TH1/TH2 repolarization in induction of immune tolerance to non-steroidal anti-inflammatory drugs during the management of sickle cell disease vaso-occlusive crisis.

Respiratory manifestations related to the intake of non-steroidal anti-inflammatory drugs (NSAIDs) during the treatment of the painful vaso-occlusive crisis of sickle cell disease are either a type I hypersensitivity mechanism of the Gell and Coombs classification, or a pharmacological mechanism of NSAIDs. The use of NSAIDs is essential in the Abidjan school because of the absence of therapeutic alternatives in the management of the inflammatory crisis of this disease. The induction of tolerance to NSAIDs initiated by the authors has had clear clinical success. The basic biological reasons for this tolerance were evaluated in this study. A group of 11 sickle cell patients aged 12 to 39 years in whom post-NSAID respiratory manifestations disappeared for at least 6 months following a short tolerance induction protocol with ibuprofen, was assayed by ELISA for TNFα, INF (Th1 cytokines), IL-4 (Th2 cytokine), IL-10, TGF-ß (immunosuppressive cytokines) and total IgE, before induction or pre-induction (D-1) and at day one (D1), D2- 3, one month (M1), and M6 after induction. A repolarization of the Th1/Th2 balance was noted during the post induction period. The high concentration of IL-4 observed at D-1 gradually decreased in favor of the cytokines TNFα, INF. The decrease in cytokine IL-4 with the level of total IgE was accompanied by the increase of IL-10 and TGF-ß demonstrating the regulatory role of these cytokines in the control of allergic diseases. In conclusion, the induction of immuno-tolerance to NSAIDs through a short protocol is well supported by immune regulation. The medium-term effects are real, unlike the results of allergen desensitization or specific immunotherapy. However, this protocol could be used in certain circumstances such as in the case of intolerance to trimethoprim-sulfamethoxazole, used as the treatment of choice for the prevention of opportunistic diseases in people living with human immunodeficiency virus.

Analysis of total antibody levels in university hospitals health workers vaccinated against COVID-19 in Abidjan (Côte d'Ivoire).

Discovered in China in December 2019, coronavirus disease-19 (COVID-19) has confronted the world with an unprecedented crisis. Healthcare workers, the first line of defense against this pandemic, have been severely affected. Clinical trial results of the emergency vaccines showed that they all produced IgG antibodies against severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) with high rates of seroconversion. While immunization against natural challenge (COVID-19 infection) and artificial challenge (vaccination) in health care workers is relatively well described in the West, the issue is not well understood in Sub-Saharan Africa, particularly in Côte d'Ivoire, where populations are genetically distinct from Caucasians. Our aim was to investigate the magnitude of post-vaccination IgG responses to SARS-CoV-2 in healthcare workers in our African epigenetic context. A cross-sectional, multicenter, analytical study was conducted from March to May 2022 among health workers employed at the University Hospital of Abidjan and vaccinated against COVID-19. The study included 77 health workers. IgG immunoassays were performed with an enzyme-linked fluorescent assays. Data were analyzed using SPSS version 22.0 software, with a p-value ˂ 0.05 considered as a significant difference. All enrolled subjects developed anti-SRAS-Cov-2 IgG, of which 88.3% had a strong response (titer ≥ 250 Binding Antibody Units/ml). IgG titers varied significantly by gender (p=0.04). Vaccine type and number of doses did not affect IgG titers. However, a history of COVID-19 infection was associated with a 5-fold greater likelihood of developing a strong IgG response after vaccination. In conclusion, humoral IgG responses developed after vaccination against SARS-CoV-2 were robust and would be influenced by a variety of factors..

Bilateral multifocal central serous retinopathy following mRNA COVID-19 vaccine.

We present a case of acute bilateral multifocal CSCR in a young healthy Caucasian female occurring 3 days after receiving the first dose of the Pfizer-BioNTech BNT162b2 COVID-19 mRNA vaccine. The true incidence of this adverse reaction might be underreported in asymptomatic unilateral or paracentral cases. We believe that the post-COVID-19 vaccination occurrence of CSCR is not a sufficient reason to withhold the second dose of the vaccine. Further studies are required to ascertain the best way to prevent and manage this complication.

Antibiotic guidelines coupled with selective reporting of antibiograms.

OBJECTIVES: We reported the impact of internal guidelines coupled with selective reporting of antibiotic susceptibility tests (srAST) on antibiotic adequacy in healthcare facilities. METHODS: This prospective study involved clinicians from three clinics with medical and surgical activities employing a full-time infectious disease (ID) specialist. Internal guidelines were updated in 2016. The clinics were working with the same laboratory, which delivered the srAST introduced in March 2017. Two weeks per month over a 6-month period, all isolated bacterial specimens, empirical antibiotic therapies (EAT) and the documented ones were analyzed. An EAT listed in the guidelines and a documented therapy mentioned in the srAST defined their adequacy. RESULTS: A total of 257 positive bacterial samples were analyzed in 199 patients, for which 106 infections were studied. Of these, 32% were urinary tract infections, 15% were primary bloodstream infections, 11% were bone infections, and 42% were other types of infection. The three main bacteria were Escherichia coli (27%), Staphylococcus aureus (24%), and Enterococcus faecalis (14%). The total number of antibiotic prescriptions was 168, with 75 (45%) EATs and 93 (55%) documented therapies. There were 35/75 (47%) adequate EATs and 86/93 (92%) adequate documented therapies. The ID specialist was not involved in 90/168 (53.5%) prescriptions, of which 43/90 (48%) were adequate, with 21/35 (60%) EATs and 22/86 (25%) documented therapies. There was a statistical correlation between compliance of the EATs with guidelines and of the documented therapy with srAST (p=0.02). CONCLUSION: Combining internal guidelines and srAST led to a high rate of antibiotic adequacy.

Understanding the foot's functional anatomy in physiological and pathological conditions: the calcaneopedal unit concept.

BACKGROUND: A thorough review of the available orthopaedic literature shows significant controversies, inconsistencies and sparse data regarding the terminology used to describe foot deformities. This lack of consensus on terminology creates confusion in professional discussions of foot anatomy, pathoanatomy and treatment of deformities. The controversies apply to joint movements as well as static relationships between the bones. DESCRIPTION: The calcaneopedal unit (CPU) is a specific anatomical and physiological entity, represented by the entire foot excepted the talus. The calcaneus, midfoot and forefoot are solidly bound by three strong ligaments that create a unit that articulates with the talus. The movement of the CPU is complex, as it rotates under the talus, around the axis of Henke that coincides with the talo-calcaneal ligament of Farabeuf.This calcaneopedal unit is deformable. It is compared with a twisted plate, able to adapt to many physiological situations in standing position, in order to acheive a plantigrade position.Moreover, the calcaneopedal unit and the talo-tibiofibular complex are interdependent; rotation of the latter produces morphologic modifications inside the former and vice versa. PURPOSE: This paper is a review article of this concept and of its physiopathological applications.

[Ophthalmic Zoster In Children: About An Observation And Literature Review]. / Zona Ophtalmique Chez L'Enfant : A Propos D'Une Observation Et Revue De Litterature.

OBJECTIVE: the goal of this clinical case is to report a case of ophthalmic zoster in children and to insist on the relevance of early antiviral treatment so as to minimize corneal affection and preserve visual function. OBSERVATION: we report an eleven-years-old-girl case, with a history of varicella infection at 5 years old, who came for consultation for a painful eruption affecting the forehead, the upper eyelid, the nose, and the upper lips. The clinical examination showed many vesicles erythematous affecting the left hemi face. The diagnosis of ophthalmic zoster has been retained. The biological checkup was done namely blood count, and glycemia in empty stomach and a HIV serology. This checkup was normal. The treatment was a local antiseptic based and systemic with acyclovir and antalgic (tramadol) during 8 days. The evolution was favorable. Zoster is rare in children. The ophthalmic form is exceptional. The diagnosis is clinical and should mention some bladdery lesions grouped in bunch with a disposition which follows a metamere. It can be responsible of serious ocular complications which can compromise the visual function. CONCLUSION: the particularity of our observation is the presence of zoster in immunocompetent child and the ophthalmic localization remaining an exceptional form in children.

OBJECTIF: le but de ce cas clinique était de rapporter un cas de zona ophtalmique chez l'enfant et d'insister sur l'intérêt d'un traitement antiviral précoce afin de limiter l'atteinte cornéenne et de préserver la fonction visuelle. OBSERVATION: nous rapportons le cas d'une fillette de 11 ans, avec un antécédent de varicelle à l'âge de 5 ans qui a consulté pour une éruption douloureuse, prenant le front, la paupière supérieure, le nez et les lèvres supérieures. L'examen clinique a mis en évidence de multiples vésicules érythémateuses, intéressant l'hémiface gauche. Le diagnostic de zona ophtalmique a été retenu. Un bilan biologique a été effectué, notamment une numération formule sanguine, une glycémie à jeun et une sérologie VIH. Ledit bilan s'est révélé normal. Le traitement a été local à base d'antiseptique et systémique fait d'aciclovir et d'antalgique (tramadol) pendant 8 jours. L'évolution a été favorable. Le zona est rare chez l'enfant. La forme ophtalmique est exceptionnelle. Le diagnostic est clinique et doit être évoqué devant des lésions vésiculeuses groupées en bouquet et dont la disposition suit un métamère. Il peut être responsable de complications oculaires graves pouvant compromettre la fonction visuelle. CONCLUSION: la particularité de notre observation est la survenue de zona chez un enfant immunocompétent et la localisation ophtalmique qui reste une forme exceptionnelle chez l'enfant.

Zona ophtalmique chez l'enfant : à propos d'une observation et revue de Literature

Objectif : le but de ce cas clinique était de rapporter un cas de zona ophtalmique chez l'enfant et d'insister sur l'intérêt d'un traitement antiviral précoce afin de limiter l'atteinte cornéenne et de préserver la fonction visuelle. Observation : nous rapportons le cas d'une fillette de 11 ans, avec un antécédent de varicelle à l'âge de 5 ans qui a consulté pour une éruption douloureuse, prenant le front, la paupière supérieure, le nez et les lèvres supérieures. L'examen clinique a mis en évidence de multiples vésicules érythémateuses, intéressant l'hémiface gauche. Le diagnostic de zona ophtalmique a été retenu. Un bilan biologique a été effectué, notamment une numération formule sanguine, une glycémie à jeun et une sérologie VIH. Ledit bilan s'est révélé normal. Le traitement a été local à base d'antiseptique et systémique fait d'aciclovir et d'antalgique (tramadol) pendant 8 jours L'évolution a été favorable. Le zona est rare chez l'enfant. La forme ophtalmique est exceptionnelle. Le diagnostic est clinique et doit être évoqué devant des lésions vésiculeuses groupées en bouquet et dont la disposition suit un métamère. Il peut être responsable de complications oculaires graves pouvant compromettre la fonction visuelle. Conclusion : la particularité de notre observation est la survenue de zona chez un enfant immunocompétent et la localisation ophtalmique qui reste une forme exceptionnelle chez l'enfant

Validity and reliability of different techniques of neck-shaft angle measurement.

AIM: To determine a valid and reliable neck-shaft angle (NSA) measurement method while rotating the pelvises in increments of 5° in order to simulate patient malpositioning. MATERIALS AND METHODS: CT images of 17 patients were used to produce digitally reconstructed radiographs in frontal and lateral views and three-dimensional (3D)-reconstructions of the femurs, considered to be the reference standard. Malpositioning was simulated by axially rotating the frontal radiographs from 0° to 20°. Three operators measured in two-dimensions the NSA using four different methods, three times each, at each axial rotation (AR) position. Method 1 (femoral neck axis drawn by joining the centre of the femoral head (CFH) to the median of the femoral neck base; femoral diaphysis axis drawn by joining the median of two lines passing through the medial and lateral edges of the femoral axis below the lesser trochanter) and method 2 (femoral axis taken as the median of a triangle passing through base of femoral neck and medial and lateral head-neck junction; femoral diaphysis as previous) were described for the first time; method 3 was based on a previous study; method 4 was a free-hand technique. Reliability, validity, and global uncertainty were assessed. RESULTS: Method 1 showed the best reliability and validity. The global uncertainty also showed minimal values for method 1, ranging from 7.4° to 14.3° across AR positions. CONCLUSION: Method 1, based on locating the CFH, was the most reliable and valid method and should be considered as a standardised two-dimensional NSA measurement method for clinical application.

Normative spino-pelvic sagittal alignment of Lebanese asymptomatic adults: Comparisons with different ethnicities.

BACKGROUND: Normative values of sagittal alignment are used as references for the diagnosis and treatment of spinal pathologies. There are currently no reference values for the normative sagittal alignment of Lebanese subjects. The objective is to describe normative values of full body sagittal alignment parameters in asymptomatic Lebanese adults and to compare the sagittal alignment of this population to that of populations of various origins. METHODS: Included subjects were aged 18 to 28 years old. Each subject underwent a full body biplanar X-ray exam with measurement of spine, pelvis and lower limb parameters of sagittal alignment. The sagittal alignment of the Lebanese population was compared to that of other ethnicities, previously reported in the literature, using one-way ANOVA. RESULTS: Ninety-two asymptomatic Lebanese young adult volunteers (48 males, 44 females, age=21.5±2.2 years) were enrolled in this study. The mean curvature in the cervical spine was kyphotic (-4.3°) in women, while it was lordotic in men (5.4°). Men were found to be significantly more kyphotic than women (-58.3° vs. -53.0°; p<0.01) but both sexes were found to have similar lordosis (61.6°) and pelvic incidence (52.0°). Lebanese subjects had intermediate pelvic incidence compared to other ethnicities but showed significantly higher thoracic kyphosis (p<0.01) and lumbar lordosis (p<0.01) compared to all other ethnicities. CONCLUSIONS: This study established reference normative values for young adult Lebanese subjects. Most women were found to have kyphotic cervical spines. The sagittal alignment of Lebanese subjects differed significantly compared to that of other ethnicities. LEVEL OF EVIDENCE: Level IV - cross sectional study.

Lower-limb lengths and angles in children older than six years: Reliability and reference values by EOS® stereoradiography.

BACKGROUND: Lower-limb alignment in children is classically assessed clinically or based on conventional radiography, which is associated with projection bias. Low-dose biplanar radiography was described recently as an alternative to conventional imaging. The primary objective of this study was to assess the reliability of length and angle values inferred from 3D reconstructions in children seen in everyday practice. The secondary objective was to obtain reference values for goniometry parameters in children. HYPOTHESIS: 3D reconstructions can be used to assess the lower limbs in children. MATERIAL AND METHODS: The paediatric reliability study was done in 18 volunteers who were divided into three groups based on whether they were typically developing (TD) children, had skeletal development abnormalities, or had cerebral palsy. The reference data were obtained in 129 TD children. Each study participant underwent biplanar radiography with 3D reconstruction performed by experts and radiology technicians. Goniometry parameters were computed automatically. Reproducibility was assessed based on the intra-class coefficient (ICC) and the ISO 5725 standard (standard deviation of reproducibility, SDR). RESULTS: For length parameters, the ICCs ranged from 0.94 to 1.00 and the SDR from 2.1 to 3.5mm. For angle parameters, the ICC and SDR ranges were 0.60-0.95 and 0.9°-4.6°, respectively. No significant differences were found across experts or radiology technicians. Age-specific reference data are reported. DISCUSSION: These findings confirm the reliability of low-dose biplanar radiography for assessing lower-limb parameters in children seen in clinical practice. In addition, the study provides reference data for commonly measured parameters. LEVEL OF EVIDENCE: IV.

Influence of patient rotational malpositioning on pelvic parameters assessed on lateral radiographs.

AIM: To estimate the effect of patients' axial rotation (AR) during pelvic radiograph acquisition, on the reliability and validity of sagittal pelvic parameters. MATERIALS AND METHODS: Lateral digitally reconstructed radiographs (LDRRs) were obtained from the pelvic computed tomography (CT) scans of eight children and nine adults. Then, the AR of the pelvis was simulated and the corresponding LDRRs were reconstructed at 5°, 10°, 15°, and 20° of the AR. Pelvic parameters were measured digitally on each radiograph. Intra- and interobserver variability were evaluated at each AR position (three operators repeated the measurements three times each). The bias on each clinical parameter, in each AR position, was calculated relatively to the 0° position. RESULTS: Interobserver variability increased similarly in children and adults with AR. It reached 4.4° for pelvic incidence and 4.7° for the sacral slope at 20° of AR. Biases on radiological parameters increased with AR and exceeded the acceptable threshold of errors when AR reached 10°. A linear regression was established (R2=0.834, p<0.0001) in order to estimate the AR of a patient on a lateral pelvic radiograph based on the measurement of the bifemoral distance normalized to the sagittal pelvic thickness. CONCLUSIONS: AR of patients during radiograph acquisition can be estimated in clinical practice, which would allow physicians to discard any radiographs where the calculated AR exceeded 10°.

A podoscopic and descriptive study of foot deformities in patients with Down syndrome.

INTRODUCTION: Subjects with Down syndrome (DS) are known to be affected by various foot deformities. Despite the fact that some of these deformities have been reported in the literature, a more comprehensive description would be of benefit. The aim of this study is to investigate the prevalence of known foot deformities in patients with DS and of other previously non-described foot anomalies in this population. HYPOTHESIS: Subjects with DS have an increased prevalence of foot deformities compared to control subjects. METHODS: Fifty-five subjects with DS (age: 14.6±7.4 years) had undergone podiatric clinical and podoscopic examinations to study their main foot deformities and their footprints, respectively. The results of these examinations were compared to those of an age-matched asymptomatic control group of fifty-three subjects (age: 13.4±11.2 years). RESULTS: Significantly more prevalent foot deformities were found in the DS group: hallux valgus (36.4%), syndactyly between the 2nd and 3rd toes (9.1%), grade II pes planus (39.1%) and grade III pes planus (30%). Moreover, joint laxity (43.6%) was significantly more prevalent in the DS group. Furthermore, the presence of an increased space between the 1st and 2nd toes in patients with DS and its prevalence (73.6%) were described for the first time. A multivariate analysis revealed a significant relationship between the presence of joint laxity and flatfoot in only the control but not the DS group. Other foot deformities were found to be consistently more frequent in the DS population but not significantly higher than the control group. DISCUSSION: Although subjects with DS had significantly greater joint laxity and BMI compared to the control group, neither of these factors was found to be related to the increased prevalence of flatfoot in DS patients. LEVEL OF EVIDENCE: IV-retrospective study.

Vitreoretinal surgery for shotgun eye injuries: outcomes and complications.

PURPOSE: To analyse the postoperative anatomic and functional outcomes in addition to complications after vitreoretinal surgery for patients with shotgun eye injuries related to hunting accidents. MATERIALS: Retrospective review of the clinical records of all cases of shotgun eye injuries presented between January 2000 and January 2011 and with a minimum follow-up of 1 year. Collection of demographics, type of injury, choice of management, complications and final surgical success with final visual acuity is reported. RESULTS: Twenty eyes of 19 patients (all male) with a mean age of 36.1 years (range 16-60 years) were included in the study. Mean postoperative follow-up was 47.5 months (range 15-118 months). Best corrected visual acuity (BCVA) at presentation ranged from perception of light to 20/200. Ten eyes had a penetrating injury and 10 others had a perforating injury. All the eyes underwent an initial vitrectomy and the intraocular pellet was removed in all the 10 penetrating injuries. Concurrent cataract surgery was performed in 12 cases, internal tamponade was used in 15 cases and a supplemental encircling scleral buckle was inserted in 12 cases. One additional vitreoretinal surgery was required in seven cases (35%) and two additional surgeries required in two other cases (10%). At last follow-up BCVA ranged from NPL to 20/20 and was 20/100 or better in 10 eyes (50%). All patients had a flat retina except for two cases (10%) that developed severe proliferative vitreoretinopathy. CONCLUSION: These results suggest that vitreoretinal surgery can offer good visual rehabilitation in patients with shotgun eye injuries.

Subject-specific musculoskeletal model of the lower limb in a lying and standing position.

Accurate estimation of joint loads implies using subject-specific musculoskeletal models. Moreover, as the lines of action of the muscles are dictated by the soft tissues, which are in turn influenced by gravitational forces, we developed a method to build subject-specific models of the lower limb in a functional standing position. Bones and skin envelope were obtained in a standing position, whereas muscles and a set of bony landmarks were obtained from conventional magnetic resonance images in a lying position. These muscles were merged with the subject-specific skeletal model using a nonlinear transformation, taking into account soft tissue movements and gravitational effects. Seven asymptomatic lower limbs were modelled using this method, and results showed realistic deformations. Comparing the subject-specific skeletal model to a scaled reference model rendered differences in terms of muscle length up to 4% and in terms of moment arm for adductor muscles up to 30%. These preliminary findings enlightened the importance of subject-specific modelling in a functional position.

Metachronous contralateral Leydig-cell tumour in an 8-year-old boy.

Leydig-cell tumours of the testis are rare and usually benign in children. The possibility of metachronous bilateral tumours should be considered not only for testicular teratomas but also in the follow up of a Leydig-cell tumour. Testis-sparing surgery is feasible and safe in prepubertal boys after exclusion of a malignant tumour.

Macular microholes: pathogenesis and natural history.

AIMS: To study the natural history and evaluate optical coherence tomography (OCT) and the retinal thickness analyser (RTA) in patients with macular microholes. METHODS: The medical records of 22 patients with a well demarcated red intraretinal foveal or juxtafoveal defect were reviewed. Fluorescein angiography (FA), RTA, and OCT were performed. The main outcome measures were visual acuity (VA), and OCT and RTA characteristics of microholes. Long term follow up was available in 13 eyes of 12 patients. RESULTS: The patients had a mean age of 50 years and a mean refractive error of -0.93 dioptres. The presenting symptom was a central scotoma in 14 eyes and metamorphopsia in eight eyes. All patients had a corrected VA ranging from 20/16 to 20/125, with 20 out of 24 eyes (83%) having a VA > or =20/40. Symptoms remained stable or improved in 16 out of 22 patients (72%). OCT 2 findings were normal but an abnormality of the outer retina and/or a defect of the retinal pigment epithelium (RPE) were demonstrated on OCT 3 in 15 of 18 eyes (83%). The RTA topographic map demonstrated a defect at the site of the microhole in two out of 12 eyes. CONCLUSION: Although biomicroscopic examination suggested an inner foveal defect, the OCT 3 scans demonstrated a localised abnormality of the outer retina and/or RPE which could not be resolved using OCT 2. Macular microholes have a favourable long term prognosis with stable VA. Bilateral involvement is uncommon.

Surgery of thyroid cancer: twelve years' personal experience.

Diagnosis and treatment of thyroid carcinoma require a multidisciplinary approach. The close and long-standing collaboration between the Otorhinolaryngology, Pathological Anatomy and Nuclear Medicine Departments of Legnano Hospital has led to a precise diagnostic and therapeutic protocol in thyroid patients. In the 1990-2002 period, 131 patients underwent total thyroidectomy after diagnosis of thyroid cancer at the Otorhinolaryngology--Head and Neck Surgery Department. Patients submitted to lobectomy for differentiated thyroid cancer were excluded from the present study. The patient population is composed of 96 females (73%) and 36 males (27%) aged between 22 and 85 years. Of the 131 patients, 115 (87%) presented papillary carcinoma, 13 (10%) follicular carcinoma, 2 (2%) medullary carcinoma and one (1%) undifferentiated carcinoma. Two patients (2%) suffered from a preoperative monolateral recurrent nerve palsy. Total thyroidectomy was performed in all 131 patients. Selective neck dissection was performed only in patients with positive lymph nodes for papillary (37/115, 32%) and follicular carcinoma histotype (2/13, 15%) and, in both patients with medullary carcinoma (100%). Of the 131 patients, 15 (11%) did not undergo routine follow-up and were, therefore, excluded from the study, the remainder completed a mean follow-up of 47 months. During follow-up, the incidence of the two most frequent complications of thyroid surgery were evaluated: recurrent nerve paralysis and permanent hypoparathyroidism (exceeding the postoperative 6 months). Results of treatment have been evaluated considering the incidence of local and/or distant recurrences and patient survival rate. As far as concerns papillary and follicular histotype, we have considered as healed (absence of signs suggesting loco regional and distant recurrence) only those patients presenting both negligible levels of plasma thyroglobulin and a negative total-body 131I scintigraphy. Briefly, in 3 cases (3%), all papillary carcinomas, local recurrence occurred; 9 (8%), all with papillary carcinoma, developed lateral neck recurrence; 6 (5%), 5 with papillary carcinoma and one with follicular carcinoma, developed distant metastases, of which 3 pulmonary, 2 bone and 1 hepatic. Serum thyroglobulin values were considered during the last control visit in 95/113 patients (84%). Of these, 86 (91%) with negligible thyroglobulin levels and negative 131I scintigraphy, were considered healed. All 113 patients with differentiated thyroid carcinoma were alive at the last control visit. Both patients with medullary carcinoma are alive with no sign of illness at the last follow-up control. The patient presenting undifferentiated carcinoma died 2 months after surgery. In conclusion, at the last follow-up control, 1 (1%) patient has died, 5 patients (4%) are alive with disease (2 of whom suffered from multiple recurrences) and the remaining 110 (95%) patients are alive without evidence of disease. As far as concerns complications of surgery, iatrogenic recurrent palsy and permanent hypoparathyroidism are present in 2 (2%) and 10 patients (8%), respectively.

Laser photocoagulation alters the pattern of staining for neurotrophin-4, GFAP, and CD68 in human retina.

AIMS: To investigate the staining pattern of neurotrophin-3 (NT3), neurotrophin-4 (NT4), and brain derived neurotrophic factor (BDNF) as well as glial fibrillary acid protein (GFAP) and CD68 in lasered human retina. METHODS: Retinal laser photocoagulation was performed on four patients (two males, two females) with choroidal malignant melanoma 1-6 days before enucleation. Three other enucleated eyes with malignant melanoma and three normal cadaveric donor eyes were used as controls. Immunohistochemistry was performed to investigate the pattern of staining of NT3, NT4, BDNF, GFAP, and CD68 in 7 mm sections of fixed specimens. RESULTS: Expression of NT4 was detected in the inner and outer nuclear layers of all the retinal sections examined but no NT3 and BDNF staining was seen. NT4 staining was found to be less intense in lasered and melanoma controls compared to normal cadaveric donor retinas. There was an upregulation of GFAP expression in both lasered and control eyes with melanoma in comparison with normal controls. CD68 staining was only observed in retinal pigment epithelium and choroid of lasered eyes. CONCLUSION: NT4 is expressed in inner and outer nuclear layers of normal human retina and its expression is downregulated following laser photocoagulation. This occurs in parallel with an increased expression of GFAP suggesting that reactive changes in Muller cells may be responsible for reduced NT4 staining. Expression of CD68 at the site of laser injury is consistent with a wound healing process as a response to local damage.

Progression on metastatic neuroendocrine carcinoma from a recurrent prolactinoma: a case report.

A 54 year old man was referred to the department of neurosurgery for frontal headache and vomiting. The patient was known in the department because of previous multiple surgery for a locally invasive pituitary prolactinoma (eight years, three years, and one year previously). The neurological examination revealed a frontal mass, which adhered to the dura, suggesting a meningioma. One year later, a left temporal metastasis was removed. Three months later, the patient died, with spinal metastases, of massive lung embolism. Histology revealed a progression of adenohypophyseal prolactinoma on neuroendocrine carcinoma, with an increase in proliferating indexes and modification of hormone production. This study documents a 10 year history of a rare prolactin producing pituitary carcinoma, which metastasised via liquoral flow.