The role of nasal-associated lymphoid tissue (NALT) as a mucosal inductive site for tear IgA antibody responses was investigated in the rat model. Fluorescent microspheres were shown to access and be taken up by NALT after intranasal of ocular-topical administration, although fewer microspheres were found in the latter case. Tear IgA anti-DNP antibody responses to dinitrophenylated Streptococcus pneumoniae were 6 micrograms/ml at day 7, 10 micrograms/ml at day 10, and were still detectable on day 21 (5 micrograms/ml) following ocular or gastrointestinal immunization. Intranasal immunization induced tear IgA responses which were 1.7-fold higher at day 7 (10 micrograms/ml), peaked by day 10 (14 micrograms/ml) and were still 1.6-fold higher (8 micrograms/ml) at day 21 than responses of ocular or gastrointestinal groups. These findings suggest that intranasal immunization may be more effective than ocular or gastrointestinal administration in eliciting tear IgA antibody responses and, taken together with the microsphere data, indicate that NALT can serve as an inductive site for ocular mucosal IgA responses.
Ameloblastic carcinoma is an unusual tumour. There have been a total of 34 cases of ameloblastic carcinoma in the English literature to date. Of these only 11 cases have occurred in the maxilla. The authors report the 12th such case. The histological classification for odontogenic cardkwma has been debated for many years and recently revised, thus differentiating between malignant ameloblastoma and ameloblastic carcinoma. The authors review the current literature regarding diagnosis and treatment of this unusual lesion, and support the use of the term malignant ameloblastoma for the tumours that metastasize in spite of their benign histological appearance, whereas, the ameloblastic carcinoma is referred to as the primary tumour with malignant transformation, regardless of its metastatic potential.
Objectives To recognize that thyroid nodules with atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS; Bethesda III) have different risks of malignancy based on genetic mutation and to consider molecular testing of nodules with AUS/FLUS to help avoid unnecessary morbidity or cost. Study Design Retrospective cohort study. Setting Multiple locations within Southern California Permanente Medical Group. Subjects and Methods Patients included those with indeterminate thyroid nodules and AUS/FLUS on 2 separate fine-needle aspirations with positive ThyGenX testing from 2014 to 2017 who underwent thyroid surgery. Patients were classified as having benign or malignant disease. Noninvasive follicular thyroid neoplasm with papillary-like nuclear features was considered benign. Results A total of 231 patients had repeat AUS/FLUS with positive molecular testing and surgery. The most frequent type of malignancy was papillary carcinoma, followed by follicular carcinoma. The overall prevalence of malignancy in nodules with mutations was 74.0%, although there was considerable variation: BRAF = 100%, RET = 100%, PAX8-PPARγ = 84.6%, HRAS = 70.7%, NRAS = 63.4%, and KRAS = 33%—a statistically significant finding ( P < .001). Conclusions Not all molecular mutations in thyroid nodules with AUS/FLUS have a high risk of malignancy. Of note, patients with BRAF and RET mutations in our population had a 100% risk of malignancy. Patients with PAX, HRAS, or NRAS mutations had a high risk of malignancy, while patients with KRAS mutations had a lower risk of malignancy. Further studies are needed to determine if the presence of certain molecular mutations can help personalize care and aid in the decision for thyroid surgery.
The introduction of "crack" and 'freebase" cocaine to the United States has resulted in an increased number of patients presenting to emergency rooms with cocaine-related burns of the upper aerodigestive tract. Because symptoms are nonspecific and histories often unreliable, the emergency room physician must keep a high index of suspicion for cocaine use when confronted with these types of patients. We present seven patients who had burns to the upper aerodigestive tract as a result of smoking crack or freebase cocaine. Two of seven patients underwent an emergency tracheotomy, probably because of delayed diagnosis and inadequate early medical intervention. This article reviews the history behind cocaine use, its different modes of administration, potential complications associated with smoking cocaine, diagnostic workup, and treatment options.
Pyriform sinus cancer remains one of the most lethal of human diseases. Regardless of approach attempted significant enhancement of survival has not been realized. In this study a retrospective single institutional review of all patients diagnosed with pyriform sinus cancer during the 1980s was conducted. The results in 93 patients show an overall determinant 5-year survival of 14.3%. Of patients undergoing surgery, median determinant survival was 37 months and 5-year survival was 34.6%. In resectable patients treated with radiation with or without chemotherapy, median determinant survival was 13 months with 5-year survival of 7.1% (P < .01). Surgical salvage was attempted in 8 patients without success. In conclusion, due to the apparent survival advantage for surgical patients, the low rate of surgical salvage, and the relatively low rate of organ preservation in prospective trials, pyriform sinus cancer is a poor site for organ preservation. Surgery followed by radiation therapy should remain the standard of care for pyriform sinus cancer.
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