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Sarcomas of the larynx are exceedingly uncommon, of which primary laryngeal osteosarcomas are the rarest. To date, 25 cases of primary laryngeal osteosarcomas have been reported in the literature. Laryngeal osteosarcomas may closely simulate sarcomatoid carcinomas, since both entities share clinical, histological and immunohistochemical features. Herein, we report a case of primary laryngeal osteosarcoma in a 55 year old male, focusing on the importance of light microscopic, immunohistochemical and ultrastructural features in accurately establishing the diagnosis. In addition, the current paper provides a review of the English language literature on the subject. Laryngeal osteosarcomas usually carry a dismal prognosis with no general consensus on the most effective mode of therapy. Similarly, the current patient developed bilateral lung metastases 8 months after the initial surgery.Keywords Laryngeal osteosarcoma Á Sarcomatoid carcinoma Á Immunohistochemistry Á Electron microscopy Case Report A 55 year old male presented at the Division of Otorhinolaryngology, Tygerberg Hospital, Cape Town, South Africa, with a 4 months history of dysphonia and mild dyspnoea on exertion. He elicited a smoking history of 2 years, a habit that ceased 28 years ago. His medical history was otherwise unremarkable and no palpable cervical lymph nodes were detected on clinical examination. Direct laryngoscopy demonstrated a solid ulcerating polypoid lesion at the level of the right vocal cord (Fig. 1). Computerized tomography (CT) scans revealed an ovoid soft tissue mass of the right glottis with increased peripheral density. The lesion occupied the laryngeal vestibule with supraglottic extension (Fig. 2a, b).Histological examination of an incisional biopsy performed at direct laryngoscopy revealed a malignant neoplasm composed predominantly of atypical spindled cells and osteoid. Due to the small size of the biopsy, it was not possible to offer an exact diagnosis. The microscopic features and the macroscopic finding of a polypoid glottic lesion were nevertheless highly suggestive of a sarcomatoid (spindle cell squamous cell) carcinoma; however, due to the lack of a squamous component, a primary laryngeal osteosarcoma could not be excluded. A chest radiograph was taken which showed no abnormalities. The patient was subsequently lost to follow up for several months. Eventually, 7 months after the initial laryngoscopy, the patient underwent a total laryngectomy with wide surgical margins.Macroscopic examination of the resected specimen disclosed a 60 9 45 9 45 mm ulcerating polypoid lesion

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Subcutaneous fat necrosis of the newborn (SCFNN) is a rare form of panniculitis classically affecting healthy full-term infants. There are a number of predisposing factors including perinatal asphyxia. The condition generally has a benign course with spontaneous resolution, but monitoring for metabolic complications, in particular the potentially life-threatening complication of hypercalcaemia, is critical. The authors report 2 cases of preterm infants with perinatal asphyxia with atypical presentations of SCFNN: the first with bony involvement resembling Langerhans cell histiocytosis and with follicular pseudocarcinomatous hyperplasia on histology; and the second presenting with a huge haematoma requiring surgical debridement. Both cases were initially erroneously diagnosed as pyogenic infections.

In financial analysis, forecasting often involves regressing one time series variable on another. However, to ensure that the models are correctly specified, one needs to first test for stationarity, co-integration and causality. In testing for causality, the variables should be stationary. If non-stationary, one can estimate the model in difference form, unless the variables are co-integrated. This article determines whether cash flow and earnings variables are stationary, and which variable causes the other, using econometric analysis. In most cases, cash flow variables are found to cause earnings variables. This is so when the models are estimated in levels. However, when estimated in first differences, the causal relationship tends to be reversed such that earnings cause cash flows. Further study is recommended, whereby panel data could be used to improve the power of the tests.

Background and Purpose: Cough-associated headaches (CAH) are thought to be distinctive for Chiari malformation type I (CMI) patients and have been shown to be related to the motion of cerebrospinal fluid (CSF) near the foramen magnum. We used computational fluid dynamics (CFD) to compute patient-specific resistance to CSF motion in the spinal canal for CMI patients to determine its accuracy in predicting CAH. Methods: 51 symptomatic CMI patients with cerebellar tonsillar position (CTP) = 5 mm were included in this study. The patients were divided into two groups based on their symptoms (CAH and non-CAH) by review of the neurosurgical records. CFD was utilized to simulate CSF motion and the integrated longitudinal impedance (ILI) was calculated for all patients. A receiver operating characteristic (ROC) curve was evaluated for its accuracy in predicting CAH. Results: The ILI for CMI patients with CAH (776 dyn/cm5, 288-1444 dyn/cm5; median, inter-quartile range) was significantly larger compared to non-CAH (285 dyn/cm5, 187-450 dyn/cm5; p = .001). The ILI was more accurate in predicting CAH in CMI patients than the CTP when the comparison was made using the area under the ROC curve (0.77 and 0.70, for ILI and CTP, respectively). ILI = 750 dyn/cm5 had a sensitivity of 50% and a specificity of 95% in predicting CAH. Conclusions: ILI is a parameter, used to assess CSF blockage in the spinal canal and can predict patients with and without CAH with greater accuracy than CTP.

Our exploratory study suggests that assessment of CSF flow response to a coughing challenge has the potential to become a valuable objective noninvasive test for clinical assessment of disease severity in patients with Chiari I malformation.