Cryptococcal Pneumonia in a Pediatric Patient with Renal Transplantation

Cryptococcosis is a significant opportunistic infection in solid organ transplant recipients. Patients may have asymptomatic colonization or symptoms of isolated pulmonary disease and severe pneumonia. The disease is diagnosed by culture, direct microscopy or detection of cryptococcal antigen in the body fluid or tissues. We herein present a C. neoformans pneumonia in a renal transplant patient. An 18-year-old male, renal transplanted from his mother, admitted to hospital due to increase in creatinine. On physical examination, there was no finding other than hypertension and operation scar. Urea and creatinine were increased. Renal doppler USG revealed increased renal parenchymal echogenicity. Immunosuppressive drug levels were in normal range. Renal biopsy was consistent with acute cellular rejection and treatment was started. Fever appeared on the following week. Immunosuppressants doses were reduced; antibiotics started empirically. HRCT revealed multiple nodules, lymphadenopathies and pleural effusion. C. neoformans was detected in blood culture. Detailed history revealed the patient was pigeon feeder. Amphotericin B and fluconazole was started. On follow up BPAP was needed owing respiratory distress. Blood culture became negative on the 13th day of treatment. The treatment of the patient was completed in six weeks and followed by prophylaxis. The patient is now being followed up at baseline creatinine 1.73 mg / dl in the 1st year after discharge. We would like to remind that opportunistic fungal infections may also be the cause of fever in solid organ transplant patients. It should be noted these infections may result with high mortality without early diagnosis and appropriate treatment.

Sternocleidomastoid-Clavicle Myoosseus Flap in Patient with Plate Displacement Post Resection and Reconstruction of Ameloblastoma

Background: ameloblastoma is a common tumor found in head and neck disorder. The definitive treatment include resection of tumor and reconstruction for filling the large defect which left after tumor resection. The reconstruction option which can be done is flap method. In this case, we used sternocleidomastoid-clavicle myoosseus flap in our patient with post traumatic plate displacement post resection and reconstruction of ameloblastoma. Case: a 22-year-old woman presented with unstability of jaw after hitting her chin to the table since 3 days prior to admission. On 2011, she had history of ameloblastoma which got resected and reconstructed with fibular graft and plate in the same year. While the plate seemed to be broken, she was managed with plate removal and reconstruct with sternocleidomastoid-clavicle myoosseus flap. Post operation, patient managed with gradual diet from liquid to solid. Observation Post Operation Day (POD) 3, flap is vital. Patient is discharged on POD 7 and visit as outpatient every 3-5 days until POD 14. Finally, we remove the suture, operation scar is good, and the flap is vital during one year follow up. Conclusion: sternocleidomastoid-clavicle myoosseus flap is practical and safe procedure, which can be used as alternative option in mandible reconstruction.

Breast cancer immunophenotype dynamic change

Aim. Comparative analysis of primary breast cancer and breast cancer local relapse phenotypes. Methods. 5808 patients with confirmed diagnosis of breast cancer, including 108 (1,86%) with local relapses, underwent surgical treatment from 2000 since 2011. 26 tumors were prospectively examined by histological and immunohistochemical methods using monoclonal antibodies to estrogen and progesterone receptors and to Her2/neu oncogene protein. Results were compared with corresponding parameters of primary tumours. Results. Local relapses occurred in 1,2% of cases after total mastectomy, and in 5,1% - after incomplete mastectomy. Surgical approach to patients with local relapse of breast cancer depended on tumor size. Ectomy of the relapsing tumor at the post-operation scar site or at anterior chest wall was preformed in 60 (55,6%) cases, simple mastectomy after incomplete mastectomy - in 33 (30,5%) cases, repeated incomplete mastectomy with breast reconstruction - in 12 (11,1%) cases, and loco-regional relapsing tumor ectomy - in 3 (2,8%) cases. Immunohistochemical phenotypes of primary and relapsing tumors were different in 15 out of 26 studied cases. Switch from hormone-negative to hormone-positive tumor was registered in 46,7% of cases, from hormone-positive to hormone-negative tumor - in 40%, isolated change of Her2/neu oncogene protein expression - in 13,3%. Conclusion. The hypothesis of change of breast cancer phenotype after treatment has been confirmed; changes of immunohistochemical parameters after the local relapse should be taken into consideration for defining the treatment tactics.