Deep neck infections (DNIs) are still emergency conditions in otorhinolaryngology. Due to rapid disease progression and life-threatening complications, the accurate surgical and medical treatment ...must be promptly applied. In the present study, we analyzed treatment protocols of 46 adults to assess efficacy of the treatment and search for prognostic factors of the outcomes. We performed retrospective analysis of medical data of 46 patients, who underwent surgical treatment in our department due to purulent DNI in the period from 2009 to 2017. Data investigated included age, sex, hospitalization time, duration of symptoms before drainage, comorbidities, selected laboratory tests results, location and the number of abscesses, results of microbiological cultures, and antibiotic treatment options. The study group consisted of 33 (71.7%) men and 13 (28.3%) women. Patients age ranged from 18 to 82 years. The mean duration of hospital stay was 13.2 ± 8.4 days. The most common site involved was submandibular space (43.5%), followed by parapharyngeal space (28.3%). The majority of patients had single abscess (81.2%), the multiple abscesses were revealed in 8 (18.8%) cases. The mean size of the abscesses was 42 mm. C-reactive protein level was increased in 96.7% patients (mean level 155.5 ± 146.7 mg/L), but the white blood cell count exceeded the normal in 60.9% cases (mean level 16.89 ± 5.59 × 109/L). Staphylococcus aureus (20.7%) and Peptostreptococcus (20.7%) were the most common species cultured from swabs. The antibiotic treatment included most commonly a combined ceftriaxone and metronidazole (n = 23). Two patients died due to complications. The correlation between different variables and the duration of hospitalization revealed only the hemoglobin level below 12.5 g/dL, a significant predictor of longer hospitalization (16.23 days vs 12.09 days, P = .017). Patients with purulent DNIs and decreased hemoglobin level are predisposed to prolonged recovery following the surgical drainage.
Renal cell carcinoma (RCC) is a common genitourinary cancer. Of the several histologic types of RCC, clear cell renal cell carcinoma (ccRCC) is the most frequent. Due to the development of imaging ...methods such as computed tomography (CT) or magnetic resonance imaging (MRI), the incidence of ccRCC diagnosis has increased rapidly. However, up to one third of patients at prime diagnosis of ccRCC are at metastatic stadium of the disease. Metastases of ccRCC are found mostly in the lungs, bones and liver. Metastasis of ccRCC to the heart is an uncommon clinical situation. We present a rare case of metastatic stadium of ccRCC with metastases to heart tissue visualized in transthoracic echocardiography.
The Triassic radiation of vertebrates saw the emergence of the modern vertebrate groups, as well as numerous extinct animals exhibiting conspicuous, unique anatomical characteristics. Among these, ...members of Tanystropheidae (Reptilia: Archosauromorpha) displayed cervical vertebral elongation to an extent unparalleled in any other vertebrate. Tanystropheids were exceptionally ecologically diverse and had a wide spatial and temporal distribution. This may have been related to their neck anatomy, yet its evolution and functional properties remain poorly understood. We used geometric morphometrics to capture the intraspecific variation between the vertebrae comprising the cervical column among early archosauromorphs, to trace the evolutionary history of neck elongation in these animals. Our results show that the cervical series of these reptiles can be divided into modules corresponding to those of extant animals. Tanystropheids achieved neck elongation through somite elongation and a shift between cervical and thoracic regions, without presacral vertebrae count increase—contrary to crown archosaurs. This suggests a peculiar developmental constraint that strongly affected the evolution of tanystropheids. The data obtained just at the base of the archosauromorph phylogenetic tree are crucial for further studies on the modularity of vertebral columns of not only Triassic reptile groups but extant and other extinct animals as well.
Some of the earliest members of the archosaur-lineage (i.e., non-archosauriform archosauromorphs) are characterised by an extremely elongated neck. Recent fossil discoveries from the Guanling ...Formation (Middle Triassic) of southern China have revealed a dramatic increase in the known ecomorphological diversity of these extremely long-necked archosauromorphs, including the fully marine and viviparous
Dinocephalosaurus orientalis
. These recent discoveries merit a reinvestigation of enigmatic Triassic diapsid fossils from contemporaneous European deposits housed in historical collections. Here, we provide a redescription of
Trachelosaurus fischeri
, represented by a single, disarticulated specimen first described in 1918. Due to its unique morphology, which includes short, bifurcating cervical ribs, and a high presacral vertebral count, this taxon has been referred to either as a “protorosaurian” archosauromorph or a sauropterygian. Our revision clearly shows that
Trachelosaurus
represents the first unambiguous
Dinocephalosaurus
-like archosauromorph known from outside the Guanling Formation. Our finding has important systematic implications. Trachelosauridae Abel, 1919 represents the senior synonym for the recently identified Dinocephalosauridae Spiekman, Fraser and Scheyer, 2021. Based on our phylogenetic analyses, which employ two extensive datasets, we also corroborate previous findings that tanystropheids and trachelosaurids represent two families within a larger monophyletic group among non-crocopodan archosauromorphs, which is here named Tanysauria (clade nov.). Trachelosauridae is minimally composed of
Trachelosaurus fischeri
,
Dinocephalosaurus orientalis
,
Pectodens zhenyuensis
, and
Austronaga minuta
, but one of our analyses also found a probably taxonomically broader clade that may also include
Gracilicollum latens
and
Fuyuansaurus acutirostris
.
Trachelosaurus fischeri
considerably expands the known spatial and temporal range of Trachelosauridae to the earliest Anisian and the Central European Basin. Our findings add to the growing evidence for the presence of a diverse group of fully marine reptiles during the Middle Triassic among Tanysauria. These trachelosaurids possess flipper-like limbs, high vertebral counts, and elongate necks, thus superficially resembling long-necked Jurassic and Cretaceous plesiosaurs in some regards.
The Middle Triassic remains a poorly understood time in the evolution of land vertebrates. Here, we report a new Ladinian-age vertebrate assemblage from Miedary (southern Poland). It consists of more ...than 20 taxa including fish (four species of Hybodontiformes, cf. Gyrolepis, Redfieldiiformes, ‘Thelodus’, Saurichthys, Serrolepis, Prohalecites, Ptychoceratodus), amphibians (Mastodonsaurus, Gerrothorax, Plagiosternum, chroniosuchian Bystrowiella), and reptiles (Owenettidae, Blezingeria, Nothosaurus, Tanystropheus, an additional, yet unidentified tanystropheid, the doswelliid Jaxtasuchus, and another archosauromorph, as well as eight archosauriform tooth morphotypes). Preliminary comparisons suggest biogeographic and environmental similarities with roughly contemporaneous localities known from the southwestern part of the Germanic Basin. Among differences in these two areas are the presence of a new armored archosauromorph and a surprising abundance of Tanystropheus remains in the new Polish site. Miedary is currently the richest source of three-dimensionally preserved Tanystropheus material in the world, which will be crucial for a better understanding of the preferred environment and lifestyle of this highly specialized reptile.
Hypothyroidism is a set of clinical symptoms associated with a deficiency of thyroid hormones. Musculoskeletal symptoms, i.e. stiffness, pain or muscle fatigue, are among the many manifestations of ...the disorder. Rhabdomyolysis, a syndrome accompanying muscle tissue damage, which leads to acute kidney injury, may be a complication of hypothyroidism. In this paper, we present a case of a 35-year-old patient with hypothyroidism due to Hashimoto’s disease, with a 4-year history of diagnosis for periodic pain and muscle weakness in the lower extremities. The patient presented to the hospital due to the recurring symptoms. One month before admission, she had discontinued thyroid hormone supplementation. Laboratory tests showed unquantifiable low levels of free thyroid hormones, elevated creatine kinase levels, and elevated kidney function parameters. Non-compliance can lead to potentially life-threatening complications in hypothyroid patients. Prompt diagnosis and implementation of treatment can lead to symptom resolution.
Niedoczynność tarczycy jest zespołem objawów klinicznych związanych z niedoborem hormonów tarczycy. Jedną z licznych manifestacji choroby są objawy ze strony układu mięśniowo-szkieletowego, takie jak ...sztywność, bóle czy męczliwość mięśni. Jej powikłaniem może być rabdomioliza - zespół chorobowy towarzyszący uszkodzeniu tkanki mięśniowej, który prowadzi do ostrego uszkodzenia nerek. W niniejszej pracy przedstawiono przypadek 35-letniej pacjentki z niedoczynnością tarczycy na podłożu choroby Hashimoto, diagnozowanej od 4 lat z powodu okresowego bólu i osłabienia mięśni kończyn dolnych. Pacjentka zgłosiła się do szpitala ze względu na ponowne wystąpienie objawów. Miesiąc przed przyjęciem zaprzestała suplementacji hormonów tarczycy. W badaniach laboratoryjnych odnotowano nieoznaczalnie niskie stężenia wolnych hormonów tarczycy, podwyższone stężenie kinazy kreatynowej, podwyższone parametry funkcji nerek. W grupie chorych z niedoczynnością tarczycy niestosowanie się do zaleceń lekarskich może prowadzić do potencjalnie zagrażających życiu powikłań. Szybka diagnostyka i wdrożenie leczenia mogą prowadzić do ustąpienia objawów.
Since 1990, several localities within the Keuper (upper Middle to Upper Triassic) strata in southern Poland have yielded remains of numerous terrestrial vertebrate species. Here we report a new Upper ...Triassic vertebrate assemblage from the rediscovered Kocury locality. An incomplete theropod dinosaur fibula named Velocipes guerichi described in 1932 was found there. The site was then forgotten and not explored until our excavations began in 2012, that yielded material of a lungfish, a proterochersid turtle, and a new typothoracin aetosaur Kocurypelta silvestris gen. et sp. nov. The new taxon is characterized by autapomorphies of the maxilla: an elongated edentulous posterior portion longer than 80% of the posterior maxillary process, a short medial shelf restricted to the posterior portion of the bone, an anteriorly unroofed maxillary accessory cavity, and lack of a distinct groove for choanal recess on the anteromedial surface of the bone. These new finds improve our knowledge on the vertebrate diversity of the Germanic Basin in the Late Triassic, evidencing the presence of yet unrecognized taxa. Additionally, the partial cranial aetosaur material emphasizes the issues with the aetosaurian taxonomy that is focused mostly on the osteoderm morphology.
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