Vertebrae Compression Fracture Due to Extra-nodal RDD Case

Vertebrae Compression Fracture Due to Extra-nodal RDD Case INTRODUCTION: RDD was first described by Destombes1 in 1965 as a rare, separate entity of benign self-limiting sinus histiocytosis with massive lymphadenopathy later Rosai and Dorfman2 in 1969, confirmed it as a separate clinic-pathologic entity. Although RDD may occur in any age group, it is most frequently seen in children and young adults. Isolated intracranial disease tend to occur older patients. The disease is more common in males and in individuals of African descent . The most frequent clinical manifestations include fever, night sweats and weight with bilateral massive cervical lymphadenopathy. Mediastinal, inguinal and retroperitoneal nodes may also be involved. RDD is potentially systemic disease and may affect extra nodal sites up to 43% of all RDD patients. The common extra-nodal sites include skin, upper respiratory tract, and bone. Skeletal involvement as a sole manifestation of RDD is extremely rare, occurring in fewer than 2% of all RDD patients and arise most frequently in long b ones such as tibia, femur, humerus, clavicle and bones of the hands. CNS involvement is rare (5%), with 75% of cases involving the brain and 25% involving the spinal canal. Involvement of the CNS without concurrent nodal involvement is rare.3 Laboratory findings are non-specific with leucocytosis, neutrophil, elevation of erythrocyte sedimentation rate (ESR), hypergammaglobulinemia being the most common findings. We present a rare case of vertebrae compression fracture due to extra-nodal RDD without lymphadenopathy later developed metastases to brain. CASE REPORT: A 45 year old lady presented with h/o sudden onset of paraplegia. Work –up was done and spinal mass was found. Later the patient underwent surgical debulking to releave her symptoms. The patient gradually improved. Histopathologically it was diagnosed as RDD. The patient was symptom free for 6 months, then she developed sudden onset of seizures and lower limb weakness. MRI showed multiple cranial and spinal metastasis, following which the patient underwent craniotomy. The patient was further treated with whole brain radiotherapy of 30Gy. There was no improvement of symptoms. The patient eventually expired 6 months following the completion of radiotherapy. Discussion: RDD in its classic form is a benign, self-limiting histiocytic proliferative disorder that is characterized by massive lymphadenopathy. Most patients with RDD are in their second or third decade of life, the mean age of onset of nodal disease is about 20years, with a male-to-female ratio of 1.4:1. It is commonly reported in African-Americans. The etiology of RDD remains unknown; immune system dysfunction and an autoimmune process or viral infection such as Epstein-Barr virus and human herpes virus type 6 have been attributed with the pathogenesis of RDD. The presentation of RDD can be categorised into three sub types: 1) those with only lymph nodes enlargement with sudden increase and spontaneous regression and without any further recurrences; 2) those with immunologic abnormalities at presentation have a more widespread nodal disease and a higher fatality rate4,5 ; 3) those with several extra-nodal site involvement, multi-nodal disease and a protracted clinical course with multiple relapses and remissions for years. In these cases, the severity of disease depends on the type and number of extra-nodal sites.6 Patients who present with or subsequently develop intracranial involvement, become symptomatic at a later mean age (34.9 years), with a strong male predominance.7 Involvement of CNS is rare (5%), with 75% of reported cases involving the brain and 25% involving the spinal canal. Involvement of the CNS in the absence nodal involvement is rare.3 The most common intra cranial presentation is solitary dural based lesion, but multiple intracranial lesions have also been reported. The suprasellar region, cerebral convexity, para sagittal region, cavernous sinus, and petroclival regions are most common locations.7 Only 11 cases of spinal RDD have been reported, of which 10 patients had an extra-medullary tumor. Seven patients presented with epidural lesion, three presented with intra dural lesions.8 Spinal cord compression has been reported in a few patients with spinal involvement causing neurologic deficits.9 Compression fracture due to spinal involvement of RDD has not been reported. CNS RDD is a rare benign histiocytic proliferative disorder, with imaging findings typically showing a meningioma-like, dural-based extra-axial mass lesion, which can be solitary or multiple. Imaging studies typically show an enhancing meningeal-based mass with a variable amount of edema surrounding the lesion. Skeletal involvement of RDD as a sole manifestation is extremely rare, occurs in less than 2% of all RDD patients and involves the long bones such as tibia, femur, humerus, clavicle and bones of the hands or skull, and is usually multiple. Skeletal lesions of RDD are intramedullary osteolytic with either poorly or sharply defined margins. Spinal Rosai-Dorfman disease can be misdiagnosed as meningioma when arising from dura or as metastatic disease of another cause when presenting as vertebral body disease.10 The most common differential diagnosis of a primary bone RDD includes bacterial osteomyelitis, fungal infections such as histoplasmosis and Langerhans cell histiocytosis. Definitive diagnosis requires tissue examination. Microscopically, lymph node enlargement with sinuses containing prominent numbers of histiocytes with phagocytosed lymphocytes. This is a typical picture of RDD. Immunopositivity is expressed by these cells for both CD68 and S-100 protein, and negative for CD1a. RDD has a typical finding in histopathologic studies, that is emperioplesis; a phenomenon of phagocytosis of intact lymphocytes, plasma cells, erythrocytes or neutrophils.11 LCH is a close differential diagnosis both on radiology and histology. Both histiocytes of RDD and LCH are positive for CD68 and S100, but CD1a is positive in LCH. Also Langerhans cell histiocytosis does not exhibit emperioplesis. Treatment in the majority of cases is not indicated as it is a benign and self-limiting.12,13 Therapy is indicated in patients with bulky extra nodal disease with involvement of vital organs or causing life threatening complications.13 Surgical resection or debulking can be considered as an option only when the nodal mass iss compressing airway or intra dural lesion.13 When complete resection cannot be achieved, adjuvant radiosurgery can be give successful partial resection.14 Surgical excision of resectable lesions induced complete remission (CR) in 8 out of 9 patients.13 The role radiotherapy in the treatment has not been established. Various medical alternatives in the management have been tried with limited results. Short term Systemic corticosteroids and prolonged course low dose oral prednisolone has been effectively used in RDD with skin and lymph nodal involvement with respiratory obstruction.15 Steroids tend to alleviate the symptoms and decrease nodal size, recurrences have been reported following withdrawal of steroids. Chemotherapeutic agents have been used without any encouraging results. Combination chemotherapy of low dose MTX and 6-MP, MTX/6MP/vinblastine/6-thioguanine and acyclovir with thalidomide have been tried with limited benefit to patients. It is possible that different patients with RDD may respond to different drugs. Targeted therapy in the form of imatinib, interferon- ÃŽ ±, cladarabine and more recently rituximab has also been in the treatment of RDD.

On Style :: Style Toward Clarity Elements Writing Essays

On Style Style is a very ambiguous word. Asking the question, â€Å"What is Style?† is almost a philosophical endeavor, comparable with â€Å"What is Truth?† Asking the question, â€Å"What is Good Style?† is even harder. Society’s boundaries are constantly shifting to accept or banish items from the definition, in art and writing specifically. Yet there are certain elements that remain constant in all these changes, and these are the elements that style manuals try to pin down. Before the class reading/blogging project began, I thought of style as the method a writer uses to communicate his/her ideas to the reader. I still do. If the point of writing is to communicate ideas, and the vehicle we use to transport the ideas from our brains to our readers is our STYLE, then the most important element of style is being clear. What I have learned from reading Strunk and White's The Elements of Style and Joseph William's Style Toward Clarity and Grace is that there are a variety of ways to make writing clear. Each book has its own unique approach to the problem of establishing clear communication in print. Strunk and White’s method of attack is from the angle of the writer. The rules outlined in the book focus on the writer’s image of what he is communicating. The rules are designed to help the writer sort through her own thoughts on paper, and extract the essence of what is being communicated. The theory seems to be that clearer writing begets clearer thinking. For example, rule #14 in Strunk and white states "Use the active voice." If we compare the two sentences given in the example; "Do not say: There were a great number of dead leaves lying on the ground. Do say: Dead leaves covered the ground." (S&W 18) we see how the active voice communicates more clearly than the passive. The excess words get in the way of what the writer is trying to say. This is compounded in rule #17, â€Å"Omit needless words.† The passage states that â€Å"Vigorous writing is concise.† (S&W 23) This reference to vigor and other health terms is mirrored in other rules, and is a clue-in to the entire Strunk and White approach to style. Good style to them is a way of thinking, a confidence in thought that lends itself to forceful, clear statements by the writer. Williams Style Toward Clarity and Grace carries on many of the same rules that are laid down in Strunk and White, only with a different approach.

America Needs the Affordable Care Act Essay -- America Needs Obamacar

According to Newsweek, the University Medical Center on average has about $100,000 dollars a month in unpaid doctor’s visits and operations and special procedures; this burden gets passed on to the County taxpayer (Johnson). Unpaid bills occur due to people taken to the hospital and either do not have, or have very poor health insurance. The current process is not fair to anyone, whether one has no health insurance or one who has paid for it. Under the Patient Protection and Affordable Care Act, otherwise referred to as Obamacare, signed into law on March 23, 2010, this requires all Americans to purchase health insurance. The purchase of this care is purchased either individually or through the government market place. The act will lower the cost of insurance on all Americans, and additionally relive pressures felt at hospitals under the circumstance one does not have health insurance. Similar acts have been passed in states like Massachusetts resulting in high success; the in dividual mandate requiring Americans to purchase health insurance is justified and constitutional. The health insurance debate is not new, as there have been numerous law debates, deriving in the law passing when it comes to health care. One of the first people to introduce a government run health care was Theodore Roosevelt in 1912. One of the reasons for bringing the bill forward was due to similar laws being passed in Europe; however, the bill never made it to a vote. Representative George H. Utter from Rhode Island once stated that he voted against the bill because he did not believe that the federal government had the resources to insure everyone (Fletcher). Also in 1949 Harry Truman proposed his Fair Deal Act: including giving aid to farmers, assist s... ...tives-20140118,0,4710689.story>. Johnson, Matthew. "How Obamacare Will Effect County Taxpayers." Newsday. N.p., 9 Sep 2012. Web. 7 Jan 2014. . King, Paul. "Study Shows Who Are The Safest Drivers in America." Associated Press. N.p., 17 Apr 2013. Web. 16 Jan 2014. . Kolesnikova, Maria. "How Romneycare Helped Massachusetts." Boston Globe. N.p., 8 Dec 2012. Web. 2 Jan 2014. . Weber, Joseph. "Obamacare Will Destroy America." Fox News. N.p., 31 May 2013. Web. 15 Jan 2014. . America Needs the Affordable Care Act Essay -- America Needs Obamacar According to Newsweek, the University Medical Center on average has about $100,000 dollars a month in unpaid doctor’s visits and operations and special procedures; this burden gets passed on to the County taxpayer (Johnson). Unpaid bills occur due to people taken to the hospital and either do not have, or have very poor health insurance. The current process is not fair to anyone, whether one has no health insurance or one who has paid for it. Under the Patient Protection and Affordable Care Act, otherwise referred to as Obamacare, signed into law on March 23, 2010, this requires all Americans to purchase health insurance. The purchase of this care is purchased either individually or through the government market place. The act will lower the cost of insurance on all Americans, and additionally relive pressures felt at hospitals under the circumstance one does not have health insurance. Similar acts have been passed in states like Massachusetts resulting in high success; the in dividual mandate requiring Americans to purchase health insurance is justified and constitutional. The health insurance debate is not new, as there have been numerous law debates, deriving in the law passing when it comes to health care. One of the first people to introduce a government run health care was Theodore Roosevelt in 1912. One of the reasons for bringing the bill forward was due to similar laws being passed in Europe; however, the bill never made it to a vote. Representative George H. Utter from Rhode Island once stated that he voted against the bill because he did not believe that the federal government had the resources to insure everyone (Fletcher). Also in 1949 Harry Truman proposed his Fair Deal Act: including giving aid to farmers, assist s... ...tives-20140118,0,4710689.story>. Johnson, Matthew. "How Obamacare Will Effect County Taxpayers." Newsday. N.p., 9 Sep 2012. Web. 7 Jan 2014. . King, Paul. "Study Shows Who Are The Safest Drivers in America." Associated Press. N.p., 17 Apr 2013. Web. 16 Jan 2014. . Kolesnikova, Maria. "How Romneycare Helped Massachusetts." Boston Globe. N.p., 8 Dec 2012. Web. 2 Jan 2014. . Weber, Joseph. "Obamacare Will Destroy America." Fox News. N.p., 31 May 2013. Web. 15 Jan 2014. .

The Importance of Corporate Social Responsibility

Corporate Social Responsibility Being a company that prospers is very much different than a company that is consistently following a guided work ethic while making revenue. Companies these days may participate in under the table schemes or anything to make that extra buck. Very a few industries willingly follow corporate social responsibility. Corporate social responsibility (which will now be referred to as CSR) is a business firm’s intention, beyond its legal and economic obligations, to do the right things and act in ways that are good for society. Dell Inc. is a showcase example of companies that oblige by CSR.Not only do they willingly do right by others, they were named Newsweek’s 2010 Greenest Company in America. Almost everything they use from building to shipping is completely recyclable. They ship and package everything in material made out of bamboo called â€Å"mushroom packaging. † This sort of packaging is very durable and has the density to protect any heavy items in need of shipping. Mushroom packaging is very unique in the sense that it is grown and not manmade. Not only are they environment friendly in their use of the highly compostable mushroom packaging, they also give back.Dell knows how important it is to donate to charity and they want to create a relationship with whom they are donating money to. As stated in the article, â€Å"Trisa Thompson, VP of Corporate Responsibility, offered that making a determination about which charitable, non-profit organizations to work with internationally must be undertaken with great care†¦.. ‘These are long-term relationships, not short-term, and need to be entered into carefully and with sufficient due diligence. ’† Dell likes to donate 1% of all pre-tax revenue to charities that support children and education.This company truly understands what it means to be successful. Rather than classifying successful as a company that earns substantial net income, the y also put emphasis on using their power and money into making the world a better place. CSR is something every single company should take interest in but some CEO’s just don’t care for lack of a better word. They want to keep every penny for themselves. Cited Source 1) http://businessexecution. wordpress. com/2011/09/06/dell-issues-2011-corporate-social-responsibility-report/

Relate the Short Story to Any of Your Personal Experiences? Essay

I’m writing this article because I get a fair share of e-mails from people asking about winning the lottery via subtle realm methods, i. e. , astral projection. I personally have used astral projection to see the daily lottery so I know it’s possible. As for if you are for or against it, that’s no concern of mine. I don’t judge why a person wants it for that’s none of my business. I believe our universe is abundant and poverty is a man-made state. What you do with your money is also your business. I save my judgments for myself only. This ability isn’t also just reserved for astral projectors. I personally know of three other women who have seen via dreams 5 of the 6 numbers who played them and won. I think women have a slightly easier time of it due to social programming but we are all of the same make-up ultimately so it’s doable by any sex. Over and over I tell people that all the human shell (body) is, is a filter. All knowledge is â€Å"out there† and we only pick up bits of it because of our filter. Lessen the density of the filter and you’ll receive more data. It’s as easy as that. Leave your body and you’ve taken a huge leap towards removing the filter but even the astral is a filter, though a much finer one than the physical. So you can help get through this filter either through astral projection (often these APs are disguised as dreams), hypnosis, remote viewing or really getting connected to the higher self. It’s similar to the three B’s of inspiration or insight (bed, bath, bus). The ego has to be set aside, the mind is quiet and receptive, and the data is then allowed to pass through. There are other things we can do to lessen our density; think very high thoughts (love resonates the highest), eat no meat, refrain from things like drinking too much, smoking and other things that clog up the chakras and ultimately the aura. When I fast for awhile, I feel as light as a feather and I pick up a much broader frequency range of psychic data. If you want to win the lottery, develop a plan. I’ll try and help if I can.

Comparing Gender Roles of Americans over Past 100 Yrs

Kristal Smith Professor Ryan Enc 1101 Section 39547 November 22, 2012 Contemporary Roles vs Roles 100 Years Ago If we look at America 100 years ago, the changes from then to now are phenomenal. In 1906, the average life span was 47 years. Only 18% of the homes had their own private bathtub. There were only 8000 cars total in the United States with only 144 miles of paved road. [1] Today we have an estimate 250 million registered vehicles in the United States. There have been laws passed that every home must have its own bathtub and fresh source of water.Considering the changes the United States has made over the past 100 years, it is no surprise that the roles of men and women have changed as well. The roles of men and women in contemporary society verses their roles in society 100 years ago present a large gap of physical and psychological differences. The American woman of the 1900’s was to be seen, not heard. She was the homemaker and the one to raise the children. She cook ed, cleaned, tended the laundry, taught the children and took care of her husband.She had no rights or freedoms in the political or religious world. was Limited rights and freedoms with a full load of responsibility was a difficult task to succeed at however the role was well defined which provided a sense of security. She was able to maintain a soft and emotional dispostion simply because there were no expectations of her to be any other way. The 1900’s American woman is the definition of what we term the traditional role of a woman. [2] Her counterpart, the 1900’s American man, was the worker, provider and protector.He had a voice in politics and religion. He gained respect and prestige by his job, his wife, and his children. The role of the man was simple but very important. He was strong and secure with the emotional support of his wife. The roles of the 1900 American women and man complimented each other well and were successful. The American woman role of modern day society has evolved since the 1900’s. In modern day, woman have the right to vote and run for presidency if she chooses to.Women have equal rights as men in the political and religious fields as well in the work force. In modern day, many women work and help support financially for their family. The modern day American woman has more weight and stress to carry along with her rights and freedoms. This often prevents her from being soft and emotional. Their counterpart, the modern day American man, still follow the traditional roles of being the provider and the protector, but there are also a lot of â€Å"stay-at-home† dads which means they are now the homemaker.In some cases, he is not the protector and security which can affect his masculinity. It is complicated to adequately detail the modern day roles of men and women as the lines are no longer clearly defined. The past 100 years has served the American man and woman a diverse amount of changes from woman gainin g equal rights to men cooking and cleaning. In the 1900’s, the roles of women and men were clearly defined and accepted. Today, the roles are not defined and the expectations are confused.Men and women both can now be the political leader, the provider, the homemaker, and the protector. The modern day roles of men and women sharing rights and freedoms are perceived as a good thing. Perhaps the traditional roles were more successful at complimenting each other as they eliminated the problem of gender role confusion. Works Cited 1. â€Å"Women 100 years Ago vs Women Now† http://recomparison. com/comparisons/100358/women-100-years-ago-vs-women-now/ 2. â€Å"100 Years Ago in America† http://rense. com/general70/100yrs. htm Copyright  © 2002 JPS/Kitco Inc

Crime scene Essay

Review Questions 1. What is physical evidence? Provide at least three examples in your answer. Physical evidence is anything that can establish a crime that has happened and anything that links the crime and the criminal. Physical evidence might include objects like weapons, fibers and hair. 2. Describe three ways that a crime scene can be recorded. What is a benefit of each? Photography can show crime scenes at wide angles and can be taken at different vantage points. Drawings can show the location of evidence and contain accurate accounts of the distances. Notes contain description of the crime scene and location of evidence. 3. What is a chain of custody? Why is it important? Chain of custody is a list of persons who had possession of the evidence during the crime investigation. Chain of custody is important because it shows who has access to the evidence and indicates that it has been in the possession of law enforcement. 4. What three types of photographs are taken at crime scenes? Describe each type? Overview Photographs are taken at different points to show any entries and exits to the crime scene. Intermediate Photographs helps to show the evidence in relation to other objects in the room. Close up Photographs are taken to help record specific details that may not b picked up by photographs taken from longer ranges. 5. Why is it important to record the crime scene? It is important to record crime scenes because it helps to create a chain of custody showing what is present at the scene and its location as well as over all location. Critical Thinking Questions 1. Why is it important to secure the crime scene? What do you think would be the most difficult part of doing this? The main reason is that has the potential for contaminating or destroying evidence even if they don’t mean to do so. The most difficult part about this is reporters, civilians and family getting in the way. 2. What type of recording do you think would be the most useful to crime investigators? Why? Videography would be a useful recording tool in a investigation because of recording and the visual elements of the scene. 3. What do you think would be the best method of submitting evidence to a crime lab? Why? 4. What type of evidence do you think would be most difficult to collect? Why? Trace evidence would be difficult to find because its small ad not easily seen. 5. What does the Fourth Amendment protect against? Do you agree with these restrictions on collecting evidence? Why or why not? The fourth Amendment protects individuals from unreasonable searches & seizures agree with the restrictions because it has to be in plane site or have probable cause.