Medicine
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High-grade cervical intraepithelial neoplasia (CIN) is a precancerous lesion of cervical cancer. The aims of this study were to evaluate the risk factors for recurrence of high-grade CIN and to determine if the specific genotype of human papillomavirus (HPV) is a predictor of recurrent high-grade CIN. Between January 2010 and December 2014, 172 patients with CIN 2+ underwent cold knife conization or a loop electrosurgical excision. ⋯ Eleven patients had persistent HPV16 and/or 18 infection and 3 had new HPV 16 infection after treatment (78.6% and 21.4%, P = .001); the HPV 16 genotype was significantly correlated with recurrent disease and persistent infection after treatment (P = .013 and P = .054, respectively, [OR], 19.4; 95% [CI], 1.89-198.79). Recurrence of high-grade CIN was related to HPV infection after treatment, and persistent HPV16 infection was the most important factor for recurrence. Therefore, HPV vaccination for the HPV16 genotype and regular follow-up with HPV testing after treatment may be useful for preventing recurrent high-grade CIN.
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Observational Study
Coagulation markers and echocardiography predict atrial fibrillation, malignancy or recurrent stroke after cryptogenic stroke.
We evaluated the utility of left atrial volume index (LAVI) and markers of coagulation and hemostatic activation (MOCHA) in cryptogenic stroke (CS) patients to identify those more likely to have subsequent diagnosis of atrial fibrillation (AF), malignancy or recurrent stroke during follow-up. Consecutive CS patients who met embolic stroke of undetermined source (ESUS) who underwent transthoracic echocardiography and outpatient cardiac monitoring following stroke were identified from the Emory cardiac registry. In a subset of consecutive patients, d-dimer, prothrombin fragment 1.2, thrombin-antithrombin complex and fibrin monomer (MOCHA panel) were obtained ≥2 weeks post-stroke and repeated ≥4 weeks later if abnormal; abnormal MOCHA panel was defined as ≥2 elevated markers which did not normalize when repeated. ⋯ We report the novel use of the MOCHA panel in CS patients to identify a subgroup of patients more likely to have occult AF, occult malignancy or recurrent stroke during follow-up. A normal MOCHA panel identified a subgroup of CS patients at low risk for recurrent stroke on antiplatelet therapy. Further study is warranted to evaluate whether the combination of an elevated LAVI and abnormal MOCHA panel identifies a subgroup of CS patients who may benefit from early anticoagulation for secondary stroke prevention.
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Case Reports
Convergent strabismus fixus after bilateral abducens nerve palsies due to aneurysms: A case report.
Convergent strabismus fixus is an ocular motor abnormality in which the eye is fixed in adduction. This condition is mostly associated with high myopia and is caused by a displacement of the extraocular muscles. We report a nonmyopic woman with convergent strabismus fixus due to aneurysms. ⋯ Chronic abducens nerve palsies may develop to nonmyopic convergent strabismus fixus without displacement of extraocular muscles, and mass lesions in the brain including aneurysms should be ruled out when orbital MRI cannot explain the condition.
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Case Reports
A case report: Co-occurrence of Wilson disease and oculocutaneous albinism in a Chinese patient.
Both Wilson disease (WD) and Oculocutaneous Albinism (OCA) are rare autosomal recessive disorders that are caused by mutations on chromosome 13 and chromosome 11, respectively. Here, we report on a patient with coexisting WD and OCA, initially presenting episodes of tremors. ⋯ In this study, we reported on the first case of a child who simultaneously presented WD and OCA, bringing up the possibility of a presumable link between these 2 rare diseases.
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Case Reports
Primary iliopsoas abscess combined with rapid development of septic shock: Three case reports.
Primary iliopsoas abscess (IPA), an uncommon clinical entity, often has no specific clinical features, and advanced imaging techniques are often required for diagnosis. ⋯ An IPA may not be diagnosed in a timely manner because it has no specific symptoms or signs. Therefore, special attention must be given to patients with sudden onset of abdominal pain, hip pain, or high fever without an obvious cause, a primary IPA should be highly suspected in such patients.