Lymphangitic Carcinomatosis of Possible Urothelial Origin

Urothelial cancer with lymphangitic carcinomatosis is a rare clinical phenomenon that is not commonly associated with acute respiratory failure. However, the recent prevalence of COVID-19 may predispose a patient's respiratory system to become more susceptible to metastatic lymphangitic spread. We present a case of a 57-year-old male with progressively worsening hypoxic respiratory failure after testing positive for COVID-19 six months prior. Imaging during the hospitalization showed adenopathy consistent with lymphangitic carcinomatosis that was not present six months prior. Acute respiratory deterioration is associated more commonly with infection rather than the progression of cancer, but infectious, autoimmune, and cardiac processes were deemed minimal contributory factors. The patient's respiratory decline only allowed for a T-11 vertebral biopsy which showed poorly differentiated metastatic carcinoma of possible urothelial origin. Urothelial cancer leading to respiratory failure due to lymphangitic carcinomatosis is an uncommon phenomenon, but in the setting of prior COVID-19, it may make the respiratory system more susceptible to lymphangitic spread. However, research is limited due to the recent prevalence of COVID-19, and more research is necessary to investigate a potential correlation with rapid lymphatic carcinomatosis after COVID-19 infection.

Cefepime-Induced Neurotoxicity

Cefepime is a common antibiotic used to treat various infections such as pneumonia, skin infections, and intra-abdominal infections due to its broad gram-positive and gram-negative spectrum. However, patients with acute kidney injury, end-stage renal disease, and renal transplantation are disproportionately at higher risk of developing complications from administration of cefepime, secondary to its predominant renal excretion. Current guidelines prescribe cefepime renal-dosing, dependent on the glomerular filtration rate, to prevent toxicity. This study presents a rare case where an acutely hospitalized patient undergoing chronic renal transplant rejection was administered renal-dose cefepime. Despite renal dosing, the patient developed neurotoxicity that manifested as delirium, inability to tolerate oral intake, and non-convulsive status epilepticus. Solely adjusting for renal dysfunction may be inadequate to prevent the accumulation of cefepime metabolites, which may present in an atypical manner in the patient. Such possibilities emphasize the need for continued evaluation of a patient’s mentation in case of cefepime administration. Cefepime-induced neurotoxicity incidences need to be evaluated and researched thoroughly.

Multiple enamel pearls in two siblings detected by volumetric computed tomography

A rare case of multiple enamel pearl formation is presented involving the maxillary molars in two siblings incidentally recognized during volumetric CT examination. Although the pathogenesis of ectopic enamel formation is not known, possible mechanisms to account for this phenomenon are discussed in the context of current knowledge regarding root genesis. The radiographic presentation of enamel pearls and its clinical significance is also discussed. The observation of multiple enamel pearls in two siblings raises the possibility of a hereditary association in the formation of enamel pearls.

Comparative pilot study of symptoms and quality of life in cancer patients and patients with end stage renal disease

BACKGROUND

Patients with advanced renal failure are increasingly opting for conservative treatment, yet little is known of their palliative care needs.

METHODS

We performed a cross-sectional study, examining symptom burden and quality of life in patients with advanced renal failure (estimated GFR < 17 mL/min; n = 11). A contemporary cohort with terminal malignancy acted as comparators (n = 11). Symptom burden was scored using an extended Memorial Symptom Assessment Scale Short Form questionnaire. Quality of life was assessed using the Euroqol-5Q questionnaire. Demographic and pathological data, performance status and co-morbidity were also recorded.

RESULTS

Baseline characteristics were similar for the two groups. Symptom burden (renal 17; cancer 15; P =NS) and quality of life scores (renal 60; cancer 60; P =NS) were remarkably similar. Both groups reported high levels of psychological distress.

CONCLUSIONS

Patients with advanced renal failure experience a symptom burden and impairment of quality of life similar to that of patients with terminal malignancy.

Giant congenital intrapericardial left atrial aneurysm diagnosed by contrast-enhanced computed tomography

A left atrial aneurysm is a rare cardiac anomaly. The etiology is usually congenital, but it can also occur as an acquired pathology secondary to mitral valve disease or a degenerative process. We report a case which, on routine PA chest radiography, presented as cardiomegaly with a bulge on the left cardiac contour. Further evaluation by contrast-enhanced computed tomography proved it to be caused by a large left atrial aneurysm.

"Meth mouth": rampant caries in methamphetamine abusers

Rampant dental caries is a characteristic finding in methamphetamine abusers. The popularity of methamphetamine, particularly among the gay community where it is linked to the spread of HIV, its ready availability, and rapid spread across the nation have placed methamphetamine use in an epidemic status in many communities unaccustomed to dealing with drug abuse. We present a case of a 25-year-old male "meth" abuser of unknown HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV) status to promote recognition by the health care team of the association of rampant dental caries with methamphetamine abuse for appropriate intervention to ensure successful treatment and prevention of disease progression.

Pseudocyst formation: a rare complication of wandering spleen

Wandering spleen is a rare entity, in which the spleen is abnormally mobile due to its attachment by a long vascular pedicle. This long vascular pedicle predisposes it to various complications, the most common being torsion. Here, we present a case in which a wandering spleen in a young female was complicated by pseudocyst formation, and discuss the possible aetiology, pathogenesis, diagnosis and therapeutic implications of this extremely rare complication.

Protective ability of acetylsalicylic acid (aspirin) to scavenge radiation induced free radicals in J774A.1 macrophage cells

Radiation generates a variety of free radicals during the exposure of biological tissues through radiolysis of water. These free radicals are highly reactive and cause oxidative damage to biological molecules. This study examined the protective ability of aspirin against radiation induced oxidative stress. The study assessed the protective effect of aspirin (0.05 mM, 0.10 mM, 0.50 mM) on the generation of free radicals during exposure of J774A.1 macrophage cells to radiation (13.25 cGy). Approximately a 2.2-fold increase in superoxide anion formation as determined by cytochrome c reduction was observed following exposure of the cells to radiation for 20 one second exposures. Preincubation with aspirin exhibited a dose dependent decrease in free radical production as assessed by chemiluminescence and cytochrome c reduction. Aspirin also produced a concentration dependent reduction in radiation induced DNA damage in the cells. The data indicate that radiation of these cells results in production of reactive oxygen species and DNA damage, and aspirin can decrease these effects in a concentration dependent manner.

A retrospective radiographic survey of embedded primary molar roots in Saudi adult patients

This retrospective study reports the radiographic prevalence of embedded primary molar roots within Saudi adult dentulous patients. Embedded roots of primary molars were viewed radiographically by evaluation of the records of 300 patients. Embedded primary molar roots were detected in 7 percent of the viewed patient radiographs. Fifty-five percent of the embedded roots demonstrated the concomitant existence of partial bony ankylosis. The remaining 45 percent of the embedded roots were surrounded by an intact lamina dura and periodontal ligament space. The frequency of occurrence demonstrated an age-based relationship, showing 9 percent prevalence in the older age-group (41-50 yr.) as compared to a 45 percent occurrence seen in the younger (15-20 yr.) group. Seventy-seven percent of the embedded roots were found within the mandible as compared with a 23 percent occurrence in the maxilla.

Multiple sclerotic masses of jaws

Multiple sclerotic masses of jaws commonly occur in middle aged black females. There exists a plethora of terminologies to describe these entities. The phenomenon has been speculated to be due to low grade infection or the result of dysplastic changes of osseous tissue. Familial history has been noticed in some cases. Radiographically the masses appear multiple, dense and globular radiopacities with a radiolucent rim. This criterion may be used to distinguish the masses from chronic diffuse sclerosing osteomyelitis. Secondary infection leading to sequestration is a common complication.

Meswak chewing stick versus conventional toothbrush as an oral hygiene aid

This study consisted of two trials. Trial 1 compared the meswak with the toothbrush when used twice and five times a day. Trial 2 compared habitual meswak users with toothbrush users. Under experimental conditions, a significant reduction in gingivitis was found both buccally (p less than 0.01) and lingually (p less than 0.05) after using a meswak five times a day compared with a conventional toothbrush. Twice a day brushing with a meswak produced a significant reduction in gingivitis buccally (p less than 0.005) compared with toothbrushing, but lingually the difference was insignificant. There were no significant differences in plaque scores between a meswak and a conventional toothbrush when brushing was continued five times a day. Plaque scores became significantly higher when a meswak was used only twice a day compared with toothbrushing, specifically on the lingual surfaces of the teeth (p less than 0.01). Habitual meswak users showed a significant reduction in gingival bleeding (p less than 0.05) and interproximal bone height (p less than 0.02) compared with toothbrush users. The differences in plaque scores and pocket depth measurements between the two groups were insignificant. The results imply that a meswak, used five times a day, may offer a suitable alternative to a toothbrush for reducing plaque and gingivitis. However, meswak may not be sufficient for maintaining interproximal dental health when used without the support of other oral hygiene aids.

Radiation doses to the Gonadal area in dental radiography

The authors study the dose of radiation received in the Gonadal areas during intra-oral or panoramic radiography performed at the college of Dentistry in Riyadh, Saudi Arabia. The results show a negligible generic risk.