Recurrent plunging ranula of the neck.

The reported case describes a mismanaged extensive recurrent plunging ranula that occupied a large portion of the neck. The ranula is usually clinically diagnosed. However, absence of visible intra-oral signs may mislead the diagnosis and leads to improper surgical management. Presence of amylase in the aspirated fluids is an important aid in the differential diagnosis. Thereby confirming the salivary origin of the fluids and thus avoiding extensive investigations. The recurrence rate varies according to the procedure performed. Diverse methods of treating ranula have been reported in the literature with variable results. These include marsuplization, excision of the ranula, incision of the ranula and drainage of the contents, excision of the sublingual gland and drainage. The successful procedure to treat plunging ranula depends on complete excision of the affected sublingual gland and drainage of its contents. In this paper, the useful diagnostic investigations and the recommended surgical intervention procedure were described.

Evaluation of the rheumatoid factors of the IgG, IgM and IgA isotypes as prognostic parameters for rheumatoid arthritis among Iraqi patients.

CONTEXT: Rheumatoid arthritis (RA) has a heterogeneous course, spanning from mild forms tending to remission and reacting well to treatment, to aggressive forms resistant to classical therapeutic measures. Reliable predictive parameters of the disease course in RA are needed. Raised levels of Rheumatoid Factors (RFs) are associated with RA and that this RF is found in IgM, IgA and IgG classes (isotypes). AIMS: To figure out the value of RF isotypes titers as predictors for RA processes and outcomes. MATERIALS AND METHODS: Fifty three RA patients were enrolled in this study. The patients were diagnosed based on ACR criteria. Blood sample was taken from each patient at time of attending; sera were separated immediately and kept frozen at -70oC until used. Disease Activity Score (DAS) was calculated using DAS28-3 formula. Radiographs were read by expert radiologists. Sandwich Enzyme-linked Immunosorbent Assay (ELISA) was used for the separate quantitative detection of RF of the IgG, IgM and IgA classes in serum. STATISTICAL ANALYSIS USED: Chi-square, Pearson's correlation coefficient and ROC statistical analyses was performed using SPSS version 15.0. RESULTS: Among the 53 RA patients who were enrolled in this study, there were statistically significant positive correlations between the presence of radiological joint changes with serum levels of IgG-RF, IgM-RF and IgA-RF as measured by calculation of area under curve (0.772, 0.703 and 0.769, respectively). However, no correlation could be found between those RF isotypes with any of other disease processes and outcomes. CONCLUSIONS: These results may indicate the importance of the titers of those isotypes as good predictors of erosive RA and may reflect a causal relationship between their titers and joint damage during the course of RA.

Multiple pericallosal lipomas in two siblings with frontonasal dysplasia.

We report cases of two siblings with frontonasal dysplasia (FND) associated with multiple pericallosal lipomas in almost similar locations. In each sibling two separate curvilinear pericallosal lipomas were present-one in relation to the posterior part of the corpus callosum and the other in relation to the rostrum. To our knowledge, multiple pericallosal lipomas in association with FND have not been described before. Pericallosal lipomas in cases of FND are of the tubulonodular type; they have been reported only in relation to the anterior part of the corpus callosum.