Abrupt withdrawal of inhaled corticosteroids does not result in spirometric deterioration in chronic obstructive pulmonary disease: effect of phenotyping?

Some studies show a decline of FEV [1] only one month after withdrawal of inhaled corticosteroids [ICS], while others show no decline. We speculate that the presence of an asthma phenotype in the Chronic Obstructive Pulmonary Disease [COPD] population, and that its exclusion may result in no spirometric deterioration. We performed a prospective clinical observation study on 32 patients who fulfilled the Global Initiative for Chronic Obstructive lung disease definition of COPD [Grade II-IV]. They were divided into two phenotypic groups. 1. Irreversible asthma [A and B] [n = 13]: A. Asthma: Bronchial biopsy shows diffuse thickening of basement membrane [>/= 6.6 microm]. B. Airflow limitation [AFL] likely to be asthma: KCO > 80% predicted if the patient refused biopsy. 2. COPD [A and B] [n = 19]: A. COPD: hypercapneic respiratory failure with raised bicarbonate, panlobular emphysema with multiple bullas, or bronchial biopsy showing squamous metaplasia and epithelial/subepithelial inflammation without thickening of the basement membrane. B. AFL likely to be COPD: KCO < 80% predicted. The asthma phenotype was significantly younger, had a strong association with hypertrophy of nasal turbinates, and registered a significant improvement of FEV [1] [350 ml] vs a decline of - 26.5 ml in the COPD phenotype following therapy with budesonide/formoterol for one year. Withdrawal of budesonide for 4 weeks in the COPD phenotype resulted in FEV [1] + 1.33% [SD +/- 5.71] and FVC + 1.24% [SD +/- 5.32]; a change of <12% in all patients. We recorded no spirometric deterioration after exclusion of the asthma phenotype from a COPD group

Low-grade malignant myoepithelioma arising in a pleomorphic adenoma: a rare case

Malignant myoepithelioma is a very rare salivary gland tumor that can arise de novo or within a preexisting pleomorphic adenoma. We report a case of malignant myoepithelioma most probably arising in a pre-existing pleomorphic adenoma of the left parotid gland. The patient was a 60-year-old man who presented with a multinodular mass lesion over left side of the face and neck. He had undergone removal of a pleomorphic adenoma of the left parotid gland twice [8 and 22 years ago]. Histological examination showed locally concentrated highly invasive myoepithelial cells with bland-looking morphology and no evidence of mitosis or necrosis. Immunohistochemistry confirmed the myoepithelial differentiation [S-100+, SMA+] and a low Ki-67 labeling index [<5%]

Hemangioendothelioma of the eyelid can mimic chalazion

Hemangioendothelioma is an uncommon vascular lesion that usually occurs in the liver, bone, lung, skin, and other organs with unknown etiology. A rare form of this lesion has been reported in the eyelid. We report the case of a 27-year-old female with right lower eyelid mass simulating chalazion of 3 weeks duration. The histopathologic examination of the excised nodule confirmed the diagnosis. To our knowledge, this is the fourth case of eyelid epithelioid hemangioendothelioma reported in the English literature

Assessment of bone flap viability and sterility after long periods of preservation in the freezer

Cranioplasty following extended, decompressive craniectomy is a formidable challenge and its complexity increases with the size of the bone defect. Several techniques and methods are described for preservation and sterilization of craniectomy bone flap, each has its own advantage and disadvantages. In this report the authors describe a simple and cheap method for preservation of large craniectomy bone flaps. To evaluate the technique of preservation of large craniectomy bone flap in the freezer at -18°C for long periods of time, by microbiological and histological examination. This prospective study was carried out at King Khalid University Hospital, College of Medicine, King Saud University, during the period January 2001 to December 2008. Twenty-four patients had decompressive craniectomy for intractable brain oedema due to different pathology. A protocol was designed to prepare the removed bone flap for preservation in domestic freezer at -18°C. Microbiology swabs and histology specimen were taken from 14 bone flaps and sent for microbiological and histological examination to check both sterility and viability of the bone flaps after long periods of preservation. During the study period 24 decompressive craniectomy bone flaps were preserved, 15 of them were bifrontal decompressive craniectomy. Sixteen bone flaps were reapplied to their patients while 8 flaps were kept in freezer for long periods of time after expiry of donor patients. The dimensions of bone flaps ranged from 5 x 7 cm to 13 x 25 cm with a mean surface area of 228 cm[2]. Duration of preservation ranged from 60 - 1920 days, mean 313. Fourteen bone flaps were examined histologically and microbiologically, all of them showed no bacterial contamination and were viable, except one flap was not viable. Mature lamellar bone was seen in 5 specimens preserved for [60, 60, 90, 120 and 150 days], mostly viable bone was seen in 4 specimens preserved for [360, 390, 480 and 900 days], focal loss of bone was seen in 4 specimens kept for [390, 630, 720 and 780 days], and one specimen was kept in freezer 1920 days and showed no viable bone. The follow-up period after cranioplasty ranged from 5 months to 6 years, mean 11 months. One patient developed superficial wound infection which was treated with antibiotics and repeated dressings. Another patient developed partial resorption of the bone flap which was treated conservatively as spontaneous bone regrowth appeared a few months later. Preservation of bone flap in the freezer at -18°C is very simple, cheap and safe and is available in all hospitals. Bone flaps preserved using our technique remains viable and sterile for periods of up to 12 months