Hodgkin and non-Hodgkin lymphoma of the head and neck: clinical, pathologic, and imaging evaluation.

Trauma induces a profound immunological dysfunction. This is characterised by an early state of hyperinflammation, followed by a phase of immunosuppression with increased susceptibility to infection and multiple organ failure. Therapeutic strategies directed at restoring immune homeostasis after traumatic injuries have largely failed in translation from "bench to bedside". The present review illustrates the role of biological modifiers of the posttraumatic immune response by portraying different modalities of therapeutic immune modulation. The emphasis is placed on anti-inflammatory (steroids) and immune-stimulatory (interferon) pharmacological strategies and modified resuscitative strategies, as well as more unconventional immunomodulatory approaches, such as immunonutrition.

Role of biological modifiers regulating the immune response after trauma.

Management of foreign bodies of the upper gastrointestinal tract

Retained surgical sponges have been reported to occur after a diversity of surgical procedures, but transmural migration is a very unusual sequela. This article reports a case in which a retained surgical sponge eroded from the intra-abdominal space into the intestinal lumen, migrated distally, and spontaneously passed with defecation 12 weeks after the cesarean section. We performed a systematic review of the literature in Pubmed and found 64 cases of transmural migration of retained surgical sponges. Sixty-four cases have been reported of transmural migration, mainly after intra-abdominal surgery. The most frequent site of impaction is the intestine (75%), but we also found 2 cases that describe migration into the stomach and 7 into the bladder. Five more cases have been published describing transdiaphragmic migration. Only 4 cases describe a sponge spontaneously expelled through the rectum, whereas more than 93% needed re-intervention. We strongly advise only the use sponges with radiopaque markers during surgery and additional methodical wound/body cavity examination.

Transmural migration of retained surgical sponges: a systematic review.

'I'easdalc G, Parker I_, Murray G, Jcnnctt B. Acta Neutrochlir 19/(9;suppl 28:205-8. 2 Jeninett 13, Bond M. Lancet 1975;i :481-4. Whitley RJ. In: Nahmias AJ, et al, eds. The humpian herpesvirzses. Ncw York: Elsevier, 1981 :513. I)ongson NM, Bailey AS, Miapper PF. Rec Adv' (C/zn Virol 1980 ;2:147-57. Klapper PE, Laing I, Longsoin M. lacet 1981 ;ii: 607-8. Longson MI, Bailey AS. Rec Adv C/,lin Virol 1977;1: 1-19. McKendriCk (GM)V. Lancet 1979;ii :1181-2. Skoldenberg BS, Kalimo K, (Carlstrom A. Forsgren P, Halocrn P. Acta Neurol Scantid 1981,63:273-85. MacCallum FO, (Chin IJ, Costling JVT. .7 Med Microbial 1974;7:325-31. Elloni (;B, Furman PA, Fyfe JA, de Niranda P, Beauchamp L, Schaeffer HJ. Proc Natl Acad Sci 1977 ;74:5716-20. 1)e ('!ercq F, I)escamps J, 1He Somer P, er al. I'roc AVatl Acaa Sci 1979;76:2947-51.

https://www.bmj.com/content/bmj/283/6305/1545.4.full.pdf

Amoebic liver abscess.

Retained surgical sponge or glossypiboma is a relatively common occurrence; however, surgeons may not report these events for fear of litigation and adverse publicity. We report postoperative complications in three cases due to retained surgical sponges. The first case, a 26-year-old woman, presented with gastric outlet obstruction due to the sponge obstructing the pyloric canal three weeks following cholecystectomy, which was completely relieved following endoscopical removal of the sponge. The second case, a 32-year-old woman, presented with repeated attacks of intestinal obstruction following cholecystectomy and tubal ligation and was treated with surgical removal of the sponge. The third patient, a 40-year-old woman, presented with features of colonic obstruction following hysterectomy. Colonoscopy revealed a partial migration of the sponge through the colonic wall and on laparotomy, she was found to have multiple internal fistulae between the small and large intestines, all occurring around the inflammation caused by the retained sponge.

Postoperative complications due to a retained surgical sponge.

A case of an isolated submandibular gland metastasis from a clinically occult papillary thyroid carcinoma is described in a 46-year old lady. Initial surgery was done based on the fine needle aspiration cytology (FNAC) report of adenocarcinoma of the submandibular gland. Histopathologic examination of the specimen suggested a metastatic papillary carcinoma. Occult papillary carcinoma in the thyroid was found by multiple blind FNACs. Subsequently to near-total thyroidectomy, no other site of metastasis was found on radio-iodine scanning.

Isolated submandibular gland metastasis from an occult papillary thyroid cancer.

An analysis of management of 546 cases of solitary thyroid nodules in an endemic area is presented. None of the evaluating procedures could effectively isolate benign from malignant disease. Of 508 cases considered clinically to be benign, 42 harboured malignancy on histological examination whereas of the 38 cases suspected clinically to be malignant, 21 were histologically benign. 131I-Thyroid scanning also lacked sensitivity in identifying malignant nodules since the prevalence of malignancy in cases which were 9cold9 (44/316) was not significantly different from that amongst the 9uniform9 cases (15/142). Fine-needle aspiration cytology, although the most sensitive and specific evaluating modality, did not decrease the number of operations for solitary thyroid nodules nor did it increase the incidence of malignancy amongst the operated cases, because of its limitations in differentiating benign from malignant follicular neoplasms. The conditions under which surgery was advocated are described.

https://pmj.bmj.com/content/postgradmedj/73/863/560.full.pdf

Management options for solitary thyroid nodules in an endemic goitrous area.

A case of an amebic liver abscess with unusual clinical manifestations is presented. A middle-aged male with an abscess in both lobes of the liver presented with obstructive jaundice due to pressure on the porta hepatis with stasis of the bile in the intrahepatic biliary radicals. The patient did not respond to repeated needle aspirations and thus required open drainage. Subsequently, the patient developed a biliary leak through the drainage sites, and an injection of contrast dye into the cavity revealed a communication between the abscess cavities and the biliary tree. The biliary leak stopped spontaneously, and the large cavities also closed completely during the followup period.

Amebic liver abscess with jaundice

A case report of isolated involvement of the mandible by non-Hodgkin lymphoma is presented The patient presented with a non-healing ulcer following a tooth extraction Biopsy revealed an undifferentiated cancer Investigations failed to reveal any involvement of the organs A hemimandibulectomy was performed followed by radiotherapy on receipt of the histopathological diagnosis of non-Hodgkin lymphoma The patient is asymptomatic two and a half years after treatment

Isolated involvement of the mandible by non-Hodgkin's lymphoma.

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