Synovial sarcoma of the Hypopharynx in a Filipino female: A case report

@#Synovial sarcoma of the hypopharynx is an uncommon malignancy, with less than 100 cases reported in available journals. We report a case of a 22-year-old female presenting with dysphagia and enlarging hypopharyngeal mass, clinically diagnosed as hypopharyngeal malignancy, right, at least stage III. Histopathologic examination including immunohistochemistry study with TLE1 and SS18 Fluorescence In Situ Hybridization (FISH) confirm the diagnosis of synovial sarcoma. This is the first reported case of synovial sarcoma of the hypopharynx in the Philippines confirmed by SS18 FISH. Due to the size of the mass, chemoradiotherapy followed by surgery is the current plan of management for this patient.

Caregiver active participation in psychoeducational intervention improved caregiving skills and competency.

AIM: To determine whether giving dementia caregivers active psychoeducational intervention is more efficacious than passive intervention for improving their caregiving skills and reducing their caregiving burden. METHODS: This study was a prospective, single-blinded, controlled trial with 43 caregiver/person-with-dementia dyads. The dyads were randomly assigned to the active psychoeducational intervention (AP) group, which used role-play, discussion, and development of problem-solving capacity to build up their caregiving skills and competence, or the passive psychoeducational intervention (PP) group, which gave caregivers educational materials on common caregiving strategies. Primary outcomes were the levels of caregiver competence (Care Skill Inventory [CSI]), burden (Chinese Zarit Burden Inventory [CZBI]), and distress caused by the behavioral and psychological symptoms of dementia (Neuropsychiatric Inventory-Questionnaire [NPI-Q]). Outcomes were assessed pre-test, post-test and after 3 months. Repeated measures one-way analysis of variance was used to compare mean-change scores between time-points, and generalized estimating equations (GEE) were used to compare groups. RESULTS: Post-test or 3-month (or both) Care Skill Inventory, Chinese Zarit Burden Inventory and Neuropsychiatric Inventory-Questionnaire distress levels were significantly (p < 0.05) better in the AP but not in the PP group. The generalized estimating equation intergroup comparison, adjusted for potential confounders, showed that Care Skill Inventory in the AP group was more significantly improved than in the PP group, and that Chinese Zarit Burden Inventory nearly reached significance. CONCLUSIONS: Active rather than passive psychoeducation, even in a short (3 months) intervention of six visits, was more efficacious for improving caregiving competence. Future studies will require larger samples. Geriatr Gerontol Int 2018; 18: 750-757.

Detection of cognitive impairment using self-rated AD8 and informant-reported AD8.

BACKGROUND/PURPOSE: Screening of dementia can help to initiate proper management of the disorder. The use of the Ascertain Dementia 8-item Questionnaire (AD8) in screening has been promoted in Taiwan recently. The purpose of this study was to compare the psychometric properties and appropriateness of informant-reported and self-rated AD8 in cognitive impairment screening in Taiwan. METHODS: The AD8 were administered to 153 participants and their informants recruited from two neurology out-patient clinics. The discriminative abilities for early cognitive impairment [Clinical Dementia Rating scale (CDR) 0.5 and 1] of informant-based and self-rating AD8 were determined and compared with their areas under the receiver operating curve. κ coefficients representing the agreement between self-rated and informant-reported AD8 scores were also calculated. RESULTS: Participants and their informants were aged 76.9 years and 56.0 years on average, respectively. Only informant-reported AD8 was significantly associated with CDR level (Spearman ρ=0.469, p<0.001) and Cognitive Abilities Screening Instrument score (Spearman ρ=-0.458, p<0.001). The item-by-item agreements between self-rated and informant-reported AD8 were poor (κ coefficients: -0.030 to 0.206). The area under the receiver-operator characteristic curve was 0.59 for self-rated AD8 scores, and 0.77 for informant-reported AD8 scores, indicating that the discriminating ability of AD8 scores between CDR 0 and CDR 0.5 or greater is better when reported by informant than when rated by self. CONCLUSION: Informant-rated AD8 gave more accurate screening results than self-reported AD8 in an out-patient clinic setting.

Antiplasmodial and chloroquine chemosensitizing and resistance reversal effects of coumarin derivatives against Plasmodium falciparum 3D7 and K1

Background Emergence of chloroquine (CQ) resistance among different strains of Plasmodium falciparum is the worst incident that has ever faced the dedicated efforts to eradicate malaria. The main cause of CQ resistance is over-activity of the pumping mechanism that ousts CQ outside the DV. This urged the scientists to look for other alternatives or adjuvants that augment its action. CQ The study aimed to test the potential of five coumarin derivatives, namely; umbeliferon, esculetin, scopoletine, herniarin and 3-aminocoumarine to inhibit plasmodium growth and reverse CQ resistance in Plasmodium falciparum K1 and 3D7. They are highly ubiquitous in nature and are famous by their diverse pharmacological effects. SYBRE green-1 based drug sensitivity assay was used to screen the effect of CQ and each coumarin on the parasite growth and isobologram technique was to assess the interaction of the coumarins with CQ. Effect of each coumarin on both RBCs and Vero cells stability as well as on RBCs fragility were screened to exclude any toxic impact on normal cells. On the other hand, their effect on hemozoin formation was screened to investigate about their molecular mechanism. For molecular characterization, Their antioxidant properties were determined using the conventional in vitro tests and their characters were obtained from Molinspiration Simulation Software. Results showed that all of them were safe to human cells, have weak to moderate plasmodial growth inhibitory effect and only umbeliferon, 3- aminocoumarin and esculetin has interacted effectively with CQ. These actions are neither correlated with hemozoin formation inhibition nor to the antioxidant mechanisms. Further studies recommended to investigate the mechanism of their action. Overall, all the tested coumarins are not ideal to be used in the conventional malaria therapy and only umbeliferon, 3-aminocoumarin and esculetin can be suggested to potentiate CQ action.

Daily consumption of foods and nutrients from institutional and home sources among young children attending two contrasting day-care centers in Guatemala City

Adequate nutrition is critical to child development and institutions such as day-care centers could potentially complement children’s diets to achieve optimal daily intakes. The aim of the study was to describe the full-day diet of children, examining and contrasting the relative contribution of home-derived versus institutional energy and nutrient sources. The present comparison should be considered in the domain of a case-study format. The diets of 33, 3-6 y old children attending low-income day-care centers serving either 3 or a single meal were examined. The home-diet was assessed by means of 3 non-consecutive 24-hr recalls. Estimated energy and nutrient intakes at the centers and at home were assessed and related to Recommended Nutrient Intakes (RNI). Nutrient densities, critical densities and main sources of nutrients were computed. We observed that in children attending the day-care center serving three meals, home-foods contributed less than half the daily energy (47.7%) and between 29.9% and 53.5% of daily nutrients. In children receiving only lunch outside the home, energy contribution from the home was 83.9% and 304 kcal lower than for children receiving 3 meals. Furthermore, between 59.0% and 94.8% of daily nutrients were provided at home. Daily energy, nutrient intakes and nutrient densities were well above the nutrient requirements for this age group, and particularly high for vitamin A. The overall dietary variety was superior in the situation of greater contribution of home fare, but overall the nutrient density and adequacy of the aggregate intakes did not differ in any important manner.

Ingesta diaria de alimentos y nutrientes provenientes de la dieta institucional y del hogar en niños que asisten a dos centros de cuidado infantil contrastantes en la ciudad de Guatemala. Una adecuada nutrición es crítica para el desarrollo infantil. Los centros de cuidado infantiles (CCI) podrían jugar un papel fundamental en la complementación de la ingesta de alimentos y nutrientes. El propósito de este estudio fue describir la dieta de niños, comparando la contribución relativa de energía y nutrientes de la dieta-hogar e institucional. El presente estudio debe ser considerado como una presentación de caso. Se examinó la dieta de 33 niños de 3-6 años que asisten a dos CCI utilizados por familias de escasos recursos y con diferencias en número de comidas servidas. Se determinó la dieta-hogar utilizando 3 recordatorios de 24-horas en días no-consecutivos. Se calculó la ingesta estimada de energía y nutrientes en las instituciones y en casa y se comparó con las Ingestas Recomendadas de Nutrientes. Se determinó la densidad de nutrientes y principales fuentes. Se observó que los alimentos consumidos en el hogar contribuyeron 47.7% de la energía diaria y entre 29.9% y 53.5% de los nutrientes diarios requeridos para los niños con 3 comidas en el CCI y de 83.9%, 59.0 y 94.8%, respectivamente, para los niños que consumen únicamente el almuerzo en el CCI. La ingesta diaria de energía fue 304 kcal mayor en los niños que consumieron 3 comidas fuera del hogar. No hubo mayor variación en las dietas cuando mayor era el consumo de alimentos en el hogar, sin embargo la densidad nutricional y la adecuación de la dieta completa fue adecuada en ambos centros, y particularmente elevadas para la vitamina A.

Effects of thoracic and fine PM and their components on heart rate and pulmonary function in COPD patients.

Population-based personal exposures to particulate matter (PM) and personal-ambient relationships of PM and component concentrations for outpatients with COPD and/or asthma were investigated in New York City (NYC) and Seattle for thoracic PM (PM(10)) and fine PM (PM(2.5)). Measurements of outdoor, indoor, and personal PM(10) and PM(2.5) concentrations were made concurrently for 12-consecutive days at 24 patients' residences. Filters were analyzed for elemental components, using XRF and black carbon (BC), by reflectance. Daily morning and evening measurements of heart rate (HR) and blood oxygen saturation (SpO(2)) by pulse oximeter, and forced expiratory volume in 1 s (FEV(1)) and peak expiratory flowrate (PEF) by spirometry were also measured, and symptom data were collected. Central monitoring site, outdoor, indoor, and personal concentration-response relationships of PM(2.5), PM(10-2.5), and their components were examined using mixed-effect models. The relatively small sample size of the study limited the interpretation of results, but of the PM chemical components examined, only nickel concentrations showed consistent associations, and only with HR in the NYC COPD patients.

Multimodality treatments with endoscopic mucosal resection of esophageal squamous cell carcinoma with submucosal invasion.

BACKGROUND AND STUDY AIMS: A standard treatment for esophageal squamous cell carcinoma (SCC) with submucosal invasion is considered to be radical resection at present. In this study, we evaluated the efficacy of multimodality treatments with endoscopic mucosal resection (EMR) of esophageal SCC with submucosal invasion. METHOD: Eighteen cases of SCC with submucosal invasion were treated with EMR. Lymphatic invasion was found in 11 cases (67%), and there were no cases of blood vessel invasion. EMR was performed prior to any other treatment. Chemotherapy and/or radiotherapy were added if indicated by the histopathological features. RESULTS: There were no cases of local recurrence. Lymph-node recurrence was detected in 1 case treated with EMR alone. There were no cases of cancer death. The overall survival rate was 83% in all patients. CONCLUSIONS: Multimodality treatments with EMR were effective in treating esophageal SCC with submucosal invasion.

Lifting of lesions during endoscopic mucosal resection (EMR) of early colorectal cancer: implications for the assessment of resectability.

BACKGROUND AND STUDY AIMS: This study assessed the indications for and limitations of endoscopic mucosal resection (EMR) for early colorectal cancer, focusing on the way in which the lesion lifts after submucosal injection. PATIENTS AND METHODS: The study included 94 patients with early colorectal cancer who received EMR treatment. The lifting of the lesion after submucosal injection was analyzed (classified as completely lifted/soft; completely lifted/hard; incompletely lifted; and non-lifted) along with the endoscopic findings, pathological findings, and clinical course. RESULTS: Almost all completely lifted/soft lesions were mucosal cancers. Some of the completely lifted/hard lesions were staged as sm2. The incompletely lifted lesions included stages sm1 to sm3. Non-lifting lesions were almost always deeper than sm3. The lifting condition was significantly associated with the depth of invasion, and the lesion type was related to the extent of lifting but not to tumor size or recurrent disease. Recurrent disease was noted in three patients who underwent piecemeal EMR. CONCLUSIONS: The indication for EMR is easily assessed on the basis of the lifting characteristics of the tumor after submucosal injection, which was found to be significantly related to the depth of invasion. The factor limiting the indication for EMR is not the size of a tumor, but its lifting condition.

ERCP imaging.

Localization and spread of pancreatic diseases has been a reality since the availability of endoscopic pancreatography in the late 1960s, particularly after development of a fiberscope for this purpose. Endoscopic pancreatography allowed the clinician to discern the position and site of cancers, cysts, and localized inflammations. Ductal anomalies, such as annular pancreas, nonfusion, and anomalous junction of pancreatobiliary connection, were clearly recognized also. The pancreatography opacified the real lumen instead of the virtual images of ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), so that precise studies comparing histopathologic details could be performed. The pancreatic ductal information visualized by using the fiberscope changed our understanding of chronic inflammation of the pancreas. Chronic diffuse pancreatitis, upstream pancreatitis, ductitis, and duct-narrowing pancreatitis were specified from their pathogenetic differences. Although the noninvasive methods such as US and CT will be the first choice for the diagnosis of pancreatic diseases, pancreatography will still be important for the morphologic studies of the pancreas in various disease conditions.

[Portal hemodynamic changes from TIPS--evaluation with pulse Doppler method].

Transjugular intrahepatic portosystemic shunt (TIPS) was applied in three patients with Child C liver cirrhosis. Portal venous pressure was reduced by an average of 10.7 mmHg, and results such as the disappearance of esophageal varices and reduction in ascites were obtained. The portal hemodynamics of these three patients was observed before and after TIPS using the pulse Doppler method. When portal hemodynamics in the main portal vein was examined before TIPS, it was found that the mean blood flow velocity had decreased, the blood flow volume was reduced and the cross-sectional area of the vein had increased. The congestion index was high and there was definite congestion of the portal venous system. After TIPS, the blood flow velocity and volume increased, the cross-sectional area of the vein was reduced and the congestion index was lower. Congestion of the portal venous system was improved in these three patients and the clinical efficacy of TIPS was proven by these results. If the stent can be detected sonographically, stent patency is easily confirmed with the pulse Doppler method which is usefull examination technique for follow-up of patients undergoing TIPS.

[Diagnosis of cholelithiasis--endoscopic pancreatocholangiography].

Endoscopic cholangiography is fundamentally evaluated as X-ray anatomy of the biliary system as well as the principal technique for endoscopic treatments that is endoscopic papillotomy and endoscopic drainage, while gallstone is routinely diagnosed by ultrasonography in medical practice. By endoscopic cholangiography, stones in the cystic duct and the common bile duct are confirmedly diagnosed in the same quality as gallbladder stones, and the anatomical information of the cystic duct, the gallbladder, and the duodenal papilla are clearly demonstrated, which are required in many therapeutic procedures for gallstones diseases including laparoscopic cholecystectomy.

Technical guidance of endoscopic pancreatocholangiography.

Endoscopic pancreatocholangiography, frequently abbreviated as ERCP, is an X-ray examination of the pancreatic and biliary ducts cannulating the duodenal papilla using the fiberscope. This procedure is the only clinical examination of the pancreatic duct, and is an indispensable technique for endoscopic treatments and further investigations: endoscopic papillotomy, drainage, lithotomy, endoprothesis, pancreatoscopy, and collection and cytology of pure juice. For this examination, a skill in endoscopy is required, and the understanding of the papilla orifice, which consists of prolapsed ampullar folds in the living body, is essential. The catheter should be inserted straight toward the individual duct: the pancreatic and the biliary duct. As ultrasonography and computed tomography are advanced, the clinical roll of ERCP should be reevaluated. However, the pancreatography expresses exactly the ductal pathology, which is reflected by the background pathology of the pancreas: chronic pancreatitis, nonfusion, pancreatobiliary maljunction, small cancerous, mucous-producing tumors, and cystic lesions.

[Non-fusion of the ventral and dorsal pancreatic ducts].

Non-fusion of the ventral and dorsal pancreatic ducts is an anomaly of the ductal system of the pancreas; no connection between the ventral and the dorsal pancreatic ducts. The pancreas, however, keeps normal shape examined by US, CT, and laparotomy. The dorsal pancreatography through the accessory papilla is essential in diagnosis of non-fusion, because the short pancreatic duct through the main papilla is sometimes observed in chronic pancreatitis, anomalous defect of the distal pancreas, pancreatic cancer, and cyst. The 30 cases of the non-fusion were experienced in our institute which were all confirmed by dorsal pancreatography; they were nearly half of the confirmed cases in Japan. The incidence is 0.5% in about 6000 endoscopic pancreatographies during 1969-1984. The age distribution is 25-79 year-old, the average 44.7, and 19 cases are male and 11 female. The pancreatitis-like pain is frequently observed in cases with non-fusion. The 13 cases, 43%, in our series complained of pancreatic pain (called P-group), but the other 17 did not (called non-P group). The age distribution, sex, and the incidence of alcohol intake, DM, gallstone diseases, however, are not different between these two groups. The figure of the ventral pancreatic duct was not characteristic in both groups. The obvious chronic pancreatitis (chronic dorsal pancreatitis) is only two even in P-group and none in non-P group. The pancreatitis-like pain may be occurred by the reason why the functionally lesser accessory papilla which is an only out-left of the larger dorsal pancreas in non-fusion could not adapt the over-load for the pancreas, for example by alcohol. The non-fusion of the pancreatic duct system is not a direct cause of pancreatitis but might be a disposition of it.

[Carcinoembryonic antigen (CEA), serum amylase and pancreozymin-secretin test in relation to stages of pancreatic cancer].

In cases of surgically proved pancreatic carcinoma, preoperative values of serum CEA, serum amylase and pancreozymin-secretin test (PST) were seen if they related to the macroscopic stages of the tumor determined by "General Rules for Surgical and Pathological Studies on Cancer of Pancreas" offered by Japanese Pancreatic Society in April 1982. Serum CEA was determined in 43 cases, serum amylase in 34 cases and PST was done in 28 cases. All of CEA, amylase and PST showed no statistically significant relationship to the stages of the carcinoma. This may suggest that these tests may not be a useful indicator of the stage of tumor.

Remote contrast injector in ERCP for protection from X-ray exposure.

To protect the assistants from radiation during ERCP, a remote contrast injector employing a lever mechanism (push lever type) was developed. Using this remote injector, safe, finely controlled and easy injection of the contrast material was achieved without X-ray exposure to the assistants in ERCP.