Smartbrandon5912

ial risk factors for thrombophilia and importance of treatment adherence.Introduction Minimally invasive intracranial pressure (ICP) screening has long been desired by neurosurgeons. A novel approach deriving ICP from tympanic membrane (TM) pulsation may offer the solution. The ICP waveform appears to be transmitted to the TM by the cochlear aqueduct. The resulting TM infrasonic pulsations can be measured by certain sensors. Elevated ICP alters brain compliance, which appears to yield slower rise times of the TM pulsation waveform. Measurement of this change may be useful in screening for elevated ICP. This paper investigates one such technique. Methods A stethoscope was modified for airtight external ear canal fit; the dome was exchanged for a magnetic reluctance pressure sensor, allowing measurement of TM pulsations. Analog TM pulsations were analyzed by measuring the pulsation's slope ratio between the waveform's downslope and upslope. Seventeen normal subjects (ages 18-32 years) underwent hyperventilation and tilt table testing to induce ICP changes. An algorithm processed this data and predicted the subject's ICP status. Results The slope ratio method showed consistent and stable changes with the expected alterations in ICP from the tilt test and hyperventilation maneuvers. The classification algorithm correctly identified subjects with elevated ICP in 60 of 60 independent recordings on 17 subjects. Conclusion This paper has four conclusions. First, the "brain stethoscope" can detect increased ICP from the TM pulsation waveform in healthy subjects. Second, analysis of the TM waveform using slope ratio calculations is capable of distinguishing normal versus elevated ICP. Third, the tilt and hyperventilation maneuvers showed the expected physiologic trends. Last, further studies are needed on patients with pathological ICP before the brain stethoscope can be implemented into clinical practice.Late presentation and resistance to chemotherapeutic agents make a deadly combination for ovarian cancer patients. The treatment of these patients is thus challenging. This study explores the possible molecular mechanisms by which tumor cells interact with the extracellular matrix (ECM) constituents, forming metastatic implants and enhancing patients' sensitivity to drugs. For the literature review, PubMed was used as a database. The standard search was done using keywords "collagen, ovarian cancer, extracellular matrix, drug resistance" in different combinations, which finally yielded 32 studies meeting the inclusion/exclusion criteria. The studies included were published in the English language in the past seven years. After analyzing, we found all of them to be histopathological studies. Nine studies also used murine cell lines besides human cell lines and tissue samples from ovarian cancer patients. One study has a retrospective analysis done. Eight studies demonstrate the role of hypoxia and matrix remodeling enzymes in ovarian cancer dissemination. Genetics playing a crucial role in cancer metastasis is demonstrated in eight studies. Ten studies included shows receptors, enzymes, and spheroid organization in disease progression. Six studies address chemotherapeutic resistance. Intraperitoneal dissemination of ovarian cancer and the development of chemotherapeutic resistance depends on certain molecular interactions, and they can be targeted to improve patients' overall survival.We present the case of a 79-year-old man on hemodialysis with immunoglobulin A (IgA) vasculitis. He developed palpable purpura three weeks after having pneumonia. A skin biopsy showed leukocytoclastic vasculitis with IgA and C3 deposition. He received a topical corticosteroid for his IgA vasculitis. He was also diagnosed with a metastatic liver lesion, which was thought to be of colorectal origin because of the elevations in carcinoembryonic antigen and cancer antigen 19-9 levels. The skin biopsy played an important role in the diagnosis of the patient on hemodialysis. Pneumonia and a metastatic liver lesion thought to be from colorectal cancer might be related to the pathogenesis of IgA vasculitis.Atypical carcinoid belongs to a spectrum of neuroendocrine tumors that can present as central airway obstruction. We treated a 58-year-old female who presented with recurrent pneumonia. Flexible bronchoscopy showed complete obstruction of the tumor in the right lower lobe. read more The tumor was excised by electrocautery snare followed by laser and argon plasma coagulation (APC). Endobronchial biopsy showed atypical carcinoid with lymph node metastasis. Succeeding bronchoscopic management, the patient's symptoms improved. In our patient, bronchoscopy with laser and APC was performed to prevent tumor recurrence after resection and reduce the risk of recurrent postobstructive pneumonia. Surveillance computed tomography at six months showed no evidence of recurrence. Bronchoscopic management should be considered in poor surgical candidates or patients with metastatic disease.A 47-year-old female presented with a minimally displaced fracture of proximal one-third of the shaft of the humerus that she suffered two months before and managed conservatively with a Plaster of Paris (POP) slab. An X-ray performed after six weeks showed complete vanishing of the proximal third portion of humerus due to massive osteolysis and generalized osteopenia. On examination, there was a soft tissue swelling over the proximal part of the left arm with painful and limited range of motion of the left shoulder. Biopsy of the lesion revealed neoplastic proliferation of plasmacytoid cells with binucleation showing strong, diffuse immunoreactivity to CD-138 and MUM-1, and thus a diagnosis of multiple myeloma was made. Typically, bone lesions in multiple myeloma present as multiple, well-defined "punched out" osteolytic lesions rather than complete vanishing of bone. The purpose of this report is to increase the awareness of this presenting feature of multiple myeloma.Primary chest wall abscess due to hematogenous spread is very rare and has seldom been documented in the literature, with most reported cases attributed to Mycobacterium tuberculosis. Prompt diagnosis and management with antibiotics, and evacuation of the abscess, is imperative as the infection can lead to systemic or disseminated infection, including erosion into surrounding bone if left untreated. We describe the case of a 67-year-old female with severe Crohn's disease receiving anti-tumor necrosis factor-alpha (TNF-α) therapy, Etanercept presenting with localized Escherichia coli (E. coli) chest wall abscess with erosion into the surrounding rib. This case highlights a rare clinical entity, chest wall abscess, which is also an unusual site of E. coli infection. Only three previous cases of E. coli primary chest wall abscess can be found in the published literature. This case also highlights a possible association of severe Crohn's disease predisposing to complicated soft tissue infection.