Color Doppler and Microvascular Flow Imaging to Evaluate the Degree of Inflammation in a Case of Hidradenitis Suppurativa

Microvascular Flow Imaging is a new ultrasound technique with better ability than Color Doppler Imaging to identify small vessels that have slow blood flow, and it permits better evaluation of the features, especially microvascular architecture, of various lesions. We describe a case of inguinal hidradenitis suppurativa in a patient with positive risk factors (young age, female, smoker, and obese), diagnosed by ultrasonography using B-Mode, Color Doppler, and finally also with Microvascular Flow Imaging. Our aim is to demonstrate the usefulness of this new technique in characterization of lesions.

Extreme laryngeal candidiasis: airway obstruction

We describe the case of a 33-year-old female smoker who presented to the Accident and Emergency department with a 1-day history of rapidly evolving airway compromise. She had no preceding illness or other objective signs/symptoms on presentation, had a history of Chronic Obstructive Pulmonary Disease (COPD) and a previous opioid addiction. Following failed endotracheal intubation, the airway was secured with an emergency surgical tracheostomy. Subsequent direct laryngoscopy revealed a severely diseased glottis and supraglottic area, from which biopsy samples revealed a multiple drug-resistant strain of Candida albicans requiring specialist microbiology input and antifungal treatment. We describe the presentation, investigation, management and outcome of this rare case, along with a literature review of the subject.

P642 Effects of Covid-19 on employment in IBD patients

Background There is an ongoing concern over the impact of COVID-19 on IBD patients. A significant proportion of IBD patients are treated with immunosuppressive medications and their effects on COVID-19 susceptibility and outcomes remain of concern to patients and physicians alike. Apart from the clinical outcome, the pandemic may have other psychosocial effects on this vulnerable cohort such as employment stability. The primary aim of this study was to analyze the percentage of COVID-19 patients who tested themselves for COVID-19 and the outcome of those who tested positive. A secondary aim was to assess their employment status. Methods This was a multicentre international study whereby IBD patients (>18 years) in clinical remission over the last year, were asked to answer an anonymous questionnaire. Demographic data, type of IBD, current and previous medication, admissions to hospital, were collected. Exclusion criteria included patients with IBD flares requiring corticosteroids in the previous 12 months. Results 573 patients (CD: 55.5%) from 8 European Centres and Israel participated in the study. The mean patient age was 39.9 years (SD+/- 13.0). 21.6% were current smokers and 48.5% were non-smokers. The rest were ex-smokers. 44.5% (n=255 ) of patients were tested for Covid-19 and 5.1% (n=13) were positive. The majority were treated at home (92.3%) with only one patient requiring hospital admission. This was a 33 year old female smoker with UC (E3 disease activity) on anti-TNF therapy. 66.7% of positive cases were on anti-TNF medication and 22.2% were on thiopurines. None of the positive cases were on dual antiTNF/thiopurine therapy. 7.2% of patients had family members who also tested positive for Covid-19. Almost half of all patients (45.2%) had their job affected during the pandemic and this was more prevalent in the UC cohort (P<0.05). 70% of patients switched to remote work from home and 21.4% became unemployed. The average age of patients becoming unemployed was 39.3years (SD+/- 11.9). Conclusion Nearly half of our cohort (45.2%) underwent testing and the majority (92.3%) were treated at home even though two thirds of them were on Anti-TNF medication. Unemployment rates affected 1 in 5 individuals and measures promoting remote work have been taken up wisely by IBD patients. Though the clinical outcomes were excellent, the psychological effects of unemployment have yet to be considered.

Case report of recurring pneumonia due to unusual foreign body aspiration in the airway

Foreign body aspiration is a rare but life-threatening event. Most accidental aspiration events occur in children. In adults, it can represent up to 25% of cases. Bronchoscopy remains the gold standard for diagnosing and treating foreign body aspiration from the lower respiratory tract. A 63-year-old female smoker with a history of chronic alcoholism and exposure to pyrotechnic smoke presented a productive cough, with whitish expectoration, dyspnea and pleuritic chest pain on the right side. On chest X-ray, she presented opacity in 2/3 of the right hemithorax. Computed axial tomography revealed consolidation with an air bronchogram on the right hemithorax, cylindrical bronchiectasis, ground glass pattern and centrilobular nodules. Bronchoscopic examination revealed a foreign body covered with granulation tissue in the right segmental bronchus (B6). The granulation tissue was integrated into the foreign body. In a second attempt, the foreign body could be removed, which was of bone consistency, seemingly a bird bone, confirmed by pathological anatomy results. After further questioning, the patient reported that two years before, she had choked when eating chicken. She had a cough and an episode of hemoptysis, but she chose not to ask for medical advice.

Joint Effect of Alcohol use and Tobacco Smoke on All-Cause Mortality and Premature Death in China: A Cohort Study

Background Tobacco smoke and alcohol use were associated with several diseases, study on joint effect of smoke and drink was rare.Objective This study aims to investigate the joint effect of tobacco smoke and alcohol use on all-cause mortality and premature death in a contemporary cohort.Methods China Health and Retirement Longitudinal Study (CHARLS) was an ongoing nationally representative survey for subjects aged over 45 years in China, which performed every 2 years for total of 3 waves from 2011 to 2015 in China. We used weighted logistic regression model to estimate the joint effect of tobacco smoke and alcohol use on total mortality and premature death.Results After adjusting for the confounders, the odd ratios (ORs) value of all-cause mortality were 1.47 (95%CI: 1.03–2.08) and 1.51 (95%CI: 1.09–2.10) in smoker and non-drinker and smoker and drinker separately. Compared with non-smoker and non-drinker, smoker and drinker increased the odds of premature death by 3.14 (95%CI: 1.56–6.34). In the subgroup analysis, there was a 5-fold (OR = 4.95; 95%CI: 2.00-12.27) increase in the odds of premature death for female smoker and drinker.Conclusion This study found a joint effect of tobacco smoke and alcohol use on all-cause mortality and premature death among a contemporary and nationally representative data in China. Our results suggested the joint effect was more pronounced in women, but further research was needed.

Just the Facts: Hypertension in the emergency department

A 65-year-old female smoker complains of dizziness and mild headache. While at the local pharmacy buying acetaminophen, she decides to check her blood pressure to see if it could be “causing her symptoms.” Her initial measurement is 220/96 mm Hg. In consultation with the on-duty pharmacist she is instructed to immediately attend the emergency department (ED) for management of her hypertension.

Hepatoid adenocarcinoma of the lung and the review of the literature

Introduction Hepatoid adenocarcinoma of the lung is an extremely rare type of the non-small cell lung cancer. Treatment principles and prognosis are similar to that of lung adenocarcinoma. Case report A 62-year-old female smoker presented with a huge mass in the left upper lobe. After diagnostic biopsy, she underwent left pneumonectomy and mediastinal lymph node dissection. A diagnosis of stage T4N1M0 hepatoid adenocarcinoma of the lung with positive surgical margins was made. Management and outcome After the operation, the level of serum alpha fetoprotein was 9010 ng/ml (N: <10). The level of serum alpha fetoprotein was decreased with concurrent chemoradiotherapy and chemotherapy. Disease progression was detected at 11 months after diagnosis. No response was obtained to other therapies. The patient died at 14 months from the time of diagnosis. Discussion Usually, patients with hepatoid adenocarcinoma of the lung are male smokers. Hepatoid adenocarcinoma tends to settle in the upper lobes of the lung. The most important prognostic factor of the hepatoid adenocarcinoma of the lung is the disease stage at the diagnosis and patients with metastatic disease have poor survival.

Comprehensive Treatment of Severe Periodontal and Periimplant Bone Destruction Caused by Iatrogenic Factors

Dental implant success requires placement after periodontal therapy, with adequate bone volume, plaque control, primary stability, control of risk factors, and use of well-designed prostheses. This report describes the surgical and prosthetic management of a patient with severe iatrogenic periodontal/periimplant bone destruction. Methods. A 55-year-old female smoker with fixed partial dentures (FPDs) supported on teeth and implants presented with oral pain, swelling, bleeding, and a 10-year history of multiple implant placements and implants/prosthesis failures/replacements. Radiographs showed severe bone loss, subgingival caries, and periapical lesions. All implants and teeth were removed except implants #4 and #10 which served to retain an interim maxillary restoration. Bone defects were covered with nonresorbable dPTFE membranes. In the mandible, three new implants were placed and loaded immediately with a bar-retained temporary denture. Results. Seven months postoperatively, the bone defects were regenerated, and three additional mandibular implants were placed. All mandibular implants were splinted and loaded with a removable overdenture. Conclusions. In this case, periimplant infection and tissue destruction resulted from the lack of periodontal treatment/maintenance and failure to use evidence-based surgical and loading protocols. Combination therapy resolved the disease and the patient's severe discomfort while providing immediate function and an aesthetic solution.

A Rare Case of Recurrent Mucoepidermoid Carcinoma of the Nasal Vestibule

We report a rare case of a large recurrent mucoepidermoid carcinoma (RMEC) in an 81-year-old female smoker, which has originated in the right nasal vestibule. The recurrent tumour was inadequately treated for 6 years. It was a slow-growing tumour for 3 years and then began to enlarge at a higher pace. In the next three years it has covered a large part of the face. The patient had refused any medical treatment. The tumour caused breathing and swallowing difficulties. Because of the profuse bleeding from the tumour, the patient underwent emergency surgery. Surgical treatment consisted of rhinectomy and resection of the central upper lip and part of the right cheek. The facial defect was reconstructed immediately. Recovery from surgery was fast with no complications. Postoperative Multislice Computed Tomography scan showed no metastases so the patient did not receive any chemotherapy or radiotherapy. During a 2.5 years’ follow-up period there was no recurrence of the disease.