Prague medical report最新文献

The sternocleidomastoid muscle (SCM) is an important landmark for many clinical procedures performed in the neck. Typically, the SCM consists of two heads of origin, sternal and clavicular. We came across bilateral accessory clavicular fibers of the SCM having extended attachment up to the middle third of the clavicle in an elderly cadaver. On the right side, the accessory fibers formed a distinct, separate belly in the form of cleidooccipital muscle. On the left side, four clavicular heads of SCM were observed, which were partially separated from each other. The presence of accessory clavicular fibers may stenose supraclavicular fossa. Additionally, the SCM with accessory clavicular fibers is not a reliable surface landmark and hence may pose difficulties in important procedures in the region such as central venous catheterization.

Eccrine hidrocystomas are rare, benign cystic lesions that usually affect the scalp, cheeks, and eyelids. They are thought to originate from the sweat glands. These lesions can be single or many in nature and frequently worsen in the summer from increased perspiration. They are caused by dilated ducts of eccrine sweat glands. Clinically, they seem like small, transparent cystic lesions that are painless, and they usually affect middle-aged or older people. However, a histological study is necessary to make a final diagnosis. We present a case of a 35-year-old woman who had an epidermal inclusion cyst first identified as a single, painless cystic growth on her right lower eyelid.

Typhoid fever, caused primarily by Salmonella Typhi and Paratyphi, stands as a significant global health concern, with complications extending beyond the typical gastrointestinal manifestations. This review systematically examines the intricate relationship between typhoid fever and hematologic complications, collectively referred to as typhoidal anemia. Hematological abnormalities, including changes in blood profiles and bone marrow responses, are scrutinized, providing a comprehensive understanding of the disease's impact on physiological systems. Specific populations, such as immunocompromised individuals, sickle cell anemia patients, and children in resource-limited settings, reveal varied susceptibilities and outcomes. Complications, such as psoas abscess and secondary hemophagocytic lymphohistiocytosis, are explored, highlighting the multifaceted nature of the disease. The distinct contributions of Salmonella Typhi and Paratyphi to anemia are elucidated, shedding light on the pathophysiological mechanisms involved. Global prevalence and epidemiological variations offer valuable perspectives, underscoring the importance of regional nuances in disease manifestation. Challenges in accurate diagnosis and treatment limitations are acknowledged, emphasizing the need for continued research to enhance diagnostic precision and therapeutic strategies. Insights into long-term effects, prognosis, and the influence of host factors contribute to a holistic understanding of typhoidal anemia. The review concludes by identifying critical gaps in knowledge, advocating for ongoing research initiatives and heightened awareness campaigns. The synthesis of diverse findings provides a comprehensive overview of typhoidal anemia, underscoring the imperative of continued research and awareness for improved patient care and global public health.

Colorectal carcinoma (CRC) is a multifactorial disease process with several factors influencing prognosis. CRC is associated with the expression of multiple cell proliferating markers such as Ki-67/MIB-1. This study was aimed to examine possible correlations between Ki-67 expression and the stage of colorectal carcinoma. This was a single centre prospective study including 93 patients who underwent surgery for colorectal carcinoma. Expression of Ki-67 was assessed by immunohistochemistry on formalin-fixed paraffin-embedded tumour tissue blocks. Categorical variables data were presented as number with corresponding percentage. Continuous data were analysed using parametric tests as applicable and categorical data using nonparametric tests. The level of significance α = 0.05 and P-value < 0.05 was considered statistically significant. The average Ki-67 expression was 77.66% (SD [standard deviation] = 9.68%) with a range of 60 to 90%. Patients with nodal involvement and larger size had a higher Ki-67 expression. To assess statistical significance, the cut-off for Ki-67 expression was set at 70%. Of 66, 48 (72.7%) adenocarcinomas and 12/18 (66.66%) mucinous adenocarcinomas had Ki-67 expression above cut-off as compared to signet ring cell variety. Ki-67 expression in colorectal carcinoma signifies mitotic activity of the tumour. Thus, it could be used as an adjunct to the existing diagnostic arsenal to help overcome its limitation in gauging the functional status of tissues.

Freeman-Sheldon syndrome is a rare form of multiple congenital contracture syndromes (arthrogryposes) and is the most severe form of distal arthrogryposis. The main skeletal malformations include camptodactyly with ulnar deviation and talipes equinovarus while facial characteristics include deep-sunken eyes with hypertelorism, increased philtrum length, small nose and nostrils, and a small mouth. Here we report a rare case of Freeman-Sheldon syndrome (FSS) in an 8-years-old patient giving emphasis on the dental management of FSS.

Foreign body aspiration is a significant cause of respiratory distress in geriatric patients, often leading to severe complications if not promptly identified and treated. Dental materials account for approximately 15-20% of foreign body aspirations in adults, with symptoms that can include dyspnea, localized wheezing, and, in some cases, cyanosis and pneumonia. We report the case of a 60-year-old man who aspirated a dental crown, resulting in shortness of breath. A computed tomography scan revealed the crown lodged in the left main bronchus. The patient underwent successful bronchoscopy for foreign body removal and experienced a full recovery without complications. Neurological conditions, such as epilepsy or Parkinson's disease, increase the risk of aspiration, particularly in elderly patients, in which symptoms may be misdiagnosed due to their nonspecific presentation. While the right bronchus is more commonly affected due to anatomical structure, foreign body aspiration in the left bronchus also warrants attention. This case underscores the importance of rapid imaging and bronchoscopy to reduce the risk of morbidity and mortality from aspiration events. Increased awareness and timely intervention are essential for improving patient outcomes in cases of dental and other foreign body aspirations in older populations.

Ormond's disease is a systemic autoimmune disease with serious complications. We present our retrospective analysis of 83 patients diagnosed with and treated for idiopathic retroperitoneal fibrosis (Ormond's disease) in our department from 1997 to 2023. In this retrospective study, we analysed the diagnostic approaches, the clinical history and surgical and immunosuppressive therapies, and their subsequent effects on our patients. Patients with established disease activity were given immunosuppressive treatment, using corticosteroids alone or in combination with azathioprine, in patients with exacerbation of the disease mycophenolate mofetil. Three patients with Ormond's disease and systemic complications (IgG4-related disease) were treated with rituximab. In the entire cohort, 83 patients received immunosuppressive therapy; the next 5 patients did not receive this treatment because they did not present inflammatory activity from the disease. In these 83 patients, computed tomography showed that immunosuppressive treatment resulted in partial or complete regression of the inflammatory infiltrate. Out of the 83 patients, 10 patients experienced disease exacerbation 7 and 24 months after the immunosuppressive treatment was discontinued. The follow-up ranged from 24 months to 26 years.

During routine cadaveric dissection for undergraduate medical teaching, we observed dual roots of origin of the inferior alveolar nerve (IAN) on the right infratemporal fossa in an elderly male cadaver. The IAN originated by two roots encircling the second part of the maxillary artery (MA). The superior root of the ansa cervicalis (AC) originated from the ipsilateral vagus nerve and two independent muscular branches of the right vagus provided additional innervations to the anterior neck muscles. Awareness about the dual roots of origin of IAN is imperative for anaesthesiologists and dentists, while administering local anaesthesia. A prior knowledge about the vagal origin of AC is essential to prevent iatrogenic damage during surgeries.

Peripheral plasma cell leukaemia (PCL) is a rare hematologic malignancy that can pose diagnostic challenges due to its resemblance to other conditions such as adult T-cell leukaemia/lymphoma (ATLL) or dissemination lymphoma in peripheral blood. We present a case report of a 40-year-old male with symptoms of fatigue, irregular heartbeat, weight loss, and bone pain, whose peripheral blood examination revealed hyperleukocytosis with atypical lymphoid cells exhibiting flower-shaped nuclei, reminiscent of adult T-cell leukaemia/lymphoma. Further investigations including bone marrow aspiration and biopsy confirmed the diagnosis of primary PCL. Immunophenotyping revealed expression of plasma cell antigens CD38 and CD138. This case underscores the importance of recognizing morphological variants and employing comprehensive immunophenotypic analysis for accurate diagnosis of PCL, especially when atypical nuclear features mimic other hematologic malignancies.

Bacterial biofilms represent the primary causative agents of pathogenic processes within the oral cavity. Biofilm microorganisms exhibit heightened resistance to adverse environmental factors. The objective of this study was to ascertain the biofilm-forming potential of clinical strains of anaerobic microorganisms isolated from the periodontal pocket of patients diagnosed with periodontitis. The study of biofilm formation was carried out by the method (Djordjevic et al., 2002) using flat-bottomed 96-well polystyrene microtitration plates. Biofilm formation was determined by staining with 0.1% crystal violet. The study utilised clinical strains isolated from the periodontal pocket of 61 patients diagnosed with grade III chronic periodontitis. Of these, 30 strains belonging to three bacterial species were selected for further analysis: Porphyromonas asaccharolytica, Slackia exigua, and Schaalia odontolytica. Among the Porphyromonas asaccharolytica strains, 80% formed biofilm; the figure for Slackia exigua was 90%, and for Schaalia odontolytica - 80%. In total, 25 strains were capable of biofilm formation. The results indicate that the isolated strains of Porphyromonas asaccharolytica, Slackia exigua, and Schaalia odontolytica exhibited a significant capacity for biofilm formation (83.3% of the strains formed biofilm), particularly Slackia exigua strains, which exhibited the highest number of strains with high biofilm formation ability - 5 (16.6%). It is also noteworthy that these microorganisms exhibited a moderate persistence frequency (16.4% each), of the total sample of microbial biocenoses from inflammatory periodontal soft tissue areas.