Alexandros G.Sfakianakis

Zusammenfassung Hintergrund Gefäßchirurgische Eingriffe in der Leiste können als Folge von Wundheilungsstörungen mit komplexen Gewebedefekten assoziiert sein. Bei der Auswahl der plastischen Deckung muss mit einem vaskulär kompromittierten Gewebe gerechnet werden. Demnach muss die Defektrekonstruktion individuell geplant werden. Zur Auswahl stehen nicht nur randomisiert durchblutete lokale Lappen, sondern auch perforatorbasierte, gestielte Lappen und mikrovaskuläre Lappen. Ziel der Arbeit Wir geben eine Übersicht über plastische Deckungsmöglichkeiten von Leistendefekten mit dem Fokus auf komplexe Wunden nach gefäßchirurgischen Komplikationen. Dabei sollen die Vor- und Nachteile der einzelnen Lappenplastiken anhand von 2 Fallberichten erklärt und Alternativen gezeigt werden. Patienten und Methoden Anhand zweier Fallbeispiele wird dargestellt, wie die Defektdeckung aufgrund der jeweiligen lokalen Gefäßsituation individuell geplant und durchgeführt wurde. Ergebnisse Sowohl der perforatorbasierte, gestielte fasziokutane Propellerlappen des Oberschenkels (ALT) wie auch der perforatorbasierte, gestielte abdominale Verschiebelappen konnten die Defekte erfolgreich versorgen. Diskussion Unter Berücksichtigung der vorliegenden individuellen Gefäßsituation sollte stets die Deckung mit der sichersten Gewebedurchblutung gewählt werden. Bei Bedarf sollten auch unkonventionelle bzw. seltener angewandte Lappenplastiken in Betracht gezogen werden, um langfristig die bestmögliche Deckung mit sicherer Wundheilung und Infektprophylaxe zu gewährleisten. fromon Inoreader http://ift.tt/29R6OuM via IFTTT from on Inoreader http://ift.tt/2a6mZFG via IFTTT

The cytological diagnosis of hepatocellular adenoma (HCA) is difficult since it is a very rare tumor and lacks characteristic cytological features. We have just reported a case of inflammatory HCA that displayed an unusual histological pattern (Clin J Gastroenterol 8:426–434, 2015). A touch cytology smear sample was obtained from the surgical specimen, and it also exhibited very unique features. A 56-year-old male underwent partial hepatectomy for an inflammatory HCA (diameter: 1.4 cm) in the right posterior lobe of the liver. The cytological sample displayed a characteristic two-cell pattern. One type of cells contained thick cytoplasm, a high nucleus/cytoplasmic (N/C) ratio, and well-defined cytoplasmic borders. The other type demonstrated small pyknotic nuclei and a lower N/C ratio. The immunohistochemical staining pattern of the histological specimen suggested that the latter cells might have been undergoing apoptosis. We report a case of inflammatory HCA with characteristic features. To diagnose this type of variant, it is important to recognize the unique pattern described in this study. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc. fromon Inoreader http://ift.tt/29ScOoe via IFTTT from on Inoreader http://ift.tt/2a8cLas via IFTTT

Although the cervical Pap test was devised for the detection of primary cervical neoplasia, it can provide additional diagnostic information, and in some cases, be diagnostic for noncervical processes. The diagnosis of metastatic extrauterine cervical cancers on the Pap test is extremely rare; and in most cases, it is the result of an ovarian or fallopian tube primary. Further, urinary tract cancers, including renal and urinary primaries are exceedingly rare. To our knowledge, six surgical cases of metastatic clear cell renal cell carcinoma (RCC) have been described. We report the first case of metastatic clear cell RCC detected on the cervical Pap test. Additionally, to our knowledge, we report the second case of metastatic high-grade urothelial carcinoma detected on the cervical Pap test. Both patients had a history of malignancy, which underscore the importance of broadening the differential diagnosis to rule out cytomorphologic features consistent with a patient's primary diagnosis when interpreting the cervical Pap test. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc. fromon Inoreader http://ift.tt/2aqprWo via IFTTT from on Inoreader http://ift.tt/2a6mCuF via IFTTT

Condition:   Head and Neck NeoplasmsIntervention:   Behavioral: Rehabilitation Consult (RC)Sponsors:   Sunnybrook Health Sciences Centre;   Princess Margaret Hospital, Canada;   Toronto General Hospital;   University Health Network, TorontoRecruiting - verified July 2016 fromon Inoreader http://ift.tt/29SkBjt via IFTTT from on Inoreader http://ift.tt/2a8cR1I via IFTTT

Background Myelomatous effusions (ME) of the serous cavities are rare. Identification of the atypical plasma cells in the body fluids may be critical for prognostic considerations. Methods We retrospectively reviewed clinicopathologic findings of 21 serous effusion specimens from 13 cases of ME including 10 pleural, two concurrent pleural and pericardial, and one peritoneal from 1994 to 2014. Result All 13 patients had bone marrow biopsy-proven plasma cell myeloma (PCM), including one plasmablastic-variant, one anaplastic-variant and one plasma cell leukemia. The time between the bone marrow diagnoses to serous cavity involvement ranged from 43 days to 9 years (mean 2.6 years, median 1.8 years). Monoclonal protein types showed predominant IgA subtypes (50%) including IgA-kappa (2), IgA-lambda (3), IgG-kappa (2), IgG-lambda (1) free kappa chain (1) and free lambda chain (1) and three unknown. All 13 patients died of disease (median survival 32 days). Concurrent imaging studies showed evidence of adjacent local disease. Cytology of the serous fluids revealed abundant plasma cells with varying degrees of atypia, including large cells with increased N/Cratios, coarse chromatin, and prominent nucleoli. All were CD138 positive. Of these, Cytology confirmed malignancy in 19/21(90%) cases. Five cases were positive for kappa-light chain and eight cases for lambda-light chain. Cytogenetics of 3/7 cases showed normal karyotype and 4/7 cases showed complex-karyotype. The patients with kappa light-chain had better survival compared to lambda light-chain (p = 0.051, log rank test). Conclusion ME in PCM can present early in the natural history of the disease or very late. The preponderance of IgA-myeloma and complex-cytogenetics abnormalities is a noteworthy finding. Although there are different hypotheses regarding how ME develops in PCM, our finding supports the hypothesis that direct spread of PCM into serous cavities is a likely mechanism. Diagn. Cytopathol. 2016. © 2016 Wiley Periodicals, Inc. fromon Inoreader http://ift.tt/29Sd2M7 via IFTTT from on Inoreader http://ift.tt/2a6mBXp via IFTTT

Conditions:   Neoplasms;   Geriatric Assessment;   Lung Neoplasms;   Colorectal Neoplasms;   Head and Neck Neoplasms;   Gastrointestinal Neoplasms;   Geriatrics;   Polypharmacy;   Quality of LifeIntervention:   Other: Comprehensive geriatric careSponsors:   Aarhus University Hospital;   Danish Cancer SocietyRecruiting - verified July 2016 fromon Inoreader http://ift.tt/29VINFB via IFTTT from on Inoreader http://ift.tt/2a8cCE7 via IFTTT

Conditions:   Head and Neck Cancer;   DepressionInterventions:   Drug: Ketamine;   Other: PlaceboSponsors:   Scott A. Irwin, MD, PhD;   Icahn School of Medicine at Mount SinaiRecruiting - verified July 2016 fromon Inoreader http://ift.tt/29SkkgE via IFTTT from on Inoreader http://ift.tt/2a6mXNK via IFTTT

Condition:   Head and Neck Squamous Cell CarcinomaIntervention:   Drug: 5-AzacitadineSponsor:   Yale UniversityRecruiting - verified July 2016 fromon Inoreader http://ift.tt/29VIWbP via IFTTT from on Inoreader http://ift.tt/2a8dh8n via IFTTT

The new capability to generate mimicking chemical analogues and perform mass screenings of candidate drugs has been tested on B-cell receptor signalling, a driver of B-cell malignancies. These efforts have identified ibrutinib as a potent inhibitor of Bruton's tyrosine kinase. As the clinical use of ibrutinib increases, continued vigilant monitoring for rare adverse events is prudent, including the development of secondary malignancies. To date, the most common reported secondary malignancy is non-melanoma skin cancer; however, we present a case of secondary primary lung adenocarcinoma becoming clinically apparent shortly after initiating therapy with ibrutinib. Our patient had a sudden regression of the tumour with discontinuance of ibrutinib, and based on our understanding of paradoxical tumour growth caused by tyrosine kinase inhibitors it is our hypothesis that the complex multikinase activity of ibrutinib may stimulate tumour growth by targeting a subset of protein kinases critical for growth in some cancer cells. from Melanoma via xlomafota13 on Inoreader http://ift.tt/29XIyJ0 from on Inoreader http://ift.tt/2a85Huz via IFTTT

Nature Immunology 17, 905 (2016). doi:10.1038/ni.3530 Author: Zoltan Fehervari from http://ift.tt/29SCzlO via IFTTT from on Inoreader http://ift.tt/29W1gBC via IFTTT

Nature Immunology 17, 896 (2016). doi:10.1038/ni.3507 Authors: Joanna Brzostek & Nicholas R J Gascoigne The thymic development of CD8+ T cells requires the presentation of different sets of peptides on major histocompatibility complex class I for positive selection and negative selection. from http://ift.tt/29VZ1yi via IFTTT from on Inoreader http://ift.tt/29SDuCT via IFTTT

Nature Immunology 17, 905 (2016). doi:10.1038/ni.3528 Author: Laurie A Dempsey from http://ift.tt/29SBo5X via IFTTT from on Inoreader http://ift.tt/29W0Qv5 via IFTTT

Nature Immunology 17, 898 (2016). doi:10.1038/ni.3516 Authors: Sascha Rutz & Wenjun Ouyang The E3 ubiquitin ligase Itch limits interleukin 17A (IL-17A)-mediated intestinal inflammation by targeting the transcription factor ROR-γt for proteasomal degradation. from http://ift.tt/29VZkZO via IFTTT from on Inoreader http://ift.tt/29SDjrv via IFTTT

Nature Immunology 17, 889 (2016). doi:10.1038/ni.3521 Authors: Nicole Baumgarth & Leonore A Herzenberg from http://ift.tt/29XOstJ via IFTTT from on Inoreader http://ift.tt/29W1hpi via IFTTT

Nature Immunology 17, 900 (2016). doi:10.1038/ni.3511 Authors: Andrea Dorfleutner & Christian Stehlik The Pyrin inflammasome guard is disabled if the activity of small cellular GTPase is compromised in response to defects in the mevalonate pathway and is disabled directly by mutations in the gene encoding Pyrin, which results in the interleukin 1β (IL-1β)-driven autoinflammatory diseases MKD and FMF. from http://ift.tt/29RI6bC via IFTTT from on Inoreader http://ift.tt/29SDi6L via IFTTT

Nature Immunology 17, 905 (2016). doi:10.1038/ni.3527 Author: Laurie A Dempsey from http://ift.tt/29XOYba via IFTTT from on Inoreader http://ift.tt/29W1bhj via IFTTT

Nature Immunology 17, 903 (2016). doi:10.1038/ni.3520 Author: Katia Georgopoulos Induction of the transcription factor Bcl11b in early T cell precursors is supported by three positive forces: signaling via the transmembrane receptor Notch1 provides stochastic permissivity; the transcription factors TCF-1 and GATA-3 poise the locus for expression; and the transcription factor Runx1 steps in to raise expression. from http://ift.tt/29RIBT7 via IFTTT from on Inoreader http://ift.tt/29SDQth via IFTTT