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Kopelman ZA, Keyser EA, Morales KJ. Ectopic pregnancy until proven otherwise … even with a negative serum hCG test: A case report. Case Rep Womens Health 2021; 30:e00288. [PMID: 33604247 PMCID: PMC7876537 DOI: 10.1016/j.crwh.2021.e00288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 02/03/2023] Open
Abstract
Ectopic pregnancy is commonly considered in the differential diagnosis for first-trimester vaginal bleeding and acute abdominal pain in women of reproductive age. Negative human chorionic gonadotropin (hCG) tests have been considered the gold standard to rule out this life-threatening diagnosis and appropriately rising hCG levels are thought to exclude it as well. In the unique case reported here, pathology confirmed ectopic pregnancy is identified in the setting of a negative serum hCG test. The patient was a 23-year-old woman (with one living child and one earlier miscarriage) who presented to the emergency department (ED) with sudden onset of abdominal pain, vaginal bleeding and syncope. She was tachycardic but normotensive and had both a negative serum hCG test and a negative urine hCG test. Imaging demonstrated a hemoperitoneum and right adnexal mass. She was taken for emergency exploratory surgery. The right fallopian tube had a tubal mass consistent with an ectopic pregnancy as well as 500 mL of blood. Pathology confirmed the ectopic pregnancy. A literature review revealed only two prior documented cases of pathology-confirmed ectopic pregnancy in the setting of a negative serum hCG test. The patient had experienced an abortion two months earlier without a documented intrauterine pregnancy. Her hCG levels were followed to <5 mIU/mL and she had not yet had return of menses at the time of her presentation. Perhaps a chronic ectopic could explain this unusual case. This case highlights that an ectopic pregnancy should never be excluded from the differential diagnosis in a woman of reproductive age. Ectopic pregnancy can occur in a patient with a negative serum human chorionic gonadotropin (hCG) test. Never exclude the diagnosis of ectopic pregnancy when evaluating a woman with an acute abdomen in the emergency room. Exploratory surgery is the treatment of choice for an unstable patient with a suspected ruptured ectopic pregnancy.
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Key Words
- ACOG, American College of Obstetricians and Gynecologists
- CT, Computed tomography
- Case report
- ED, Emergency department
- Ectopic pregnancy
- FAST, Focused assessment with sonography for trauma
- G, # of total pregnancies
- Hemoperitoneum
- P, # of full-term pregnancies, # of preterm pregnancies, # of miscarriages and/or abortion, # of living children
- hCG, Human chorionic gonadotropin
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Mukund A, Bhardwaj K, Choudhury A, Sarin SK. Survival and Outcome in Patients Receiving Drug-Eluting Beads Transarterial Chemoembolization for Large Hepatocellular Carcinoma (>5 cm). J Clin Exp Hepatol 2021; 11:674-681. [PMID: 34866846 PMCID: PMC8617544 DOI: 10.1016/j.jceh.2021.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/AIMS This study aimed to study the outcome and survival of patients with large hepatocellular carcinoma (HCC) receiving drug-eluting beads (DEBs) transarterial chemoembolization (TACE). In addition, tumor morphologies were correlated with the response and survival to analyze the association of morphology with the outcome. METHODS Patients with large HCC (>5 cm) who underwent DEB-TACE for palliation were analyzed retrospectively. Patients were assessed for objective response (OR) and overall survival (OS), which was calculated from the first session of DEB-TACE to the last follow-up/death. OR and OS were calculated for the entire study group and were compared among the subgroups consisting of solitary versus multifocal HCC, unilobar versus bilobar disease, well-defined versus ill-defined HCC, and HCC with homogeneous enhancement versus HCC with heterogeneous enhancement. RESULTS Sixty-seven DEB-TACE procedures were performed in 25 patients (average: 2.7 ± 1.4 sessions per patient). The mean lesion size was 9.9 ± 4.5 cm. Of 25 patients, 13 (52%) had multifocal HCC. Unilobar disease was seen in 15 patients (60%). The mean duration of follow-up was 24.4 months. OR at 6 and 12 months were 56% and 48%, respectively, with well-defined lesions showing better OR. The median OS was 28 months (95% confidence interval, 12.3-43.6). OS rate at 12 and 24 months was 92% and 57%, respectively. OS was seen to be superior in well-defined HCC and unilobar disease. CONCLUSION In this study, DEB-TACE has shown to have a good response in patients having large/multifocal HCC with preserved liver functions. Well-defined HCC and unilobar disease have a better response and survival.
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Key Words
- AFP, Alpha-fetoprotein
- ALT, Alanine aminotransferase
- AST, Aspartate aminotransferase
- BCLC, Barcelona-Clinic Liver Cancer Classification
- CBC, Complete blood count
- CR, Complete response
- CT, Computed tomography
- DEB-TACE
- DEB-TACE, Drug-eluting beads TACE
- HBV, Hepatitis B virus
- HCC, Hepatocellular carcinoma
- HCV, Hepatitis C virus
- INR, International normalized ratio
- MRI, Magnetic resonance imaging
- OR, Objective response
- OS, Overall survival
- PD, Progressive disease
- PR, Partial response
- SD, Stable disease
- TLC, Total leucocyte count
- cTACE, Conventional (Lipiodol) TACE
- hepatocellular carcinoma (HCC)
- loco-regional therapy
- mRECIST, Modified Response Evaluation Criteria in Solid Tumors
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Agarwal A, Joy D, Das P, Dash NR, Srivastava DN, Madhusudhan KS. Hemorrhage and Rupture of an Unusual Benign Liver Lesion in Pregnancy: A Case Report. J Clin Exp Hepatol 2021; 11:260-263. [PMID: 33746452 PMCID: PMC7953012 DOI: 10.1016/j.jceh.2020.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/12/2020] [Indexed: 12/12/2022] Open
Abstract
Liver rupture in pregnancy is an acute condition with significant risk to the mother and fetus. It is known to occur with tumors such as hepatic adenoma, infective causes such as abscess, granulomatous diseases, and parasitic infections, and rarely spontaneously. Most of these conditions have overlapping clinicoradiological findings, almost always requiring histopathological confirmation. We report a case of a ruptured hepatic lesion, with an unusual diagnosis of Bartonella henselae infection causing cat-scratch disease, in a 24-year-old pregnant lady.
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Key Words
- ALFP, Acute liver failure in pregnancy
- CSD, Cat-scratch disease
- CT, Computed tomography
- FNH, Focal nodular hyperplasia
- HCC, Hepatocellular carcinoma
- HELLP, Hemolysis, elevated liver enzymes, and low platelet
- IFA, Immunofluorescent assay
- Ig-G, Immunoglobulin-G
- MRI, Magnetic resonance imaging
- PCR, Polymerase chain reaction
- USG, Ultrasonography
- cat-scratch disease
- hemorrhagic liver lesion
- liver rupture in pregnancy
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Mozafari A, Miladinia M, Sabri A, Movaseghi F, Gholamzadeh Baeis M. The challenge of deciding between home-discharge versus hospitalization in COVID-19 patients: The role of initial imaging and clinicolaboratory data. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020; 10:100673. [PMID: 33289003 PMCID: PMC7710471 DOI: 10.1016/j.cegh.2020.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 01/17/2023] Open
Abstract
Background/Objective It is important to predict the COVID-19 patient's prognosis, particularly in countries with lack or deficiency of medical resource for patient's triage management. Currently, WHO guideline suggests using chest imaging in addition to clinicolaboratory evaluation to decide on triage between home-discharge versus hospitalization. We designed our study to validate this recommendation to guide clinicians. This study providing some suggestions to guide clinicians for better decision making in 2020. Methods In this retrospective study, patients with RT-PCR confirmed COVID-19 (N = 213) were divided in different clinical and management scenarios: home-discharge, ward hospitalization and ICU admission. We reviewed the patient's initial chest CT if available. We evaluated quantitative and qualitative characteristics of CT as well as relevant available clinicolaboratory data. Chi-square, One-Way ANOVA and Paired t-test were used for analysis. Results The finding showed that most patients with mixed patterns, pleural effusion, 5 lobes involved, total score ≥10, SpO2% ≤ 90, ESR (mm/h) ≥ 60 and WBC (103/μL) ≥ 8000 were hospitalized. Most patients with Ground-glass opacities only, ≤3 lobes involvement, peripheral distribution, SpO2% ≥ 95, ESR (mm/h) < 30 and WBC(103/μL) < 6000 were home-discharged. Conclusions This study suggests the use of initial chest CT (qualitative and quantitative evaluation) in addition to initial clinicolaboratory data could be a useful supplementary method for clinical management and it is an excellent decision making tool (home-discharge versus ICU/Ward admission) for clinicians.
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Key Words
- COVID-19
- COVID-19, Coronavirus disease 19
- CRP, C-Reactive protein
- CT scan
- CT, Computed tomography
- ESR, Erythrocyte sedimentation rate
- GGO, Ground-glass opacities
- Human coronavirus
- ICU, Intensive care unit
- LLL, Left Lower Lobe
- LUL, Left upper lobe
- Medical imaging
- Prognosis
- RLL, Right lower lobe
- RML, Right middle lobe
- RT-PCR, real-time polymerase chain reaction
- RUL, Right upper lobe
- SARS-CoV
- SpO2, Peripheral oxygen saturation
- WBC, White blood cells
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Mehta C, Loecher M, Sih A, Reese AC. A report of a retained bullet in the bladder which migrated from an extraperitoneal injury. Urol Case Rep 2020; 34:101463. [PMID: 33224728 PMCID: PMC7666374 DOI: 10.1016/j.eucr.2020.101463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 10/21/2020] [Indexed: 11/29/2022] Open
Abstract
Genitourinary trauma secondary to a gunshot wound is uncommon as it only occurs in about 10% of cases. We present a case of a gentleman who suffered a gunshot wound to the pelvis. The bullet was originally extraluminal to the bladder; however, upon repeat CT scan eight days later, the bullet had migrated intra-luminally. We hope to show through this case that uncomplicated extraperitoneal injuries with an adjacent missile might benefit from early surgical exploration.
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Wei H, Feng H, Lv M, Zhong Y, Yang X, Zhou X, Lei Z, Xia J. Smoking Status Affects the Association Between Hematoma Heterogeneity and Hematoma Expansion. World Neurosurg X 2020; 9:100095. [PMID: 33225256 PMCID: PMC7666337 DOI: 10.1016/j.wnsx.2020.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 10/03/2020] [Indexed: 11/26/2022] Open
Abstract
Objective The purpose of this study was to verify the relationship between hematoma heterogeneity and hematoma expansion and explore any effect modifiers through subgroup analyses. Methods Clinical records of 357 patients with spontaneous cerebral hemorrhage at Shenzhen Second People’s Hospital from March 2016 to October 2018 were included in the study. Hematoma heterogeneity was measured on the first noncontrast computed tomography image according to the Barras scale. Hematoma expansion was defined as an absolute hematoma volume increase of 6 mL, or a 33% increase. We performed univariate and multivariate logistic regression analyses, as well as subgroup analyses, to assess the relationship between the presence of heterogeneity on noncontrast computed tomography and hematoma expansion. Results Hematoma expansion occurred in 79 (22.13%) of the 357 patients with intracerebral hemorrhage (ICH). Among the patients with ICH, there were 83 smokers, accounting for 23.24%. The average patient age was 56.21 ± 13.75 years, and 74.51% were male. Compared with the absence of heterogeneity, the risk of hematoma expansion increased by 1.06 times (odds ratio, 2.06; 95% confidence interval, 1.10–3.86). Based on the subgroup analysis, smoking status was found to modify the association between heterogeneity and hematoma expansion; the association was stronger in smokers than in nonsmokers (odds ratio, 10.23; 95% confidence interval, 2.15–48.65). Conclusions Heterogeneity independently predicts hematoma expansion, especially in smoking patients.
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Kizildag Yirgin I, Has D, Arslan G, Aydin EC, Sari M, Onder S, Yasemin S, Cabioglu N, Karanlik H, Tukenmez M, Dursun M, Muslumanoglu M, Ozmen V. Comparison between body composition parameters and response to neoadjuvant chemotherapy by using pre-treatment PET CT in locally advanced breast cancer. Eur J Radiol Open 2020; 7:100286. [PMID: 33294497 PMCID: PMC7689395 DOI: 10.1016/j.ejro.2020.100286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/06/2020] [Indexed: 11/22/2022] Open
Abstract
Weight and the BMI are inadequate proxies for adiposity that do not distinguish between muscle and adipose tissue or different specific deposits of adipose tissue (visceral and subcutaneous), which have different physiological effects. Patients with the same BMI are likely to have different anatomical distribution of adipose and muscle tissue. To our knowledge, only few studies have investigated the association between fat and muscle tissue distribution of the body, and response to neoadjuvant chemotherapy.
Purpose To compare the adipose and muscle tissue areas in patients who responded differently to neoadjuvant chemotherapy. Methods One hundred and eighty six patients diagnosed with breast cancer who underwent neoadjuvant chemotherapy between January 2015- October 2019 and were operated after the treatment were retrospectively included in the study. Pathological results were divided into five groups using the Miller-Payne grading systems. Grade 1 indicating no significant reduction in malignant cells; Grade 2: a minor loss of malignant cells (≤ 30 %); Grade 3: reduction in malignant cells between 30 % and 90 %; Grade 4: disappearance of malignant cells >90 %; Grade 5: no malignant cells identifiable. Pre-treatment PET CT scans were evaluated, and calculation of body composition parameters were performed on a single axial section passing through the L3 vertebrae. Spearman’s correlation test was used to analyze the correlation between SAT, VAT, MT parameters and pathological responses. Results There was no strong correlation between the 5 groups separated according to neoadjuvant chemotherapy treatment response and tissue distributions. However, that there was a very low correlation found between superficial adipose tissue and pathological response (r=, 156). Conclusion In conclusion, our results have provided a very low correlation between SAT and more than 30 % response. More research is required to evaluate the role of the body fat and muscle parameters in response to neoadjuvant chemotherapy in larger patient populations.
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Key Words
- ASP, Acylation-stimulating protein
- Adipose tissue
- BMI, Body mass index
- Body composition parameter
- Breast cancer
- CT, Computed tomography
- Computed tomography
- DCIS, Ductal carcinoma in situ
- ER, Estrogen receptor
- HER-2, Human epidermal growth factor receptor-2
- IHC, Immunohistochemistry
- MP, Miller -Payne
- MT, Muscle tissue
- NAC, Neoadjuvant chemotheraphy
- PAI-1, Plasminogen activator inhibitor-1
- PET, CT Positron-emission tomography-computed tomography
- PR, Progesterone receptor
- SAT, Subcutaneous adipose tissue
- VAT, Visceral adipose tissue
- ypCR, Pathological complete response
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Araujo-Filho JDAB, Menezes RSAA, Horvat N, Panizza PSB, Bernardes JPG, Damasceno RS, Oliveira BC, Menezes MR. Lung radiofrequency ablation: post-procedure imaging patterns and late follow-up. Eur J Radiol Open 2020; 7:100276. [PMID: 33225024 PMCID: PMC7666375 DOI: 10.1016/j.ejro.2020.100276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 12/30/2022] Open
Abstract
RFA is an effective minimally invasive treatment for selected patients with primary and secondary lung tumors. We described the expected imaging features after RFA of lung tumors, and their frequency over time after the procedure. Radiologists should be familiar with these features in order to avoid misinterpretation and inadequate treatments. These normal post-procedure imaging features must be considered in future post-ablation follow-up protocols.
Purpose To describe expected imaging features on chest computed tomography (CT) after percutaneous radiofrequency ablation (RFA) of lung tumors, and their frequency over time after the procedure. Methods In this double-center retrospective study, we reviewed CT scans from patients who underwent RFA for primary or secondary lung tumors. Patients with partial ablation or tumor recurrence during the imaging follow-up were not included. The imaging features were assessed in pre-defined time points: immediate post-procedure, ≤4 weeks, 5−24 weeks, 25−52 weeks and ≥52 weeks. Late follow-up (3 and 5 years after procedure) was assessed clinically in 48 patients. Results The study population consisted of 69 patients and 144 pulmonary tumors. Six out of 69 (9%) patients had primary lung nodules (stage I) and 63/69 (91 %) had metastatic pulmonary nodules. In a patient-level analysis, immediately after lung RFA, the most common CT features were ground glass opacities (66/69, 96 %), consolidation (56/69, 81 %), and hyperdensity within the nodule (47/69, 68 %). Less than 4 weeks, ground glass opacities (including reversed halo sign) was demonstrated in 20/22 (91 %) patients, while consolidation and pleural thickening were detected in 17/22 patients (77 %). Cavitation, pneumatocele, pneumothorax and pleural effusions were less common features. From 5 weeks onwards, the most common imaging features were parenchymal bands. Conclusions Our study demonstrated the expected CT features after lung RFA, a safe and effective minimally invasive treatment for selected patients with primary and secondary lung tumors. Diagnostic and interventional radiologists should be familiar with the expected imaging features immediately after RFA and their change over time in order to avoid misinterpretation and inadequate treatments.
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Walls GM, Oughton JB, Chalmers AJ, Brown S, Collinson F, Forster MD, Franks KN, Gilbert A, Hanna GG, Hannaway N, Harrow S, Haswell T, Hiley CT, Hinsley S, Krebs M, Murden G, Phillip R, Ryan AJ, Salem A, Sebag-Montefoire D, Shaw P, Twelves CJ, Walker K, Young RJ, Faivre-Finn C, Greystoke A. CONCORDE: A phase I platform study of novel agents in combination with conventional radiotherapy in non-small-cell lung cancer. Clin Transl Radiat Oncol 2020; 25:61-66. [PMID: 33072895 PMCID: PMC7548952 DOI: 10.1016/j.ctro.2020.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 12/18/2022] Open
Abstract
Lung cancer is the leading cause of cancer mortality worldwide and most patients are unsuitable for 'gold standard' treatment, which is concurrent chemoradiotherapy. CONCORDE is a platform study seeking to establish the toxicity profiles of multiple novel radiosensitisers targeting DNA repair proteins in patients treated with sequential chemoradiotherapy. Time-to-event continual reassessment will facilitate efficient dose-finding.
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Key Words
- ATM, Ataxia telangiectasia mutated
- ATR, Ataxia telangiectasia and Rad3 related
- CRT, Chemoradiotherapy
- CT, Computed tomography
- CTCAE, Common terminology criteria for adverse events
- CTRad, Clinical and Translational Radiotherapy Research Working Group
- Continual reassessment method
- DDRi, DNA damage response inhibitor
- DLT, Dose limiting toxicity
- DNA damage repair inhibitor
- DNA, Deoxyribonucleic acid
- DNA-PK, DNA-dependent protein kinase
- ECOG, Eastern Cooperative Oncology Group
- EORTC, European Organisation for Research and Treatment of Cancer
- ICRU, International Commission on Radiation Units and Measurements
- IMPs, Investigational medicinal products
- LA, Locally advanced
- MRC, Medical Research Council
- NCRI, National Cancer Research Institute
- NSCLC, Non-small cell lung cancer
- Non-small cell lung cancer
- PARP, Poly (ADP-ribose) polymerase
- PET, Positron emission tomography
- PFS, Progression free survival
- PROMs, Patient-reported outcome measures
- Platform trial
- RECIST, Response evaluation criteria in solid tumours
- RP2D, Recommended phase II dose
- RT, Radiotherapy
- SACT, Systemic anti-cancer therapy
- SRC, Safety review committee
- Sequential chemoradiotherapy
- TNM, Tumour node metastasis
- TiTE-CRM, Time to event continual reassessment method
- cfDNA, Cell-free DNA
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Birowo P, Tambunan MP, Rasyid N, Atmoko W. Case report: Treatment of urinary calculi using percutaneous nephrolithotomy in patient with ileal conduit and history of bladder transitional cell carcinoma. Urol Case Rep 2020; 33:101330. [PMID: 33102032 PMCID: PMC7573933 DOI: 10.1016/j.eucr.2020.101330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/23/2020] [Accepted: 06/26/2020] [Indexed: 11/08/2022] Open
Abstract
Urinary calculi are a frequent complication of urinary diversion following radical cystectomy, including in ileal conduit systems. We report the case of a 38-year-old man with ileal conduit urinary diversion, following radical cystectomy for transitional cell cancer, who presented with symptomatic bilateral kidney stones. By reporting the medical record and management procedure for this patient, we aim to demonstrate the successful management of kidney stones via supine percutaneous nephrolithotomy, using an Alken telescopic metal dilator, under spinal anesthesia. Consistent with most literature, percutaneous nephrolithotomy was the best management procedure in this case.
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Su L, Li Y, Wang T, Wang L, Wang W, Wei X. Synchronous multiple primary lung cancers with shared EGFR mutation but differential imaging findings and pathological subtypes: A case report. Respir Med Case Rep 2020; 31:101244. [PMID: 33083221 PMCID: PMC7552085 DOI: 10.1016/j.rmcr.2020.101244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/21/2022] Open
Abstract
Lung cancer is a leading cause of cancer mortality worldwide. As the incidence of lung cancer increases in recent years, the number of patients diagnosed with synchronous multiple primary lung cancers (SMPLC) is also rising. SMPLC diagnosis is often made based on the clinical course, imaging findings, and histologic and molecular features. Standard lobectomy is the main therapeutic modality for SMPLC. Because maximum retention of lung function is essential, sublobectomy is also a commonly used surgical strategy when appropriate. The question is how to optimize the sequence of lobectomy and sublobectomy for patients with SMPLC. Thoracoscope lobectomy for the primary lesion plus sublobectomy for the secondary lesions is the most commonly used approach. Here we present a case of SMPLC with sublobectomy followed by lobectomy.
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Key Words
- ARMS, amplification refractory mutation system
- CT, Computed tomography
- EGFR, Epidermal growth factor receptor
- FEV1, Forced expiratory volume in the first second
- FVC, Forced vital capacity
- LLL, Left lower lobe
- LUL, left upper lobe
- Lung function
- MIA, minimally invasive adenocarcinoma
- MPLC, Multiple primary lung cancer
- MVV, Maximum voluntary ventilation
- Main driving genes
- NGS, next-generation sequencing
- NSCLC, non-small cell lung cancer
- PET-CT, Positron emission tomography-CT
- SMPLC, Synchronous multiple primary lung cancer
- SUV, Standardized uptake value
- Synchronous multiple primary lung cancers
- TLC, Total lung capacity
- Thoracoscope surgery
- VC, Vital capacity
- pGGO, pure ground glass opacity
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Robertson FC, Gnanakumar S, Karekezi C, Vaughan K, Garcia RM, Abou El Ela Bourquin B, Derkaoui Hassani F, Alamri A, Mentri N, Höhne J, Laeke T, Al-Jehani H, Moscote-Salazar LR, Al-Ahmari AN, Samprón N, Stienen MN, Nicolosi F, Fontoura Solla DJ, Adelson PD, Servadei F, Al-Habib A, Esene I, Kolias AG. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part II): Barriers to Professional Development and Service Delivery in Neurosurgery. World Neurosurg X 2020; 8:100084. [PMID: 33103110 PMCID: PMC7573643 DOI: 10.1016/j.wnsx.2020.100084] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Strengthening health systems requires attention to workforce, training needs, and barriers to service delivery. The World Federation of Neurosurgical Societies Young Neurosurgeons Committee survey sought to identify challenges for residents, fellows, and consultants within 10 years of training. METHODS An online survey was distributed to various neurosurgical societies, personal contacts, and social media platforms (April-November 2018). Responses were grouped by World Bank income classification into high-income countries (HICs), upper middle-income countries (UMICs), low-middle-income countries (LMICs), and low-income countries (LICs). Descriptive statistical analysis was performed. RESULTS In total, 953 individuals completed the survey. For service delivery, the limited number of trained neurosurgeons was seen as a barrier for 12.5%, 29.8%, 69.2%, and 23.9% of respondents from HICs, UMICs, LMICs, and LICs, respectively (P < 0.0001). The most reported personal challenge was the lack of opportunities for research (HICs, 34.6%; UMICs, 57.5%; LMICs, 61.6%; and LICs, 61.5%; P = 0.03). Other differences by income class included limited access to advice from experienced/senior colleagues (P < 0.001), neurosurgical journals (P < 0.0001), and textbooks (P = 0.02). Assessing how the World Federation of Neurosurgical Societies could best help young neurosurgeons, the most frequent requests (n = 953; 1673 requests) were research (n = 384), education (n = 296), and subspecialty/fellowship training (n = 232). Skills courses and access to cadaver dissection laboratories were also heavily requested. CONCLUSIONS Young neurosurgeons perceived that additional neurosurgeons are needed globally, especially in LICs and LMICs, and primarily requested additional resources for research and subspecialty training.
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Núñez-Velasco S, Mercado-Pimentel R, Ochoa-Plascencia M, Rodríguez-Arias R, Lopez-Espinoza G, González-González ME, Estrella-Sánchez C, Ramírez-Huerta C. Response to SARS-CoV-2 Pandemic in a Non-COVID-19 Designated Latin-American Neurosurgery Department. World Neurosurg 2020; 142:506-512. [PMID: 32438005 PMCID: PMC7211578 DOI: 10.1016/j.wneu.2020.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/02/2020] [Indexed: 01/08/2023]
Abstract
Background Mexico declared the first case of novel coronavirus disease (COVID-19) in February 2020. At the time we write this article, our country is facing a community spread phase, expecting a rapid increase in the number of cases and fatalities. The Fray Antonio Alcalde Civil Hospital of Guadalajara has been declared a non-COVID-19 hospital with the mission of providing care to patients already registered and also those transferred from neurosurgical departments of neighboring centers, which have been converted into COVID-19 only hospitals. Methods An organized response regarding personnel, surgical case selection, operating room behavior, and facility reorganization were designed to prevent an internal coronavirus outbreak in the neurosurgery department at the Fray Antonio Alcalde Civil Hospital of Guadalajara. Results Distancing actions by the staff and residents, including ward case discussions, neurosurgery rounds, and classes, will be carried out virtually. We classified neurosurgical patients into 4 groups depending on whether their condition demands care in 0-6 hours, 6-48 hours, 48 hours to 14 days, and >14 days. Subsequently, a questionnaire with epidemiologic, radiologic, clinical, and serologic criteria will be applied to determine the risk of COVID-19 infection to define to which area they are going to be transferred according to the different risk zones in our facility. Conclusions Despite not being a COVID-19 center, we consider all patients at the neurosurgical ward and staff members as asymptomatic carriers or infected in the preclinical period. Specific measures must be taken to ensure the safety and care of neurosurgical patients and medical staff during the community spread phase.
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Gnanakumar S, Abou El Ela Bourquin B, Robertson FC, Solla DJF, Karekezi C, Vaughan K, Garcia RM, Hassani FD, Alamri A, Höhne J, Mentri N, Stienen M, Laeke T, Moscote-Salazar LR, Al-Ahmari AN, Al-Jehani H, Nicolosi F, Samprón N, Adelson PD, Servadei F, Esene IN, Al-Habib A, Kolias AG. The World Federation of Neurosurgical Societies Young Neurosurgeons Survey (Part I): Demographics, Resources, and Education. World Neurosurg X 2020; 8:100083. [PMID: 33103109 PMCID: PMC7573644 DOI: 10.1016/j.wnsx.2020.100083] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 04/23/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Providing a comprehensive and effective neurosurgical service requires adequate numbers of well-trained, resourced, and motivated neurosurgeons. The survey aims to better understand 1) the demographics of young neurosurgeons worldwide; 2) the challenges in training and resources that they face; 3) perceived barriers; and 4) needs for development. METHODS This was a cross-sectional study in which a widely disseminated online survey (April 2018-November 2019) was used to procure a nonprobabilistic sample from current neurosurgical trainees and those within 10 years of training. Data were grouped by World Bank income classifications and analyzed using χ2 tests because of its categorical nature. RESULTS There were 1294 respondents, with 953 completed responses included in the analysis. Of respondents, 45.2% were from high-income countries (HICs), 23.2% from upper-middle-income countries, 26.8% lower-middle-income countries, and 4.1% from low-income countries. Most respondents (79.8%) were male, a figure more pronounced in lower-income groups. Neuro-oncology was the most popular in HICs and spinal surgery in all other groups. Although access to computed tomography scanning was near universal (98.64%), magnetic resonance imaging access decreased to 66.67% in low-income countries, compared with 98.61% in HICs. Similar patterns were noted with access to operating microscopes, image guidance systems, and high-speed drills. Of respondents, 71.4% had dedicated time for neurosurgical education. CONCLUSIONS These data confirm and quantify disparities in the equipment and training opportunities among young neurosurgeons practicing in different income groups. We hope that this study will act as a guide to further understand these differences and target resources to remedy them.
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Abdelrahman A, Nada A, Park E, Humera A. Neurological involvement and MRI brain findings in an adult with hemolytic uremic syndrome: A case report. Radiol Case Rep 2020; 15:2056-2058. [PMID: 32944099 PMCID: PMC7481498 DOI: 10.1016/j.radcr.2020.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 08/09/2020] [Accepted: 08/13/2020] [Indexed: 11/30/2022] Open
Abstract
Hemolytic uremic syndrome is a frequent complication of shiga toxin producing Escherichia coli in pediatric population. It rarely affects adults with extremely rare neurological manifestation. We present a case of hemolytic uremic syndrome in a 64-year-old male who presented with a bloody diarrhea 30 minutes after eating an expired meat sandwich. Shiga-toxin producing Escherichia coli O157:H7 was confirmed as the causative agent. The patient developed neurological manifestations with persistent encephalopathy that ultimately leads to his death after 22 days of hospitalization. Magnetic resonance imaging findings was significant for signal changes in the thalami, tectum, insulae, and central pons, impressive of hemolytic uremic syndrome.
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Key Words
- ADC, Apparent diffusion coefficient
- CNS, Central nervous system
- CT, Computed tomography
- DWI, Diffusion weighted imaging
- E. Coli, Escherichia coli
- EHEC, Enterohemorrhagic Escherichia Coli
- FLAIR, Fluid attenuated inversion recovery
- GCS, Glasgow coma scale
- HUS, Hemolytic Uremic Syndrome
- Hemolytic uremic syndrome
- IV, Intravenous
- MRI
- MRI, Magnetic resonance imaging
- NICU, Neurological intensive care unit
- Neurological complications
- STEC, Shiga toxin producing E. Coli
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66
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Chang CW, Chien CC, Juan YS, Chueh KS. Primary renal angiosarcoma mimicking urothelial carcinoma - A case report and literature reviews. Urol Case Rep 2020; 34:101407. [PMID: 33145170 PMCID: PMC7596193 DOI: 10.1016/j.eucr.2020.101407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/08/2020] [Indexed: 01/01/2023] Open
Abstract
Angiosarcoma (AS) is a rare aggressive tumor originating from endothelial cells. We reported a 66-year-old female with primary renal angiosarcoma (PRA) who presented as urothelial carcinoma with hematuria and dysuria. Based on ureterorenoscopic tumor biopsy, the initial diagnosis suggested low-grade non-invasive urothelial carcinoma. However, the specimen retrieved from nephroureterectomy confirmed the diagnosis of primary renal angiosarcoma. Primary renal angiosarcoma could uncommonly present as urothelial carcinoma in renal pelvis. Surgical resection remains to be the most effective therapy but there is no consensus about adjuvant therapies. The overall prognosis of primary renal angiosarcoma is dismal. Primary renal angiosarcoma is a rare disease that could mimic urothelial carcinoma. Surgical resection is considered to be main treatment. The effectiveness osf adjuvant therapies remain to be clarified.
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Wu MH, Xiao LF, Zhang C, Lei J, Deng ZM. The minimally invasive endoscopic technique for the treatment of symptomatic benign bone lesions: Preliminary results from a retrospective study. J Bone Oncol 2020; 24:100313. [PMID: 32817813 PMCID: PMC7426450 DOI: 10.1016/j.jbo.2020.100313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/30/2022] Open
Abstract
Symptomatic benign bone lesions may cause pain and refractory limp. Conventional open surgery usually involves high risks of complications, which may greatly compromise the overall efficacy of surgery in the long term. This single-institution retrospective study of 34 patients with symptomatic benign bone lesions. All surgical procedures were performed under endoscopic guidance for direct visualization followed by complete curettage of tumor tissue. Patients reported significant improvements in pain, quality of life and functional recovery without complications or need for secondary interventions. Study limitations included a relatively small population of Chinese patients and the lack of a comparative surgical or other minimally invasive techniques. The procedure described may be a valuable alternative to open surgery for symptomatic benign bone lesions.
Objective The present study aimed to evaluate the short-term clinical feasibility and efficacy of the minimally invasive endoscopic technique (MIET) for the treatment of symptomatic benign bone lesions. Materials and methods This single-institution retrospective study investigated 34 patients with symptomatic benign bone lesions from December 2015 to June 2017. Patients involved in this study presented with definite indications for surgical intervention. All procedures were performed under endoscopic guidance for direct visualization followed by complete curettage of tumor tissue. There were 19 males and 15 females, with a mean age of 33.3 ± 12.7 years (range, 17–68 years). The lesions were located in the upper extremities (20, 58.8%), lower extremities (9, 26.5%) and pelvis (5, 14.7%). Primary outcomes were measured before and after intervention using the visual analog scale (VAS), the Musculoskeletal Tumor Society (MSTS) stage and the 36-item Short-Form Health Survey (SF-36) scoring system. Results Of the 34 patients included in this study, all completed follow-up examinations, with a mean follow-up duration of 22.4 ± 7.6 months (range, 13–35 months). Significantly improved VAS, MSTS and SF-36 scores were observed at 3 months after the initial treatment (P < 0.001), suggesting enhanced pain relief and improved functional recovery and quality of life following surgery. All procedures were technically successful, with the exception of 3 cases (8.8%) manifesting access site numbness; these patients recovered within the follow-up period through symptomatic treatment alone. Only 2 patients (5.9%; one osteoblastoma and one enchondroma) experienced local recurrence and underwent standard open curettage within the follow-up period. All patients showed functional stability without any major complications. Conclusion The MIET is an effective and safe alternative treatment for symptomatic benign bone lesions. The short-term efficacy of MIET was favorable and associated with improved pain palliation, quality of life and functional recovery.
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Key Words
- ABC, Aneurysmal bone cyst
- Benign bone lesion
- CT, Computed tomography
- Clinical efficacy
- Endoscopy
- GCTB, Giant cell tumor of bone
- MDT, Multidisciplinary team
- MIET, Minimally invasive endoscopic technique
- MRI, Magnetic resonance imaging
- MSTS, Musculoskeletal Tumor Society
- MWA, Microwave ablation
- Minimally invasive
- PKP, Percutaneous kyphoplasty
- PPSF, Percutaneous pedicle screw fixation
- PVP, Percutaneous vertebroplasty
- RFA, Radiofrequency ablation
- SF-36, 36-item Short-Form Health Survey
- STIR, Short tau inversion recovery
- Surgical intervention
- VAS, Visual analog scale
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68
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Zhang L, Guo H. Biomarkers of COVID-19 and technologies to combat SARS-CoV-2. ADVANCES IN BIOMARKER SCIENCES AND TECHNOLOGY 2020; 2:1-23. [PMID: 33511330 PMCID: PMC7435336 DOI: 10.1016/j.abst.2020.08.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 02/06/2023] Open
Abstract
Due to the unprecedented public health crisis caused by COVID-19, our first contribution to the newly launching journal, Advances in Biomarker Sciences and Technology, has abruptly diverted to focus on the current pandemic. As the number of new COVID-19 cases and deaths continue to rise steadily around the world, the common goal of healthcare providers, scientists, and government officials worldwide has been to identify the best way to detect the novel coronavirus, named SARS-CoV-2, and to treat the viral infection - COVID-19. Accurate detection, timely diagnosis, effective treatment, and future prevention are the vital keys to management of COVID-19, and can help curb the viral spread. Traditionally, biomarkers play a pivotal role in the early detection of disease etiology, diagnosis, treatment and prognosis. To assist myriad ongoing investigations and innovations, we developed this current article to overview known and emerging biomarkers for SARS-CoV-2 detection, COVID-19 diagnostics, treatment and prognosis, and ongoing work to identify and develop more biomarkers for new drugs and vaccines. Moreover, biomarkers of socio-psychological stress, the high-technology quest for new virtual drug screening, and digital applications are described.
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Key Words
- ACE2, Angiotensin-converting enzyme 2
- ACEI, Angiotensin-converting enzyme inhibitor
- AI, Artificial intelligence
- AIOD-CRISPR, All-In-One Dual CRISPR-Cas12a
- ARB, Angiotensin receptor blocker
- ARDS, Acute respiratory distress syndrome
- COVID
- COVID-19, Coronavirus disease 2019
- CQ, Chloroquine
- CT, Computed tomography
- Coronavirus
- DC, Dendritic cell
- Detection
- Diagnosis
- ELISA, Enzyme-linked immunosorbent assay
- EUA, Emergency use authorization
- FDA, U.S. Food and Drug Administration
- GenOMICC, Genetics of Mortality in Critical Care
- HCQ, Hydroxychloroquine
- LFAs, Lateral flow assays
- LSPR, Localized surface plasmon resonance
- MERS, Middle East respiratory syndrome
- ML, Machine learning
- NIAID, U.S. National Institute of Allergy and Infectious Diseases
- NIH, National Institutes of Health
- PAC-MAN, Prophylactic Antiviral CRISPR in huMAN cells
- PCR, Polymerase chain reaction
- PCT, Procalcitonin
- Prevention
- Prognosis
- RT-PCR, Reverse transcription polymerase chain reaction
- SARS, Severe acute respiratory syndrome
- SARS-CoV-2, SARS coronavirus type 2
- SaaS, Software as a Service
- TCM, Traditional Chinese medicine
- Treatment
- UCB, University of California Berkeley
- UCSF, University of California San Francisco
- cDNA, Complementary DNA
- mAb, Monoclonal antibody
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Matsubayashi S, Kanzaki E, Tsujimoto R, Osaki M, Wada A. Neglected subluxation of the hip after trauma: A case report. Ann Med Surg (Lond) 2020; 57:223-227. [PMID: 32793343 PMCID: PMC7415628 DOI: 10.1016/j.amsu.2020.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/12/2020] [Accepted: 07/12/2020] [Indexed: 11/03/2022] Open
Abstract
Introduction In children, the pelvis contains a large amount of cartilage components; therefore, when traumatic hip dislocation spontaneously reduces, it can be impossible to see on X-ray or computed tomography (CT) images in some cases, which can delay its detection. Case presentation We report the case of a 10-year-old boy who was injured by being hit by a car while walking. Upon diagnosis of pelvic ring fracture, the patient received conservative treatment. Seven months after injury, the patient was referred to our department with the chief complaint of limping. Diagnosis Marked limitation was observed in the left hip with extension of −40°, abduction of 10°, and internal rotation of 20°. X-ray revealed narrowing of the left hip joint space, with deformity of the femoral head, obturator foramen narrowing, and the break in the Shenton line. CT revealed proximal dislocation of the posterior acetabular wall and posterior subluxation of the femoral head. Magnetic resonance imaging (MRI) revealed necrosis of the femoral head. Intervention Operation was performed with soft tissue dissection, varus-extension-internal rotation femoral osteotomy, greater trochanteric epiphysiodesis, and pelvic osteotomy (incomplete periacetabular osteotomy: IPO). After operation, complete paralysis of the sciatic nerve was observed. Outcomes At 1 year after operation, the patient's limited range of motion (ROM) and femoral head necrosis had improved. The sciatic nerve paralysis had fully recovered. Conclusion If hip extension, abduction, and internal rotation are limited and X-ray reveals a break in the Shenton line., subluxation of the hip should be suspected. Pelvic fractures in children. Limited ROM in hip. Break in Shenton line. Subluxation of hip.
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Petnak T, Suwatanapongched T, Klaisuban W, Nitiwarangkul C, Pornsuriyasak P. Initial diagnosis and successful treatment of pulmonary tumor embolism manifesting as the first clinical sign of prostatic adenocarcinoma. Respir Med Case Rep 2020; 31:101163. [PMID: 32714825 PMCID: PMC7378679 DOI: 10.1016/j.rmcr.2020.101163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 07/03/2020] [Indexed: 11/28/2022] Open
Abstract
Although pulmonary tumor embolism (PTE) is a well-recognized end-stage form of pulmonary metastases at postmortem examination, the entity is rarely the first clinical sign of prostate cancer. Diagnosis of this condition in patients who have no previous history of malignancy is a challenge. Herein, we reported a 79-year-old man presented with progressive, unexplained dyspnea on exertion. Microscopic PTE coinciding with pulmonary lymphangitic carcinomatosis were readily recognized based on the presence of multifocal dilatation and beading of the peripheral pulmonary arteries with thickening of the bronchial walls and interlobular septa on the initial thin-section chest CT images. Pathologic examination of the transbronchial lung biopsy specimen revealed tumor emboli occluding both the small muscular pulmonary arteries and lymphatic vessels. These tumor cells were positive for prostatic specific antigen on immunohistochemical staining. The final diagnosis of prostatic adenocarcinoma was confirmed. Remarkable clinical and radiographic improvement was achieved following bilateral orchiectomies and anti-androgen treatment. Pulmonary tumor embolism (PTE) can be the first clinical sign of advanced prostatic adenocarcinoma. CT findings of dilated, beaded peripheral pulmonary arteries should raise a concern of microscopic PTE. Dilated, beaded pulmonary arteries should not be mistaken for tree-in-bud opacities caused by bronchiolar disease on CT. Prostate cancer should always be considered in the differential diagnosis of adenocarcinoma of unknown origin in men.
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Tutiya CT, Siaulys MM, Kondo MM, Miglioli-Galvão L, C. A. Galvão E, Pinheiro CC, Torloni MR, de Mello FB. Possible formation of pulmonary microthrombi in the early puerperium of pregnant women critically ill with COVID-19: Two case reports. Case Rep Womens Health 2020; 27:e00237. [PMID: 32637327 PMCID: PMC7320266 DOI: 10.1016/j.crwh.2020.e00237] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/30/2023] Open
Abstract
Background Limited data are available on the management of pregnant women with severe or critical forms of COVID-19, such as the optimal timing of provider-initiated delivery, and post-partum care, including antithrombotic prophylaxis. We present the clinical course, pre- and post-partum management, and outcomes of two pregnant women critically ill with COVID-19. Cases Both women had confirmed SARS-CoV-2 pneumonia with rapid clinical decompensation that required admission to the intensive care unit, intubation, and delivery by emergency cesarean section at 32 and 29 weeks. Both patients clinically improved in the first two postoperative days, but this was followed by clinical, laboratory and radiological deterioration on the third postoperative day; however, they both improved again after full anticoagulation. This pattern suggests the possible formation of pulmonary microthrombi in the early puerperium. We discuss the challenges faced by the multiprofessional team in the management of these patients. Conclusions There are few resources to guide health professionals caring for pregnant women with critical COVID-19. These two cases contribute to the rapidly evolving knowledge on the management and outcomes of pregnant women with COVID-19. There are limited data on the management of critical COVID-19 pregnancies. It is unclear what post-partum care, including antithrombotic prophylaxis, is ideal. We present the management and outcomes of two pregnant women critically ill with COVID-19. Deterioration of the women after cesarean section may have been due to pulmonary microthrombi. Full post-partum anticoagulation of critical COVID-19 patients should be considered.
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Key Words
- Anticoagulants
- BMI, Body mass index
- BP, Blood pressure
- COVID-19
- CS, Cesarean section
- CT, Computed tomography
- Critical illness
- HR, Heart rate
- ICU, Intensive care unit
- NICU, Neonatal intensive care unit
- PaO2/FiO2, Partial pressure of arterial oxygen /fraction of inspired oxygen
- Postpartum period
- Pregnancy
- RR, respiratory rate
- SpO2, Oxygen saturation
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Biomechanical, histologic, and molecular characteristics of graft-tunnel healing in a murine modified ACL reconstruction model. J Orthop Translat 2020; 24:103-111. [PMID: 32775202 PMCID: PMC7390781 DOI: 10.1016/j.jot.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 02/07/2023] Open
Abstract
Purpose The purpose of our study was to introduce and validate a metal-free, reproducible and reliable mouse model of anterior cruciate ligament (ACL) reconstruction (ACLR) surgery as an effective tool for a better understanding of molecular mechanisms of graft-tunnel healing after ACLR. Methods A total of 150 C57BL/6 mice were randomly allocated into five Groups: Group 1 (mice with intact ACL), Group 2–4 (mice underwent modified ACLR surgery and sacrificed 1-, 2-, and 4-weeks after surgery), and Group 5 (mice underwent unmodified ACLR surgery and sacrificed 4 weeks after surgery). Micro-computed tomography (CT), biomechanical histological as well as immunohistochemical (IHC) analyses were performed to characterize the modified ACLR. Results Micro-CT analysis demonstrated there is a non-significant increase in BV/TV and BMD of the bone tunnel during the tendon-to-bone healing following ACLR. Biomechanical tests showed that the mean load-to-failure forces of Group 3 and 4 are equal to 31.7% and 46.0% of that in Group 1, while the stiffness was 33.1% and 57.2% of that of Group 1, respectively. And no obvious difference in biomechanical parameters was found between Group 4 and 5. Histological analysis demonstrated that formation of fibrovascular tissue in the tibial tunnel and aperture in Groups 4 and 5 and direct junction appeared between tendon graft and tunnel both in Groups 4 and 5. IHC results showed that there are gradually enhanced expression of Patched1, Smoothened and Gli2 concomitant with decreased Gli3 protein in the tendon-bone interface during the tendon-bone healing process. Conclusion We introduced a metal-free, reproducible and reliable mouse model of ACLR compared to the unmodified ACLR procedure, and characterized the expression pattern of key molecules in Ihh signaling during the graft healing process. The translational potential of this article In the present study we introduced and validated, for the first time, a metal-free, reproducible and reliable ACLR mouse model, which could be used to investigate the detailed molecular mechanisms of graft-tunnel healing after ACLR. We also explored new strategies to promote the healing of tendon-to-bone integration.
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Key Words
- ACL, Anterior cruciate ligament
- ACLR, ACL reconstruction
- Anterior cruciate ligament
- BMD, Bone mineral density
- BV/TV, Bone volume/total volume
- CI, Confidence interval
- CT, Computed tomography
- Gli1, Glioma-associated oncogene homologue 1
- Gli2, Glioma-associated oncogene homologue 2
- Gli3, Glioma-associated oncogene homologue 3
- H&E, Haematoxylin-eosin
- Hedgehog signaling
- Ihh, Indian hedgehog
- Mouse model
- NS, Non-significant
- Ptch1, Patched1
- Smo, Smoothened
- Tendon-bone healing
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73
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Somiya S, Aoyama A, Yamasaki T, Inoue T, Ogawa O, Kobayashi T. Successful surgical management of recurrent urachal adenocarcinoma: A case report. Urol Case Rep 2020; 32:101196. [PMID: 32322529 PMCID: PMC7171456 DOI: 10.1016/j.eucr.2020.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 11/23/2022] Open
Abstract
Urachal carcinoma is a rare neoplasm for which there is a lack of a standard effective chemotherapeutic treatment. There is also no standard treatment available for recurrent metastatic urachal carcinoma and the prognosis is generally poor. We report a case of urachal carcinoma where the patient achieved long-term disease-free survival after repeated surgeries for recurrent lung metastases.
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Dendriform pulmonary ossification complicated by recurrent spontaneous pneumothorax: Two case reports and a review of the literature. Respir Med Case Rep 2020; 30:101067. [PMID: 32368485 PMCID: PMC7184270 DOI: 10.1016/j.rmcr.2020.101067] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background Dendriform pulmonary ossification (DPO) is a rare disease characterized by the presence of mature bone in the lung parenchyma with typical radiologic findings of diffuse and numerous calcified nodules. We present two cases of primary DPO complicated by recurrent spontaneous pneumothorax. Case presentation Case 1 is a 53-year-old male with recurrent pneumothorax unresponsive to chest tube drainage or subtotal pleurectomy via video assisted thoracoscopy (VATS) who was finally treated with talc pleurodesis. Chest computed tomography (CT) revealed bilateral partially calcified reticulonodular opacities with a basal predominance. VATS biopsy revealed patchy foci of fibrous organizing pneumonia with multifocal ossifications confirming DPO histopathology. Pneumothorax recurred on the same side eight months later managed with talc pleurodesis. Case 2 is a 45-year-old Caucasian male who presented for evaluation of three prior spontaneous left-sided pneumothoraces occurring over eight years, treated with chest tube drainage and eventual talc pleurodesis. Chest CT demonstrated multiple high attenuation peripheral branching opacities greatest in the left lower lobe with several nonspecific, non-calcified pulmonary nodules. VATS biopsy revealed cicatrical organizing pneumonia with associated extensive intraalveolar ossification consistent with DPO. Conclusions We describe two cases of DPO complicated by recurrent pneumothorax and reviewed the world literature. Summarized findings included a propensity for middle-aged males with a generally indolent course though pneumothorax was often refractory to initial chest tube drainage requiring more definitive mechanical management. There was also a predominance of primary disease without associated causes other than several reports of obstructive lung disease (asthma).
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Metachronous ureteral metastasis of clear cell renal cell carcinoma in a duplex collecting system 1 year after nephrectomy. Urol Case Rep 2020; 32:101214. [PMID: 32368499 PMCID: PMC7184155 DOI: 10.1016/j.eucr.2020.101214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 04/15/2020] [Indexed: 11/24/2022] Open
Abstract
While renal cell carcinoma is known to metastasise in an unpredictable pattern, even after resection of a primary tumour, delayed ureteric metastasis is a very rarely reported phenomenon. In this case report, we describe a case of ipsilateral metachronous ureteric metastasis in a patient with a complete duplex collecting system. This case demonstrates some useful strategies in the diagnosis and treatment of renal cell carcinoma in this context. To our knowledge, this is the first case report of delayed ureteric metastasis of a renal clear cell carcinoma in a patient with a duplex collecting system.
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