Spindle Cell Melanoma Harboring a Nodule of Epitheloid Cell Melanoma Component: A Study of a Diagnostically Challenging Case

Background: Melanoma is a very heterogeneous human neoplasm. In addition to four major (conventional) histologic subtypes a number of uncommon variants do exist. Objective: An unusual case of a spindle cell melanoma (SCM) containing a demarcated nodule of conventional epitheliod cell melanoma component is described. Material and Methods: A 71-year-old man manifested with a protuberated ulcerated skin tumor arising on the right forearm. The resected biopsy was analyzed immunohistochemically with a variety of anti-human antibodies. Results: The tumor consisted of a highly cellular mass of spindle-shaped cells without any significant intratu-moral fibrosis. In addition, a nodule of epithelioid cell tumor component was present within the lesion. The spindle cell component showed a disperse reactivity for S100 protein and was negative for other melanocytic markers. It exhibited a very high mitotic activity and proliferation Ki-67 index. No melanin pigment was detected. In contrast, the epithelioid cell component was strongly positive for S100 protein, Melan-A/MART-1, HMB-45, and PNL-2. The mitotic and proliferation indices were much less pronounced and melanin deposits were visible. A diagnosis of a non-desmoplastic SCM harboring a nodule of epithelioid cell melanoma component was established. Conclusion: SCM often posses a diagnostic dilemma because its histomorphology is atypical and its immunohistochemical profile may differ from other subtypes of melanomas. The present paper points out this uncommon histopathological entity that may sometimes be encountered in dermatopathological practice and that requires more complex diagnostic approach.

Correlation of Increased Total Serum Immunoglobulin E Levels and Hidradenitis Suppurativa

Introduction: Hidradenitis suppurativa is a chronic inflammatory skin disease with a typical formation of inflamed nodules, abscesses, and sinus tracts usually in the axillary, inguinal, and anogenital region. We decided to investigate the possible association of hidradenitis suppurativa and total IgE elevation and to explore the patients’ characteristics which can be related to high IgE levels. Methods: We performed a retrospective observational study which included 67 patients with moderate-to-severe stage of hidradenitis suppurativa followed up in our outpatient dermatology department. Total IgE, IgA, IgG, IgM, and CRP serum levels were measured. A personal and family history was taken. We asked them about allergic diseases and cigarette smoking and determined the basic parameters such as the weight and height of the patients. Results: Elevated total IgE levels were noticed in 21 patients (31.3%), of which 6 had a history of allergic disorder. Three of them had allergic rhinoconjunctivitis and the other three were suffering from atopic dermatitis. The mean total IgE level was 203.0 IU/ml with a maximum value of 1,954 IU/ml. Analysis of the factors, such as cigarette smoking, sex, elevated CRP, body mass index, and the number of affected areas, did not show an association with increased IgE levels. Conclusion: Our study showed a higher mean value of total IgE in patients with moderate to severe hidradenitis suppurativa than in the general population. However, we did not confirm an association with any characteristics of the patients. Limitations of this work include a small number of patients and a lack of the control group, therefore further and more extensive studies are needed to support these results.

The Effect of Music on Heart Rate Variability (Review)

Music therapy and the use of music in medical practice have now become rapidly advancing and promising areas of non-invasive alternative medicine. However, the opinions of physicians and therapists on the implementation of this complementary therapy, especially in the process of treating the patient, are constantly different. In addition, the effect of music and individual methodological procedures are not uniform and defined in detail. Therefore, this review study summarizes the results and conclusions of some selected high-quality publications over the last decade and makes suggestions for improvement and further research. It focuses mainly on the evaluation of changes in heart rate variability (HRV) as an indicator of the activity of the autonomic nervous system (ANS) in connection with the application of music in the process of passive music therapy.

A Retrospective Analysis of the Palliative Surgical Treatment in Patients with Malignant Pleural Effusion

Introduction: The formation of malignant pleural effusion (MPE) is a clinical manifestation of an advanced malignancy or its dissemination. The focus of treatment is primarily palliative and aimed at relieving symptoms, especially dyspnoea. Material and Methods: Clinical data from patients who were hospitalized at the Clinic of Thoracic Surgery, JFMED CU and Martin University Hospital, in the years 2015–2019 were retrospectively explored and statistically analyzed based on their medical records. Results: From the group of patients with proven MPE (n=67), 32 patients were male (48%) and 35 were female (52%). The mean age was 62.3 years (65.4 for males and 59.4 for females). The three most common primary malignancies were lung cancer (n=24), breast cancer (n=14), and kidney cancer (n=6). In 38 patients with MPE a talc pleurodesis via VATS was performed, with a median survival of 341 days (95% CI 256–859). Drainage following the talc slurry pleurodesis was performed in 10 patients with a median survival of 91.5 days (95% CI 64-NA). Ten patients with MPE underwent drainage only. The overall median survival time after all types of surgical interventions was 301 days (95% CI 207-389 days). Conclusion: Management of MPE depends on the patient´s prognosis. A definitive intervention is required in patients with a long-term survival, while in patients with a short life expectancy procedures leading to the shortest hospital stay are preferred. Videothoracoscopic procedures with pleurodesis represent an effective treatment for patients with symptomatic MPE with a good performance status, presence of lung re-expansion following pleural drainage or expected survival.

Ecstasy-Induced Malignant Hyperthermia with Fatal Outcome: A Case Report

3,4-methylenedioxymetamphetamine (MDMA), also known as “ecstasy”, “tulips”, or “Molly”, is an increasingly used “recreational drug” particularly among teenagers and young adults along with the widespread conviction that MDMA is a “safe drug”. The reason for this substance being abused is a desire for closeness to other people, develop a greater tolerance of their views and feelings, and even to touch them physically. According to these effects MDMA is classified also as an “empatogenic” or “entactogenic”. Although MDMA is used for the above-mentioned socially acceptable purposes, in many individuals the drug usage is followed with side-effects varying from mild to severe, potentially even life-threatening. One of the most significant complication of MDMA intoxication is hyper-thermia in the consumer. Authors presented a case of MDMA toxicity with severe hyperthermia (42 ºC) with a fatal outcome to the ecstasy-influenced subject. The aim of this article is to describe the effects of ecstasy, the “recreational drug” widely used in local pubs, dance clubs, and during open air festivals, even in the Slovak Republic.

Experimental Models of Acute Lung Injury: their Advantages and Limitations

Acute damage to the lung may originate from various direct and indirect reasons. Direct lung injury may be caused by pneumonia, near-drowning, aspiration, inhalation of toxic gases etc., while indirect lung injury is secondary, following any severe extra-pulmonary disease, e.g. sepsis, acute pancreatitis, or severe trauma. Due to a complex pathophysiology of the acute lung injury, the treatment is also extremely complicated and except for lung-protective ventilation there have been no specific treatment approaches recommended. An urgent need for a reliable and sufficiently effective treatment forces the researchers into testing novel therapeutic strategies. However, most of these determinations should be done in the laboratory conditions using animals. Complex methods of preparation of various experimental models of the acute lung injury has gradually developed within decades. Nowadays, there have been the models of direct, indirect, or mixed lung injury well established, as well as the models evoked by a combination of two triggering factors. Although the applicability of the results from animal experiments to patients might be limited by many factors, animal models are essential for understanding the patho-physiology of acute lung injury and provide an exceptional opportunity to search for novel therapeutical strategies.

Congenital Abdominal Wall Defects: A Topic Review and a Case Report of a Lethal Polymalformation Syndrome with a Giant Abdominoschisis

Abdominal wall defects (AWDs) represent a wide spectrum of congenital anomalies which are characterized by a herniation of abdominal organs through a pathologic opening in the abdominal region. The author describes a 29-year-old pregnant woman who was prenatally found to have a living female fetus with a giant omphalocele and a spinal deformation in the lumbosacral region. An evisceration of the abdominal contents into the amnionic cavity was visible. Based on USG findings the limb-body wall complex was suggested. An amniocentesis was performed and a genetic testing identified a chromosome 17q23.1–q23.2 duplication. As the fetal anomaly was considered incompatible with life, a medical termination of the pregnancy was carried out. Postmortem examination of the fetus revealed a huge abdominoschisis with a complete evisceration of the liver, stomach, small and large intestines, spleen, and the right kidney. A severe left-sided scoliosis deformity of the spine with crooked trunk was evident. The gross findings shared the features of omphalocele and limb-body wall complex with no postnatal life expectancy. Most fetal AWDs have poor prognosis. The pathology of these conditions differ greatly and require specific prenatal evaluation and pregnancy management for each entity. Accurate assessment of AWDs will allow the identification of isolated forms with better clinical outcomes compared to associated multiple malformations with chromosomal anomalies or genetic syndromes.

Case Report of a Term Newborn with Prenatally Diagnosed Alobar Holoprosencephaly

Holoprosencephaly is a congenital structural abnormality of brain resulting from incomplete cleavage of prosencephalon into two cerebral hemispheres. It is classified as a disorder of organogenesis and brain histogenesis and is typically associated with facial anomalies.Holoprosencephaly is relatively rare – the incidence in live births varies between 1:10,000 – 1:15,000 but is described in 1 out of 250 spontaneously aborted embryos.There are four major varieties of holoprosencephaly according to the degree of separation of the brain hemispheres; this division is crucial for the patient’s prognosis. Three classic subtypes are alobar, semilobar, and lobar holoprosencephaly and there is also a fourth subtype called middle interhemispheric variant.We present a case study of a term newborn with prenatally diagnosed holoprosencephaly with severe facial dys-morphism and associated health complications.

Development Strategies in the Field of Lifelong Learning of Older Adults

Introduction: European gerontological research confirms that accelerated aging of the population will lead to a pronounced occurrence of target groups of functionally capable older people. Lifelong learning is a tool that enables an active post-retirement period in order to enhance cognitive mental capacities, prevent dementia, and overcome the intergenerational gap. The aim of this paper is to develop strategies in the field of lifelong learning for older adults through SWOT analysis.Methods: A qualitative study on lifelong learning for older adults was conducted during the month of November 2019 using 4 SWOT matrices which were subsequently analyzed and integrated into one common matrix. Four strategies were developed based on this template.Results: The analysis of the SWOT matrix showed that lifelong learning contributes most to a sense of belonging, prevention of social isolation, prevention of dementia, and better personal satisfaction. The biggest obstacles for older people when it comes to participating in lifelong learning programs are finances, physical illness, and a lack of understanding from their family members and the wider society for this kind of activity.Discussion: Lifelong learning contributes to a long-term maintenance of cognitive processes of participants involved in education processes. Lifelong learning provides the opportunity to promote older people’s health regardless of the formal education they received in early adulthood.Conclusion: Learning and further education are not only the indicators of active aging, but also a need for older people to master new tools so that they can actively participate and contribute to the society.

Oral Microbiome of Permanently Mentally Disabled and Healthy Children

The oral cavity is a biologically significant and complex site of the human body. It is a gateway into the internal environment of the organism. There are many processes, such as the beginning of digestion, speech creation, and sensory perception of taste. Oral health is closely related to the general health of a person. The oral cavity contains an enormous number of microorganisms that can cause various diseases. Oral bacteria are responsible for diseases in the mouth, but can also seriously harm human health. The oral microbiome also serves as an indicator of health, respectively morbidity of the human organism. Compared to healthy children, mentally disabled children suffer from many congenital and acquired diseases and disorders that affect their overall and oral health. These children require a specific approach to the examination, but also to the therapy.Therefore, it is necessary to pay attention to the prevention of oral diseases in children, whether healthy or mentally disabled.