Jeremiah C. Tracy

Identification of a Novel Membrane-Associated Gene Product That Suppresses Toxicity of a TrfA Peptide from Plasmid RK2 and Its Relationship to the DnaA Host Initiation Protein

The toxicity of a peptide derived from the amino-terminal portion of 33-kDa TrfA, one of the initiation proteins encoded by the broad-host-range plasmid RK2, was suppressed by a host protein related to DnaA, the initiation protein of Escherichia coli. The newly identified 28.4-kDa protein, termed a DnaA paralog (Dp) because it is similar to a region of DnaA but likely has a different function in initiation of plasmid RK2 replication, interacts physically with the 33-kDa TrfA initiation protein, including the initiation-active monomeric form. The Dp has a cellular distribution similar to that of the 33-kDa TrfA initiation protein, being found primarily in the inner membrane fraction, with lesser amounts detected in the outer membrane fraction and almost none in the soluble fraction of E. coli. Maintenance and inner membrane-associated replication of plasmid RK2 were enhanced in a Dp knockout strain and inhibited in strains containing extra copies of the Dp gene or in membrane extracts to which a tagged form of Dp was added. Recently, the Dp was independently shown to help prevent overinitiation in E. coli and was termed Hda (S. Kato and T. Katayama, EMBO J. 20:4253-4262, 2001).

Interdisciplinary management of congenital infiltrating lipomatosis

Congenital infiltrating lipomatosis is a benign yet locally invasive lipomatous tumor. Current treatment involves surgical excision and reconstruction of craniofacial deformity. Invasion of vital structures often makes complete resection problematic and recurrence is common. We present the case of a 15-year-old female patient with extensive congenital infiltrating lipomatosis involving the left face. A broad treatment algorithm was devised involving surgical resection as well as targeted chemotherapy. At 18 month follow-up the patient demonstrated improved facial symmetry without evidence of disease progression. Combining surgical and medical intervention may allow for a synergistic approach to controlling this rare disease.

Short Hospital Stay Following Neck Dissection

OBJECTIVES To review the clinical characteristics of patients who had a short hospital stay (<24 hours) following neck dissection, and to assess the incidence and type of complications in this patient group. DESIGN Case series. SETTING University-based academic medical center. PATIENTS All patients who underwent neck dissection at our institution from July 2004 through June 2008 and were discharged within 24 hours postoperatively (short stay) were included. MAIN OUTCOME MEASURES Patient demographics, cancer site and type, and details of the procedures performed were quantified. In addition, medical records were reviewed for complications requiring readmission within 30 days postoperatively. RESULTS Review of a prospectively maintained surgical database identified 122 consecutive neck dissections performed at our institution from July 1, 2004, to June 30, 2008. Of these 122 procedures, 71 involved a subsequent postoperative stay of less than 24 hours. These 71 procedures were performed in 69 patients; they had a mean age of 59 years and a sex distribution that was 33% female and 67% male. Neck dissection alone was performed in 22 of the 71 short-stay cases (31%). The most commonly performed concurrent procedures included limited oral cavity or oropharyngeal resections (21 patients) and parotidectomy (13 patients). Modified radical neck dissection was performed in 22 of the 71 cases (31%); the remaining procedures were selective neck dissections. Cranial nerve XI, the internal jugular vein, and the sternocleidomastoid muscle were all preserved in 57 cases (80%). Of the 71 short-stay cases, only 2 (3%) required readmission for a surgical complication within 30 days of their procedure. CONCLUSIONS In carefully selected patients, discharge within 24 hours following neck dissection seems to be safe and appropriate. Given the potential for substantial cost savings, short stay should be studied further in this patient population.

Intramuscular myxoma of the cervical paraspinal musculature: case report and review of the literature☆

CASE A 57year old female patient presented with a painful right-sided neck mass that on MRI was shown to be adherent to the posterior aspect of the sternocleidomastoid muscle. The mass was surgically resected en bloc without complications. Histopathologic analysis revealed the mass to be a myxoma. REVIEW To date, there have been several case reports of myxomas, although very few involving the head or neck. The majority of the literature available concurs that myxomas are benign neoplasms that exhibit characteristic qualities on MRI imaging. The definitive treatment by consensus is surgical excision. CONCLUSIONS Although the incidence of head and neck myxomas is low, it is important to include in the differential of a neck mass with certain radiographic findings.

Intrapericardial paraganglioma associated with succinate dehydrogenase complex subunit C mutation syndrome

Paragangliomas are benign neoplasms of neuroendocrine origin. It is estimated that from 20% to 50% of these tumors are familial. Mutations in the succinate dehydrogenase (SDH) gene family have been found to be responsible for a significant percentage of familial paragangliomas.

Metastatic breast carcinoma of the jugular foramen: A rare case of Villaret syndrome

The differential diagnosis of skull base masses is diverse and includes benign and malignant neoplasms, vascular anomalies, congenital lesions, as well as infectious and inflammatory processes. Metastatic masses of the skull base are a rare manifestation of systemic malignancies. Breast cancer is the most common cause of skull base metastases. Villaret syndrome refers to cranial nerves IX, X, XI, and XII and sympathetic chain neuropathies. It is a clinical subtype of jugular foramen syndromes.

Biomechanical Comparison of Hybrid Tibialis-Semitendonosus and Single-Loop Tibialis Tendon Grafts in ACL Reconstruction

The hybrid tibialis-semitendonosus graft provides femoral fixation strength comparable to a currently accepted graft.

Nasopharyngeal Carcinoma: An Awareness and Screening Initiative in Boston's Chinatown

Aims: Our objective is to describe our institutional experience with nasopharyngeal carcinoma (NPC), and the initiation of a community education and screening program. Study Design: Retrospective case series; academic medical center. Methodology: All cases of NPC treated at our institution between 1995 and 2009 were included; in total, 63 consecutive cases. Initially a retrospective review of patient characteristics was performed (Phase 1). Information reviewed included stage at presentation, completion of primary treatment and follow-up greater than 1 year. Findings of Phase 1were interpreted as demonstrating an issue in communication between the medical center and the community of patients at large. As such, a community education and screening program was instituted as part of an attempted community outreach program (Phase 2). The primary goals were to increase awareness about this disease, symptoms requiring evaluation and to educate patients about the resources available to them. Results: At the time of diagnosis, 67% of patients with NPC presented with advancedstage (III,IV) disease. Of the patients treated with curative intent, only 76% fully completed their plan of treatment. Also of note, only 60% of patients were seen in follow-up at 1-year post-treatment. A community education and screening program was initiated in order to address a presumed gap in provider-patient communication. To date a total of 176 patients have been screened; with approximately 10% warranting further diagnostic

Intravascular Papillary Endothelial Hyperplasia Presenting as a Lateral Neck Mass

Objective: 1) To present an abnormal presentation of intravascular papillary endothelial hyperplasia (IPEH) as a lateral neck mass. 2) Discuss typical pathologic and radiographic findings associated with IPEH. Method: Case presentation representing a patient who presented with a lateral neck mass. The ultimate pathologic diagnosis was IPEH, a rare benign condition. The typical radiographic and pathologic characteristics of this rare entity are presented and discussed. Results: IPEH is a proliferation of vascular endothelial cells that typically presents as a subcutaneous mass. In the aerodigestive tract it may also present as a tender submucosal nodule or a bluish, raised mucosal lesion. The mass manifested in IPEH represents an exaggerated growth response by endothelial cells as they respond to an inciting stimulus. It may present in a normal blood vessel, a vascular malformation, or in response to trauma. IPEH occurs in the setting of recannalization after thrombosis. IPEH shares many clinical and histopathologic features with angiosarcoma. It is important to differentiate this benign proliferative process from malignant disease. Conclusion: IPEH is a rare cause of a slowly growing neck mass. This condition is not a true neoplasm but rather reactive hyperplasia of the vascular endothelium. Diagnosis is based on micropathology and it is important to differentiate it from angiosarcoma. The primary curative management of these lesions is surgical excision.