Wiener medizinische Wochenschrift最新文献

Background: There are few studies that have analyzed the characteristics of hypercalcemia in hospitalized oncological patients. Our objectives were to describe the clinical characteristics of hospitalized patients with paraneoplastic hypercalcemia and to identify prognostic variables for mortality.

Methods: This was an observational, longitudinal, retrospective, and bicentric study. It included adult patients admitted to two hospitals in Málaga, Spain (2014-2018). The minimum follow-up period was 2 years or until death.

Results: A total of 154 patients were included; the majority (71.4%) were admitted to the internal medicine department. The median follow-up was 3.5 weeks (interquartile range [IQR] 1.1-11.5). The mean (standard deviation) age was 67.6 (12.3) years, with a predominance of males (58.4%). The median (IQR) serum calcium at admission was 13.2 (11.8-14.6) mg/dl. The most common neoplasms were pulmonary (27.3%), hematologic (23.4%), urological (13%), and breast (12.3%). Furthermore, 56.5% of cases had a known history of neoplasia at the time of diagnosis. The parathyroid hormone (PTH) level was determined in 24%; of these, 10.8% had elevated levels. In all, 95.5% of patients died during follow-up. The median survival was 3.4 weeks (95% confidence interval 2.6-4.3). Factors associated with higher mortality were age, serum calcium at admission, previous history of neoplasia, etiology other than multiple myeloma, and noncorrection of hypercalcemia.

Conclusions: In hospitalized patients, paraneoplastic hypercalcemia was associated with high short-term mortality. Several factors associated with a worse prognosis were identified in these patients.

Positional plagiocephaly, characterized by an asymmetric skull shape, is the most common craniofacial malformation in infancy. Associated risk factors include a preference for the supine position, first and assisted delivery, multiple pregnancy, prematurity, and congenital muscular torticollis. The diagnosis is established by clinical and anthropometric examinations. In the case of moderate or severe deformity, three-dimensional optical scanning enables a detailed depiction of the deformity and provides a safe and noninvasive tool for follow-up. Treatment mainly includes repositioning of the infant, while orthotic therapy is considered in cases of severe deformity. Cranial orthotic therapy is most effective when started between 4 and 7 months of age. The total duration of orthotic treatment ranges from 2 to 6 months. Although the clinical course of positional plagiocephaly is generally benign and the prognosis favorable, its increasing prevalence has prompted the development of novel diagnostic and therapeutic strategies over the past decade.

Background: The prevalence of gastroesophageal reflux disease (GERD) in children is increasing in different societies. This study aims to investigate the value of mean platelet volume (MPV) for diagnosing esophagitis in children with GERD.

Methods: This cross-sectional study conducted at Amirkola Children's Hospital between 2022 and 2023 involved children aged 2 to 16 years diagnosed with GERD. The diagnosis was based on the GSQ-YC and GASP‑Q questionnaires. All patients underwent endoscopy, with a biopsy for pathology and a blood sample for MPV analysis. The data were then analyzed using SPSS software version 22 (IBM Corp., Armonk, NY, USA), with a significance level set at lower than 0.05.

Results: The frequency of esophagitis among 194 participants was 39.7%. The overall sensitivity and specificity of MPV for diagnosing esophagitis in children were 64.63% and 52.14%, respectively (area under the curve [AUC] = 0.59). In terms of gender, the overall sensitivity and specificity of the MPV were 85.00% and 32.65% in boys and 70.27% and 51.47% in girls (AUC = 0.58 and AUC = 0.61, respectively). In terms of age, the overall sensitivity and specificity of MPV in children under 12 years were 52.46% and 62.26% and in children older than 12 years 87.5% and 36.36% (AUC = 0.58 and AUC = 0.55, respectively).

Conclusion: In summary, the results of this study indicate that MPV is not a reliable method for diagnosing esophagitis in children with GERD.

Background: Tinea pseudoimbricata is a variant of tinea incognito, with multiple erythematous concentric rings (ring in a ring) and pruritus. Misuse of topical corticosteroids is a major exogenous factor.

Objective: We provide an overview of published cases and report the first case series from Romania.

Patients and methods: A narrative review of the literature was conducted in PubMed and amended by ResearchGate. A series of pediatric cases from Romania with clinical suspicion of tinea pseudoimbricata was investigated by clinical examination, KOH preparations of skin scrapings, and mycological culture when possible.

Results: We collected 137 cases of tinea pseudoimbricata from the literature and added a series of 5 pediatric patients from Romania. Oral treatment with fluconazole was effective in all of them. Worldwide, most reports came from India (86%), 3.5% were from other Asian countries, 3.5% were from the Americas, and 7% were from Europe. M. canis and T. mentagrophytes were identified in 2 patients from Romania. T. mentagrophytes, T. rubrum, and T. tonsurans are the dominant species worldwide, but molecular diagnostics were available for only a minor part of cases.

Conclusion: Tinea pseudoimbricata is most common in India. This is the first case series on tinea pseudoimbricata from Romania. Tinea pseudoimbricata is an emerging disease in Europe. Identification of fungi has rarely been done by molecular mycology. This may have caused an overestimation of T. mentagrophytes and an underestimation of T. indotineae.

Lichen planus is a common pruritic inflammatory disorder of the skin with an autoimmune background. It affects < 1% of the general population. The disease has significant comorbidities that must be considered in a holistic approach. Skin and skin adnexa, mucosa, eyes, and the esophagus may be affected. There are various clinical subtypes in addition to classical cutaneous lichen planus. These subtypes depend on age and gender. Nail involvement can result in functional and psychological impairment. Lichen planopilaris in adults leads to irreversible cicatrical alopecia. Erosive and ulcerated lichen planus of the mucosa carries an increased risk of malignant transformation, at least in adults. Treatment must consider the affected area, the severity of disease, age, gender, and comorbidities.

Acquired digital fibrokeratoma (ADFK) is a rare benign mesenchymal tumor often presenting as a small, firm, hyperkeratotic lesion, typically located in the periungual or subungual regions of the digits. Though benign, ADFK can lead to significant functional or cosmetic issues and may be mistaken for more serious conditions such as squamous cell carcinoma or pyogenic granuloma. We report the case of a 36-year-old male with a 3- to 4‑year history of a progressively enlarging periungual tumor leading to nail deformity and mild pressure effects on the underlying bone. The patient's history included minor trauma, possibly contributing to the lesion's development. Dermatological and histopathological evaluations revealed a well-demarcated mesenchymal lesion with orthohyperkeratosis, irregular acanthosis, and stellate fibroblasts within a vascular stroma, consistent with ADFK. A CT scan confirmed mild deformity of the distal phalanx but no bone infiltration. Surgical excision was offered but deferred by the patient, who preferred monitoring of the lesion. This case highlights the importance of accurate diagnosis through clinical, histopathological, and imaging evaluations to distinguish ADFK from other periungual tumors and underscores the need for individualized treatment based on patient preferences and the lesion's impact.

Big data collected in large international cooperations now allow validation of findings from traditional national patient cohorts for proving consistency. In this study, we compared findings in RUNX1-mutated patients of the Austrian biodatabase for chronic myelomonocytic leukemia (ABCMML) with the CMML cohort documented in cBioPortal. In the cBioPortal cohort, RUNX1-mutated patients had significantly inferior survival and AML-free survival as compared to nonmutated patients. In the ABCMML cohort, survival and AML-free survival were numerically shorter in RUNX1-mutated patients than in wildtype patients, but this did not reach significance. Regarding phenotype, in both cohorts, RUNX1-mutated patients had a significantly higher proportion of patients with thrombocytopenia and lower metric values for platelets as compared to wildtype patients. Validation of data, as we have done in this study in CMML patients using two independent cohorts, ensures the quality standards that are required for their use in clinical decision making.

Big data from large international cooperations allow proving consistency of findings in national patient cohorts. We compared features in NRAS-mutated patients of the Austrian biodatabase for chronic myelomonocytic leukemia (ABCMML) with the chronic myelomonocytic leukemia (CMML) cohort documented in cBioPortal. It is consistently demonstrated in both CMML cohorts that NRAS mutations are associated with shorter overall survival, acute myeloid leukemia-free survival, increased white blood cell count, decreased platelet values and the presence of blast cells in peripheral blood. Hemoglobin values did not differ between patients with or without NRAS mutations in either cohort. Validation of data in CMML patients using two independent cohorts, ensures the quality standards for clinical decision making.

Big data collected in large international cooperations allow validation of findings from traditional national patient cohorts for proving consistency. In this study we analyzed outcomes and phenotypic features of TP53-mutated chronic myelomonocytic leukemia (CMML) patients in the Austrian biodatabase for CMML (ABCMML; n = 322) and in the international platform cBIOPORTAL (n = 399). The prevalences of TP53 mutations were 1.58 and 3.66, respectively. Numerically, overall survival was shorter in TP53-mutated patients in both cohorts (ABCMML 10.0 vs. 30.0 months and cBIOPORTAL 8.9 vs. 34.5 months), but this was statistically significant only in the cBIOPORTAL cohort. Decreased hemoglobin values and the presence of blast cells in peripheral blood were significantly associated with TP53 mutations in the cBIOPORTAL group but not in the ABCMML database. Our study indicates the necessity of sufficient patient numbers for the comparison of CMML patients regarding outcome and phenotype according to their molecular subtype, particularly in the case of rare mutations.