We present the case of a 39-year-old woman with postpartum cerebellar infarction (CI) following spinal anesthesia for cesarean delivery. The patient experienced mild headache after postoperative day 1 and returned on postoperative day 6 with a severe headache. For the subsequent 3 days, she underwent conservative treatment for presumed postdural puncture headache (PDPH) before neurologic decline and diagnosis of CI on postoperative day 9. She subsequently underwent craniotomy and debridement of necrotic tissues. Prolonged or position-independent postpartum headache should prompt broadening of the differential diagnosis beyond PDPH to include other more rare but serious causes of postpartum headache.
Primary pulmonary leiomyosarcomas (PPLs) are extremely rare tumors of the lungs. They can present with non-specific symptoms or can also be asymptomatic with clues towards diagnosis being found on routine examination or radiographs. We present a case of a 54-year-old woman who presented with worsening shortness of breath and spells of dizziness. Her chest radiographs showed right-sided pleural effusion and CT revealed a large enhancing pleural mass with compression atelectasis and mediastinal shift. She underwent a thoracoscopy and right pleural biopsy. Histopathology and immunohistochemistry were most consistent with leiomyosarcoma. An extensive search for a possible primary in other sites was unrevealing, thus diagnosing the patient with PPL. She was managed with surgery and radiotherapy.
RATIONALE: This study found Cystatin SN (CST1), a type 2 cystatin subfamily member, to be highly expressed in nasal polyps from patients with intractable chronic rhinosinusitis with nasal polyps (CRSwNP), using a whole transcript analysis with next-generation sequencing. Eosinophilic chronic rhinosinusitis (ECRS) involves nasal polyps that are refractory and recurrent immediately after endoscopic sinus surgery. We hypothesized that CST1 may contribute to the pathogenesis of ECRS. METHODS: The expression of CST1 in nasal polyps from patients with ECRS was examined by mRNA expression levels, using real-time PCR and immunohistochemistry. We examined the function of CST1 using nasal epithelial cells and nasal fibroblasts. RESULTS: CST1 was significantly expressed in the epithelial cells of the nasal polyps from patients with ECRS, compared with patients who did not have ECRS (non-ECRS). Particularly, CST1 showed very strong expression in patients with severe ECRS. The expression of CST1 may be correlated with the recurring and refractory nature of ECRS. Stimulation by a combination of IL-4 plus dsRNA plus CST1 significantly elevated mRNA expression levels and protein levels of TSLP in nasal epithelial cells. Stimulation by TSLP or IL-33 significantly elevated mRNA expression levels of CST1 in nasal epithelial cells. Stimulation of CST1 significantly elevated mRNA expression levels of CCL11 and POSTN in nasal fibroblasts. CONCLUSIONS: CST1 could amplify eosinophilic infiltration and Th2 inflammation by interacting with epithelial-derived cytokines and fibroblasts on nasal polyps. CST1 may be involved in the pathogenesis of ECRS, and may contribute to the severity and recurrence of CRSwNP after ESS.
RATIONALE: Eosinophilic esophagitis (EoE) is diagnosed and monitored by identification of esophageal eosinophilia via endoscopic biopsy. The endoscopic reference score (EREFS) is used to describe EoE by grading edema, rings, exudate, furrows, and strictures. This study aimed to predict esophageal eosinophilia with EREFS in pediatric patients. METHODS: This retrospective study stratified 137 endoscopies among 58 patients (ages 5 to 22) by the diagnosis of EoE, defined by a peak eosinophil count >15 eos/hpf. Component and composite EREFS were compared to histology using Fisher's exact and Chi-square tests. Generalized estimating equations were used to assess risk factors for EoE, estimate ROC curves, and determine sensitivity and specificity. RESULTS: On average, a 1-point increase in EREFS was associated with a 9.8-point increase in eosinophilic count (95% CI: 7.0, 12.6; p<0.001). The odds of having EoE were 31 times (95% CI: 6, 159) greater among patients with an EREFS > _4 compared with EREFS < _1. Utilizing exudate and furrows (reduced score) to discriminate among patients with EoE yielded an AUC of 0.88 for the ROC compared with 0.74 for EREFS (p50.15). A cut point of 1 for the reduced score had an 88% sensitivity and 86% specificity; while a cut point of 1 for EREFS yields a 91% sensitivity and 69% specificity. CONCLUSIONS: EREFS correlates with esophageal eosinophilia; however, a reduced score may be more accurate at identifying EoE. These findings suggest that esophageal appearance can screen for EoE, raising the possibility of using less invasive techniques, such as esophageal video capsule, for diagnosis or surveillance. Abstracts AB137 SUNDAY
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.