Coexistence of squamous cell tracheal papilloma and carcinoma treated with chemotherapy and radiotherapy: a case report

BACKGROUND: Papillomatosis presents, most frequently, as multiple lesions of the respiratory tract, which are usually considered benign. Malignant degeneration into squamous cell carcinoma is quite common, although curative approaches vary a lot in modern literature. CASE REPORT: We report a case of a 66-year-old male patient with the coexistence of multiple squamous cell papilloma and carcinoma in the upper trachea with severe airway obstruction that was diagnosed through bronchoscopy and treated by performing an urgent tracheostomy, followed by concurrent chemotherapy and radiotherapy. There was no evidence of recurrence after a 12-month follow-up period. CONCLUSION: This study underlines the diagnostic and therapeutic value of bronchoscopy as well as multimodality palliative treatment in such cases. To the best of our knowledge, this is the first study to describe an immediate treatment protocol with tracheostomy and concurrent chemotherapy/radiotherapy in a patient with squamous cell tracheal papilloma and carcinoma

A rare case of anastomosis between the external and internal jugular veins

Jugular veins bring deoxygenated blood from the head back to the heart. There are two sets of external and internal veins. The external jugular vein receives the greater part of the blood from the cranium and the deep parts of the face. It commences from the substance of the parotid gland and runs down the neck at the posterior border of sternocleidomastoideus and ends in the subclavian vein in front of the scalenus anterior. The external jugular vein is covered by the platysma and its upper half runs parallel with the great auricular nerve. There is also another minor jugular vein, the anterior, draining the submaxillary region. In our patient, we recognized a shunt between the external and internal jugular veins. It appeared in the middle of the veins, between the pair of valves, which are placed ~2.5 cm above the termination of the vessel. The anastomosis was fully functional, and there was no problem in the blood pressure of the patient. Moreover, the shunt was not associated with any systemic disease

Sex differences of continuous positive airway pressure treatment on flow-mediated dilation in patients with obstructive sleep apnea syndrome

Introduction: There is growing research evidence suggesting the presence of endothelial dysfunction and systemic inflammation in patients with obstructive sleep apnea syndrome (OSAS). Continuous positive airway pressure (CPAP) is the most effective method for treating OSAS; nonetheless, the effects of CPAP on the aforementioned pathophysiologic pathways as well as on the systemic disease that result or coexist with the OSAS remain elusive. Aim: To assess the effect of 3-month CPAP therapy on endothelial-dependent dilation, plasma levels of inflammatory markers, blood pressure (BP), and glucose control on male and female patients with OSAS. Methods: Our study group consisted of 40 (24 males and 16 females) patients with no prior history of cardiovascular disease, with an apnea-hypopnea index >= 15, who were assigned to receive CPAP treatment. Measurements of flow-mediated dilation (FMD), 24-hour ambulatory BP, and blood analysis were performed at baseline and 3 months after CPAP therapy. Results: Baseline FMD values were negatively correlated with the apnea-hypopnea index (r=-0.55, P=0.001). After 3 months of CPAP, there was an increase in the FMD values (5.40%+/- 2.91% vs 3.13%+/- 3.15%, P<0.05) and a significant reduction in the patients’ 24-hour systolic BP (122.82 +/- 11.88 mmHg vs 130.24 +/- 16.75 mmHg, P<0.05), diastolic BP (75.44 +/- 9.14 mmHg vs 79.68 +/- 11.09 mmHg, P<0.05), and pulse pressure (47.38 +/- 9.77 mmHg vs 52.72 +/- 11.38 mmHg, P<0.05); daytime systolic BP (125.76 +/- 12.69 mmHg vs 132.55 +/- 17.00 mmHg, P<0.05) and diastolic BP (77.88 +/- 10.39 mmHg vs 82.25 +/- 11.01 mmHg, P<0.05); nighttime systolic BP (118.17 +/- 13.16 mmHg vs 126.22 +/- 17.42 mmHg, P<0.05) and pulse pressure (46.61 +/- 10.76 mmHg vs 52.66 +/- 11.86 mmHg, P<0.05); and C-reactive protein and HbA1c levels (0.40 [0.40-0.70] mg/L vs 0.60 [0.40-0.84] mg/L and 5.45%+/- 0.70% vs 5.95%+/- 1.08%, respectively; P<0.05). When divided by sex, only male patients produced similar statistically significant results, while female patients failed to show such associations. Conclusion: Our results suggest that CPAP therapy improves the endothelial function, the BP, and the glucose control in male patients with OSAS. Further research is warranted in order to verify these results and to further elucidate the impact of CPAP on the cardiovascular risk of male and female patients with OSAS

Apparent Diffusion Coefficient Quantification in Determining the Histological Diagnosis of Malignant Liver Lesions

Purpose: Diffusion Weighted Imaging is an established diagnostic tool for accurate differential diagnosis between benign and malignant liver lesions. The aim of our study was to evaluate the role of Histogram Analysis of ADC quantification in determining the histological diagnosis as well as the grade of malignant liver tumours. To our knowledge, there is no study evaluating the role of Histogram Analysis of ADC quantification in determining the histological diagnosis as well as the grade of malignant liver tumours. Methods: During five years, 115 patients with known liver lesions underwent Diffusion Weighted Imaging in 3Tesla MR scanner prior to core needle biopsy. Histogram analyses of ADC in regions of interest were drawn and were correlated with biopsy histological diagnosis and grading. Results: Histogram analysis of ADC values shows that 5th and 30th percentile parameters have statistically significant potency of discrimination between primary and secondary lesions groups (p values 0.0036 and 0.0125 respectively). Skewness of the histogram can help discriminate between good and poor differentiated (p value 0.17). Discrimination between primary malignancy site in metastases failed for the present number of patients in each subgroup. Conclusion: Statistical parameters reflecting the shape of the left side of the ADC histogram can be useful for discriminating between primary and secondary lesions and also between well differentiated versus moderate or poor. For the secondary malignancies, they failed to predict the original site of tumour