Use of Methylene Blue to Treat Vasoplegia Syndrome in Cystic Fibrosis Patients Undergoing Lung Transplantation: A Case Series

Background: Several studies have demonstrated the utility of methylene blue (MB) to treat vasoplegic syndrome (VS), but some have cautioned against its routine use in lung transplantation with only two cases described in prominent literature. Cystic fibrosis patients commonly have chronic infections which predispose them to a systemic inflammatory syndrome-like vasoplegic response during lung transplantation. We present 13 cystic fibrosis patients who underwent lung transplantation and received MB for vasoplegic syndrome while on cardiopulmonary bypass, with or without inhaled pulmonary vasodilator therapy. Methods: Single?center, retrospective, case series analysis of cystic fibrosis patients who underwent lung transplant and received MB for vasoplegia. We defined the primary outcome as 30-day mortality, and secondary outcomes as primary graft failure, 1-year mortality, postoperative complications, and hemodynamic response to MB. Results: MB was associated with a significant increase in mean arterial pressure (MAP) (P < 0.001) in all patients, and 84.6% (11/13) of the patients had either a decrease or no change in vasopressor requirement. No patients developed acute primary graft dysfunction and there was 100% 30?day and 1?year survival. One patient required Extracorporeal membrane oxygenation (ECMO) for hypoxemia and 69% (9/13) of the patients had evidence of postoperative right ventricular dysfunction, but no patients required a right ventricular assist device. Conclusion: This case series demonstrates the effectiveness of MB in treating vasoplegia in cystic fibrosis patients during lung transplantation, without evidence of primary graft dysfunction, 30?day or 1?year mortality. The safety of MB regarding hypoxemia and increased pulmonary vascular resistance requires further investigation.

Biomechanical Characterization of a New Locking Loop Stitch for Graft Fixation versus Krackow Stitch

Background@#The purpose of this study was to quantify and compare the biomechanical characteristics of a new locking loop stitch (LLS), developed utilizing the concepts of both running locking stitch and needleless stitch, to the traditional Krackow stitch. @*Methods@#The Krackow stitch with No.2 braided suture and the LLS with 1.3-mm augmented polyblend suture tape were compared biomechanically. The LLS was performed with single strand locking loops and wrapping suture around the tendon, resulting in half the needle penetrations through the graft compared to the Krackow stitch. Twenty bovine extensor tendons were divided randomly into two groups. The tendons were prepared to match equal thickness and cross-sectional area. Each suture-tendon was stitched and preloaded to 5 N for 60 seconds, cyclically loaded to 20 N, 40 N, and 60 N for 10 cycles each, and then loaded to failure. The deformation of the suture-tendon construct, stiffness, yield load, and ultimate load were measured. @*Results@#The LLS had significantly less deformation of the suture-tendon construct at 100 N, 200 N, 300 N, and at ultimate load compared to the Krackow stitch (Krackow stitch and LLS at 100 N: 1.3 ± 0.1 mm and 1.0 ± 0.2 mm, p < 0.001; 200 N: 3.0 ± 0.3 mm and 1.9 ± 0.2 mm, p < 0.001; 300 N: 5.1 ± 0.6 mm and 2.9 ± 0.4 mm, p < 0.001; ultimate load: 12.8 ± 2.8 mm and 5.0 ± 1.2 mm, p < 0.001).The LLS had significantly greater stiffness (Krackow stitch and LLS: 97.5 ± 6.9 N/mm and 117.2 ± 13.9 N/mm, p < 0.001) and yield load (Krackow stitch and LLS: 66.2 ± 15.9 N and 237.9 ± 93.6 N, p < 0.001) compared to the Krackow stitch. There was no significant difference in ultimate load (Krackow stitch: 450.2 ± 49.4 N; LLS: 472.6 ± 59.8 N; p = 0.290). @*Conclusions@#The LLS had significantly smaller deformation of the suture-tendon construct compared to the Krackow stitch. The LLS may be a viable surgical alternative to the Krackow stitch for graft fixation when secure fixation is necessary.

Preventive programs in public health: seminar presentations on HIV, malaria and visual impairment

Preventive programs are standardized behavioral interventions that either stop or reduce course of diseases. Indeed, it is known that much of public health programs are synonymous to preventive medicine, which constitute major theme in primary healthcare. The objective of this study was to provide preliminary summaries of research programs, which determined nutritional status on visual impairment (VI) among children,utilization of ITNs and reduction of HIV/AIDS infection in Nigeria. The studies adopted intervention approaches. In Delta state, antioxidant vitamins and ferrous sulphate were administered to participants, to assess impact on visual impairment. In health education on utilizationof ITNs in Bayelsa and Rivers states; as well as on HIV/AIDS infection in Northern Nigeria. Statistically, the studies followed a quantitative method. Baseline percentages of vitamin A and C deficiencies, anaemia, and VI differed with respective post-intervention levels. Post-intervention result showed that 92.1% owned ITNs, improved knowledge of causes and consequences of malaria. On HIV, community-based television, and radio awareness programs on the use of condom influenced the reduction of HIV/AIDS infection by up to 30%. In conclusion, the preliminary reports indicatethatantioxidant vitamins and iron supplementation ameliorated anaemia and VI. Public health awarenesscampaign influenced behavioural change wheel on use of ITNs as well asuse of condom for the reduction of HIV/AIDS infection in Nigeria.

Parental, Perinatal, and Childhood Risk Factors for Development of Irritable Bowel Syndrome:A Systematic Review

Background/Aims@#Adverse early life experiences are associated with the development of stroke, cancer, diabetes, and chronic respiratory and ischemic heart diseases. These negative experiences may also play a role in the development of irritable bowel syndrome (IBS)––a functional gastrointestinal disease. This review discusses the research to date on the parental, perinatal, and childhood risk and protective factors associated with the development of IBS. @*Methods@#A literature search was completed for studies published between 1966 and 2018 that investigated premorbid factors occurring during the perinatal and childhood periods as well as parental factors that were associated with the development of IBS. @*Results@#Twenty-seven studies fulfilled the review criteria. Risk factors that appeared in more than one study included: (1) parental IBS, substance abuse, parental punishment, and rejection as parental risk factors; (2) low birth weight as a perinatal risk factor; and (3) crowded living conditions in low-income families, childhood anxiety, depression, or child abuse as childhood risk factors. Protective factors for IBS were emotional warmth from the parents and being born to an older mother. @*Conclusions@#More effort is needed to identify what fetal and maternal factors are associated with low birth weight and IBS. A well-executed prospective birth cohort with a collection of bio-samples and functional data will provide a better understanding of how adversity and the interplay between genetics, epigenetics, and numerous risk factors affect the development of IBS.

Non-pharmacological Approach in the Management of Functional Dyspepsia

Functional dyspepsia (FD) is a common functional gastrointestinal disease which bears a significant burden on society and individuals. Despite the high prevalence of FD, its pathophysiology remains poorly understood and the treatment options are limited and unsatisfactory. In the absence of effective pharmacological treatments for FD, non-pharmacological approaches, including: reassurance, lifestyle modification, psychotherapy, dietary interventions, medical food, acupuncture, and electrical stimulation and modulation are sought after by many physicians and FD patients. In this article, we review clinical studies which investigate nonpharmacological therapies for FD. We will also discuss potential mechanisms involved in the therapeutic effects of these nonpharmacological approaches. Though the evidences to support the routine use of the non-pharmacological management is still lacking, the non-invasive nature and potentially minimal side-effects of these therapies may be attractive in the FD management. In order to confirm the clinical effectiveness of these non-pharmacological approaches, more well-conducted, methodologically rigorous, and large-scaled clinical trials are required.

Does Knee Arthroscopy for Treatment of Meniscal Damage with Osteoarthritis Delay Knee Replacement Compared to Physical Therapy Alone?

Background@#To determine patient factors that lead to treatment of meniscal tears with osteoarthritis (OA) with knee arthroscopy (KA) or physical therapy only (PT-only); and to assess differences in clinical outcomes including the time to knee arthroplasty. @*Methods@#Patients aged ≥ 45 years with OA at meniscal tear diagnosis were followed up from the date of surgery (KA) or first PT visit (PT-only) until partial/total knee replacement surgery, death, disenrollment, or end of study. Demographic and clinical characteristics were compared and used to derive propensity scores. A Cox proportional hazards model was used to estimate the risk of knee replacement surgery and greater healthcare utilization associated with KA vs. PT-only. @*Results@#Among 7,026 patients (KA, 69%; PT-only, 31%), 27% had partial or total knee replacement surgery during follow-up.PT-only patients were older and more likely to be women and had more comorbidities. After accounting for differences between groups, the cumulative incidence of knee replacement was modestly but significantly higher for those who received KA than those who underwent PT-only (hazard ratio, 1.30; 95% confidence interval, 1.17–1.44; p < 0.001), although there was no significant difference in health service utilization, narcotic medication dispenses, or knee injections after initiating treatment. @*Conclusions@#For patients with meniscal damage complicated by OA, those who underwent KA were 30% more likely to have partial or total knee replacement surgery at any given time than those who had PT alone.

The anterolateral ligament of the knee joint: a review of the anatomy, biomechanics, and anterolateral ligament surgery

Residual knee instability and low rates of return to previous sport are major concerns after anterior cruciate ligament (ACL) reconstruction. To improve outcomes, surgical methods, such as the anatomical single-bundle technique or the double-bundle technique, were developed. However, these reconstruction techniques failed to adequately overcome these problems, and, therefore, new potential answers continue to be of great interest. Based on recent anatomical and biomechanical studies emphasizing the role of the anterolateral ligament (ALL) in rotational stability, novel surgical methods including ALL reconstruction and anterolateral tenodesis have been introduced with the possibility of resolving residual instability after ACL reconstruction. However, there is still little consensus on many aspects of the ALL, including: several anatomical issues, appropriate indications for ALL surgery, and the optimal surgical method and graft choice for reconstruction surgery. Therefore, further studies are necessary to advance our knowledge of the ALL and its contribution to knee stability.

Evaluation of Thyroid Hormones Changes and CD4+ T-cell Count during Menstrual Cycle in Pulmonary TB Infected Women in Nnewi, Nigeria.

Background: Tuberculosis remains a disease of major public health importance worldwide including Nigeria. Endocrine abnormalities have been reported among Tuberculosis patients with the thyroid inclusive. Aims of Study: The present study was designed to evaluate the thyroid hormones changes and CD4+ T-cell count during menstrual cycle in women infected with Pulmonary Tuberculosis in Nnamdi Azikiwe University Teaching Hospital, Nnewi, south east Nigeria. Materials and Methods: The study comprised 90 premenopausal females aged 15-45 years randomly recruited at Direct Observed Therapy (DOT) Clinic at NAUTH, Nnewi from 2013-2014. 30 participants were Symptomatic TB infected females who were not yet on drugs at the time of sample collection while 30 were Symptomatic TB infected females on Anti tuberculosis therapy. The remaining 30 were apparently healthy hospital staff with regular menstrual cycle. After due consent, a detailed medical history was obtained and routine investigations of pulmonary tuberculosis and confirmation using Ziehl Neelsen and sputum culture techniques for AFB and chest x-ray were done. Blood samples were collected at follicular and luteal phases of their menstrual cycle for analysis of Thyroid hormones (T3, T4 and TSH) using Enzyme Linked Immunosorbent Assay (ELISA) method. CD4 T-cell counts was determined using cyflow SL Green Cytometer. Results: Result showed significantly lower T3 and CD4 T-cells with normal TSH values in Symptomatic TB compared with control females at both phases of menstrual cycle (P=.05 respectively). TSH value was significantly lowered in Symptomatic TB than Symptomatic TB on ATT while T3 and CD4 T-cell count were significantly higher in Symptomatic TB on ATT compared to Symptomatic TB at both phases of menstrual cycle (P=.05). Conclusion: Euthyroid sick syndrome was observed among Symptomatic TB females which showed some level of improvements with administration of ATT. A new national strategic plan for TB control is advocated to include routine thyroid function check with special attention paid to the reproductive function.

Does intensified case finding increase tuberculosis case notification among children in resource-poor settings? A report from Nigeria

Objective/Background: Tuberculosis [TB] is a major cause of morbidity and mortality in developing countries. Passive case detection in national TB programmes is associated with low case notification, especially in children. This study was undertaken to improve detection of childhood TB in resource-poor settings through intensified case-finding strategies

Methods: A community-based intervention was carried out in six states in Nigeria. The creation of TB awareness was undertaken, and work aids, guidelines, and diagnostic charts were produced, distributed, and used. Various cadres of health workers and ad hoc project staff were trained. Child contacts with TB patients were screened in their homes, and children presenting at various hospital units were screened for TB. Baseline and intervention data were collected for evaluation populations and control populations

Results: Detection of childhood TB increased in the evaluation population during the intervention, with a mean quarterly increase of 4.0% [new smear positive [NSP], although the increasing trend was not statistically significant [chi[2] = 1.8; p <.179]]. Additionally, there was a mean quarterly increase of 3% for all forms of TB, although the trend was not statistically significant [chi[2] = 1.48; p <.224]. Conversely, there was a decrease in case notification in the control population, with a mean decline of 3% [all forms]. Compared to the baseline, there was an increase of 31% [all forms] and 22% [NSP] in the evaluation population

Conclusion: Intensified case finding combined with capacity building, provision of work aids/guidelines, and TB health education can improve childhood-TB notification

Suprasellar clear cell meningioma in an infant

Clear cell meningiomas are an uncommon subtype of meningioma rarely seen in infancy. We report a case of clear cell meningioma in an 8-month-old male infant. He presented at the Lagos University Teaching Hospital, Lagos, Nigeria, in 2015 with persistent vomiting, poor feeding and failure to thrive over a four month period. Generalised hypertonia and hyperreflexia were noted on examination. Computed tomography of the brain revealed a huge largely isodense suprasellar mass with a hypodense core. The tumour, which measured 6 x 5 x 4 cm, enhanced non-uniformly with contrast injection and extended to occlude the third ventricle. The patient underwent a bifrontal craniotomy with subtotal tumour excision. Six hours postoperatively, he went into cardiac arrest and could not be resuscitated. A histological diagnosis of clear cell meningioma was made as the tumour cells were immunoreactive to epithelial membrane antigen, S100 protein and vimentin. This case of clear cell meningioma was unusual due to its early occurrence and supratentorial location

Simultaneous determination of 3-chlorotyrosine and 3-nitrotyrosine in human plasma by direct analysis in real time-tandem mass spectrometry

A novel method for the simultaneous determination of 3-nitrotyrosine (NT) and 3-chlorotyrosine (CT) in human plasma has been developed based on direct analysis in real time-tandem mass spectrometry (DART-MS/MS). Analysis was performed in the positive ionization mode using multiple reaction monitoring (MRM) of the ion transitions at m/z 216.2/170.1 for CT, m/z 227.2/181.1 for NT and m/z 230.2/184.2 for the internal standard, d (3)-NT. The assay was linear in the ranges 0.5-100 μg/mL for CT and 4-100 μg/mL for NT with corresponding limits of detection of 0.2 and 2 μg/mL. Intra- and inter-day precisions and accuracies were respectively <15% and ±15%. Matrix effects were also evaluated. The method is potentially useful for high throughput analysis although sensitivity needs to be improved before it can be applied in clinical research.

Heterotopic Ossification Causing Radiculopathy after Lumbar Total Disc Arthroplasty

To date, no reports have presented radiculopathy secondary to heterotopic ossification following lumbar total disc arthroplasty. The authors present a previously unpublished complication of lumbar total disk arthroplasty (TDA) secondary to heterotopic ossification (HO) in the spinal canal, and they propose a modification to the McAfee classification of HO. The patient had undergone an L5/S1 lumbar TDA two years prior due to discogenic back pain. His preoperative back pain was significantly relieved, but he developed new, atraumatic onset radiculopathy. Radiographs and a computed tomography myelogram revealed an implant malposition posteriorly with heterotopic bone formation in the canal, causing an impingement of the traversing nerve root. Revision surgery was performed with implant extraction, L5/S1 anterior lumbar interbody fusion, supplemental posterior decompression, and pedicle screw fixation. The patient tolerated the procedure well, with complete resolution of the radicular leg pain. At a two-year follow up, the patient had a solid fusion without subsidence or recurrence of heterotopic bone. This case represents a novel pattern of heterotopic ossification, and it describes a previously unreported cause for implant failure in lumbar disc replacement surgery-reinforcing the importance of proper intraoperative component positioning. We propose a modification to the existing McAfee classification of HO after TDA with the addition of Class V and VI HO.

Effect of moderate - vigorous intensity physical exercise on female sex hormones in premenopausal university students in Nnewi, Nigeri.

Background: Sedentary lifestyle and diseases associated with it is on the increase in our communities, state and country as a whole. The objective was to determine the effect of exercise on ovarian reserve status of the participants using day 3 FSH, LH and estrogen values and the ovulatory status of the participants using day 21 progesterone values. Methods: The study was a prospective comparative study. A total of 30 participants were recruited for this work. They were divided into 2 groups: 15 subjects that did exercise for 1 month and 15 controls that didn’t do any form of exercise. Baseline blood samples were collected from the two groups on day 3 and day 21 of the menstrual cycle. The subjects started exercise on day 1 of the next menstrual cycle. Blood samples were collected from the subjects and control on day 3 and day 21 of the next menstrual cycle. Results: There was significant reduction in weight and therefore BMI of the study group compared to control group and study group baseline after one month of exercise (P<0.05). There were no significant differences in the baseline levels of Estrogen, FSH, LH and progesterone between the subjects and control groups before the exercise, but after 1 month of exercise, there were significant differences in the levels of estrogen, FSH, LH and progesterone in these groups (P<0.01). Among the study group there were significant differences in the baseline and final levels of Estrogen, FSH, LH and Progesterone (P<0.01). Conclusions: The hormonal pattern shows that moderate-vigorous exercise may increase the responsiveness and sensitivity of the follicles to FSH and LH with attendant increase in ovulatory status of young females.

The Utilization Pattern and Costs Analysis of Psychotropic Drugs at a Neuropsychiatric Hospital in Nigeria.

Background/Aim: Drug utilisation study is essential for evaluating patient care to improve service delivery through awareness creation for appropriate choice of drugs. The study analysed the prescription pattern and associated costs of psychotropic drugs at the outpatient unit of a mental health facility in Nigeria, to assess and document information for enhancing rational and cost-effective use of psychotropic medicines. Methods: A retrospective analysis of prescription records covering 8 September and 28 October 2008, was carried out using the WHO recommended use indicators, adapted for mental health care. Data was analysed for number of drugs, number of prescriptions, cost of prescription and cost per defined daily dose (DDD). Results: 1,756 prescriptions were analysed. Each prescription contained an average of 2.1 (±0.75) drugs, at a mean cost of N1, 089 (±N2, 127). Antipsychotics accounted for the highest number of prescribed drugs in 82% (1441/1756) of prescriptions, followed by antidepressants, 13%. Atypical antipsychotics were the most expensive psychotropics at an average cost per DDD of N241.67 (±N97.77), about 35 times the average cost per DDD of traditional psychotropics at N7.00 (±N2.65), which were the cheapest, accounting for over 90% of total prescriptions. Conclusion: The high use frequency of antipsychotics suggests psychosis as the prevalent mental health disorders in the environment. Significant antipsychoticantipsychotic combinations indicate scope for improving the use of antipsychotics. Average cost of prescription reflects the economic status of patients’ population where cost appears to be the major consideration of the choice of prescribers, limiting the use of newer and better tolerated psychotropics. Policy measures are required to improve access to the utilisation of newer psychotropics for enhanced quality of life of patients. The study provides a baseline data for carrying out further utilisation studies, to provide regular information for improving psychotropic drugs utilisation in mental health facilities in Nigeria.

Condrosarcoma tóraco-abdominal / Thoraco-abdominal chondrosarcoma

Chondrosarcomas represent the third primary malignant bone tumor. Costal location occurs in 12 percent, being the most common tumor of the ribs. It affects most frequently in the second and fifth decades of life. This tumor is histologically classified into grades 1, 2 and 3 in descending order of differentiation. For grade 2, with oncologic resection, there is a 10-year survival of 64 percent, and a 10 percent risk for metastasis. Radiotherapy has a limited therapeutic role and chemotherapy has not shown benefits. We report a case of a 45 years old woman, who presented with a symptomatic growing mass in the right rib cage, of three months of evolution, whose evaluation by magnetic resonance imaging and computed tomography shows a sarcomatous tumor with involvement of ribs, muscles, diaphragm, pleura, peritoneum and liver. A small amount of intraperitoneal free fluid was observed. A block resection was made, resulting a 16.8 cm long at the widest point chondrosarcoma, grade 2, with involvement of all layers of the wall, tumor microfoci in the liver capsule and malignant tumor cells in peritoneal fluid.

Los condrosarcomas representan la tercera neoplasia ósea maligna primaria. La ubicación costal representa el 12 por ciento, siendo el tumor más frecuente de las costillas. Se presenta con mayor frecuencia en la segunda y quinta décadas de la vida. Este tumor se clasifica histológicamente en grados 1, 2 y 3 en orden decreciente de diferenciación. Para el grado 2, resecado oncológicamente, se observa una sobrevida a 10 años del 64 por ciento; existiendo un 10 por ciento de riesgo de metástasis. La radioterapia tiene un escaso rol terapéutico y la quimioterapia no ha demostrado beneficios. Presentamos el caso de una mujer de 45 años que consultó por un aumento de volumen sintomático de la parrilla costal derecha, de tres meses de evolución, cuya evaluación a través de tomografía axial y resonancia magnética permitió delinear un tumor sarcomatoso de la pared con afectación de costillas, músculos, diafragma, pleura, peritoneo e hígado. Además se observaba escasa cantidad de líquido libre intraperitoneal. Fue resecado en block un condrosarcoma de 16,8 cm de eje mayor, grado 2, con compromiso de todos los planos de la pared, microfocos tumorales en cápsula hepática y células neoplásicas malignas en líquido peritoneal.

La utilidad de la resonancia magnética en el abdomen agudo durante el embarazo / The use of MRI in acute abdomen in pregnancy

La utilidad de la resonancia magnética para el diagnóstico en el abdomen agudo en el embarazo está demostrada. Permite evaluar el ángulo de inclinación cecal para intentar identificar el apéndice en una paciente embarazada con diagnóstico presuntivo de apendicitis. Se requiere una elevada sospecha diagnóstica para determinar que una embarazada con antecedentes de cirugía bariátrica padece un cuadro de obstrucción de intestino delgado. Los métodos de diagnóstico por imágenes no siempre resultan útiles en esta ocasión. Estos métodos carecen de la sensibilidad suficiente como para reemplazar el examen clínico oportuno de una embarazada con diagnóstico presuntivo de apendicitis. La demora del tratamiento incrementa la morbilidad. El tratamiento conservador de una ruptura apendicular se basa sobre la información retrospectiva. Sólo existen publicaciones de casos aislados sobre el empleo de esta estrategia en las embarazadas.

The Impact of Herbal Remedies on Adverse Effects and Quality of Life in HIV-Infected Individuals on Antiretroviral Therapy

Introduction: Use of herbal remedies among HIV-infected individuals in Africa increased in the past decade; mainly due to traditional beliefs and at times inconsistent access to antiretroviral drugs. In Zimbabwe; accessibility and availability of antiretroviral drugs has increased in recent years; however; the use of herbal remedies remains high. This study was conducted to determine the impact of concomitant use of herbal remedies with antiretroviral drugs on adverse events and on quality of life. Methodology: A convenient sample of HIV positive patients at Parirenyatwa group of hospitals' Family Care Clinic (Harare; Zimbabwe) was enrolled. A questionnaire was used to collect data on the adverse event experiences of the patients using herbal remedies for their HIV; as well as the types of herbal remedy used. Quality of life index was measured using an HIV/AIDS targeted quality of life (HAT-QOL) tool developed by the World Health Organization. Results: Abdominal pain (odds ratio = 2.7; p-value = 0.01) and rash (odds ratio = 2.5; p-value = 0.02) had significant associations with using herbal remedies during antiretroviral therapy. Improved quality of life index was not significantly associated with herbal remedy use during antiretroviral therapy. Conclusions: There is evidence to suggest that some traditional herbal remedies used in Zimbabwe may increase incidence of certain types of adverse events when used in combination with antiretroviral drugs. Use of herbal drugs in combination with antiretroviral therapy does not significantly improve quality of life index in comparison to antiretroviral drug use only

Massive bone marrow involvement by clear cell variant of rhabdomyosarcoma.

A 16-year-old boy with generalized myalgia and petechial hemorrhage was found to have a diffuse infiltrative disease in his bone marrow (BM). The BM aspirate contained a dense population of vacuolated blast-like cells. The BM biopsy displayed compact sheets of small round cells with clear cytoplasm, reminiscent of Ewing sarcoma. Immunostains were not diagnostically conclusive while transmission electron microscopy on the BM cells demonstrated a clear skeletal muscle differentiation. The morphologic findings led to a tentative designation of metastatic embryonal rhabdomyosarcoma (RMS). It was not until cytogenetic analysis revealed the specific translocation t(2;13)(q35;q14) did the alveolar RMS finally get confirmed. Despite an exhaustive search by imaging studies, a primary tumor was not detected. This case illustrates that the massive BM involvement by atypical alveolar RMS of unknown origin may pose serious diagnostic challenges. Multidisciplinary studies are required to reach a definitive diagnosis.

The Past, Present and Future of Bionic Devices Restoring Cranial Nerve Function / 대한평형의학회지

No abstract available.