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Proc (Bayl Univ Med Cent) ; 32(2): 283-285, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31191156


Yellow fever is a mosquito-borne viral hemorrhagic fever endemic to sub-Saharan Africa and South America associated with significant morbidity and mortality. The use of a live attenuated vaccine can prevent yellow fever, but vaccine-associated neurologic disease has been reported and is a safety concern. We present the case of a previously healthy 35-year-old active-duty man who received the yellow fever vaccine prior to deployment and subsequently developed progressive neurologic dysfunction consistent with transverse myelitis.

Laryngoscope ; 125(11): 2503-8, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26227748


OBJECTIVES/HYPOTHESIS: The purpose of this study was to retrospectively review patients with human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPSCC) for the presence of retropharyngeal lymph nodes (RPLNs) prior to treatment using positron emission tomography/computed tomography (PET/CT), and to determine if the presence of RPLNs is of utility in predicting outcomes. STUDY DESIGN: Retrospective review of patient data from a single institution. METHODS: Two hundred thirty patients with a diagnosis of HPV-associated OPSCC were identified from 2002 to 2013. The presence of RPLNs was determined primarily from findings on PET/CT as reviewed in a standardized fashion by two neuroradiologists. RESULTS: Of the 230 patients, 165 had pretreatment PET/CT imaging available for review. There were a total of 16 patients (9.70%) with evidence of RPLNs. Among patients positive for RPLNs pretreatment, with an average follow-up of 2 years, there was a 5.2-times greater odds of having recurrence or death (31.3% vs. 8.1%, P=.004). When T and N stage were adjusted for with multiple regression, there was no significant association between RPLN status and recurrence free survival. CONCLUSIONS: This is a unique investigation utilizing PET/CT to classify RPLN status in HPV-associated OPSCC. RPLNs were relatively common in our HPV-associated OPSCC cohort at 9.70%, at the low end of the quoted positivity of 10% to 27% in all OPSCC. A combination of PET/CT is useful in identifying RPLNs. Prospective investigation will be needed to determine the sensitivity and specificity of PET/CT in identifying RPLNs, and the precise impact of RPLNs on HPV-associated OPSCC treatment and outcomes. LEVEL OF EVIDENCE: 4.

Alphapapillomavirus , Carcinoma de Células Escamosas/patologia , Neoplasias de Cabeça e Pescoço/patologia , Neoplasias Orofaríngeas/patologia , Infecções por Papillomavirus/complicações , Idoso , Carcinoma de Células Escamosas/virologia , Feminino , Neoplasias de Cabeça e Pescoço/virologia , Humanos , Linfonodos/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Orofaríngeas/virologia , Radiografia , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço , Neoplasias da Língua/patologia , Neoplasias da Língua/virologia , Neoplasias Tonsilares/patologia , Neoplasias Tonsilares/virologia
Otolaryngol Clin North Am ; 48(5): 805-15, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26117299


The purpose of this article is to identify and define the appropriate imaging techniques in the evaluation of post-functional endoscopic surgery (FESS) complications. Although most complications encountered during FESS are identified readily during surgery, some are less conspicuous and require postoperative imaging. As illustrated in this article, these include cerebrospinal fluid leak, vascular injury, brain injury, orbital injury, and infectious complications of the brain and meninges. Some of the common anatomic variants of the paranasal sinuses are identified, and how these may predispose to surgical complications is discussed.

Vazamento de Líquido Cefalorraquidiano/diagnóstico , Endoscopia/efeitos adversos , Seios Paranasais/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Humanos , Imagem por Ressonância Magnética
Synapse ; 59(8): 513-20, 2006 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-16565967


Myocyte enhancer factor 2A (MEF-2A) is a calcium-regulated transcription factor that promotes cell survival during nervous system development. To define and further characterize the distribution pattern of MEF-2A in the adult mammalian brain, we used a specific polyclonal antiserum against human MEF-2A to identify nuclear-localized MEF-2A protein in hippocampal and frontal cortical regions. Western blot and immunocytochemical analyses showed that MEF-2A was expressed not only in laminar structures but also in blood vessels of rat and human brains. MEF-2A was colocalized with doublecortin (DCX), a microtubule-associated protein expressed by migrating neuroblasts, in CA1 and CA2 boundaries of the hippocampus. MEF-2A was expressed heterogeneously in additional structures of the rat brain, including the striatum, thalamus, and cerebellum. Furthermore, we found a strong nuclear and diffuse MEF-2A labeling pattern in spinal cord cells of rat and human material. Finally, the neurovasculature of adult rats and humans not only showed a strong expression of MEF-2A but also labeled positive for hyperpolarization-activated, cyclic nucleotide-regulated (HCN) channels. This study further characterizes the distribution pattern of MEF-2A in the mammalian nervous system, demonstrates that MEF-2A colocalizes with DCX in selected neurons, and finds MEF-2A and HCN1 proteins in the neurovasculature network.

Lobo Frontal/metabolismo , Hipocampo/metabolismo , Proteínas de Domínio MADS/biossíntese , Fatores de Regulação Miogênica/biossíntese , Medula Espinal/metabolismo , Adulto , Animais , Western Blotting , Feminino , Lobo Frontal/irrigação sanguínea , Hipocampo/irrigação sanguínea , Humanos , Imuno-Histoquímica , Fatores de Transcrição MEF2 , Masculino , Neurônios/metabolismo , Ratos , Ratos Long-Evans , Medula Espinal/irrigação sanguínea