.560,P=0.047).The toe-out gait could decrease the second peak knee adduction moment in this population(SMD=-0.510,95%CI:-0.830 to-0.190,P=0.002).(3)Meta-regression showed that the greater the toe-out in elderly patients,the lower the second peak knee adduction moment. CONCLUSION:(1)Toe-in reduced the first peak knee adduction moment and knee adduction angular impulse in young knee osteoarthritis patients aged 18 to 34 years.Since knee adduction moment and knee adduction angular impulse were associated with medial knee loading and knee osteoarthritis incidence,toe-in gait intervention may be a suitable rehabilitation strategy for young patients.(2)Toe-in increased the second peak of knee adduction moment in older knee osteoarthritis patients over 60 years of age,which may exacerbate knee osteoarthritis in this population.However,the second peak of knee adduction moment during walking in this population decreases as the toe-out increases,contributing to a reduction in medial knee loading,suggesting that older patients may consider using toe-out gait during walking.

Osteonecrosis múltiple inducida por glucocorticoides / Multiple osteonecrosis induced bye glucocorticoids / Osteonecrose múltipla induzida por glicocorticóides

La osteonecrosis múltiple es una entidad poco frecuente que se define por el compromiso de al menos tres regiones diferentes. Es indispensable el abordaje multidisciplinario de los pacientes que la padecen tanto para el diagnóstico como el tratamiento oportuno. Presentamos el caso clínico de un paciente joven que presenta una osteonecrosis múltiple con compromiso de ambas caderas, hombros, rodillas, codo derecho y cuello de pie izquierdo. El principal factor de riesgo presente en nuestro caso es el consumo de glucocorticoides.

Multiple osteonecrosis is a rare entity that is defined by the involvement of at least three different regions. A multidisciplinary approach to patients who suffer from it is essential for both diagnosis and timely treatment. We present the clinical case of a young patient who presented multiple osteonecrosis with involvement of both hips, shoulders, knees, right elbow, and neck of the left foot. The main risk factor present in our case is the consumption of glucocorticoids.

A osteonecrose múltipla é uma entidade rara que se define pelo envolvimento de pelo menos três regiões diferentes. Uma abordagem multidisciplinar aos pacientes que sofrem com isso é essencial para o diagnóstico e tratamento oportuno. Apresentamos o caso clínico de um paciente jovem que apresenta osteonecrose múltipla envolvendo quadris, ombros, joelhos, cotovelo direito e pescoço do pé esquerdo. O principal fator de risco presente no nosso caso é o consumo de glicocorticóides.

Paciente joven con accidente cerebrovascular isquémico: ¿Se debe buscar una trombofilia? / Ischemic stroke in a young patient, is it needed to look for a thrombophilia?

Resumen El accidente cerebrovascular isquémico es un evento de gran importancia debido a las implicaciones y el impacto en la calidad de vida de la población afectada. Su incidencia es más alta en adultos mayores y en personas con factores de riesgo cardiovascular. Existe un grupo de pacientes jóvenes (18-44 años) sin factores de riesgo que presentan dicho evento, por lo que, en la práctica clínica, se tiende a evaluar rutinariamente las trombofilias hereditarias y adquiridas como factor etiológico principal para los eventos isquémicos en este grupo etario. No obstante, son pocos los casos donde se documenta algún trastorno de este tipo, ya que es más frecuente la presencia de otras etiologías como el cardioembolismo y trastornos vasculares. La evaluación de las trombofilias es compleja, dado el alto costo, las limitaciones técnicas para hacerlo y el impacto clínico y terapéutico incierto al documentarse estos estados. Se realiza esta revisión de tema con el fin de orientar al clínico acerca de la pertinencia de objetivar estas condiciones en el paciente joven con accidente cerebrovascular isquémico.

Abstract Acute ischemic stroke is a pathology of great complexity due to the implications and impact on the quality of life of the affected population. The incidence of this pathology is higher in older adults and in people with cardiovascular risk factors. There is a group of young patients with no risk factors who present these events. Therefore, in clinical practice, hereditary thrombophilias tend to be frequently evaluated as the main etiological factor for this age group. However, there are few cases where a disorder of this type is documented and the presence of other etiologies such as cardioembolism and vascular disorders are more frequent. Thus, the evaluation of thrombophilia is complex due to its high cost, technical limitations when evaluating, and its uncertain clinical and therapeutic impact when documented. For this reason, this review is carried out in order to guide the clinician about the relevance of objectifying these conditions in young patient with acute ischemic stroke

A young patient with recurrent myocardial infarction within a half month / 中南大学学报(医学版)

In this study, we reported a young male patient with acute chest pain who was diagnosed as myocardial infarction. The regular medication was performed following coronary intervention. Under such condition, this patient had 3 times myocardial infarction within a half month. The laboratory results showed that there might be a state of hypercoagulability. Aspirin combined with clopidogrel and other treatment were administrated. Meanwhile, the examination demonstrated that there was aspirin-resistant in the patient. The antiplatelet drug and extended anticoagulation therapy were carried out. There was no further myocardial infarction, and no coronary arteries stenosis was found in the re-examination angiography. Aspirin resistance and hypercoagulability should be considered when patients occurred the repeated myocardial infarction after regular medication and coronary intervention. Replacement of the antiplatelet treatment or combination with anticoagulant therapy is necessary in similar patient to avoid the sever consequence.

Analysis of clinicopathological features and prognosis of young patients with breast cancer in different age groups / 上海交通大学学报（医学版）

Objective: To explore and analyze the differences of clinicopathological features and prognosis and influencing factors in young breast cancer patients in different age groups. Methods: A total of 277 female breast cancer patients with invasive ductal carcinoma under 40 years old who were diagnosed and treated by operation at the International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine from Jan. 2010 to Dec. 2018 were retrospectively analyzed. The patients were divided into two groups by the age of 35 years old, i.e. aged ≤ 35 group and aged >35 and ≤ 40 group. The differences of clinicopathological features were compared between the two groups, including histological classification of cells, tumor size, lymph node metastasis, estrogen receptor (ER) expression, progesterone receptor (PR) expression, human epidermal growth factor receptor-2 (HER2) expression, the expression of Ki-67, the degree of intravascular invasion, pathological stage and molecular subtype. The prognostic differences and influencing factors of the two groups were analyzed. Results: There were no significant differences in histological classification of cells, tumor size, lymph node metastasis, ER expression, PR expression, HER2 expression, the expression of Ki-67, the degree of intravascular invasion, pathological stage and molecular subtype between the two groups. The 3-year disease-free survival (DFS) of the patients in the aged ≤ 35 and >35 and ≤ 40 group were 89.66% and 95.03%, respectively, and there was no significant difference. There was no statistically significant difference in the 3-year DFS among the four molecular subtypes between the two groups. Cox proportional hazards model showed that intravascular invasion and lymph node metastasis were the independent risk factors of DFS. Conclusion: >35 and ≤ 40 year-old breast cancer patients and ≤ 35 year-old breast cancer patients have similar clinicopathological features and prognosis, so the same treatment strategy should be given.

Conservative Management Of Ameloblastoma In An Adolescent Patient

Introduction- Ameloblastoma is an aggressive, benign odontogenic tumour of the jaw with varying clinical features and histologic patterns. The treatment options of en block and segmental resection reduce the chance of recurrence. Resection of the mandible is associated with many complications like loss of jaw bone integrity, deformity, dysfunction, cosmetic and psychological distress. For these reasons, young, growing patients find these treatment options simply unacceptable. An alternative method for young growing patients is the conservative approach. Materials and methods- Enucleation and chemical cauterization of the lesion with carnoy's solution (6% ethanol, 3%chloroform, 1% acetic acid, 1 gm ferric chloride) followed by iodoform dressing routinely. Results- Patient was followed up for 1.5 year. No recurrence was noticed. Conclusion-In young growing patient a more conservative approach with close postoperative follow-up will significantly reduces the morbidity

Modified suture suspension by annular ligature the frontalis muscle to correct severe congenital blepharoptosis in very young patients / 中华整形外科杂志

Objective@#To explore the effect of the modified suture suspension by annular ligaturing the frontalis muscle to treat severe congenital blepharoptosis in children (age≤3).@*Methods@#From October 2016 to October 2017, 11 patients (16 eyes) with severe blepharoptosis were treated using the modified suture suspension in the Affiliated Hospital of Weifang Medical University. There were 7 males and 4 females, aged from 1 to 3 years old, with the average of 26.3 months. Three suture lines were used in three directions respectively. One end was fixed to the upper edge of the tarsus, the other end was fixed to the frontalis muscle by annular ligation. The operation effect and complications were evaluated 1 week and 6 months after the operation.@*Results@#All the incisions healed well. Hypophasis was observed in 1 eye. The exposed palpebral fissure was less than 3 mm when the eye was closed. No corneal exposure was observed in other cases. One week after surgery, the blepharoptosis of 5 patients were fully corrected (6 eyes, 37.5 %). Blepharoptosis in 5 patients were basically corrected (9 eyes, 56.2 %). One patients was over corrected (1 eyes, 6.3%). Six months after surgery, the blepharoptosis of 5 patients were fully corrected (5 eyes, 31.2 %). Blepharoptosis in 5 patients were basically corrected (9 eyes, 56.3%). However, the blepharoptosis of 1 patient was under corrected (2 eyes, 12.5%).@*Conclusions@#This modified suture suspension by annular ligature the frontalis muscle has the advantages of simple operation, low cost, stable effect, small wound, and satisfactory clinical effect.

Gutter Splint for Ingrown Toe Nail in Young Patients / 대한족부족관절학회지

PURPOSE: Ingrown toenails are a common disease in the adolescent period and the treatments could be more conservative for this early stage of the disease. This study is a case series on the results of a gutter splint for an adolescent ingrown toe nail as a simple, comfortable treatment method. MATERIALS AND METHODS: From 2011 to 2018, 22 patients (mean age, 12.2 years; range, 8~15 years) with ingrown toenails were treated with a gutter splint. There were 16 boys and 6 girls with 7 patients on both great toes, and additional 4 both corners of a nail, giving a total of 33 splints. Flat, plastic straws and glue or suture were used to protect the nail corners under local anesthesia. The medical records were reviewed retrospectively and phone calls were made to obtain the long-term results. RESULTS: Fifteen splints were fixed with a suture and the other 18 splints were fixed with glue. There were 9 cases of recurrence out of 33 gutter splints, 8 out of 15 sutured splints and 1 out of 18 glued splints (p=0.010). There was no gender (p=0.383) or age (p=0.305) difference in the number of recurrences. CONCLUSION: For growing people, ingrown nails can be cured easily by conservative treatment for a transiently shortened or broken toenail. The glued gutter splint had a reasonable success rate as a first line treatment.

Circulating tumor cells as a new and additional approach to follow-up patients with serous low-grade ovarian adenocarcinoma: a case report and review of the literature

Background: Current methods for follow-up of Ovarian Cancer (OC) are widespread, especially with CA125, which, however, is not a perfect biomarker and thus further investigation for new methods of evaluation are warranted. The feasibility of Circulating Tumor Cells (CTCs) in advanced OC was investigated in this case report. Case presentation: A 19-year-old woman with advanced low-grade serous papillary adenocarcinoma and relapsed disease did not have a CA125 correspondent with disease relapse. CTCs were evaluated, compared with CA125 and with image exams. Relapses were not correspondent to elevations of CA125. CTCs demonstrated usefulness, being proportional to major disease relapse, especially in the peritoneum. CTCs may be used as a complementary diagnosis tool when marginal/small increases in CA-125 levels are observed. Conclusions: In OC, CTCs can be an important tool to predict recurrence, response to treatment and improve the quality of decision-making, in order to offer the best treatment to a determined group of patients (AU)

Mieloma múltiple en paciente joven / Multiple Myeloma in Young Patient

Introducción: el mieloma múltiple es una enfermedad hematológica maligna caracterizada por una proliferación de células plasmáticas en la médula ósea. La edad más común del inicio es entre 65 y 70 años, sin embargo se documentan casos en jóvenes en formas cada vez más graves. Presentación de caso: hombre de 31 años, que cursa con dolores óseos generalizados, pérdida de peso y adinamia, de 6 meses de evolución. Se constatan cifras de creatinina y calcio sérico elevadas durante su hospitalización, presenta proteína de Bence-Jones positiva para cadenas ligeras Kappa, y se realiza biopsia de médula que concluye en mieloma plasmoblástico. Conclusiones: se comienza tratamiento con citostático asociado a esteroides. La presentación antes de los 40 años es infrecuente y el pronóstico, sombrío, a pesar del tratamiento oncoespecífico(AU)

Introduction: Multiple myeloma is a malignant hematologic disease characterized by a proliferation of plasma cells in the bone marrow. The most common age of onset is between 65 and 70 years, however cases are documented in young people in increasingly severe forms. Case presentation: A case of a 31-year-old man, with generalized bone pain, weight loss and adynamia, of 6 months of evolution is presented here. Serum creatinine and serum calcium levels are high during hospitalization, Bence-Jones protein is positive for Kappa light chains, and marrow biopsy is performed, which concludes in plasmoblastic myeloma. Conclusions: Treatment with cytostatic associated with steroids is started. This onset before age 40 is not frequent, and prognosis is bleak, despite the specific oncology treatment(AU)

Tuberculoma cerebral en paciente joven inmunocompetente / Cerebral tuberculoma in young immunocompetent patient

RESUMEN La tuberculosis con afección del sistema nervioso central es una afectación infrecuente pero muy grave de esta enfermedad, representa el 1% de todos los casos de tuberculosis. Reportamos el caso de una joven HIV negativa, con daño del sistema nervioso central de tipo miliar a nivel cerebral y sin enfermedad pulmonar. La tuberculosis puede afectar extensamente a sujetos inmunocompetentes y este fenómeno ha sido descripto en muchas series a los largo del tiempo. Ante la sospecha clínica, el seguimiento de un protocolo específico para confirmar el diagnóstico es de vital importancia para el temprano diagnóstico y correcto manejo de una situación que puede comprometer la vida y generar a largo plazo secuelas graves. Se presenta el caso por el reto diagnóstico que ha supuesto y rara presentación en paciente inmunocompetente.

ABSTRACT Tuberculosis with central nervous system involvement is an uncommon but very serious disease, with a frecuence of 1% of all cases of tuberculosis. We report the case of a young HIV negative woman, with central nervous system damage of the miliary type in the brain without lung disease. Tuberculosis can extensively affect immunecompetent subjects and this phenomenon has been described in many series over the time. In the presence of clinical suspicion, the follow-up of a specific protocol to confirm the diagnosis is of vital importance for the early diagnosis and correct management of a situation that can compromise life and generate long-term serious sequelae. The case is presented because of diagnostic challenge and a rare presentation in an immunocompetent patient.

Evaluación de la calidad de vida en pacientes intervenidos de artroplastia total de cadera / Evaluating quality of life in total hip arthroplasty patients

Objetivo: Determinar el estado de salud general percibida por los pacientes jóvenes sometidos a artroplastia total de cadera con el implante tipo minivástago. Material y método: Se administró el cuestionario de salud SF-36 para evaluar el estado de salud percibido por 13 pacientes varones, con una media de edad de 46.62 (34 a 53) años, en los que se realizó una artroplastia total de cadera no cementada tipo MiniHip (CorinMedical) tras un seguimiento medio de 23.2 (12 a 47) meses. Los resultados obtenidos se compararon con los valores de referencia de la población española en varones de 45 a 54 años. Resultados: En las respuestas del cuestionario SF-36 se hallaron diferencias en aspectos como rol físico y rol emocional, desempeño físico, desempeño social y dolor; mientras que en el resto de los ítems la puntuación obtenida fue similar a la de la población de referencia. Discusión: Existe la necesidad de conocer en qué grado nuestras intervenciones afectan la calidad de vida de los pacientes y la manera en que son percibidas por ellos mismos para complementar la valoración de los resultados de nuestrasintervenciones. Conclusión: Es necesaria una nueva perspectiva para la valoración funcional y de calidad de vida de los pacientes jóvenes sometidos a una artroplastia total de cadera.

Objective: To determine the general health status perceived by patients undergoing total hip arthro-plasty with a mini-stem implant. Material and Methods: SF-36 health questionnaire was used to assess perceived health status in 13 male patients with a mean age of 46.62 (34-53) years after the implanta-tion of an uncemented, MiniHip® (CorinMedical) total hip arthroplasty, with a mean follow-up of 23.2 (12-47) months. Results were compared with the reference values for Spanish males aged from 45 to 54 years. Results: In the responses to the SF-36 questionnaire differences were found in areas such as physi-cal and emotional role, physical function, social function and pain; while scores for the remaining items were similar to those of the reference population. Discussion: It is important to know to what extent our surgical actions affect the quality of life of patients and how it is perceived by them to complement the results of our surgeries. Conclusion: A new perspective of function and quality of life evaluation is required in young patients undergoing total hip arthroplasty.

Orthodontic treatment of a transposed maxillary canine and first premolar in a young patient with Class III malocclusion / 대한치과교정학회지

A 12-year-old girl was referred to our clinic for evaluation of an unaesthetic dental appearance. All permanent teeth were erupted, while the deciduous maxillary right canine was retained. Cone-beam computed tomography revealed a complete transposition of the maxillary left canine and first premolar involving both the crowns and the roots. Initial cephalometric analysis showed a skeletal Class III pattern, with a slight maxillary retrusion and a compensated proclination of the upper incisors. The patient's teeth were considered to be in the correct position; therefore, we decided to attempt treatment by correcting the transposition and using only orthodontic compensation of the skeletal Class III malocclusion. After 25 months of active orthodontic treatment, the patient had a Class I molar and canine relationship on both sides, with ideal overbite and overjet values. Her profile was improved, her lips were competent, and cephalometric evaluation showed acceptable maxillary and mandibular incisor inclinations. The final panoramic radiograph showed that good root parallelism was achieved. Two-year follow-up intraoral photography showed stable results.

Combination of Platelet Rich Fibrin with Hydroxyapatite in Treating a Large Periapical lesion-Case Report of Young Patient.

The primary goal of any dental treatment is the maintenance of the natural dentition in health and for optimum function, and esthetics. Successful treatment for periapical lesion depends on removal of lesion along with causative microorganisms. In cases where conventional root canal therapy fails to eliminate the lesion surgery is the last alternative. Peri-apical surgery aims to eliminate the pathology and thus aims to achieve complete wound healing. There have been many attempts to devise a wonder material which can achieve healing and regeneration and platelet rich fibrin is one such material. Platelet rich fibrin (PRF) is a wonderful tissue engineering product and has gained much popularity due to its promising results in wound healing bone induction. The platelets release growth factors which lead to rapid healing and regeneration. Along with the addition of hydroxyapatite this combination can achieve regeneration and repair in no time. This case report illustrates the use of this combination in a 16- year- old male for better and faster healing.

Adenoma pleomórfico de paladar en un paciente joven: reporte de caso / Pleomorphic adenoma of the palate in a young patient: Case report

El Adenoma Pleomórfico (AP) es el tumor benigno más común de la glándula parótida, aunque se presenta frecuentemente en glándulas salivales mayores, puede encontrarse en glándulas salivales menores del paladar y del labio, siendo infrecuente en pacientes jóvenes; se detecta en muchos casos como un hallazgo casual durante el examen clínico odontológico, puede evaluarse a través de diferentes estudios imagenológicos y su diagnóstico definitivo se basa en el análisis histopatológico de la lesión. El tratamiento quirúrgico dependerá de la localización y del tamaño. En pocos casos presenta recidiva y la trasformación maligna es rara, pero es necesario realizar un seguimiento periódico a largo plazo después de su exéresis. A continuación se presenta el caso de un adenoma pleomórfico de glándula salival menor localizado en el paladar duro de una paciente de 16 años de edad, diagnosticado y tratado oportunamente mediante la resección completa con un margen adecuado de tejido sano, con un pronóstico favorable...

The Pleomorphic Adenoma (PA) is the most common benign tumor of salivary glands, although frequently in major salivary glands can be found in minor salivary glands of the palate and lip, are uncommon in young patients; often detected as an incidental finding during dental clinical, examination can be assessed by different imaging studies and definitive diagnosis is based on histopathological analysis of the lesion. The surgical treatment depends on the location and size. In a few cases presented recurrence and malignant transformation is rare, but it is necessary to regularly monitor long term after excision. A case is reported of pleomorphic adenoma of minor salivary gland located in the hard palate in a 16 year old girl, diagnosed and treated by complete resection with an adequate margin of healthy tissue, with a favorable prognosis...

Clinical characteristics of young patients with malignent pancreatic tumors / 中华胰腺病杂志

Objective To improve the diagnostic and therapeutic efficacy for young patients with malignant tumors of pancreas at the early stage, and describe the clinical characteristics of this group of patients. Methods The clinical data of 46 young patients less than forty years old with malignant tumors of pancreas received treatment and follow up, including clinical features, clinicopathological parameters, status of misdiagnosis, CA 19-9, CEA, were retrospectively reviewed. Results The main manifestations of young patients with malignant tumors of pancreas were abdominal bloating (78.26% ), epigastric discomfort (73.91%), weight loss (73.91%), loss of appetite (69.57%), abdominal pain (60.87%). Majority of the tumors were located in pancreatic head. 30 cases (65.22%) had pathological evidence of metastasis, among them 13 cases had multi-organ involvement. Pancreatic exocrine tumor accounted for 72.73% (24/33) of all the tumors, while endocrine tumor accounted for 27.27% (9/33). The positive rates of CA 19-9 and CEA were 73.91% (34/46) and 32.6% (15/46). The misdiagnosis rate of young patients with malignant tumors of pancreas was up to 80.43% (37/46). The main misdiagnoses were acute or chronic gastritis (36.96%). The rate of radical operation for young patients with malignant tumors of pancreas was 23.91%, and the median survival was 12.6 months. Conclusions The symptoms of young patients with malignant pancreatic tumors are non-speciflc and the misdiagnosis rate was high and the prognosis was poor, therefore, the early diagnosis of pancreatic malignant tumors shall be emphasized.

The little master-results of proxima hip replacement / 中国矫形外科杂志

[Objective] Total hip replacement has given good results in the elderly population but with an increasing number of younger patients requiring hip replacement,soft tissue and bone preservation has become important.Studies have shown that a more natural loading of the proximal femur leads to preservation of bone stock and aids remodeling.Proxima hip was developed keeping these requirements in mind.[Methods] Twenty nine Proxima hip replacements were performed on twenty one patients between July 2006 and March 2008 by the senior author.The average age of the patients at the time of surgery was 44 years.Eight of the patients had bilateral hip replacement in the same sitting.The implant used was a Proxima stem with a large diameter metal on metal XL head.Particular care was taken in preserving the full length of femoral neck and the trechanteric muscles.The patients were assessed by Harris hip acore,return to normal and advanced hip functions and satisfaction levels.All patients were followed up with serial X rays and clinical examination.[Results] Average duration of follow up was 1 year.The mean Harris hip score pre surgery was 48 and at last follow up was 88.All patients at 3 to 4 months achieved full weight bearing.One patient had an intra-operation fracture of the lateral cortex which recovered without any sequelae.Another patient had persistent thigh pain without any apparent cause and a poor result.One stem was revised because of aseptic loosening after 9 months.None of the hips showed any sign of acetabular cup loosening or migration.[Conclusions] Early results in this young group of patients are very encouraging.This small implant relies on the preserved neck and the lateral flare for its stability,ensuring a more natural loading of the proximal femur and preserving bone stock and facilitating remodeling.As our results show the Proxima stem as an implant that stands the test of biomechanics and holds a promising future.

Rituximab-induced Interstitial Pneumonitis in a Young Patient: A Case Report and Review of the Literature

Side effects of rituximab are mild in most cases, but there have been a few cases of severe pulmonary toxicity reported in elderly patients. Here we report a case of interstitial pneumonitis following rituximab treatment in a young patient. A 35-year-old woman with diffuse large B-cell lymphoma was admitted complaining of dry cough and dyspnea without fever after the 3 treatments with rituximab-CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. Her chest CT with high-resolution CT scanning confirmed the presence of bilateral diffuse ground-glass opacities. The analysis of arterial blood gases indicated hypoxemia. The pulmonary function testing showed a restrictive pattern. There were no other findings suggesting an infection. The findings were compatible with a rituximab-induced interstitial pneumonitis. After the patient was treated with prednisolone, the symptoms resolved. Cases with rituximab-induced interstitial pneumonitis develop principally in elderly patients. However, the condition also can occur in young patients.

Comparison of the Clinicopathologic Features and the Survival Rates in Young and Elderly Patients with Gastric Cancer

PURPOSE: We analyzed the clinicopathologic features, including treatment and outcome, and the survival rates between young and elderly patients with gastric cancer. MATERIALS AND METHODS: Clinical information was reviewed for 1086 patients who had undergone a gastrectomy for gastric cancer during a 10-year period from 1990 to 1999, and the patients were assigned to one of two groups: the A group ( or =70 years of age, 85 patients). RESULTS: Compared to the B group, the A group had more females (47.3% vs 32.9%), a greater frequency of family history of cancer (15.4% vs 3.5%), and greater proportions of histologically poorly differentiated tumors (84.5% vs 40.2%) and Lauren diffuse-type tumors (69.1% vs 35.1%)(P<0.05). There was no difference in TNM stage. Cardiopulmonary co-morbidities were more in the B group, respectively, 1.1% (A group) and 11.8% (B group)(P<0.01), but the morbidity and the mortality were similar. Although there was no difference in curability, the B group underwent less aggressive operations in lymph-node dissection above D3 and had a shorter operation time, a smaller number of retrieved lymph nodes, and less adjuvant chemotherapy (P<0.001). However, there were no differences in the disease-specific 5-year survival rates, 67.6% and 67.0% respectively. CONCLUSION: Young and elderly patients with gastric cancer had different clinicopathological features. Especially, elderly patients underwent relatively less aggressive treatment. In spite of these facts, the outcome of treatment and the disease-specific survival rates were not different.