Primary Lacrimal Canaliculitis with clinically detected concretions: One-snip punctoplasty with lateral canaliculotomy vs. punctum sparing canalicular curettage.

PURPOSE: To compare two distinct surgical techniques in the management of chronic Primary Lacrimal Canaliculitis (PLC) with clinically detectable concretions. MATERIALS AND METHODS: Inclusion criteria: Patients presenting with symptoms consistent with the diagnosis of primary lacrimal canaliculitis (PLC) with ocular involvement were gathered. Gomori-Grocott Methenamine Silver test was used for concretion staining. Two groups were identified based on the surgical technique. Group A consisted of patients who underwent a punctum sparing canalicular curettage using a chalazion curette, while the patients in Group B underwent one-snip punctoplasty with lateral canaliculotomy. Failure was defined as recurrence of the initial symptoms at any time (ocular and canalicular inflammation with purulent discharge and pouting punctum). The results were analyzed by comparisons using a Fisher's exact test. RESULTS: Ninety-six consecutive patients (96) with a confirmed diagnosis of PLC underwent surgical treatment between 1987 and 2017. Data were collected and divided based on the surgical technique discussed above (Group A and B). Group A: 51 cases with a mean follow-up time of 22 months [1-224] presented with a mean age of 51.5 [25-83] and a surgical failure rate of 19.6%. Group B: 45 patients with a mean follow-up time of 27 months [1-176], a mean age of 68 [17-87] years and a surgical failure rate of 4.4%. Statistical significance was demonstrated, with a p-value of 0.033, odds ratio (OR) of 0.1936 and Standard Deviation (SD) at a 95% confidence interval of [0.0195-0.9885]. CONCLUSIONS: One-snip punctoplasty with lateral canaliculotomy is a simple, fast and effective procedure that allows better anatomical visualization intraoperatively and is thus shown to be statistically superior to punctum sparing canalicular curettage using a chalazion curette.

Evaluation of a routine screening program with tuberculin skin testing on rates of detection of latent tuberculosis infection and prevention of active tuberculosis in patients with multiple myeloma at a Canadian cancer centre.

Background: Chemotherapy-induced T cell dysfunction, resulting from treatment of multiple myeloma (mm), enhances the risk for reactivation of latent tuberculous infection (ltbi). However, routine screening for ltbi has its limitations. The objective of the present study was to assess the number of patients treated for ltbi both before and after the introduction of a consistent tuberculin skin test (tst) screening program for patients with mm at our cancer centre. Methods: This retrospective observational study analyzed adult patients with mm treated with autologous hematopoietic stem-cell transplantation from 1 January 2013 to 31 December 2014, for whom tst was consistently performed at our cancer facility. Baseline demographic characteristics of patients who received tst testing and ltbi therapy were compared with those of a pre-intervention cohort of patients (1 January 2008 to 31 December 2009) who were not tested. Results: During the post-intervention period, 170 patients with mm had a tst. In 14 patients (8.2%) results were positive, and 11 of the 14 received ltbi therapy. Of another 12 patients with radiographic imaging changes consistent with prior granulomatous disease and negative tst results, 2 were treated. No cases of tuberculosis (tb) reactivation were noted in individuals who completed ltbi therapy. One case of active tb was diagnosed in a patient with a negative tst. In contrast, in the pre-intervention matched cohort of 170 patients, no tsts were performed, and no cases of active tb were documented. Conclusions: Patients with mm could benefit from a consistent tst testing policy coupled with subsequent ltbi therapy. However, universal testing might not be required. A targeted program combining evaluation of host risk factors, imaging findings, and screening tests might optimize ltbi diagnosis and management, and thus be effective in preventing the development of active tb in at-risk patients with mm.

DOCA/salt hypertension alters Period1 and orexin-related gene expression in the medulla and hypothalamus of male rats: Diurnal influences.

In peripheral tissues, aldosterone alters expression of multiple genes, including the clock gene Period 1 (Per1), 11 beta-hydroxysteroid dehydrogenase-2 (11-HSD2), and α-ENAC, the epithelial sodium channel subunit. We evaluated the impact of chronic aldosterone exposure (DOCA) and salt intake on nocturnal changes in gene expression in the male Sprague Dawley rat brain. Additionally, genes associated with the orexin (ORX) system were also evaluated based on the role of this neuropeptide in arousal, feeding and hypertension and an interconnection with Per1 expression. DOCA/salt treatment increased saline intake primarily at night, elevated arterial pressure and lowered heart rate. In the medulla oblongata, DOCA/salt upregulated Per1, 11-HSD2, and α-ENAC expression independent of time of day, but did not change ORX receptor type 1 (ORX-R1) or type 2 (ORX-R2) expression. ORX-R1, and ORX-R2 expression in the medulla did however correlate with Per1 expression following DOCA/salt treatment but not in controls. In the hypothalamus, DOCA/salt treatment upregulated Per1, ORX-A, and ORX-R2 expression, in general, and Per1 and ORX-A expression at night. ORX-A, ORX-R1 and ORX-R2 expression in the hypothalamus correlated with Per1 expression following DOCA/salt but not in controls. These findings demonstrate for the first time that DOCA/salt hypertension modulates ORX gene expression in the brain and suggest that changes in expression in the ORX system may occur directly or indirectly via aldosterone-induced changes in Per1 expression. Our findings also build on emerging evidence that monitoring gene expression during both the day and night is critical to understanding the role of specific genes in hypertension.

The impact of psychiatric and extraintestinal comorbidity on quality of life and bowel symptom burden in functional GI disorders.

BACKGROUND: Functional gastrointestinal disorders (FGID) patients report poor health-related quality of life (HRQOL) and experience high rates of psychiatric and extraintestinal functional disorder (EIFD) comorbidity. The independent influence of these comorbidities on HRQOL and symptom burden remains unknown. We sought to determine whether FGID with mood or EIFD comorbidity have poorer HRQOL and greater GI symptom burdens; to determine the influence of comorbidities on HRQOL in FGID independent of bowel symptoms. METHODS: Subjects reported on comorbidities (anxiety, depression, somatization, EIFD), FGID criteria (irritable bowel syndrome, IBS; functional dyspepsia, FD) using ROME III Research questionnaire, GI symptom burden, and HRQOL. Differences in measures were assessed between subjects with and without ROME III criteria. Multiple regression determined the relative contribution of comorbidities to HRQOL, and mediation analysis explored whether comorbidity influences HRQOL. KEY RESULTS: In a cohort of 912 GI outpatients (47.2 ± 1.5 years, 75.8% female), 606 (66.4%) met Rome III IBS and/or FD criteria. Comorbidities were common in FGID (≥1 in 77.4%), leading to lower HRQOL and greater GI symptom burden (each p < 0.05). Poorer HRQOL was predicted by both psychiatric and EIFD comorbidity (each p < 0.05) independent of GI symptoms (p < 0.001). Comorbidities together exerted a greater effect on predicted variation in HRQOL (70.9%) relative to GI symptoms (26.5%). CONCLUSIONS & INFERENCES: Psychiatric and EIFD comorbidities are common in FGID, decrease HRQOL and are associated with greater GI symptom burdens; these factors were stronger predictors of HRQOL than GI symptoms in FGID patients.

Subcutaneous myoepithelioma of soft tissue: a case report.

We present a case of a 75-year-old female with a subcutaneous back mass diagnosed as myoepithelioma of soft tissue. The diagnosis of this tumor may be challenging and familiarity with its broad morphological spectrum is important to distinguish it from a number of histologically similar soft tissue proliferations, in particular those displaying a prominent myxoid stroma. The correct diagnosis can be facilitated by the use of a panel of confirmatory immunohistochemical markers, including cytokeratins, neural, and muscular antigens, revealing the myoepithelial nature of the tumor cells.

Improved soil fumigation by Telone C35 using carbonation.

Soil fumigation to control pests and pathogens is an important part of current agricultural practice. A reduction in fumigant emissions is required to ensure worker safety and environment health. A field trial in Florida was conducted to investigate whether carbonating Telone C35™ ((Z)- and (E)-1,3-dichloropropene with 35 % chloropicrin) would improve the delivery of the fumigant to such an extent that the application rate could be decreased without sacrificing efficacy. All treatments were carried out in three replications in a complete block design. The use of carbon dioxide (CO(2)) to carbonate and pressurize Telone C35 provided quicker and deeper distribution initially compared to application by nitrogen gas (N(2)) pressurization. The deeper distribution of Telone C35 components found with CO(2) application may have lowered the initial concentration of Telone C35, but it did not appreciably alter the disappearance rate of the three chemicals, chloropicrin, (Z)- and (E)-1,3-dichloropropene. The faster vertical distribution within the bedded soil of the Telone C35 by CO(2) did enhance volatilization of the active ingredients into the atmosphere compared to volatilization of similar reduced rate applied by N(2) pressurization. However, the cumulative amount volatilized from the carbonated fumigant beds at 75 % application rate was lower than the cumulative amount emitted by full rate of Telone C35 using N(2). The efficacy of the carbonated Telone C35 at a lower application rate was statistically equivalent to that of non-carbonated fumigant using N(2) pressurized injection at a higher application rate, based on weed enumeration and the root-knot nematode galling index.