Castleman's disease is an uncommon benign disease that causes progressive lymph node enlargement. We report 12 cases of Castleman's disease in the head and neck region in a retrospective review of the medical records of all patients with the pathological diagnosis of Castleman's disease during the period of 1993 through 2002. In the 12 patients, the neck was the most commonly involved site with 9 (75%) cases. Level III was the most common subsite (five cases). The most common sign in our study was an asymptomatic neck mass. No patient had any past histories that required medical attention. Preoperative work up such as fine-needle aspiration and radiographic study was not helpful for diagnostic confirmation. The histopathologic evaluation was the only way to make a definitive diagnosis. The histopathologic subtype of our study was hyaline-vascular type. Excision was curative for all cases. There was no evidence of recurrence with a minimum follow-up duration of 24 months.
Atypical chest pain and diabetic autonomic neuropathy attract less clinical attention, leading to underdiagnosis and delayed treatment. To evaluate the long-term clinical impact of atypical chest pain and diabetes mellitus (DM), we categorized 11,159 patients with acute myocardial infarction (AMI) from the Korea AMI-National Institutes of Health between November 2011 and December 2015 into four groups (atypical DM, atypical non-DM, typical DM, and typical non-DM). The primary endpoint was defined as patient-oriented composite endpoint (POCE) at 2 years including all-cause death, any myocardial infarction (MI), and any revascularization. Patients with atypical chest pain showed higher 2-year mortality than those with typical chest pain in both DM (29.5% vs. 11.4%, p < 0.0001) and non-DM (20.4% vs. 6.3%, p < 0.0001) groups. The atypical DM group had the highest risks of POCE (hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.48–2.10), all-cause death (HR 2.23, 95% CI 1.80–2.76) and any MI (HR 2.34, 95% CI 1.51–3.64) in the adjusted model. In conclusion, atypical chest pain was significantly associated with mortality in patients with AMI. Among four groups, the atypical DM group showed the worst clinical outcomes at 2 years. Application of rapid rule in/out AMI protocols would be beneficial to improve clinical outcomes.
The increased level of caspase-14 expression in cholesteatoma tissues may play a role in terminal differentiation of epithelium and accumulation of keratin debris from external matrix.
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