Introduction: Malignant melanoma is a cancer of melanocytic origin, typically cutaneous.Despite recent advances, the prognosis is poor.Brain metastases occur in approximately 7-16% of cases and leptomeningeal metastases in 5-7%.Primary central nervous system (CNS) melanoma is rare, accounting for 1% of all melanoma cases and 0.07% of brain tumors.Methods: A 65-year old man presented with haemorrhagic venous infarction of the left temporal lobe, leading to reversible motor aphasia and right-sided hemiparesis.Brain magnetic resonance imaging also revealed peculiar supratentorial cerebral and meningeal lesions suggesting neoplasia or vasculitis.Ancillary tests were unremarkable, a brain biopsy was proposed, but the patient declined.After 1.5 years symptoms recurred and imaging studies found progression of lesions, with necrosis and surrounding vasogenic oedema.The patient fi nally agreed to a brain biopsy for conclusive diagnosis.Results: Histopathological and immunohistochemical assessment was consistent with malignant pigmented melanoma.There were no suspicious primary lesions, but the patient recounted having had a thoracic skin lump excised some years prior, allegedly benign, yet unavailable for second opinion.Conclusion: In suspicious CNS presentations, histopathological reevaluation of previously excised skin lesions is advised, especially if brain biopsy cannot be performed.Albeit rare, primary CNS melanoma should also be considered.
Introduction: In younger patients, ceramic-on-ceramic (CoC) bearing surfaces are usually recommended for total hip replacement (THR) because of their low wear rate and longer expected functional life. Although technical advancements have reduced the risk of ceramic bearings fracture, this complication remains a major concern. Case description: We present the case of a 56-year-old patient undergoing 3 revision hip arthroplasties of the right hip due to ceramic liner fractures. Initial THR (2008) was performed with a CoC bearing, followed by liner fracture due to trauma a year later. The acetabular component and liner were replaced, with a minor incongruence between the old head and new insert. The 2nd ceramic insert fractured 3.5 years later, following minor trauma. Upon revision, the bearing surface was changed to metal-on-polyethylene (MoP). The performed retrieval analysis demonstrated stripe and rim wear, and evidence of adhesive wear. The patient was referred to us a month later, with a fistula on the lateral side of the hip, discharging black, petroleum-like liquid. Radiology showed well-fixed implants, no dislocation and no apparent polyethylene wear. Microbiological assessment of the discharge showed no infection. Intraoperatively massive metallosis was noticed, with stable acetabular and femoral components. The metal femoral head was heavily abraded, with almost 1% volumetric wear. Hematoxylin and eosin stained frozen tissue samples showed muscular and adipose tissue necrosis, while polarized light microscopy highlighted metal, polyethylene, and ceramic particles. Conclusion: The present case is yet another report showing the adverse outcomes of using MoP bearings for revision after ceramic liner fracture in THR.
It was accepted several years ago that, in the carcinogenesis process of human cancers, biologic agents, especially the viruses, are playing an etiologic role. This is the case of lymphomas (retroviruses), hepatocarcinoma (hepatic viruses) and cervical carcinoma (papilloma viruses). Helicobacter pylori is the first bacteria recognized as a first class carcinogen for gastric cancer. Nevertheless, comparing with the most validated human carcinogens, the activity of H. pylori is very little studied. As a consequence, at this moment, in its case, explanation of carcinogenesis mechanism is more or less hypothetical.
The first medical hypothesis about the possible relationship between chronic inflammatory response and carcinogenesis belongs to Virchow and it was published in 1893. In these days, multiple studies demonstrate the certain involvement of chronic inflammation as trigger of progression towards malignancy. The fact that in 1994, the International Agency for Research on Cancer considered Helicobacter pylori as first class carcinogenic agent, is postulating the existence of the pathogenical chain carcinogenesis, of chronic inflammatory lesions as it was described by Correa, as a first step. Our study including 75 patients who underwent surgical procedures for gastric lesions uses immunohistochemical studies for lymphocytes phenotyping, to identify the nature of inflammatory cells involved, correlating the results with the presence of Helicobacter pylori. We tried to bring new information needed for establish to what extent the chronic inflammation of gastric mucosa is a response to the presence of bacteria and is implicated in tumorigenesis. We used T cells antibodies: CD3, CD4, CD5, CD8, CD57, GranzymeB and B cells antibodies: Cd20 and CD23. Our results revealed the presence of immune cellular response to Helicobacter pylori in gastric mucosa, based on T helper, cytotoxic and NK cells. B cells have a minor role in this response. CD4+ cells seem to be involved in local protection response as well as in carcinogenesis, while CD8+ have a minor or no role in carcinogenesis.
Anterior cruciate ligament (ACL) reconstruction technique was under tremendous improvement during last 10 years; anatomical versus transtibial technique gradually increased, with soft tissue graft overcoming bone-tendon-bone, and biodegradable exceeding metallic implants. Still, complications related to ACL reconstruction are reported; one of it is pretibial cyst formation. Pretibial cyst formation is reported to develop between 2 and 5 years post-operation. We report a case in which the cyst was developed at 2 years after surgery; a biocomposite screw was used for fixation on tibial site, in an ACL reconstruction done with soft tissue autograft. The MRI examination suggested the diagnostic, which was confirmed by histological examination of the cyst. The screw suffered multiple fragmentation; the remnants were retrieved and analyzed. The knee stability was not affected by the cyst development. After retrieval of the screw and appropriate rehabilitation, the patient recovery was complete. The presented case confirms that even biocomposite screw may be related to these sorts of complications, mainly related to plain biodegradable screws. The case offers a point of start for analysis of the literature. A precise ethology of this kind of complications is still unknown; a lot of theories have been developed, two of them seem to be related to our case. Technical improvement together with long time surveillance of cases in which biocomposite implants were used may improve our knowledge concerning the fate of these implants.
Periodontal pathology is often represented by increases in gingival volume, with pronounced inflammatory phenomena.These manifestations require a more accurate diagnosis and knowledge of the etiopathogenic factors involved.The periodontal treatment applied must be related with the etiopathogenic circumstances.Periodontal disease sometimes has a complex appearance, with intertwined local and systemic favorable factors that make it difficult to include it in a certain taxonomic form.Also, in general, the adult patients have associated chronic diseases that involve the administration of several drugs, which induce on long-term both therapeutic and side effects.Furthermore, diseases in the oral cavity may occur frequently, which require complex and associated dental and periodontal treatment, also occlusal rebalancing, which is a real interdisciplinary challenge.In this case report, periodontal status is determined by a combination of local and systemic favorable factors.However, the histopathological analysis of the gingival samples revealed inflammation without characteristic fibrous hyperplasia changes of the Amlodipine calcium channel blocker (CCB) administration, the antihypertensive medication of the patient.Thus, Amlodipine does not have a hyperplasic effect on gingival mucosa in all cases.Therefore, even if they are more expensive, investigations must be complex, if necessary, in establishing the involvement of the side effect of the systemic medication in periodontal pathological changes.CCB systemic medication is essential, even vital, for maintain the arterial pressure at normal values, should not be altered without the real indication and to the recommendation from a specialist doctor, and the periodontal treatment must be focused to eliminate the local factors.
Objectives. Dysferlinopathies are a group of rare genetic myopathies characterized by muscle weakness and atrophy with four distinct clinical phenotypes: Miyoshi myopathy, limb girdle muscular dystrophy type 2B, distal myopathy with anterior tibial onset and an intermediate proximo-distal phenotype. We report a case of dysferlinopathy and discuss relevant clinical, pathological and genetic data. Material and methods. We present the case of a 36 years old man with more than ten years history of progressive muscle weakness and atrophies in the distal lower limbs. He had a first clinical evaluation at the age of 24 years and a muscle biopsy was performed but it was inconclusive. On current admission, he presented with clinical suspicion of Charcot-Marie-Tooth disease, but because of increased serum creatine kinase levels and EMG (electromyography) findings of myopathy, another muscle biopsy was recommended. The muscle tissue obtained was analysed by histopathology, immunohistochemistry, and Western blot techniques, and also a genetic confirmation was recommended. Results. Based on morphological findings, electrodiagnostic study results and clinical context, the diagnosis of primary dysferlinopathy was established, supported by genetic data. Conclusions. The diagnosis may be challenging in these rare genetic myopathies, due to the high variability of phenotypes, ranging from asymptomatic hyperCKemia (high serum creatine kinase level) to a severe clinical picture with loss of ambulation. Repeated evaluation, increasing access to genetic testing and a multidisciplinary approach made an accurate diagnosis possible in our case.
Metallosis is an adverse event developed in relation with an orthopedic implant. It was brought into attention by metal on metal total hip arthroplasty. Lately, cases were diagnosed in total knee, total elbow, and spinal surgery. Metallic debris - released because of wear or corrosion - start an inflammatory response in a chronic condition. Beside local effects, systemic effects are also described; among them toxic effects, neurological and psychiatric, alteration in thyroid and heart function, skin rushes and discoloration. Diagnosis is helped by x-ray examination but is based on fluid aspiration with ions level determination and histological examination. Osteolysis phenomena induced by metallosis may compromise bone ingrowth and promote implant loosening; as result bone stock may be compromised. The cases we present have a particular development pattern; each of them was initiated as a result of atypical behavior of the implants. Two of them necessitated bone grafting in order to replace the reduced bone stock and all three required revision surgery. The cases emphasize the diagnosis methodology and the possible complications encountered during orthopedic implant surgery.
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