Soft tissue swelling in children: case report, differential diagnosis, and diagnostic delay.

A general practitioner faces regularly soft tissue swelling in otherwise healthy children. Delay in diagnosis of soft tissue malignancies is often due to asymptomatic nature and the unfamiliarity with the age-dependent differential diagnosis. Hence, an accurate knowledge is important to prevent important delay in diagnosis of potential malignancies.

Fluorescent activated cell sorting: an effective approach to study dendritic cell subsets in human atherosclerotic plaques.

Different immune cell types are present within atherosclerotic plaques. Dendritic cells (DC) are of special interest, since they are considered as the 'center of the immuniverse'. Identifying inflammatory DC subtypes within plaques is important for a better understanding of the lesion pathogenesis and pinpoints their contribution to the atherosclerotic process. We have developed a flow cytometry-based method to characterize and isolate different DC subsets (i.e. CD11b(+), Clec9A(+) and CD16(+) conventional (c)DC and CD123(+) plasmacytoid (p)DC) in human atherosclerotic plaques. We revealed a predominance of pro-inflammatory CD11b(+) DC in advanced human lesions, whereas atheroprotective Clec9A(+) DC were almost absent. CD123(+) pDC and CD16(+) DC were also detectable in plaques. Remarkably, plaques from distinct anatomical locations exhibited different cellular compositions: femoral plaques contained less CD11b(+) and Clec9A(+) DC than carotid plaques. Twice as many monocytes/macrophages were observed compared to DC. Moreover, relative amounts of T cells/B cells/NK cells were 6 times as high as DC numbers. For the first time, fluorescent activated cell sorting analysis of DC subsets in human plaques indicated a predominance of CD11b(+) cDC, in comparison with other DC subsets. Isolation of the different subsets will facilitate detailed functional analysis and may have significant implications for tailoring appropriate therapy.

Aortic hammer syndrome.

PURPOSE: To present a case of penetrating aortic ulcer with extraordinary etiology. CASE REPORT: A 57-year-old man was admitted with acute retrosternal and interscapular pain. He was a demolition worker and often used a pneumatic drill to which he pressed his chest as he drilled. Clinical examination showed previously undiagnosed hypertension. Computed tomographic angiography disclosed a penetrating aortic ulcer in the descending thoracic aorta without any sign of atherosclerosis. Initial treatment consisted of blood pressure control. However, due to progression of the lesion, endovascular treatment was performed to implant a covered endoprosthesis. CONCLUSION: We hypothesize that the etiology of the ulcer was the shear forces developed by incorrect, repetitive use of the pneumatic hammer in combination with the untreated hypertension. This is analogous to the hypothenar hammer syndrome, and we propose naming this the "aortic hammer syndrome."

Free jejunal autograft reconstruction after total pharyngolaryngeal resection.

A free jejunal autograft reconstruction after debulking high stage larynx and hypopharynx tumors has become a popular method in our 10-year experience. We retrospectively studied the efficacy and outcome. Nine patients (M/F, 8/1) underwent a total of 10 free jejunal autograft reconstructions. The median age was 58.6 years (range, 48-78 years). The median hospital stay was 32 days (range, 13-67 days) and the graft failure rate was 10% (1/10), 9/10 successfully retransplanted. Postoperative mortality rate was 0%; one patient was lost during follow-up, one patient died of lung cancer, three died of local recurrence, and four patients have no evidence of disease at this moment (mean follow-up of 16.5 months; range, 9-41 months). Salivation fistulas were present postoperatively in four patients: one closed spontaneously and three closed after surgery. In our hands, the free jejunal graft is the preferred method for single-stage reconstruction of circumferential defects of the gullet.