1
|
Van Ravenswaay L, Parnes A, Nisly SA. Clicks for credit: an analysis of healthcare professionals' social media use and potential for continuing professional development activities. Med Educ Online 2024; 29:2316489. [PMID: 38359156 PMCID: PMC10877644 DOI: 10.1080/10872981.2024.2316489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/05/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND Previous studies have examined social media habits and utilization patterns among various groups of healthcare professionals. However, very few studies have evaluated the use of social media to support continuing professional development activities. The goal of the 2023 Clinical Education Alliance social media survey was to explore how HCPs interact professionally with social media, describe utilization trends, and identify barriers to using social media to disseminate CPD content. METHODS We conducted an online anonymous, voluntary survey of healthcare professionals contained in the Clinical Education Alliance learner database from January to March 2023. The survey was distributed via email and all learners were invited to participate regardless of profession or specialty. This survey consisted of 16 questions and collected demographic information and social media utilization and habits of healthcare professionals. RESULTS Of the 2,615 healthcare professionals who completed the survey, 71.2% use social media. Most respondents were physicians (50.6%) practicing in an urban setting (59.6%) and have been practicing for more than 15 years (70.5%). The most widely used platform was Facebook (70.7%), but there were no significant differences among the different professions. Of the respondents who use social media, 44.5% used social media to access continuing professional development-certified activities. Surveyed learners preferred passive participation with social media content. Participant-reported concerns include issues with legitimacy of the information, privacy, time constraints, and institutional barriers. DISCUSSION As the continuing professional development community continues to evolve and seek new innovative strategies to reach healthcare professionals, the findings of this survey highlight the need to identify and enact social media-based strategies aimed to engage healthcare professionals and provide them with unbiased evidence-based education.
Collapse
Affiliation(s)
- Logan Van Ravenswaay
- Healthcare Education and Outcomes Postdoctoral Fellow, Clinical Education Alliance, Reston, VA, USA
| | - Alex Parnes
- Marketing and Engagement, Clinical Education Alliance, Reston, VA, USA
| | - Sarah A. Nisly
- Outcomes and Clinical Impact, Clinical Education Alliance, Reston, VA, USA
| |
Collapse
|
2
|
Faraji N, Goli R, Mohsennezhad P, Mohammadpour Y, Parizad N, Salamat E, Pourbahram R, Bazbandi S. NSAID (nonsteroidal anti-inflammatory drugs) Induced Stevens Johnson Syndrome in a 50-year-old woman: A case study. Toxicol Rep 2024; 12:289-291. [PMID: 38469333 PMCID: PMC10925921 DOI: 10.1016/j.toxrep.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/25/2024] [Accepted: 02/26/2024] [Indexed: 03/13/2024] Open
Abstract
Stevens-Johnson Syndrome (SJS) is a severe and rare adverse drug reaction associated with significant morbidity and mortality. Although SJS is commonly triggered by multiple drugs, non-steroidal anti-inflammatory drugs (NSAIDs), including diclofenac, have been frequently implicated. A middle-aged woman, who is 50 years old, has a prior medical record of high blood pressure, type 2 diabetes, and has recently suffered from a pulmonary embolism. She was later admitted to the intensive care unit (ICU), where she was ultimately diagnosed with Steven Johnson syndrome. Careful drug selection, close monitoring of patients with predisposing factors, and prompt identification of adverse events are crucial to prevent severe drug reactions.
Collapse
Affiliation(s)
- Navid Faraji
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Rasoul Goli
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Pariya Mohsennezhad
- Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Islamic Azad University, Urmia, Iran
| | - Yousef Mohammadpour
- Department of Medical Education, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Naser Parizad
- Patient Safety Research Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Elaheh Salamat
- Department of Anesthesia and Surgical Technology, School of Allied Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Raheleh Pourbahram
- Department of Nursing, School of Nursing and Midwifery, Islamic Azad University Chalus, Iran
| | - Samaneh Bazbandi
- Department of Anesthesiology, School of Nursing and Midwifery, Islamic Azad University Tehran Medical sciences, Tehran, Iran
| |
Collapse
|
3
|
Mishra S, Taneja S. Algorithmic Approach to Deranged Liver Functions After Transplantation. J Clin Exp Hepatol 2024; 14:101317. [PMID: 38264576 PMCID: PMC10801315 DOI: 10.1016/j.jceh.2023.101317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
Liver transplant (LT) recipients require close follow-up with regular monitoring of the liver function tests (LFTs). Evaluation of deranged LFT should be individualized depending upon the time since LT, peri-operative events, clinical course, and any complications. These derangements can range from mild and asymptomatic to severe and symptomatic elevations requiring expedited personalized assessment and management. Pattern of LFT derangement (hepatocellular, cholestatic, or mixed), donor-recipient risk factors, timing after LT (post-operative, 1-12 months, and >12 months since LT) along with clinical context and symptomatology are important considerations before proceeding with the initial evaluation. Compliance to immunosuppression and drug interactions should be ascertained along with local epidemiology of infections. Essential initial evaluation must include an ultrasound abdomen with Doppler to rule out any structural causes such as biliary or vascular complications apart from focussed laboratory evaluation. Early allograft dysfunction, ischemia reperfusion injury, small-for-size syndrome, biliary leaks, hepatic artery, and portal vein thrombosis are usual culprits in the early post-operative period whereas viral hepatitis (acute or reactivation), opportunistic infections, and recurrence of the primary disease are more frequent in the later period. Graft rejection, biliary strictures, sepsis, and drug induced liver injury remain possible etiologies at all times points after LT. Initial evaluation algorithm must be customized based on history, clinical examination, risk factors, and pattern and severity of deranged LFT. Allograft rejection is a diagnosis of exclusion and requires liver biopsy to confirm and assess severity. Empirical treatment of rejection sans liver biopsy is discouraged.
Collapse
Affiliation(s)
- Saurabh Mishra
- Department of Gastroenterology and Hepatology, Paras Health, Sector 22, Panchkula, Haryana 134109, India
| | - Sunil Taneja
- Department of Hepatology, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh 160012, India
| |
Collapse
|
4
|
Liu Y, Peng L, Li Y, Lu X, Wang F, Chen D, Lin N. Effect of liver cancer on the accumulation and hepatobiliary transport of per- and polyfluoroalkyl substances. J Hazard Mater 2024; 468:133743. [PMID: 38377901 DOI: 10.1016/j.jhazmat.2024.133743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 01/30/2024] [Accepted: 02/05/2024] [Indexed: 02/22/2024]
Abstract
In this study, we examined the distribution of per- and polyfluoroalkyl substances (PFASs) in liver and bile tissues from the patients with liver cancer (n = 202) and healthy controls (n = 30), and calculated the hepatobiliary transport efficiency (TB-L) of PFASs. Among 21 PFASs, 13 PFASs were frequently detected in the liver (median: 8.80-16.3 ng/g) and bile (median: 11.03-14.26 ng/mL) samples. PFAS concentrations in liver were positively correlated with age, with higher levels of PFASs in the older. Variance analysis showed that gender and BMI (Body Mass Index) have an important impact on the distribution of PFASs. A U-shaped trend in TB-L of PFASs with the increasing of carbon chain length was found for the first time, and the TB-L of most PFASs in the control was higher than that of those in cases (p < 0.05), suggesting that hepatic injury would affect their transport. PFASs were positively associated with liver injury biomarkers, including γ-glutamyl transferase (GGT), alanine aminotransferase (ALT), and total bilirubin (TB) levels (p < 0.05). This is the first study on examining the hepatobiliary transport characteristics of PFASs, which may help understand the connection between PFAS accumulation and liver cancer risk.
Collapse
Affiliation(s)
- Ying Liu
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, China; School of Environmental Studies, China University of Geosciences, Wuhan 430074, China
| | - Lin Peng
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, China; State Key Laboratory of Environmental and Biological Analysis, Department of Chemistry, Hong Kong Baptist University, the Hong Kong Special Administrative Region of China
| | - Yanjie Li
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Xingwen Lu
- School of Environmental Science and Engineering, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, Guangzhou 510006, China
| | - Fei Wang
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, China.
| | - Da Chen
- School of Environment, Guangdong Key Laboratory of Environmental Pollution and Health, Jinan University, Guangzhou 510632, China
| | - Nan Lin
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China.
| |
Collapse
|
5
|
Nagashima F, Inoue S, Oda T, Hamagami T, Matsuda T, Kobayashi M, Inoue A, Hifumi T, Sakamoto T, Kuroda Y. Optimal chest compression for cardiac arrest until the establishment of ECPR: Secondary analysis of the SAVE-J II study. Am J Emerg Med 2024; 78:102-111. [PMID: 38244243 DOI: 10.1016/j.ajem.2024.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 01/03/2024] [Accepted: 01/07/2024] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION The widespread incorporation of extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest requires the delivery of effective and high-quality chest compressions prior to the initiation of ECPR. The aim of this study was to evaluate and compare the effectiveness of mechanical and manual chest compressions until the initiation of ECPR. METHODS This study was a secondary analysis of the Japanese retrospective multicenter registry "Study of Advanced Life Support for Ventricular Fibrillation by Extracorporeal Circulation II (SAVE-J II)". Patients were divided into two groups, one receiving mechanical chest compressions and the other receiving manual chest compressions. The primary outcome measure was mortality at hospital discharge, while the secondary outcome was the cerebral performance category (CPC) score at discharge. RESULTS Of the 2157 patients enrolled in the SAVE-J II trial, 453 patients (329 in the manual compression group and 124 in the mechanical compression group) were included in the final analysis. Univariate analysis showed a significantly higher mortality rate at hospital discharge in the mechanical compression group compared to the manual compression group (odds ratio [95% CI] = 2.32 [1.34-4.02], p = 0.0026). Multivariate analysis showed that mechanical chest compressions were an independent factor associated with increased mortality at hospital discharge (adjusted odds ratio [95% CI] = 2.00 [1.11-3.58], p = 0.02). There was no statistically significant difference in CPC between the two groups. CONCLUSION For patients with out-of-hospital cardiopulmonary arrest who require ECPR, extreme caution should be used when performing mechanical chest compressions.
Collapse
Affiliation(s)
- Futoshi Nagashima
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan.
| | | | - Tomohiro Oda
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan.
| | - Tomohiro Hamagami
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan.
| | - Tomoya Matsuda
- Tajima Emergency and Critical Care Medical Center, Toyooka Public Hospital, Hyogo, Japan.
| | - Makoto Kobayashi
- Emergency Medical Center, Tottori Prefectural Central Hospital, Tottori, Japan.
| | - Akihiko Inoue
- Hyogo Emergency Medical Center, Department of Emergency and Critical Care Medicine, Hyogo, Japan.
| | - Toru Hifumi
- St. Luke's International Hospital, Department of Emergency and Critical Care Medicine, Tokyo, Japan.
| | - Tetsuya Sakamoto
- Teikyo University School of Medicine, Department of Emergency Medicine, Tokyo, Japan.
| | - Yasuhiro Kuroda
- Kagawa University Hospital, Department of Emergency, Disaster and Critical Care Medicine, Kagawa, Japan.
| |
Collapse
|
6
|
Pilioneta M, Chen HH, Losito E, Bourgeois M, Chémaly N, Eiserman M, Guida L, Dangouloff-Ros V, Fumagalli L, Kaminska A, Boddaert N, Auvin S, Nabbout R, Sainte-Rose C, Blauwblomme T. Interhemispheric Vertical Hemispherotomy: Technique, Outcome, and Pitfalls-A Bicentric Retrospective Case Series of 39 Cases. Oper Neurosurg (Hagerstown) 2024; 26:413-422. [PMID: 37994857 DOI: 10.1227/ons.0000000000000992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/23/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES When seizure onset affects a whole hemisphere, hemispheric disconnections are efficient and safe procedures. However, both lateral peri-insular hemispherotomy and vertical paramedian hemispherotomy approaches report a failure rate around 20%, which can be explained by residual connections giving rise to persistent seizures. In this study, we present the interhemispheric vertical hemispherotomy (IVH), a technical variation of the vertical paramedian hemispherotomy approach, that aims to increase seizure control avoiding residual connections while exposing the corpus callosum. METHODS This is a retrospective study of IVH in two centers, with analysis of clinical and MRI data and outcomes. A detailed description of the technique is provided with a video. RESULTS IVH was performed in 39 children. The mean age at surgery was 7.2 years, and etiologies were as follows: malformations of cortical development (n = 14), Rasmussen's encephalitis (n = 10), stroke (n = 10), post-traumatic (3), and Sturge-Weber Syndrome (2). Hemispheric disconnection was complete on postoperative MRI in 34 cases. There was no mortality, hydrocephalus occurred in one case, and subdural collection occurred in four cases. A second surgery was performed in four cases because of seizure relapse (n = 3) and/or incomplete disconnection on MRI (n = 4). With a mean follow-up of 3.2 years, International League Against Epilepsy class I epilepsy outcome was obtained for 37/39 patients. CONCLUSION IVH is a safe and effective variation of the vertical approaches for hemispheric disconnection. It allows a good exposure and anatomic control of the corpus callosum, which is a frequent site of incomplete disconnection. IVH may be limited by the thalamic volume and the ventricular size, notably in hemimegalencephaly cases.
Collapse
Affiliation(s)
- Martin Pilioneta
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
| | | | - Emma Losito
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
| | - Marie Bourgeois
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
| | - Nicole Chémaly
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
| | - Monika Eiserman
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
| | - Lelio Guida
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
- Université de Paris Cité, Paris , France
| | - Volodia Dangouloff-Ros
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
- Université de Paris Cité, Paris , France
| | - Luca Fumagalli
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
| | - Anna Kaminska
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
| | - Nathalie Boddaert
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
- Université de Paris Cité, Paris , France
| | - Stéphane Auvin
- Université de Paris Cité, Paris , France
- Hôpital Robert Debré, Assistance Publique Hôpitaux de Paris, Paris , France
| | - Rima Nabbout
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
- Université de Paris Cité, Paris , France
| | | | - Thomas Blauwblomme
- Hôpital Necker, Assistance Publique Hôpitaux de Paris, Paris , France
- Université de Paris Cité, Paris , France
| |
Collapse
|
7
|
Pu LY, Li Z, Huang F, Li L, Ma Y, Ma M, Hu S, Wu Z. Efficient synthesis of novel colchicine-magnolol hybrids and evaluation of their inhibitory activity on key proteases of 2019-nCoV replication and acute lung injury. Nat Prod Res 2024; 38:1238-1247. [PMID: 36302171 DOI: 10.1080/14786419.2022.2138870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 10/31/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or 2019-nCoV), is a life-threatening infectious condition. Acute lung injury is a common complication in patients with COVID-19. 3-chymotrypsin-like protease (3CLpro) of 2019-nCoV and neutrophil elastase are critical targets of COVID-19 and acute lung injury, respectively. Colchicine and magnolol are reported to exert inhibitory effects on inflammatory response, the severe comorbidity in both COVID-19 and acute lung injury. We thus designed and synthesized a series of novel colchicine-magnolol hybrids based on a two-step synthetic sequence. It was found that these novel hybrids provided unexpected inhibition on 3CLpro and neutrophil elastase, a bioactivity that colchicine and magnolol did not possess. These findings not only provide perquisites for further in vitro and in vivo investigation to confirm the therapeutic potentiality of novel colchicine-magnolol hybrids, but also suggest that the concurrent inhibition of 3CLpro and neutrophil elastase may enable novel colchicine-magnolol hybrids as effective multi-target drug compounds.
Collapse
Affiliation(s)
| | - Zhiyue Li
- Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shenzhen Institute of Geriatrics, Shenzhen, China
| | - Feijuan Huang
- Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shenzhen Institute of Geriatrics, Shenzhen, China
| | - Limin Li
- Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shenzhen Institute of Geriatrics, Shenzhen, China
| | - Yucui Ma
- Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shenzhen Institute of Geriatrics, Shenzhen, China
| | - Min Ma
- Integrated Chinese and Western Medicine Postdoctoral Research Station, Jinan University, Guangzhou, China
| | - Shengquan Hu
- Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shenzhen Institute of Geriatrics, Shenzhen, China
| | - Zhengzhi Wu
- Shenzhen Institute of Translational Medicine, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Shenzhen Institute of Geriatrics, Shenzhen, China
| |
Collapse
|
8
|
Muzembo BA, Kitahara K, Ohno A, Khatiwada J, Dutta S, Miyoshi SI. Vibriosis in South Asia: A systematic review and meta-analysis. Int J Infect Dis 2024; 141:106955. [PMID: 38311027 DOI: 10.1016/j.ijid.2024.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/04/2024] [Accepted: 01/29/2024] [Indexed: 02/06/2024] Open
Abstract
OBJECTIVES South Asia remains home to foodborne diseases caused by the Vibrio species. We aimed to compile and update information on the epidemiology of vibriosis in South Asia. METHODS For this systematic review and meta-analysis, we searched PubMed, Web of Science, EMBASE, and Google Scholar for studies related to vibriosis in South Asia published up to May 2023. A random-effects meta-analysis was used to estimate the pooled isolation rate of non-cholera-causing Vibrio species. RESULTS In total, 38 studies were included. Seven of these were case reports and 22 were included in the meta-analysis. The reported vibriosis cases were caused by non-O1/non-O139 V. cholerae, V. parahaemolyticus, V. fluvialis, and V. vulnificus. The overall pooled isolation rate was 4.0% (95% confidence interval [CI] 3.0-5.0%) in patients with diarrhea. Heterogeneity was high (I2 = 98.0%). The isolation rate of non-O1/non-O139 V. cholerae, V. parahaemolyticus, and V. fluvialis were 9.0 (95% CI 7.0-10.0%), 1.0 (95% CI 1.0-2.0%), and 2.0 (95% CI: 1.0-3.0%), respectively. Regarding V. parahaemolyticus, O3:K6 was the most frequently isolated serotype. Cases peaked during summer. Several studies reported antibiotic-resistant strains and those harboring extended-spectrum beta-lactamases genes. CONCLUSIONS This study demonstrates a high burden of infections caused by non-cholera-causing Vibrio species in South Asia.
Collapse
Affiliation(s)
- Basilua Andre Muzembo
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
| | - Kei Kitahara
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; Collaborative Research Centre of Okayama University for Infectious Diseases in India at ICMR-NICED, Kolkata, India
| | - Ayumu Ohno
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan; Collaborative Research Centre of Okayama University for Infectious Diseases in India at ICMR-NICED, Kolkata, India
| | | | - Shanta Dutta
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shin-Ichi Miyoshi
- Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| |
Collapse
|
9
|
Luo F, Li M, Chen Y, Song S, Yu H, Zhang P, Xiao C, Lv G, Chen X. Immunosuppressive enzyme-responsive nanoparticles for enhanced accumulation in liver allograft to overcome acute rejection. Biomaterials 2024; 306:122476. [PMID: 38266349 DOI: 10.1016/j.biomaterials.2024.122476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 01/09/2024] [Accepted: 01/18/2024] [Indexed: 01/26/2024]
Abstract
Acute rejection is a life-threatening complication after liver transplantation. Immunosuppressants such as tacrolimus are used to inhibit acute rejection of liver grafts in clinic. However, inefficient intragraft accumulation may reduce the therapeutic outcomes of tacrolimus. Here, an enzyme-responsive nanoparticle is developed to selectively enhance the accumulation of tacrolimus in liver allograft through enzyme-induced aggregation to refine immunotherapeutic efficacy of tacrolimus. The nanoparticles are composed of amphiphilic tacrolimus prodrugs synthesized by covalently conjugating tacrolimus and matrix metalloproteinase 9 (MMP9)-cleavable peptide-containing methoxy poly (ethylene glycol) to poly (l-glutamic acid). Upon exposure to MMP9, which is overexpressed in rejected liver allografts, the nanoparticles undergo a morphological transition from spherical micellar nanoparticles to microscale aggregate-like scaffolds. Intravenous administration of MMP9-responsive nanoparticles into a rat model of acute liver graft rejection results in enhanced nanoparticle accumulation in allograft as compared to nonresponsive nanoparticles. Consequently, the MMP9-responsive nanoparticles significantly inhibit intragraft inflammatory cell infiltration and proliferation, maintain intragraft immunosuppressive environment, alleviate graft damage, improve liver allograft function, abate weight loss and prolong recipient survival. This work proves that morphology-switchable enzyme-responsive nanoparticles represent an innovative strategy for selectively enhancing intragraft accumulation of immunosuppressive agents to improve treatment of liver allograft rejection.
Collapse
Affiliation(s)
- Feixiang Luo
- General Surgery Center, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, 130021, PR China
| | - Mingqian Li
- General Surgery Center, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, 130021, PR China
| | - Yuguo Chen
- General Surgery Center, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, 130021, PR China
| | - Shifei Song
- General Surgery Center, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, 130021, PR China
| | - Haiyang Yu
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, PR China
| | - Peng Zhang
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, PR China.
| | - Chunsheng Xiao
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, PR China.
| | - Guoyue Lv
- General Surgery Center, Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, 130021, PR China.
| | - Xuesi Chen
- Key Laboratory of Polymer Ecomaterials, Changchun Institute of Applied Chemistry, Chinese Academy of Sciences, Changchun, 130022, PR China
| |
Collapse
|
10
|
Rennert RC, Atai NA, Nguyen VN, Abedi A, Sternbach S, Chu J, Carey JN, Russin JJ. Three-Vessel Anastomosis for Direct Multiterritory Cerebral Revascularization: Case Series. Oper Neurosurg (Hagerstown) 2024; 26:423-432. [PMID: 38084991 DOI: 10.1227/ons.0000000000001013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/29/2023] [Indexed: 03/16/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Cerebral revascularization of multiple territories traditionally requires multiple constructs, serial anastomoses, or a combination of direct and indirect approaches. A novel 3-vessel anastomosis technique allows for direct, simultaneous multiterritory cerebral revascularization using a single interposition graft. We herein present our experience with this approach. METHODS Retrospective review of perioperative data and outcomes for patients undergoing multiterritory cerebral revascularization using a 3-vessel anastomosis from 2019 to 2023. RESULTS Five patients met inclusion criteria (median age 53 years [range 12-73]). Three patients with complex middle cerebral artery aneurysms (1 ruptured) were treated with proximal ligation or partial/complete clip trapping and multiterritory external carotid artery-M2-M2 revascularization using a saphenous vein interposition graft. Two patients with moyamoya disease, prior strokes, and predominately bilateral anterior cerebral artery hypoperfusion were treated with proximal superficial temporal artery-A3-A3 revascularization using a radial artery or radial artery fascial flow-through free flap graft. No patients experienced significant surgery-related ischemia. Bypass patency was 100%. One patient had new strokes from vasospasm after subarachnoid hemorrhage. One patient required a revision surgery for subdural hematoma evacuation and radial artery fascial flow-through free flap debridement, without affecting bypass patency or neurologic outcome. On hospital discharge, median Glasgow Outcome Scale and modified Rankin Scale scores were 4 (range 3-5) and 2 (range 0-5), respectively. On follow-up, 1 patient died from medical complications of their presenting stroke; Glasgow Outcome Scale and modified Rankin Scale scores were otherwise stable or improved. CONCLUSION The 3-vessel anastomosis technique can be considered for simultaneous revascularization of multiple intracranial territories.
Collapse
Affiliation(s)
- Robert C Rennert
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
| | - Nadia A Atai
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
| | - Vincent N Nguyen
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
| | - Aidin Abedi
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
| | - Sarah Sternbach
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
| | - Jason Chu
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
- Department of Neurosurgery, Children's Hospital Los Angeles, Los Angeles , California , USA
| | - Joseph N Carey
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
| | - Jonathan J Russin
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
- Neurorestoration Center, Keck School of Medicine, University of Southern California, Los Angeles , California , USA
| |
Collapse
|
11
|
Lin PS, Qi WH, Ding CY, An YJ, Yao YT. The Effects of Daytime Variation on Short-term Outcomes of Patients Undergoing Off-Pump Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2024; 38:931-938. [PMID: 38246822 DOI: 10.1053/j.jvca.2023.12.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To evaluate the effects of time of surgery on the short-term outcomes of patients undergoing off-pump coronary artery bypass grafting (OPCABG). DESIGN A retrospective cohort study. SETTING A single large-volume cardiovascular center. PATIENTS Patients undergoing elective OPCABG between September 2019 and July 2022. INTERVENTIONS Patients were divided into the following 2 groups according to the start time of surgery: morning (AM group, before 11 AM) and afternoon (PM group, after 11 AM). Propensity-score matching (PSM) with a 1:1 matching ratio was used to create comparable cohorts. MEASUREMENTS AND MAIN RESULTS The primary endpoint was the composite incidence of mortality and morbidities during hospitalization. Secondary endpoints included postoperative bleeding and transfusion, mechanical ventilation duration (MVD), and lengths of stay (LOS) in the intensive care unit (ICU) and hospital. From a consecutive series of 1,039 patients, PSM yielded 317 well-matched pairs. There was no difference in the composite incidence of in-hospital mortality and morbidities between the AM and PM groups (16.4% v 17.4%, p = 0.832). However, patients in the PM group were associated with less postoperative blood loss over the first 24 hours (470 v 540 mL, p = 0.002), decreased MVD (14 v 16 hours, p < 0.001), and shorter LOS in ICU (46 v 68 hours, p = 0.002) compared to patients in AM group. CONCLUSIONS The current study suggested a lack of relevance regarding the time of surgery with in-hospital mortality and morbidities in patients undergoing OPCABG.
Collapse
Affiliation(s)
- Pei-Shuang Lin
- Department of Cardiovascular Surgery, Fujian Medical University Affiliated First Quanzhou Hospital, Quanzhou, China; Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wen-Hui Qi
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology, Hengshui People's Hospital, Hengshui, China
| | - Chen-Ying Ding
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology, the First Hospital of Hohhot, Hohhot, China
| | - Yu-Jie An
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China; Department of Anesthesiology, the Friendship Hospital of Ili Kazakh Autonomous Prefecture, Yining, China
| | - Yun-Tai Yao
- Department of Anesthesiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
| |
Collapse
|
12
|
Yoo H, Hong KY, Min S, Lee HS, Park DJ, Kim YS, Kong SH, Chang H. Distribution of Perigastric Station 4d Lymph Nodes in Vascularized Gastroepiploic Lymph Node Transfer: An Anatomic Study and Case Series. Ann Surg Oncol 2024:10.1245/s10434-024-15113-2. [PMID: 38530528 DOI: 10.1245/s10434-024-15113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 02/12/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Vascularized gastroepiploic lymph node transfer (VGLNT) is a well-accepted surgical treatment for restoring physiological function in chronic lymphedema. However, the inclusion of substantial lymph nodes (LNs) in the flap remains uncertain. This study aimed to identify the anatomical basis for reliable flap harvest for VGLNT. PATIENTS AND METHODS The anatomy of perigastric station 4d LNs was studied in healthy cadavers (n = 15) and patients with early gastric cancer (EGC) (n = 27). The omentum was divided into three segments: proximal, middle, and distal from the origin of the right gastroepiploic vessels. The flap dimension, number, location, size of LNs, and caliber of the vessels were reviewed. Eight patients underwent VGLNT for upper/lower limb lymphedema. RESULTS The mean numbers of LNs in the proximal, middle, and distal segment were 2.5, 1.4, 0.5 in the cadavers, and 4.9, 2.7, 0.7 in the gastrectomy specimens, respectively. The proximal third included a significantly greater number of LNs than the distal third in the cadaveric (p = 0.024) and ECG (p = 0.016) specimens. A total of 95% of the LNs were located within proximal two-thirds of the flap from the vessel origin both in the cadavers (21.0 × 5.0 cm) and in the gastrectomy specimens (20 × 3.5 cm). In VGLNT, the transferred flap was 25.5 ± 6.9 × 4.1 + 0.7 cm in dimension, containing a mean number of 6.5 ± 1.9 LNs. At postoperative 6 months, the volumetric difference was significantly reduced by 22.8 ± 9.2% (p < 0.001). CONCLUSIONS This study provides a distinct distribution pattern of station 4d LNs. Inclusion of the proximal two-thirds of the flap, which carries majority of the LNs, is recommended for VGLNT.
Collapse
Affiliation(s)
- Hyokyung Yoo
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Yong Hong
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sally Min
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hye Seung Lee
- Department of Pathology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do-Joong Park
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yi-Suk Kim
- Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, Catholic University of Korea, Seoul, South Korea
| | - Seong-Ho Kong
- Department of Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hak Chang
- Department of Plastic and Reconstructive Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
13
|
Katti N, Kp R, Barik AK, Das SK, Peri S, Mohanty D. Enhancing root coverage and esthetic outcomes in isolated gingival recession using orthodontic intervention and lateral closed tunnel technique: An interdisciplinary prospective case series. Clin Adv Periodontics 2024. [PMID: 38526009 DOI: 10.1002/cap.10285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/21/2024] [Accepted: 02/22/2024] [Indexed: 03/26/2024]
Abstract
BACKGROUND Gingival recession (GR) in malposed tooth in association with bone dehiscence and/or fenestration poses a challenge for successful root coverage treatment. Lateral closed tunnel (LCT) technique is particularly useful in isolated GR in mandibular anterior region, where the shallow vestibular depth prevents tension-free coronal mobilization of tissues. METHODS Twenty patients with GR associated with tooth malposition were treated using a combined orthodontic-periodontic approach with a torquing auxiliary spring followed by LCT technique. RESULTS The two techniques resulted in a combined recession depth reduction from 3.75 ± 1.14 mm to 0.40 ± 0.50 mm at the end of 6-month study period. The orthodontic intervention led to an increase in labial marginal bone levels, as assessed through cone beam computed tomography (CBCT), while the LCT achieved closure of residual recession defect. Also, an increase of keratinized tissue width from 0.81 ± 0.88 mm at baseline to 3.30 ± 0.67 mm at 6 months was achieved. Mean root coverage percentage (MRC%) of 91.40% + 10.25% was seen, with 11 out of 20 sites (55%) showing complete root coverage (CRC). CONCLUSIONS Single tooth orthodontic repositioning followed by LCT technique proved effective in successfully managing isolated recession defects in the mandibular anterior gingival region, which often presents challenging mucogingival conditions. The precise single tooth repositioning resulted in labial marginal bone augmentation, while the LCT surgical approach allowed residual defect closure. KEY FINDINGS Why are these cases new information? Correction of single tooth malposition is achieved before recession coverage treatment to achieve a favorable environment for graft uptake. The reduction in denuded root surface along with the bone remodeling results in increasing the ratio of vascular to avascular region, thus improving the overall prognosis of the treatment. What are the keys to successful management of these cases? The lateral closed tunnel technique involves creating a mucoperiosteal tunnel to close the recession site. Precision is crucial to avoid damage to surrounding tissues. The recipient site should be wider than the width of recession to improve graft vascularity. What are the primary limitations to success in these cases? Limitations may arise when dealing with complex cases, such as multiple teeth involvement or teeth with significant vertical or horizontal bone loss.
Collapse
Affiliation(s)
- Neelima Katti
- Department of Periodontics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| | - Rimsha Kp
- Department of Orthodontics and Dentofacial Orthopaedics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| | - Ashish Kumar Barik
- Department of Orthodontics and Dentofacial Orthopaedics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| | - Surya Kanta Das
- Department of Orthodontics and Dentofacial Orthopaedics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| | - Srivani Peri
- Department of Periodontics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| | - Devapratim Mohanty
- Department of Periodontics, S.C.B. Dental College and Hospital, Cuttack, Odisha, India
| |
Collapse
|
14
|
Fu CX, Qin XR, Chen JS, Zhong J, Xie YX, Li BD, Fu QQ, Li F, Zheng JF. Effect of an Airbag-selective Portal Vein Blood Arrester on the Liver after Hepatectomy: A New Technique for Selective Clamping of the Portal Vein. Curr Med Sci 2024:10.1007/s11596-024-2837-7. [PMID: 38517675 DOI: 10.1007/s11596-024-2837-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/13/2023] [Indexed: 03/24/2024]
Abstract
OBJECTIVE A novel technique was explored using an airbag-selective portal vein blood arrester that circumvents the need for an intraoperative assessment of anatomical variations in patients with complex intrahepatic space-occupying lesions. METHODS Rabbits undergoing hepatectomy were randomly assigned to 4 groups: intermittent portal triad clamping (PTC), intermittent portal vein clamping (PVC), intermittent portal vein blocker with an airbag-selective portal vein blood arrester (APC), and without portal blood occlusion (control). Hepatic ischemia and reperfusion injury were assessed by measuring the 7-day survival rate, blood loss, liver function, hepatic pathology, hepatic inflammatory cytokine infiltration, hepatic malondialdehyde levels, and proliferating cell nuclear antigen levels. RESULTS Liver damage was substantially reduced in the APC and PVC groups. The APC animals exhibited transaminase levels similar to or less oxidative stress damage and inflammatory hepatocellular injury compared to those exhibited by the PVC animals. Bleeding was significantly higher in the control group than in the other groups. The APC group had less bleeding than the PVC group because of the avoidance of portal vein skeletonization during hepatectomy. Thus, more operative time was saved in the APC group than in the PVC group. Moreover, the total 7-day survival rate in the APC group was higher than that in the PTC group. CONCLUSION Airbag-selective portal vein blood arresters may help protect against hepatic ischemia and reperfusion injury in rabbits undergoing partial hepatectomy. This technique may also help prevent liver damage in patients requiring hepatectomy.
Collapse
Affiliation(s)
- Ce-Xiong Fu
- Department of Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
- University of South China, Hengyang, 421001, China
| | - Xiao-Ri Qin
- Department of Gastroenterology, Gastroenterology Endoscopy Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Jin-Song Chen
- Department of Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Jie Zhong
- Department of Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Yu-Xu Xie
- Center of Clinical Laboratory, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Bi-Dan Li
- Department of Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Qing-Qing Fu
- Department of Radiology, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China
| | - Fang Li
- Department of Gastroenterology, Gastroenterology Endoscopy Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China.
| | - Jin-Fang Zheng
- Department of Hepatobiliary and Pancreatic Surgery, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, 570311, China.
| |
Collapse
|
15
|
Gürses G, Ömeroğlu Akkoç Fİ, Aktı A, Körez MK. Effectiveness of wearing glasses with green lenses on dental anxiety for third-molar surgery: A randomized clinical trial. J Am Dent Assoc 2024:S0002-8177(24)00077-1. [PMID: 38520420 DOI: 10.1016/j.adaj.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/14/2024] [Accepted: 02/18/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Dental anxiety is a common problem for oral surgeries. This study investigated the effectiveness of wearing glasses with green lenses in reducing dental anxiety, blood pressure, heart rate, and intraoperative pain in patients undergoing first-time third-molar surgery. METHODS The authors planned this study as a randomized and parallel-group clinical trial. Patients' dental anxiety was measured with the use of a visual analog scale and a State-Trait Anxiety Inventory for baseline measurement purposes. At the same time, blood pressure, oxygen saturation, and heart rate values were recorded. Patients were given glasses with clear or green lenses, depending on their group. After 10 minutes, all parameters were measured again for preoperative measurement. Patients wore glasses with either green or clear lenses throughout the operation. After the operation, patients were asked to estimate the degree of intraoperative pain using the visual analog scale. RESULTS The study included 128 patients. On the basis of the change between baseline and preoperative measurements, the authors found a statistically significant difference in anxiety and heart rate. Intraoperative pain showed a significant difference between groups. No significant changes were found in blood pressure and oxygen saturation. CONCLUSIONS Patients with anxiety could wear low-cost, easy-to-use glasses with green lenses for 10 minutes before an operation to reduce anxiety and heart rate. In addition, wearing glasses during the surgical procedure can reduce intraoperative pain. PRACTICAL IMPLICATIONS By means of using glasses with green lenses throughout the procedure, existing anxiety and pain can be reduced. An operation can be performed more comfortably for both the patient and the dentist. This clinical trial was registered at ClinicalTrials.gov. The registration number is NCT05584696.
Collapse
|
16
|
Sample JW, Yonkus JA, Mirande MD, Graham RP, Kelley SR. Gastrointestinal histoplasmosis with small intestinal perforation: 20-year experience. Updates Surg 2024:10.1007/s13304-024-01797-4. [PMID: 38507175 DOI: 10.1007/s13304-024-01797-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/25/2024] [Indexed: 03/22/2024]
Abstract
Postmortem studies show gastrointestinal tract involvement in as many as 70% of patients affected by disseminated histoplasmosis. Although gastrointestinal involvement is common in disseminated disease, the presentation of small intestinal perforation is exceedingly rare with few reported cases in the literature. Herein we present our institutional case series. The aim of the study is to describe small intestinal perforation in gastrointestinal histoplasmosis with attention to management and outcomes. This is a retrospective single-institution review of patients ≥ 18 years of age treated for small intestinal perforation due to gastrointestinal histoplasmosis. A prospectively maintained institutional database was searched from 2002 to 2022. Data obtained included demographics, comorbidities, treatment course, and outcomes. Five patients with a mean age of 54 years (range 25-72) were identified. Pertinent underlying comorbid conditions included Crohn's disease, psoriatic arthritis, rheumatoid arthritis, and solid organ transplantation. All patients were on chronic immunosuppressive medication(s) with the most common being tumor necrosis factors alpha inhibitors and corticosteroids. Four had a clinical diagnosis of perforation based on physical examination and imaging. All patients underwent segmental resection(s) of the small intestine and received medical treatment with intravenous amphotericin B and eventual transition to an oral antifungal. No patients experienced complications related to surgery. The limitations of the study include nonrandomized retrospective review, single-institution experience, and small patient sample size. Although rare, histoplasmosis should be considered in the differential of patients on chronic immunosuppressive therapy who present with gastrointestinal symptoms concerning perforation, especially from endemic areas. Small intestinal perforation due to gastrointestinal histoplasmosis can be successfully treated with resection and antifungal therapy.
Collapse
Affiliation(s)
- Jack W Sample
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Jennifer A Yonkus
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Maxwell D Mirande
- Department of Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Rondell P Graham
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
17
|
Díaz-Martínez J, Hizojo-Aloé FT, Rivera-Chávez RJ, González-Hernández NA. Misdiagnosed superior mesenteric artery syndrome due to diabetic gastroparesis. Case report and literature review. Int J Surg Case Rep 2024; 117:109543. [PMID: 38513416 DOI: 10.1016/j.ijscr.2024.109543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
INTRODUCTION Superior mesenteric artery syndrome (SMAS) is a rare cause of upper intestinal obstruction. This occurs due to duodenal compression between the superior mesenteric artery and the aorta. Anatomical alterations, eating disorders, after some surgical procedures, and trauma are frequent causes of this rare syndrome. Diabetes is a highly prevalent disease that can cause gastroparesis in up to 12 %. Its association with SMAS is extremely rare and challenging to identify. CASE PRESENTATION A 32-year-old man experienced nausea and vomiting after diagnosis and treatment for type II diabetes. He was treated for diabetic gastroparesis for 2 years without improvement until he lost 40 kg of weight. After imaging studies, a distance between the superior mesenteric artery and the aorta of 5.3 mm and an angle of 17 degrees were detected, corroborating the diagnosis of SMAS syndrome. Due to medical failure, surgical treatment via duodenojejunostomy was performed. DISCUSSION Diabetes is a very prevalent disease in the world population that can cause gastrointestinal symptoms. In our patient, diabetic gastroparesis delayed the diagnosis of SMAS until severe symptoms of upper intestinal obstruction and significant weight loss occurred. In our patient, due to medical failure, surgical treatment significantly improved his symptoms and stopped his weight loss. CONCLUSION Superior mesenteric artery syndrome is a rare syndrome, and challenging to differentiate from diabetic gastroparesis. Delays in management may result in excessive weight loss. Surgical treatment can improve symptoms and weight loss.
Collapse
Affiliation(s)
- Jair Díaz-Martínez
- General Surgery Service, High Specialty Regional Hospital "Centenario de la Revolución Mexicana" ISSSTE, Morelos, México.
| | - Francisco Tomás Hizojo-Aloé
- General Surgery Service, High Specialty Regional Hospital "Centenario de la Revolución Mexicana" ISSSTE, Morelos, México
| | - Renata Jimena Rivera-Chávez
- General Surgery Service, High Specialty Regional Hospital "Centenario de la Revolución Mexicana" ISSSTE, Morelos, México
| | | |
Collapse
|
18
|
Echalier C, Chevrier B, Gros P, Teboul F, Goubier JN. Case report of a primary ectopic extradural and extraspinal meningioma of the brachial plexus. Neurochirurgie 2024; 70:101551. [PMID: 38508105 DOI: 10.1016/j.neuchi.2024.101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 02/28/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024]
Abstract
Primary ectopic extradural and extraspinal meningiomas are rare. We present a unique case of this type of meningioma in the brachial plexus. A 25-year-old man consulted us because of neuropathic supraclavicular pain and the appearance of a supraclavicular mass whose volume had increased. Clinical examination found paresis of the deltoid, biceps brachii and brachialis muscles rated as M4 (MRC) and a strong Tinel sign at the supraclavicular fossa, over the palpable mass. There was no sign pointing towards central nervous system involvement or altered general condition. MRI revealed a mass measuring 53 × 24 mm invading the C5-C6 plexus roots and the primary upper trunk, but not the bone or spinal area. This lesion was hyperintense on DWI/ADC, hyperintense on T2 with hypointense spots, and hypointense on T1 with intense heterogeneous gadolinium enhancement. Excisional biopsy was done 6 months after symptoms started. The tumor had developed at the C5 root, which was fibrous and at the C6 root, which was grossly normal. Anatomical pathology confirmed the WHO grade 1 meningioma, meningothelial and psammomatous histological subtypes. At 6 months, a follow-up MRI found no postoperative tumor remnants or recurrence. During the postoperative course, persistent paralysis of the deltoid muscle at 5 months justified a nerve transfer. This is a rare case of ectopic extraspinal and extradural meningioma of the brachial plexus. The diagnosis of an ectopic meningioma must be considered when a patient presents with a brachial plexus tumor causing neurological deficits. The extradural nature is not sufficient to rule out this diagnosis.
Collapse
Affiliation(s)
- C Echalier
- Clinique Bizet, 22 bis rue Georges Bizet, 75116 Paris, France; Institut de Chirurgie Nerveuse et du Plexus Brachial, 92 bd de Courcelles, 75017 Paris, France; Clinique Nollet Paris, 23 rue Brochant, 75017 Paris, France
| | - B Chevrier
- Groupe Union Imagerie, 21 rue Oudinot, 75007 Paris, France
| | - P Gros
- Centre ACP, PRAXEA-UNILABS, 1 rue Galvani, 91300 Massy, France
| | - F Teboul
- Clinique Bizet, 22 bis rue Georges Bizet, 75116 Paris, France; Institut de Chirurgie Nerveuse et du Plexus Brachial, 92 bd de Courcelles, 75017 Paris, France
| | - J-N Goubier
- Clinique Bizet, 22 bis rue Georges Bizet, 75116 Paris, France; Institut de Chirurgie Nerveuse et du Plexus Brachial, 92 bd de Courcelles, 75017 Paris, France.
| |
Collapse
|
19
|
Gomes FH, Fonseca MDF, Favorito LA, Gasparoni MP, da Silva Filho FS, Diniz ALL, de Resende Júnior JAD. Changes in lower urinary tract function after minimally invasive nerve-sparing for complete excision of endometriosis: An observational study. Neurourol Urodyn 2024. [PMID: 38497524 DOI: 10.1002/nau.25414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/04/2024] [Accepted: 01/24/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES The objective of this paper is to evaluate changes in lower urinary tract symptoms (LUTS), severity of pain and urodynamic parameters after minimally invasive nerve-sparing surgery for patients with endometriosis. METHODS We analyzed 143 patients undergoing minimally invasive nerve-sparing surgery for endometriosis excision (laparoscopy/robot-assisted). The endometriosis was confirmed by preoperative clinical evaluation, magnetic resonance imaging (MRI) showing at least one lesion deeper than 5 mm, and histological confirmation after laparoscopy. We evaluated three points prior and after surgery: LUTS parameters according to the International Urogynecological Association; urodynamic measures of storage and voiding and the severity of the dyspareunia, dyschezia and dysmenorrhea assessed on a self-reported 11-point numeric rating scale. The Wilcoxon signed rank and McNemar tests were used for statistical analyses (p < 0.05). RESULTS We observed significant improvements in LUTS after the surgery with postoperative symptom-free probabilities in urgency (64.5%), daytime frequency (38.5%), and dysuria (87.1%). However, slow stream prevalence increased significantly postsurgery (p = 0.022), with a 20.5% risk of asymptomatic patients developing this symptom. Urodynamic responses varied; for instance, maximum cystometric capacity improved significantly (p = 0.004), while postvoiding residual worsened (p = 0.006). Significant worsening in postvoiding residual occurred in women with normal preoperative values (p = 0.002), with a 17.7% risk of normal values becoming abnormal. Compliance or maximum cystometric capacity not considered normal preoperatively showed significant improvements (p < 0.001), but the risk of normal values becoming abnormal after surgery was 14.5%. CONCLUSION The minimally invasive nerve-sparing surgery for endometriosis excision shows improvement in lower urinary tract symptoms, urodynamics parameters and severity of pain. The majority of patients became asymptomatic in the postoperative period. When compared to the benefits of the patients' surgical treatment, particularly when considering the reduction of pain, the risks of the lower urinary tract treatment seem to be acceptable. The surgical intervention seems to be a safe alternative in patients with endometriosis, although studies with larger samples are needed to confirm these findings.
Collapse
Affiliation(s)
- Fernanda Hack Gomes
- Hospital Federal da Lagoa and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luciano Alves Favorito
- Hospital Federal da Lagoa and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - André Luiz Lima Diniz
- Hospital Federal da Lagoa and Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | |
Collapse
|
20
|
Sivanandam LK, Arunkumar H, Marlecha P, Madamanchi V, Maheshwari C, Naseer MQ, Sanker V, Dave T. Indoxacarb poisoning causing methemoglobinemia treated with parenteral vitamin C: a case report. J Med Case Rep 2024; 18:157. [PMID: 38493134 PMCID: PMC10944591 DOI: 10.1186/s13256-024-04455-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 02/12/2024] [Indexed: 03/18/2024] Open
Abstract
INTRODUCTION This case study reports on a suicide attempt involving indoxacarb and vitamin C. Indoxacarb is a neurotoxic insecticide used in agriculture and as a flea controller in pets. Cotton, vegetables, and fruits are treated with indoxacarb, an insecticide that can be applied both indoors and outdoors. It causes skin allergies, methemoglobinemia, and hemolytic anemia. It is also attributed to allergic reactions through ingestion, inhalation, physical contact, and translaminar action. This case report highlights use of vitamin C in methemoglobinemia caused by indoxacarb poisoning. Indoxacarb poisoning has the potential to be extremely serious and even lethal. In this instance, the patient initially had no symptoms after ingesting a substance containing indoxacarb in an attempt at suicide. However, further tests revealed methemoglobinemia and low oxygen levels. CASE PRESENTATION A 28-year-old south-east Asian female patient ingested an insecticide containing 5.25% novaluron, 4.5% indoxacarb, and 25% thiamethoxam, and reported that she noticed muddy brown urine but presented with no active signs or symptoms of poisoning. Upon examination, the patient was fully conscious, alert, and hemodynamically stable, but had an oxygen saturation of 84%. Gastric lavage was performed, and blood investigations revealed a muddy-brown-colored blood sample and methemoglobin levels of 12%. The patient was treated with high-dose vitamin C and showed significant improvement, with a drop in methemoglobin levels to 1.2% and an increase in oxygen saturation to 97%. DISCUSSION Indoxacarb poisoning can cause severe methemoglobinemia. Vitamin C may be a useful treatment option for methemoglobinemia caused by indoxacarb, particularly in cases in which traditional treatment with methylene blue is contraindicated or not tolerated. Hence high doses of ascorbic acid, that is, vitamin C, were administered to the patient, which lowered their methemoglobin levels and improved oxygen levels without much safety concerns. CONCLUSION This example emphasizes the significance of early indoxacarb poisoning detection and treatment as well as the possible advantages of utilizing ascorbic acid in the management of methemoglobinemia, and highlights the use of vitamin C in the treatment of methemoglobinemia caused by indoxacarb poisoning. Therefore, it is important for healthcare professionals to be aware of the potential for indoxacarb to cause methemoglobinemia and to consider vitamin C as a treatment option.
Collapse
Affiliation(s)
- Lokesh Koumar Sivanandam
- Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India
- Team Erevnites, Puducherry, India
| | - H Arunkumar
- Team Erevnites, Puducherry, India
- Junior Resident, Medicine, Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India
| | - Pranay Marlecha
- Team Erevnites, Puducherry, India
- Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Varsha Madamanchi
- Team Erevnites, Puducherry, India
- Maharaja's Institute of Medical Sciences, Vizianagaram, Andhra Pradesh, India
| | - Chanchal Maheshwari
- Team Erevnites, Puducherry, India
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Mohammed Quader Naseer
- Team Erevnites, Puducherry, India
- Ayaan Institute of Medical Sciences, Moinabad, Telangana, India
| | - Vivek Sanker
- Team Erevnites, Puducherry, India
- Noorul Islam Institute of Medical Sciences, Trivandrum, India
| | - Tirth Dave
- Bukovinian State Medical University, Chernivtsi, Ukraine.
| |
Collapse
|
21
|
Miller A, Patro A, Stevens MN, Scott Fortune D, Gelbard A, Haynes DS, Topf MC. #OtoTwitter: The Top 75 Twitter Influencers in Otolaryngology and Association With Academic Impact. Otolaryngol Head Neck Surg 2024. [PMID: 38494744 DOI: 10.1002/ohn.721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/21/2024] [Accepted: 02/17/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVES Social media has enabled discussion of relevant topics within otolaryngology. With increasing academic discourse occurring on virtual platforms, it is important to examine who is influencing these discussions. This study thus aims to: (1) identify the top Twitter influencers in otolaryngology and (2) assess the relationship between Twitter influence and academic impact. STUDY DESIGN Cross-sectional analysis. SETTING Twitter. METHODS The Right Relevance program was used to identify and rank the top 75 Twitter influencers, excluding organizations, according to the search terms "otolaryngology," "head and neck surgery," "ear nose throat," "rhinology," "head and neck," "laryngology," "facial plastics," and "otology." Demographic data and h-index were collected for each influencer. Correlational analyzes were performed to assess the relationships between Twitter rank and geographic location, sex, subspecialty, and h-index. RESULTS The majority of the top 75 influencers were otolaryngologists (87%), female (68%), and located in the United States (61%). General otolaryngology (n = 20, 31%) was more well-represented than any individual subspecialty including facial plastics (n = 10, 15%), rhinology (n = 10, 15%), and neurotology (n = 9, 14%). There was a significant relationship between Twitter rank and h-index (Spearman ρ value of -0.32; 95% confidence interval: -0.51 to -0.01; P = .006). Twitter rank was not significantly correlated with subspecialty, sex, or geographic location (P > .05). CONCLUSION The majority of Twitter influencers within otolaryngology were otolaryngologists, female, and located in the United States. Social media influence is positively associated with academic impact among otolaryngologists.
Collapse
Affiliation(s)
- Alexis Miller
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Ankita Patro
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Madelyn N Stevens
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | | | - Alexander Gelbard
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David S Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Michael C Topf
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| |
Collapse
|
22
|
Wang AJ, Lee CK, Blanch M, Talati PA, Gray ST, Bleier BS, Scangas GA, Holbrook EH, Curry WT. Endoscopic endonasal approach for olfactory groove meningioma resection: Strategies and outcomes in a retrospective case series. J Clin Neurosci 2024; 122:93-102. [PMID: 38492512 DOI: 10.1016/j.jocn.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 02/20/2024] [Accepted: 03/05/2024] [Indexed: 03/18/2024]
Abstract
OBJECTIVE Though the endoscopic endonasal approach (EEA) is a widely accepted treatment for skull base tumors, the specific use of EEA for olfactory groove meningiomas (OGMs) is debated, with variable outcomes reported in the literature. We review the surgical results of OGM resections for one surgeon including the operative approach, surgical nuances, and outcomes, with a focus on factors relating to patient selection which favor EEA over transcranial approaches. METHODS We retrospectively reviewed thirteen cases of endoscopic endonasal resection of olfactory groove meningiomas. Patient characteristics, clinical characteristics, surgical outcomes, and complications were analyzed. Extent of resection was determined based on volumetric analysis of pre- and postoperative MRI. RESULTS Anatomic characteristics that render a tumor difficult to access fully are lateral extension beyond the mid-orbit and anterior extension to the falx. Simpson Grade I resection was achieved in 11/13 (84.6 %) cases. Mean pre-operative tumor volume was 8.99 cm3 (range 2.19-16.79 cm3), and 92 % of tumors were WHO grade I. We demonstrate 2 cases of smell preservation, possible with small unilateral tumors and tumors that are confined to either the anterior or posterior portion of the cribriform plate. The post-operative CSF leak rate was 7.7 %, without prophylactic lumbar CSF drainage. The mortality rate was 7.7 % (n = 1) after infectious complications following CSF leak. CONCLUSIONS Endoscopic endonasal resection of olfactory groove meningiomas is an effective and safe operative method with outcomes and complication rates comparable to transcranial approaches. Key considerations include careful patient selection and familiarity with technical nuances of endoscopic endonasal approach for this specific tumor type.
Collapse
Affiliation(s)
- Amy J Wang
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Christine K Lee
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Max Blanch
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Pratik A Talati
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA
| | - Benjamin S Bleier
- Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA
| | - George A Scangas
- Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA
| | - Eric H Holbrook
- Department of Otolaryngology, Massachusetts Eye and Ear, 243 Charles St., Boston, MA, 02114, USA
| | - William T Curry
- Department of Neurosurgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
| |
Collapse
|
23
|
Takei Y, Toyama G, Takahashi T, Omatsu K. Optimal duration and timing of basic-life-support-only intervention for patients with out-of-hospital cardiac arrest. Sci Rep 2024; 14:6071. [PMID: 38480805 PMCID: PMC10937976 DOI: 10.1038/s41598-024-56487-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/07/2024] [Indexed: 03/17/2024] Open
Abstract
To elucidate the relationship between the interval from cardiopulmonary resuscitation initiation to return of spontaneous circulation (ROSC) and neurologically favourable 1-month survival in order to determine the appropriate duration of basic life support (BLS) without advanced interventions. This population-based cohort study included patients aged ≥ 18 years with 9132 out-of-hospital cardiac arrest of presumed cardiac origin who were bystander-witnessed and had achieved ROSC between 2018 and 2020. Patients were classified into two groups based on the resuscitation methods as the "BLS-only" and the "BLS with administered epinephrine (BLS-AE)" groups. Receiver operating characteristic (ROC) curve analysis indicated that administering BLS for 9 min yielded the best neurologically outcome for patients with a shockable rhythm [sensitivity, 0.42; specificity, 0.27; area under the ROC curve (AUC), 0.60] in the BLS-only group. Contrastingly, for patients with a non-shockable rhythm, performing BLS for 6 min yielded the best neurologically outcome (sensitivity, 0.65; specificity, 0.43; AUC, 0.63). After propensity score matching, multivariate analysis revealed that BLS-only resuscitation [6.44 (5.34-7.77)] was associated with neurologically favourable 1-month survival. This retrospective study revealed that BLS-only intervention had a significant impact in the initial minutes following CPR initiation. Nevertheless, its effectiveness markedly declined thereafter. The optimal duration for effective BLS-only intervention varied depending on the patient's initial rhythm. Consequently, advanced interventions should be administered within the first few minutes to counteract the diminishing effectiveness of BLS-only intervention.
Collapse
Affiliation(s)
- Yutaka Takei
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, 950-3198, Japan.
| | - Gen Toyama
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, 950-3198, Japan
| | - Tsukasa Takahashi
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, 950-3198, Japan
| | - Kentaro Omatsu
- Graduate School of Health and Welfare, Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, 950-3198, Japan
| |
Collapse
|
24
|
Nakamura S, Ozeki M, Hayashi D, Yasue S, Endo S, Ohnishi H. Sirolimus monotherapy for Kasabach-Merritt phenomenon in a neonate; Case report. Int J Surg Case Rep 2024; 117:109497. [PMID: 38518465 DOI: 10.1016/j.ijscr.2024.109497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE The Kasabach-Merritt Phenomenon (KMP), characterized by thrombocytopenia and consumptive coagulopathy due to endothelial cell growth in the infantile vascular tumor kaposiform hemangioendothelioma, presents a therapeutic challenge. This case highlights the novel use of sirolimus in a neonate, an approach less explored in this age group. CASE PRESENTATION A female neonate presented with a right anterior chest mass, progressing to respiratory distress and congestive heart failure. Diagnosed with KMP, she exhibited low platelet count and coagulation abnormalities. Treatment with sirolimus (0.06 mg/day) led to mass reduction, improved bleeding, and a stable tumor after 12 months, without side effects. This case contrasts with existing literature advocating for combination therapy or higher sirolimus concentrations for effective treatment. Yet, our patient achieved favorable outcomes with low-dose monotherapy, suggesting a potentially safer approach in neonates with immature hepatic and renal metabolism. CLINICAL DISCUSSION This case demonstrates the efficacy of low-dose sirolimus monotherapy in treating KMP in a neonate, challenging current preferences for combination therapies or higher doses. It emphasizes the need for further research into age-specific treatment protocols in KMP, considering the unique metabolic profiles of neonates and infants. CONCLUSION Sirolimus has demonstrated potential in treating KMP in pediatric patients. While initial results are promising, determining optimal dosages and trough concentrations, especially in neonates and infants, remains essential.
Collapse
Affiliation(s)
- Shoji Nakamura
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Michio Ozeki
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan.
| | - Daichi Hayashi
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Shiho Yasue
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Saori Endo
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| | - Hidenori Ohnishi
- Department of Pediatrics, Gifu University Graduate School of Medicine, Gifu 501-1194, Japan
| |
Collapse
|
25
|
Soh GT, Ndong A, Diallo AC, Tendeng JN, Diao ML, Konate I. Bezoar in Meckel's diverticulum: Case report and narrative review. Int J Surg Case Rep 2024; 117:109512. [PMID: 38471214 PMCID: PMC10945273 DOI: 10.1016/j.ijscr.2024.109512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Bezoars are a known cause of complications in Meckel's diverticulum. We present a case in which a bezoar in a Meckel's diverticulum resulted in intestinal obstruction. In addition, we conducted a narrative review to explore the association between Meckel's diverticulum and bezoars. CASE PRESENTATION We present the case of a 22-year-old patient admitted for bowel obstruction persisting for three days and periumbilical tenderness. Abdominal CT tomography revealed a hyper dense circular structure with a diameter of 2 cm, small bowel distension of 41 mm, and free fluid. During surgical exploration, a Meckel diverticulum was found between the antimesenteric border of the small bowel and posterior wall of the umbilicus. The Meckel diverticulum was resected, and upon examination, it was found to contain a calcified phytobezoar. The postoperative course was uneventful. DISCUSSION The clinical and paraclinical presentation of bezoars in Meckel's diverticulum is nonspecific and diagnosis remains challenging despite improved diagnostic modalities. The association between Meckel's diverticulum and bezoars is often identified during surgery, as it is difficult to diagnose using CT scans. The choice between laparoscopic and open surgery depends on the patient's situation. CONCLUSION Diagnosing a bezoar in a Meckel's diverticulum remains challenging. Treatment involves surgery, and the choice of surgical approach depends on the context.
Collapse
Affiliation(s)
| | | | | | | | | | - Ibrahima Konate
- Department of Surgery, Gaston Berger University, Saint-Louis, Senegal
| |
Collapse
|
26
|
Gédor M, Bourgkard È, Dziurla M, Ribet C, Goldberg M, Grzebyk M, Hédelin G, Boini S. Relationship between night work and health-related quality of life: an analysis based on profiles and cumulative duration of exposure to night work among French workers in the CONSTANCES cohort. Int Arch Occup Environ Health 2024:10.1007/s00420-024-02053-3. [PMID: 38466419 DOI: 10.1007/s00420-024-02053-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/29/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The aim of this study is to estimate the association between night work and health-related quality of life (HRQoL) among French workers. The association between cumulative duration of night work and HRQoL was also investigated. METHODS Three career-long night work exposure groups were defined at inclusion in the CONSTANCES cohort: permanent night workers, rotating night workers and former night workers. Day workers with no experience of night work were the reference group. HRQoL was assessed using the Short Form Health Survey (SF-12), in particular the physical component summary (PCS) and mental component summary (MCS) scores, with a higher score indicating better HRQoL. Several linear regression models were built to test the association between night work exposure and HRQoL. The relationship between cumulative duration of night work and HRQoL scores was analyzed using generalised additive models. RESULTS The sample consisted of 10,372 participants. Former night workers had a significantly lower PCS score than day workers (β [95% CI]: - 1.09 [- 1.73; - 0.45], p = 0.001), whereas permanent night workers had a significantly higher MCS score (β [95% CI]: 1.19 [0.009; 2.36], p = 0.048). A significant decrease in PCS score from 5 to 20 years of cumulative night work was observed among former night workers. CONCLUSIONS Former night workers had poorer physical HRQoL in contrast to permanent and rotating night workers who had similar or even better HRQoL than day workers, suggesting the well-known healthy worker survivor effect. Consequently, both current and former night workers require regular and specific follow-up focused on the physical components of their health.
Collapse
Affiliation(s)
- Maud Gédor
- Department of Occupational Epidemiology, French Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), 1, Rue du Morvan, CS 60027 54519, Vandœuvre-Lès-Nancy, France.
| | - Ève Bourgkard
- Department of Occupational Epidemiology, French Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), 1, Rue du Morvan, CS 60027 54519, Vandœuvre-Lès-Nancy, France
| | - Mathieu Dziurla
- Department of Occupational Epidemiology, French Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), 1, Rue du Morvan, CS 60027 54519, Vandœuvre-Lès-Nancy, France
| | - Céline Ribet
- Population-Based Epidemiological Cohorts Unit, Inserm UMS 11, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), Villejuif, France
| | - Marcel Goldberg
- Population-Based Epidemiological Cohorts Unit, Inserm UMS 11, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), Villejuif, France
| | - Michel Grzebyk
- Department of Occupational Epidemiology, French Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), 1, Rue du Morvan, CS 60027 54519, Vandœuvre-Lès-Nancy, France
| | - Guy Hédelin
- Department of Occupational Epidemiology, French Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), 1, Rue du Morvan, CS 60027 54519, Vandœuvre-Lès-Nancy, France
| | - Stéphanie Boini
- Department of Occupational Epidemiology, French Research and Safety Institute for the Prevention of Occupational Accidents and Diseases (INRS), 1, Rue du Morvan, CS 60027 54519, Vandœuvre-Lès-Nancy, France
| |
Collapse
|
27
|
Padte S, Samala Venkata V, Mehta P, Tawfeeq S, Kashyap R, Surani S. 21st century critical care medicine: An overview. World J Crit Care Med 2024; 13:90176. [DOI: 10.5492/wjccm.v13.i1.90176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/28/2023] [Accepted: 01/24/2024] [Indexed: 03/05/2024] Open
Abstract
Critical care medicine in the 21st century has witnessed remarkable advancements that have significantly improved patient outcomes in intensive care units (ICUs). This abstract provides a concise summary of the latest developments in critical care, highlighting key areas of innovation. Recent advancements in critical care include Precision Medicine: Tailoring treatments based on individual patient characteristics, genomics, and biomarkers to enhance the effectiveness of therapies. The objective is to describe the recent advancements in Critical Care Medicine. Telemedicine: The integration of telehealth technologies for remote patient monitoring and consultation, facilitating timely interventions. Artificial intelligence (AI): AI-driven tools for early disease detection, predictive analytics, and treatment optimization, enhancing clinical decision-making. Organ Support: Advanced life support systems, such as Extracorporeal Membrane Oxygenation and Continuous Renal Replacement Therapy provide better organ support. Infection Control: Innovative infection control measures to combat emerging pathogens and reduce healthcare-associated infections. Ventilation Strategies: Precision ventilation modes and lung-protective strategies to minimize ventilator-induced lung injury. Sepsis Management: Early recognition and aggressive management of sepsis with tailored interventions. Patient-Centered Care: A shift towards patient-centered care focusing on psychological and emotional well-being in addition to medical needs. We conducted a thorough literature search on PubMed, EMBASE, and Scopus using our tailored strategy, incorporating keywords such as critical care, telemedicine, and sepsis management. A total of 125 articles meeting our criteria were included for qualitative synthesis. To ensure reliability, we focused only on articles published in the English language within the last two decades, excluding animal studies, in vitro/molecular studies, and non-original data like editorials, letters, protocols, and conference abstracts. These advancements reflect a dynamic landscape in critical care medicine, where technology, research, and patient-centered approaches converge to improve the quality of care and save lives in ICUs. The future of critical care promises even more innovative solutions to meet the evolving challenges of modern medicine.
Collapse
Affiliation(s)
- Smitesh Padte
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | | | - Priyal Mehta
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | - Sawsan Tawfeeq
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
| | - Rahul Kashyap
- Department of Research, Global Remote Research Scholars Program, St. Paul, MN 55104, United States
- Department of Research, WellSpan Health, York, PA 17403, United States
- Department of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
| | - Salim Surani
- Department of Pulmonary & Critical Care Medicine, Mayo Clinic, Rochester, MN 55905, United States
- Department of Medicine & Pharmacology, Texas A&M University, College Station, TX 77843, United States
| |
Collapse
|
28
|
Wang M, Luo X, Xiao X, Zhang L, Wang Q, Wang S, Wang X, Xue H, Zhang L, Chen Y, Lei J, Štupnik T, Scarci M, Fiorelli A, Laisaar T, Fruscio R, Elkhayat H, Novoa NM, Davoli F, Waseda R, Estill J, Norris SL, Riley DS, Tian J. CARE-radiology statement explanation and elaboration: reporting guideline for radiological case reports. BMJ Evid Based Med 2024:bmjebm-2023-112695. [PMID: 38458654 DOI: 10.1136/bmjebm-2023-112695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/10/2024]
Abstract
Despite the increasing number of radiological case reports, the majority lack a standardised methodology of writing and reporting. We therefore develop a reporting guideline for radiological case reports based on the CAse REport (CARE) statement. We established a multidisciplinary group of experts, comprising 40 radiologists, methodologists, journal editors and researchers, to develop a reporting guideline for radiological case reports according to the methodology recommended by the Enhancing the QUAlity and Transparency Of health Research network. The Delphi panel was requested to evaluate the significance of a list of elements for potential inclusion in a guideline for reporting mediation analyses. By reviewing the reporting guidelines and through discussion, we initially drafted 46 potential items. Following a Delphi survey and discussion, the final CARE-radiology checklist is comprised of 38 items in 16 domains. CARE-radiology is a comprehensive reporting guideline for radiological case reports developed using a rigorous methodology. We hope that compliance with CARE-radiology will help in the future to improve the completeness and quality of case reports in radiology.
Collapse
Affiliation(s)
- Mengshu Wang
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China
| | - Xufei Luo
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Xiaojuan Xiao
- Department of Radiology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Shenzhen, China
| | - Linlin Zhang
- Editorial Office of Chinese Journal of Radiology, Beijing, China
| | - Qi Wang
- Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
| | - Shiyu Wang
- Department of Radiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Huadan Xue
- Department of Radiology, Translational Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Longjiang Zhang
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, General Hospital of Eastern Theater Command, Nanjing, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Research Unit of Evidence-Based Evaluation and Guidelines, Chinese Academy of Medical Sciences (2021RU017), School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine of Gansu Province, Lanzhou, China
- Institute of Health Data Science, Lanzhou University, Lanzhou, China
- World Health Organization Collaboration Center for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Junqiang Lei
- Department of Radiology, The First Hospital of Lanzhou University, Lanzhou, China
- Intelligent Imaging Medical Engineering Research Center of Gansu Province, Lanzhou, China
- Accurate Image Collaborative Innovation International Science and Technology Cooperation Base of Gansu Province, Lanzhou, China
| | - Tomaž Štupnik
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Marco Scarci
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, London, UK
| | - Alfonso Fiorelli
- Thoracic Surgery Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Tanel Laisaar
- Department of Thoracic Surgery and Lung Transplantation, Lung Clinic, Tartu University Hospital, Tartu, Estonia
- Lung Clinic, Institute of Clinical Medicine, Medical Faculty, University of Tartu, Tartu, Estonia
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, IRCCS San Gerardo, Monza, Italy
| | - Hussein Elkhayat
- Cardiothoracic Surgery Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Nuria M Novoa
- Thoracic Surgery, Puerta de Hierro University Hospital-Majadahonda, Madrid, Spain
- Biomedical Institute of Salamanca, Salamanca, Spain
| | - Fabio Davoli
- General & Thoracic Surgery Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Ryuichi Waseda
- Department of General Thoracic, Breast and Pediatric Surgery, Fukuoka University, Fukuoka, Japan
| | - Janne Estill
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Susan L Norris
- Oregon Health & Science University, Portland, Oregon, USA
| | - David S Riley
- University of New Mexico Medical School, Santa Fe, New Mexico, USA
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine of Gansu Province, Lanzhou, China
| |
Collapse
|
29
|
Kondapavulur S, Scheer JK, Safaee MM, Clark AJ. Completely Minimally Invasive Implant Removal and Transforaminal Lumbar Interbody Fusion for Adjacent Segment Disease: Case Series and Operative Video. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01086. [PMID: 38451097 DOI: 10.1227/ons.0000000000001121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 01/16/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Adjacent segment disease is a relatively common late complication after lumbar fusion. If symptomatic, certain patients require fusion of the degenerated adjacent segment. Currently, there are no posterior completely minimally invasive techniques described for fusion of the adjacent segment above or below a previous fusion. We describe here a novel minimally invasive technique for both implant removal (MIS-IR) and adjacent level transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar stenosis. METHODS Demographic, surgical, and radiographic outcome data were collected for patients with lumbar stenosis and previous lumbar fusion, who were treated with MIS-IR and MIS-TLIF through the same incision. Radiographic outcomes were assessed postoperatively and complications were assessed at the primary end point of 3 months. RESULTS A total of 14 patients (7 female and 7 male), with average age 64.6 years (SD 13.4), were included in this case series. Nine patients had single-level MIS-IR with single-level MIS-TLIF. Three patients had 2-level MIS-IR with single-level MIS-TLIF. Two patients had single-level MIS-IR with 2-level MIS-TLIF. Only 1 patient had a postoperative complication-hematoma requiring same-day evacuation. There were no other complications at the primary end point and no fusion failure at the hardware removal levels to date (average follow-up, 11 months). Average increases in posterior disk height and foraminal height after MIS-TLIF were 4.44, and 2.18 mm, respectively. CONCLUSION Minimally invasive spinal IR can be successfully completed along with adjacent level TLIF through the same incisions, via an all-posterior approach.
Collapse
Affiliation(s)
- Sravani Kondapavulur
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael M Safaee
- Department of Neurological Surgery, University of Southern California, Los Angeles, California, USA
| | - Aaron J Clark
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
30
|
Capo G, Calvanese F, Vandenbulcke A, Zaed I, Di Carlo DT, Cao R, Barrey CY. Lateral-PLIF for spinal arthrodesis: concept, technique, results, complications, and outcomes. Acta Neurochir (Wien) 2024; 166:123. [PMID: 38451339 DOI: 10.1007/s00701-024-06024-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Accepted: 02/13/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Posterior lumbar interbody fusion (PLIF) surgery represents an effective option to treat degenerative conditions in the lumbar spine. To reduce the drawbacks of the classical technique, we developed a variant, so-called Lateral-PLIF, which we then evaluated through a prospective consecutive series of patients. METHODS All adult patients treated at our institute with single or double level Lateral-PLIF for lumbar degenerative disease from January to December 2017 were prospectively collected. Exclusion criteria were patients < 18 years of age, traumatic patients, active infection, or malignancy, as well as unavailability of clinical and/or radiological follow-up data. The technique consists of insert the cages bilaterally through the transition zone between the central canal and the intervertebral foramen, just above the lateral recess. Pre- and postoperative (2 years) questionnaires and phone interviews (4 years) assessed pain and functional outcomes. Data related to the surgical procedure, postoperative complications, and radiological findings (1 year) were collected. RESULTS One hundred four patients were selected for the final analysis. The median age was 58 years and primary symptoms were mechanical back pain (100, 96.1%) and/or radicular pain (73, 70.2%). We found a high fusion rate (95%). A statistically significant improvement in functional outcome was also noted (ODI p < 0.001, Roland-Morris score p < 0.001). Walking distance increased from 812 m ± 543 m to 3443 m ± 712 m (p < 0.001). Complications included dural tear (6.7%), infection/wound dehiscence (4.8%), and instrument failure (1.9%) but no neurological deterioration. CONCLUSIONS Lateral-PLIF is a safe and effective technique for lumbar interbody fusion and may be considered for further comparative study validation with other techniques before extensive use to treat lumbar degenerative disease.
Collapse
Affiliation(s)
- Gabriele Capo
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesco Calvanese
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France.
- Department of Neurosurgery, Helsinki University Hospital and University of Helsinki, Haartmaninkatu 4, 00290, Helsinki, Finland.
| | - Alberto Vandenbulcke
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
| | - Ismail Zaed
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
| | - Davide Tiziano Di Carlo
- Department of Neurosurgery, Azienda Ospedaliero Universitaria Pisana (AOUP), Via Paradisa 2, 56100, Pisa, Italy
- Department of Translational Research On New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Roberta Cao
- Department of Neuroradiology, Pierre Wertheimer Hospital, GHE, Hospices Civils de Lyon, and Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 696777, Lyon-Bron, France
| | - Cédric Y Barrey
- Department of Spine and Spinal Cord Surgery, Pierre Wertheimer Hospital, Hospices Civils de Lyon, 59 Boulevard Pinel, 696777, Lyon-Bron, France
- Laboratory of Biomechanics, ENSAM, Arts Et Metiers ParisTech, 153 Boulevard de L'Hôpital, 75013, Paris, France
| |
Collapse
|
31
|
Shen A, Yu Y, Lyu L, Jiang S, Zhou D, Xu J, Zhou P. "One-and-a-Half" Interdural Transcavernous Pituitary Transposition/Rotation for Protection of Hypophyseal Portal System in Adult Peripheral Retroinfundibular Craniopharyngioma. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01083. [PMID: 38451095 DOI: 10.1227/ons.0000000000001067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/05/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Craniopharyngiomas originate from the pituitary stalk (PS) and extend along the pituitary-hypothalamic axis. Peripheral retroinfundibular craniopharyngiomas, particularly, may have worse surgery outcomes than other types. This study aims to investigate the advantage of using "one-and-a-half" interdural transcavernous pituitary transposition/rotation to dissect the tumor from the residual stalk and hypophyseal portal system for this subtype of craniopharyngioma. METHODS From August 2018 to February 2023, patients with peripheral retroinfundibular craniopharyngioma underwent surgical treatment. We analyzed clinical information, surgical records, imaging, and examination findings. The surgical procedure, including "one-and-a-half" interdural transcavernous pituitary transposition and rotation, was explained. Postoperative follow-up included endocrinological tests, MRI examinations, and urination surveys. RESULTS Among the 52 patients diagnosed with craniopharyngioma who underwent surgical treatment, 9 were classified as peripheral retroinfundibular craniopharyngioma, and they received "one-and-a-half" interdural transcavernous pituitary transposition and stalk rotation. In 6 cases, the residual PS and most of the hypophyseal portal system were preserved. Gross total resection was achieved in 5 patients and near total resection in 1 patient. One patient had a transection of the bilateral inferior hypophyseal arteries and 5 unilaterally. None experienced permanent diabetes insipidus, but varying degrees of anterior pituitary dysfunction postoperatively required hormone replacement therapy, which gradually decreased over time. CONCLUSION The natural anatomic corridor, "one-and-a-half" interdural transcavernous pituitary transposition, and stalk rotation provide increased working space compared with intradural or extradural pituitary transposition. Simultaneously rotating the tumor and pituitary enables a specific attack angle for lesion dissection after the anteriorly displaced residual stalk is rotated laterally. This approach preserves the residual PS and hypophyseal portal system, avoiding complications of diabetes insipidus and hypopituitarism. In most cases, only one side of the inferior hypophyseal artery needs to be sacrificed, ensuring normal pituitary function.
Collapse
Affiliation(s)
- Ao Shen
- Department of Neurosurgery, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
32
|
Kyejo W, Moshi B, Massanga E, Ntiyakunze G, Mgonja M, Kaguta M, Mdachi E. Abdominal wall endometriosis in cesarean scar: A case report. SAGE Open Med Case Rep 2024; 12:2050313X241237333. [PMID: 38463448 PMCID: PMC10921851 DOI: 10.1177/2050313x241237333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 02/16/2024] [Indexed: 03/12/2024] Open
Abstract
Abdominal wall endometriosis refers to the presence of endometrial tissue within surgical scars, most commonly occurring following gynecological procedures such as cesarean sections. This case report presents a rare case of abdominal wall endometriosis in a cesarean scar. The patient, a 32-year-old woman with a history of two previous cesarean sections, presented with cyclic pain and swelling in the lower abdominal region. Physical examination revealed a tender, well-defined mass within the cesarean scar. Surgical excision of the mass was performed, and histopathological examination confirmed the presence of endometrial tissue. This case highlights the importance of considering abdominal wall endometriosis in the differential diagnosis of patients presenting with cyclic pain or swelling in previous surgical scars. Prompt diagnosis and appropriate management can help alleviate symptoms and prevent complications.
Collapse
Affiliation(s)
- Willbroad Kyejo
- Department of Family Medicine, Aga Khan University, Dar es Salaam, Tanzania
| | - Brenda Moshi
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Euphraim Massanga
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Gregory Ntiyakunze
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Miriam Mgonja
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Munawar Kaguta
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| | - Ernest Mdachi
- Department of Obstetrics and Gynecology, Aga Khan University, Dar es Salaam, Tanzania
| |
Collapse
|
33
|
Horesh N, Emile SH, Garoufalia Z, Gefen R, Zhou P, Wexner SD. Trends in management and outcomes of colon cancer in the United States over 15 years: Analysis of the National Cancer Database. Int J Cancer 2024. [PMID: 38454540 DOI: 10.1002/ijc.34910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/29/2023] [Accepted: 01/17/2024] [Indexed: 03/09/2024]
Abstract
Management of colon cancer has changed over the last few decades. We assessed the trends in management and outcomes using the US National Cancer Database (NCDB). A retrospective analysis of all patients with colonic adenocarcinoma between 2005 and 2019 was conducted. The cohort was divided into three equal time periods: Period 1 (2005-2009), Period 2 (2010-2014), and Period 3 (2015-2019) to examine treatment and outcomes trends. The primary outcome was 5-year overall survival (OS). The study included 923,275 patients. A significant increase in patients with stage IV disease was noted in Period 3 compared to Period 1 (47.9% vs. 27.9%, respectively), whereas a reciprocal reduction was seen in patients with locally advanced disease (stage II: 20.8%-12%; stage III: 14.5%-7.7%). Use of immunotherapy significantly increased from 0.3% to 7.6%. Mean 5-year OS increased (43.6 vs. 42.1 months) despite the increase in metastatic disease and longer time from diagnosis to definitive surgery (7 vs. 14 days). A reduction in 30-day readmission (5.1%-4.2%), 30- (3.9%-2.8%), and 90-day mortality (7.1%-5%) was seen. Laparoscopic and robotic surgery increased from 45.8% to 53.1% and 2.9% to 12.7%, respectively. Median postoperative length of hospital stay decreased by 2 days. Rate of positive resection margins (7.2%-6%) and median number of examined lymph nodes (14-16) also improved. Minimally invasive surgery and immunotherapy for colon cancer significantly increased in recent years. Patient outcomes including OS improved over time.
Collapse
Affiliation(s)
- Nir Horesh
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of Surgery and Transplantation, Sheba Medical Center, Ramat Gan, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sameh Hany Emile
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Colorectal Surgery Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Zoe Garoufalia
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Rachel Gefen
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
- Department of General Surgery, Faculty of Medicine, Hadassah Medical Organization, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peige Zhou
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| | - Steven D Wexner
- Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, Florida, USA
| |
Collapse
|
34
|
Romero-Marcos JM, Sampson-Dávila JG, Cuenca-Gómez C, Altet-Torné J, González-Abós S, Ojeda-Jiménez I, Galaviz-Sosa ML, Delgado-Rivilla S. Colorectal procedures with the novel Hugo™ RAS system: training process and case series report from a non-robotic surgical team. Surg Endosc 2024:10.1007/s00464-024-10760-8. [PMID: 38448626 DOI: 10.1007/s00464-024-10760-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 02/16/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND The landscape of robotic surgery is evolving with the emergence of new platforms. However, reports on their applicability in different surgical fields are still limited and come from teams with robotics experience. This study aims to describe the training process for colorectal surgery with the Hugo™ RAS system of a robotics-inexperienced surgical team and present the initial patient series. METHODS The training process is depicted, and data from the first 10 consecutive patients operated on for colorectal conditions with the Hugo™ RAS system by a surgical team with no prior experience in robotic surgery were prospectively recorded and analysed. RESULTS The team received intensive training in robotic surgery and specifically in the Hugo™ RAS system previously to the first case. Between May 2023 and December 2023, 10 patients underwent colorectal procedures: 5 right colectomies, 3 sigmoid resections, 1 high rectal resection and 1 ventral mesh rectopexy. The first case was proctored by an expert. Median docking time was 14 min and median total operative time was 185 min. The only technical difficulty during the procedures was occasional clashing of robotic arms. None had to be converted, and no intraoperative or postoperative morbidity was recorded. Hospital stays ranged from 2 to 4 days. A median of 21 lymph nodes were yielded in the operations for malignant conditions. CONCLUSIONS Common colorectal procedures can be safely performed using the Hugo™ RAS platform. Prior experience in robotic surgery is not a necessary requirement, but following a structured training program is essential.
Collapse
Affiliation(s)
- Juan-Manuel Romero-Marcos
- Department of General Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain.
- , Plaça del Doctor Robert, 5, 08221, Terrassa, Barcelona, Spain.
| | | | - Carlota Cuenca-Gómez
- Department of General Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Juan Altet-Torné
- Department of General Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Sandra González-Abós
- Department of General Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | - Iris Ojeda-Jiménez
- Department of General Surgery, Hospital Universitari MútuaTerrassa, Terrassa, Barcelona, Spain
| | | | | |
Collapse
|
35
|
Liao CH, Wu TY, Lin YL, Liu WD, Wang JT, Chen JS, Ho YL. Case Report: Pericardial Actinomycosis in a 79-Year-Old Man with Poor Dental Hygiene. Am J Trop Med Hyg 2024; 110:504-508. [PMID: 38295417 PMCID: PMC10919186 DOI: 10.4269/ajtmh.23-0618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 10/27/2023] [Indexed: 02/02/2024] Open
Abstract
Actinomycosis is an uncommon infection caused by Actinomyces species, and the diagnosis is often challenging owing to low prevalence and diverse clinical manifestations. Pericardial involvement of actinomycosis is particularly rare. Here, we present a case of a 79-year-old man who initially complained of exertional dyspnea, orthopnea, and decreased urine amount. There was no fever, chest pain, or productive cough. Physical examination was remarkable for decreased breath sounds at the left lower lung field. Poor dental hygiene and a firm, well-defined mass without discharge over the hard palate were noted. Echocardiography revealed reduced ejection fraction of the left ventricle, global hypokinesia, and thickened pericardium (> 5 mm) with a small amount of pericardial effusion. On admission, the patient underwent diagnostic thoracentesis, and the results suggested an exudate. However, bacterial and fungal cultures were all negative. There was no malignant cell by cytology. Computed tomography revealed contrast-enhanced pericardial nodular masses. Video-assisted thoracoscopic pericardial biopsy was performed. Histopathology confirmed actinomycosis with chronic abscess formation, and a tissue culture yielded Aggregatibacter actinomycetemcomitans. The symptoms resolved with administration of clindamycin for 6 months. This case highlights the challenge in the diagnosis of cardiac actinomycosis, the potential role of concomitant microorganisms as diagnostic clues, and the favorable clinical response achieved with appropriate antibiotic treatment.
Collapse
Affiliation(s)
- Chun-Hsun Liao
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzong-Yow Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Liang Lin
- Department of Internal Medicine, National Taiwan University Hsinchu Branch, Hsinchu, Taiwan
| | - Wang-Da Liu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Jann-Tay Wang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Jin-Shing Chen
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Surgical Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Yi-Lwun Ho
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| |
Collapse
|
36
|
Kim J, Lim MH, Kim K, Yoon HJ. Continual learning framework for a multicenter study with an application to electrocardiogram. BMC Med Inform Decis Mak 2024; 24:67. [PMID: 38448921 DOI: 10.1186/s12911-024-02464-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 02/21/2024] [Indexed: 03/08/2024] Open
Abstract
Deep learning has been increasingly utilized in the medical field and achieved many goals. Since the size of data dominates the performance of deep learning, several medical institutions are conducting joint research to obtain as much data as possible. However, sharing data is usually prohibited owing to the risk of privacy invasion. Federated learning is a reasonable idea to train distributed multicenter data without direct access; however, a central server to merge and distribute models is needed, which is expensive and hardly approved due to various legal regulations. This paper proposes a continual learning framework for a multicenter study, which does not require a central server and can prevent catastrophic forgetting of previously trained knowledge. The proposed framework contains the continual learning method selection process, assuming that a single method is not omnipotent for all involved datasets in a real-world setting and that there could be a proper method to be selected for specific data. We utilized the fake data based on a generative adversarial network to evaluate methods prospectively, not ex post facto. We used four independent electrocardiogram datasets for a multicenter study and trained the arrhythmia detection model. Our proposed framework was evaluated against supervised and federated learning methods, as well as finetuning approaches that do not include any regulation to preserve previous knowledge. Even without a central server and access to the past data, our framework achieved stable performance (AUROC 0.897) across all involved datasets, achieving comparable performance to federated learning (AUROC 0.901).
Collapse
Affiliation(s)
- Junmo Kim
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea
| | - Min Hyuk Lim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
- Graduate School of Health Science and Technology, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hyung-Jin Yoon
- Interdisciplinary Program in Bioengineering, Seoul National University, Seoul, Republic of Korea.
- Medical Bigdata Research Center, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, Republic of Korea.
| |
Collapse
|
37
|
Shah ZA, Zeb M, Ilyas M, Hamid H, Fatima K, Batool M, Abbas M. Peutz-Jeghers syndrome with polyps in the stomach, duodenum, and small and large intestine: a case report. J Med Case Rep 2024; 18:86. [PMID: 38438911 PMCID: PMC10913253 DOI: 10.1186/s13256-023-04335-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/22/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Peutz-Jeghers syndrome is a rare hereditary condition characterized by gastrointestinal polyps and pigmented oral lesions. The case contributes to a deeper understanding of Peutz-Jeghers syndrome and underscores the significance of interdisciplinary collaboration for accurate diagnosis and tailored therapeutic strategies. CASE DESCRIPTION We present a case of a 15-year-old Afghan female patient with multiple polyps throughout the gastrointestinal tract and mucocutaneous pigmentation. Despite previous medical visits and colonoscopies, her symptoms persisted. A multidisciplinary team discussed the case and recommended further investigations and interventions. A polypectomy was performed, confirming the presence of hamartomatous polyps. The patient was diagnosed with Peutz-Jeghers syndrome, but during the course of treatment she went through complications and was managed surgically as well. CONCLUSION Timely polyp removal and lifelong surveillance are crucial in managing Peutz-Jeghers syndrome. Further research and genetic analysis are needed to improve understanding and management of this rare disorder.
Collapse
Affiliation(s)
| | - Muhammad Zeb
- General Surgery, Hayatabad Medical Complex, Peshawar, Pakistan.
| | | | - Hasnain Hamid
- Hayatabad Medical Complex Peshawar, Peshawar, Pakistan
| | - Komal Fatima
- Hayatabad Medical Complex Peshawar, Peshawar, Pakistan
| | - Maria Batool
- Hayatabad Medical Complex Peshawar, Peshawar, Pakistan
| | - Muhammad Abbas
- General Surgery, Hayatabad Medical Complex, Peshawar, Pakistan
| |
Collapse
|
38
|
Sharifi G, Mohammadi E, Paraandavaji E, Tavangar SM, Dabbagh Ohadi MA, Jafari A, Jahanbakhshi A, Akbari Dilmaghani N, Davoudi Z, Smith TR, Banihashemi G, Azadi M, Hatami N, Zenonos GA, Mohajeri Tehrani M. Empty sella in somatotropic pituitary adenomas; a series of 23 cases. Front Surg 2024; 11:1350032. [PMID: 38500594 PMCID: PMC10944865 DOI: 10.3389/fsurg.2024.1350032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/08/2024] [Indexed: 03/20/2024] Open
Abstract
Purpose We aimed to investigate empty sella syndrome in somatotrophic pituitary adenoma for possible etiology, complications, and treatment options. Method Among over 2,000 skull base masses that have been managed in our center since 2013, we searched for growth hormone-producing adenomas. Clinical, surgical, and imaging data were retrospectively collected from hospital records to check for sella that lacked pituitary tissue on routine imaging. Result In 220 somatotrophic adenomas, 23 patients had an empty sella with surgical and follow-up data. The mean age of the sample was 46 years with the same male-to-female ratio. Five cases had partial empty sella and the rest were complete empty sellas. The most common simultaneous hormonal disturbance was high prolactin levels. Six had adenoma invasion into the clivus or sphenoid sinus and 10 had cavernous sinus intrusion. Peri-operative low-flow and high-flow cerebrospinal fluid (CSF) leaks were encountered in one and two patients, respectively, which were successfully sealed by abdominal fat. The majority of cases required growth hormone replacement therapy while it was controlled without any replacement therapy in nine patients. No pituitary hormonal disturbance occurred after transsphenoidal surgery except for hypothyroidism in one patient. Conclusion An empty sella filled with fluid can be detected frequently in pituitary adenomas, especially in the setting of acromegaly. The pituitary gland may be pushed to the roof of the sella and might be visible as a narrow rim on imaging or may be detected in unusual places out of the sella. The pathophysiology behind such finding originates from soft and hard tissue changes and CSF pressure alternations during abundant growth hormone production.
Collapse
Affiliation(s)
- Guive Sharifi
- Department of Neurosurgery, Loghman Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Mohammadi
- Department of Neurosurgery, Tehran University of Medical Sciences, Tehran, Iran
| | - Elham Paraandavaji
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Tavangar
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Chronic Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Ali Jafari
- Department of Neurosurgery, Loghman Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amin Jahanbakhshi
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nader Akbari Dilmaghani
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Davoudi
- Skull Base Research Center, Loghman Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Timothy R. Smith
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Gelareh Banihashemi
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoumeh Azadi
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Hatami
- Endocrine Research Center, Institute of Endocrinology and Metabolism, Iran University of Medical Sciences, Tehran, Iran
| | - Georgios A. Zenonos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Mohammadreza Mohajeri Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
39
|
Lunsford-Avery JR, Bidopia T, Jackson L, Sloan JS. Behavioral Treatment of Insomnia and Sleep Disturbances in School-Aged Children and Adolescents. Psychiatr Clin North Am 2024; 47:103-120. [PMID: 38302200 DOI: 10.1016/j.psc.2023.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Insomnia and related sleep disturbances are prevalent among youth and are associated with adverse consequences, including poorer psychiatric functioning. Behavioral sleep interventions, ranging from brief educational interventions to behavioral therapies (cognitive behavior therapy-insomnia), are associated with positive outcomes for pediatric sleep health. In addition, sleep interventions may improve psychiatric health for children and adolescents with neurodevelopmental and internalizing disorders. Additional research is necessary to clarify the efficacy of these interventions over the long-term and across demographic groups; however, evidence suggests incorporating behavioral sleep strategies may prove beneficial to pediatric patients with sleep disturbances and related psychiatric complaints.
Collapse
Affiliation(s)
- Jessica R Lunsford-Avery
- Department of Psychiatry, Duke University School of Medicine, 2400 Pratt Street, Office 7036, 7th Floor, North Pavilion, Durham, NC 27705, USA.
| | - Tatyana Bidopia
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Leah Jackson
- HRC Behavioral Health & Psychiatry, PA, Chapel Hill, NC, USA
| | | |
Collapse
|
40
|
Abdoh Q, Darwish A, Alnees M, Awwad M, Najajra D, Alsadi M, Alawneh M. A rare delayed onset of esophageal varices and portal vein thrombosis in a ten-year-old patient following umbilical vein catheterization. Ann Med Surg (Lond) 2024; 86:1654-1658. [PMID: 38463113 PMCID: PMC10923273 DOI: 10.1097/ms9.0000000000001588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/26/2023] [Indexed: 03/12/2024] Open
Abstract
Introduction and significance Portal vein thrombosis (PVT) is not commonly observed in patients, particularly those who have gone through neonatal intensive care unit (NICU) stays and had umbilical catheters. Although PVT can potentially cause hypertension and gastrointestinal bleeding it is highly unusual for this condition to manifest during childhood. Case presentation The authors present a case of a 10-year-old child who developed portal hypertension, esophageal varices, and multiple thrombophilia associated mutations. This child was born prematurely. Had to stay in the NICU, where an umbilical venous catheter was used which likely triggered the development of PVT. At the age of 7 he started experiencing distension, anemia and low platelet count, which eventually led to splenectomy. On at the age of 10 he began experiencing episodes of bleeding. Was diagnosed with esophageal varices and portal gastropathy. Through procedures, like Histoacryl glue injection and band ligation bleeding was successfully controlled. Genetic analysis revealed mutations associated with thrombophilia. Clinical discussion This case highlights how rare it is for older children to develop PVT and emphasizes the possibility of delayed onset symptoms following catheterization. The placement of catheters in NICUs can disrupt blood flow and increase the likelihood of clot formation. The presence of hypertension resulting from PVT can lead to complications such as varices. Effective control, over bleeding was achieved through interventions.Importantly, the presence of ACE I/D, FXIII Val34Leu, and Factor V Leiden mutations introduces an aspect to this scenario. It is worth noting that these mutations are not commonly linked to thrombophilia or clotting disorders. Conclusion This case highlights pediatric PVT, emphasizing the need for a collaborative approach among gastroenterologists, hematologists, and geneticists. Further research is required to understand PVT mechanisms and long-term implications, aiding in diagnosis and management, especially when it appears in late childhood. Evaluation is crucial in deciphering thrombophilia-related complications in the context of hypertension.
Collapse
Affiliation(s)
- Qusay Abdoh
- Department of Medicine, Faculty of Medicine and Health Sciences
- Department of Internal Medicine, GI and Endoscopy Unit
| | | | - Mohammad Alnees
- Department of Medicine, Faculty of Medicine and Health Sciences
- Harvard Medical School Postgraduate Medical Education, Global Clinical Scholars Research Training program, Boston, US
| | - Mahdi Awwad
- Department of Medicine, Faculty of Medicine and Health Sciences
| | - Duha Najajra
- Department of Medicine, Faculty of Medicine and Health Sciences
| | - Mai Alsadi
- Department of Medicine, Faculty of Medicine and Health Sciences
| | - Maysa Alawneh
- Department of Medicine, Faculty of Medicine and Health Sciences
- Department of Pediatrics, An-Najah National University Hospital, Nablus, Palestine
| |
Collapse
|
41
|
Pedersen MRV, Precht H, Jensen J, Mussmann B, Abdi AJ, Hansen PL, Holm S, Mørup SD, Brage K. Radiographers use of social media - SoMe in a Nordic perspective. Radiography (Lond) 2024; 30:651-658. [PMID: 38341986 DOI: 10.1016/j.radi.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 01/16/2024] [Accepted: 01/22/2024] [Indexed: 02/13/2024]
Abstract
INTRODUCTION Social media (SoMe) is widely used as a communication platform in everyday life. Also, healthcare professionals have embraced SoMe as a communication tool for both peers and patients. It is becoming an interactive tool for discussing professionals' issues and a place where learning and education occur. This study explores the specific patterns of SoMe use for radiographers' in the Nordic countries. The aim of this survey was to investigate radiographers use of social platforms in a professional setting. METHODS A 29-item survey was prepared, and pilot-tested. The survey was produced in Danish a language that all Nordic countries master. In general, most Nordic languages are very similar. The survey was distributed by online platforms such as Facebook, LinkedIn, Twitter/X, and also distributed by newsletters by the Norwegian and Danish national radiographers societies. All data was collected anonymously. An Ethical Research approval was obtained from the University of Southern Denmark. RESULTS A total of 242 respondents completed the survey (Denmark n = 183, Norway n = 48, Sweden n = 8, and n = 3 from other Scandinavian countries). The respondents included 186 females, 52 males and four were undisclosed. On average, the respondents spent approximately 2 h and 23 min daily on SoMe, with 27 min specifically dedicated to content relevant to radiographers. Facebook was the preferred platform with 93 % (n = 226). A total of 5.4 % (n = 13) respondents had experienced contact from patients and/or next of kin, while 92 % (n = 222) reported no such interactions and 2.9 % (n = 7) were undisclosed. A total of 52.8 % (n = 128) used SoMe in relation to courses, conferences, or online meetings. This shows that time spent on content relevant to radiographers imply that SoMe can be a relevant tool for reaching radiographers. CONCLUSION The survey demonstrates radiographers' use of SoMe for personal and professional interest, with Facebook as the preferred social media platform. SoMe were mostly used during courses, conferences, or online meetings with half of the respondent reported using SoMe platforms during working hours. These results underscore the untapped potential of SoMe in professional healthcare settings. Additionally, the study offers insight into current practices, facilitating comparisons to identify trends in SoMe usage within the radiographer community. IMPLICATIONS FOR PRACTICE The findings advocate for the strategic use of SoMe by radiographers', emphasizing professional networking and knowledge sharing. However, clear guidelines are necessary to ensure patient confidentiality and data security in these digital interactions.
Collapse
Affiliation(s)
- M R V Pedersen
- Department of Radiology, University Hospital of Southern Denmark, Vejle, Denmark; Department of Radiology, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Sciences, University of Southern Denmark, Denmark.
| | - H Precht
- Department of Radiology, University Hospital of Southern Denmark, Kolding, Denmark; Department of Regional Health Sciences, University of Southern Denmark, Denmark; Health Sciences Research Centre, UCL University College, Odense, Denmark; Education of Radiography, UCL University College, Odense, Denmark
| | - J Jensen
- Research and Innovation Unit of Radiology, University Hospital, Odense, Denmark; Department of Radiology, Odense University Hospital, Odense, Denmark
| | - B Mussmann
- Research and Innovation Unit of Radiology, University Hospital, Odense, Denmark; Department of Radiology, Odense University Hospital, Odense, Denmark
| | - A J Abdi
- Research and Innovation Unit of Radiology, University Hospital, Odense, Denmark; Department of Radiology, Odense University Hospital, Odense, Denmark; Department of Clinical Engineering, Region of Southern Denmark, Denmark
| | - P L Hansen
- Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - S Holm
- Health Sciences Research Centre, UCL University College, Odense, Denmark; Education of Radiography, UCL University College, Odense, Denmark
| | - S D Mørup
- Department of Radiology, University Hospital of Southern Denmark, Vejle, Denmark
| | - K Brage
- Health Sciences Research Centre, UCL University College, Odense, Denmark; Education of Radiography, UCL University College, Odense, Denmark
| |
Collapse
|
42
|
Welsh F, Weilert F, Grunewald B, Lanka L, Patil S. Rare finding of a symptomatic epidermoid cyst of the diaphragm - a case report. J Surg Case Rep 2024; 2024:rjae111. [PMID: 38455988 PMCID: PMC10918447 DOI: 10.1093/jscr/rjae111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/11/2024] [Indexed: 03/09/2024] Open
Abstract
Cystic lesions of the diaphragm are rare and accordingly present a diagnostic challenge. Specific radiological features with which to clinch a diagnosis may be elusive. Herein we present the case of a patient who presented with symptoms attributable to a cyst in the left upper abdomen, irritating the diaphragm. Surgery was considered appropriate for diagnostic and symptomatic purposes. Final histology demonstrated an epidermoid cyst. Resolution of symptoms was reported after surgery. Diaphragmatic epidermoid cysts appear to be a rare entity with only three prior cases reported in the literature. Given the rarity of this lesion and the lack of unique features by which they can be characterized, accurately diagnosing epidermoid cysts of the diaphragm is likely to remain difficult without surgery, although they are presumed to have a benign behaviour.
Collapse
Affiliation(s)
- Fraser Welsh
- Department of General Surgery, Te Whatu Ora Waikato, 183 Pembroke Street Hamilton, Waikato 3204, New Zealand
| | - Frank Weilert
- Deparment of Gastroenterology, Te Whatu Ora Waikato, 183 Pembroke Street Hamilton, Waikato 3204, New Zealand
| | - Bernd Grunewald
- Department of General Surgery, Te Whatu Ora Waikato, 183 Pembroke Street Hamilton, Waikato 3204, New Zealand
| | - Laxmi Lanka
- Department of Radiology, I-MED Radiology Network, 11 Thackeray Street Hamilton 3204, New Zealand
| | - Sudha Patil
- Department of Pathology, Pathlab Waikato, 58 Tristram Street Hamilton 3204, New Zealand
| |
Collapse
|
43
|
Kamaleddine I, Popova M, Angles T, Neese M, Brinkmann B, Volmer E, Weber MA, Lamprecht G, Schafmayer C, Alwali A. Retroperitoneal cecal volvulus: a complication of a rare internal hernia - a case report. Ann Med Surg (Lond) 2024; 86:1647-1653. [PMID: 38463092 PMCID: PMC10923356 DOI: 10.1097/ms9.0000000000001540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/17/2023] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance The foramen of Winslow hernia (FWH) is a rare type of internal hernia. In one-third of cases, the cecum was found in the lesser sac. More rarely, the herniated cecum might be volvulated, which represents 1-1.5% of the causes of intestinal obstruction. Once diagnosed, surgical reduction and/or resection of the nonviable herniated bowel is crucial for a positive outcome. Case presentation The authors report a case of retroperitoneal cecal volvulus that complicated FWH in a patient with a history of laparoscopic cholecystectomy. Clinical discussion A delay in the diagnosis is associated with high morbidity and even higher mortality. Because of lacking a consensus, the treatment of FWH depends on the team's surgical experience. Conclusion Reporting this case will help us to keep in mind this differential diagnosis while treating patients in our daily practice.
Collapse
Affiliation(s)
- Imad Kamaleddine
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Magdalena Popova
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Theresa Angles
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Manuela Neese
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Beate Brinkmann
- Department of Medicine II, Division of Gastroenterology and Endocrinology
| | - Erik Volmer
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Marc-André Weber
- Institute of Diagnostic and Interventional Radiology, Pediatric Radiology and Neuroradiology, Rostock University Medical Center, Rostock, Germany
| | - Georg Lamprecht
- Department of Medicine II, Division of Gastroenterology and Endocrinology
| | - Clemens Schafmayer
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| | - Ahmed Alwali
- Department of General, Visceral, Vascular, Thoracic, and Transplantation Surgery
| |
Collapse
|
44
|
Adji NK, Putri KYW, Indreswari L, Gunawan R, Nugraha MY. Multiple thoracic intramedullary schwannoma: A case report. Int J Surg Case Rep 2024; 116:109330. [PMID: 38354576 PMCID: PMC10943640 DOI: 10.1016/j.ijscr.2024.109330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/27/2024] [Accepted: 01/29/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Schwannoma's are benign but clinically progressive tumours. Mostly, they present as intradural extramedullary and as a single lesion. They are quite rare in the intramedullary region and multiple lesions. We report a rare case of Multiple Intramedullary Schwannoma in the thoracic region. The aim of this study to inform an uncommon case of intramedullary schwannoma and support an appropriate preoperative diagnostic. CLINICAL PRESENTATION A 43-year-old female patient was admitted with gradual onset weakness of both lower limbs (4/2) for last two months. Magnetic resonance imaging (MRI) scan disclosed an intramedullary tumour at the thoracal 11th and 12th vertebral levels. It measured 30x20x15 mm and 20x20x12 mm. Complete total resection of multiple lesions was done. Schwanoma's was confirmed based on the histopathological finding. The patient was discharged on 4th day post operative with both leg power 5/5 and needed to medical rehabilitation. Follow-up examination 1 months after surgery revealed favourable, neurological condition (modified McCormick scale: grade I). CLINICAL DISCUSSION Intramedullary schwannoma is often misdiagnosed as other types of intramedullary tumour. Schwannomas are usually benign and have well defined cleavage plane. Total resection achievable in most cases, offers the best clinical outcome and avoids subsequent recurrence. CONCLUSION Preoperative diagnosis of intramedullary schwannoma will help establish the optimum medical and surgical treatment and the prognosis. Timely surgery before permanent neurological deficit and gross total resection is recommended to achieve good clinical outcome.
Collapse
Affiliation(s)
- Novan Krisno Adji
- Department of Neurosurgery, Soebandi Regional Hospital, Jember, Indonesia; Faculty of Medicine, University of Jember, Indonesia.
| | - Komang Yunita Wiryaning Putri
- Department of Neurology, Soebandi Regional Hospital, Jember, Indonesia; Faculty of Medicine, University of Jember, Indonesia
| | - Laksmi Indreswari
- Department of Surgery, Soebandi Regional Hospital, Jember, Indonesia; Faculty of Medicine, University of Jember, Indonesia
| | - Rudy Gunawan
- Faculty of Medicine, University of Jember, Indonesia
| | | |
Collapse
|
45
|
Lavía KF, Segú OB, Ruzafa E, Barrantes S, Monsonet CT, Corbacho AL. First-ever ankle arthrodesis with the Capanna technique in an infected open fracture. JPRAS Open 2024; 39:157-163. [PMID: 38283862 PMCID: PMC10819165 DOI: 10.1016/j.jpra.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 12/03/2023] [Indexed: 01/30/2024] Open
Abstract
Although bone transport by means of distraction osteogenesis has become the standard of care for massive segmental bone defects, the technique faces limitations such as the lengthy period of time during which patients must wear an external fixator. Thus, other techniques may be more appropriate in certain circumstances. Capanna developed a combination of vascularized fibular grafts and strut allografts in a way that the strut allograft provides with significant initial mechanical stability, which facilitates incorporation of a vascularized fibular graft and promotes long-term survival of the reconstruction. The case presented in this report is the first in the medical literature where a circular external fixator is used as a stabilization method in a patient with a structural bone deficiency treated by means of the Capanna technique. It is also one of the few reported cases where the underlying condition does not originate in a tumor and where the joint is involved.
Collapse
Affiliation(s)
- Kilian Fraga Lavía
- Trauma and Orthopaedics Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Oriol Bermejo Segú
- Plastic Surgery Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Eric Ruzafa
- Plastic Surgery Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Sergi Barrantes
- Plastic Surgery Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Carles Tramunt Monsonet
- Trauma and Orthopaedics Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| | - Alfred Llop Corbacho
- Trauma and Orthopaedics Department, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Spain
| |
Collapse
|
46
|
El Abbassi I, ElHodaigui N, Boufettal H, Mahdaoui S, Samouh N. Solitary ovarian plasmacytoma: About a rare entity of extramedullary plasma cell tumor. Int J Surg Case Rep 2024; 116:109096. [PMID: 38364751 PMCID: PMC10943662 DOI: 10.1016/j.ijscr.2023.109096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/18/2023] [Accepted: 11/27/2023] [Indexed: 02/18/2024] Open
Abstract
INTRODUCTION Solitary ovarian plasmacytoma is a rare form of extramedullary plasmacytic tumor that develops outside the bone marrow. PRESENTATION OF CASE We report the case of a 52-year-old female patient who consulted for pelvic pain and abdominal distension. Clinical examination revealed an abdominopelvic mass and a pelvic MRI confirmed a right ovarian mass. The diagnosis of ovarian plasmacytoma was made after exploratory laparotomy. DISCUSSION Extramedullary plasmacytoma (EMP) is rare and most often found in the upper aerodigestive tract, ovarian localization is exceptional. Histological and immunohistochemical features of EMP highlights similarities with multiple myeloma. EMP treatment options are discussed, including radiotherapy, surgery, and chemotherapy. The prognosis of EMP depends on several factors, including tumor size and timing of treatment. CONCLUSION Solitary ovarian plasmacytoma is a rare but important entity to consider in the diagnosis of abdominopelvic masses. Appropriate treatment, such as surgery combined with radiotherapy, can be effective, although regular monitoring is necessary due to the risk of relapse and transformation into multiple myeloma.
Collapse
Affiliation(s)
- Imane El Abbassi
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco.
| | - N ElHodaigui
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - H Boufettal
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - S Mahdaoui
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| | - N Samouh
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca, Morocco; Faculty of Medicine and Pharmacy, Hassan II University, Casablanca, Morocco
| |
Collapse
|
47
|
Ficky, Wahyudi I, Widia F, Irdam GA. Challenges in the diagnosis of delayed presentation of intraperitoneal Iatrogenic bladder trauma post Caesarean delivery: A case report. Urol Case Rep 2024; 53:102679. [PMID: 38495850 PMCID: PMC10940946 DOI: 10.1016/j.eucr.2024.102679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/29/2024] [Accepted: 02/09/2024] [Indexed: 03/19/2024] Open
Abstract
Iatrogenic bladder trauma (IBT), a rare complication of Caesarean delivery (CD), can present with delayed symptoms, posing diagnostic challenges. A case study reports IBT presenting six days post-CD, initially undetected by retrograde cystography and CT urography. Subsequent surgical exploration revealed an 8-cm wound in the bladder dome, concealed by a hematoma and enlarged uterus. While retrograde cystography is typically accurate, false negatives may occur. CT cystography offers higher sensitivity but may still miss small perforations. Delayed IBT can manifest with abdominal pain, hematuria, and elevated renal function tests, warranting clinical suspicion and consideration of surgical exploration despite negative imaging.
Collapse
Affiliation(s)
- Ficky
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fina Widia
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Gampo Alam Irdam
- Department of Urology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| |
Collapse
|
48
|
de Araújo Lopes LL, Costa FWG, Cevidanes LHS, de Barros Silva PG, Gurgel ML, Carvalho FSR, Júnior CMC, Ribeiro TR. Anthropometric measures and obstructive sleep apnea in children and adolescents: a systematic review of the literature and meta-analysis. Sleep Breath 2024; 28:11-28. [PMID: 37421521 PMCID: PMC10772209 DOI: 10.1007/s11325-023-02861-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 03/19/2023] [Accepted: 05/23/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Anthropometric measurements can be used to identify children at risk of developing obstructive sleep apnea (OSA). The study aimed to assess which anthropometric measurements (AMs) are most associated with an increased predisposition to develop OSA in healthy children and adolescents. METHODS We performed a systematic review (PROSPERO #CRD42022310572) that searched eight databases and gray literature. RESULTS In eight studies with low-to-high risk of bias, investigators reported the following AMs: body mass index (BMI), neck circumference, hip circumference, waist-to-hip ratio, neck-to-waist ratio, waist circumference, waist-to-height ratio, and facial AMs. The meta-analysis showed that the OSA group had an average of 1.00 cm greater for the neck circumference (p < 0.001; Cohen's d = 2.26 [0.72, 5.23]), 3.07 cm greater for the waist circumference (p = 0.030; Cohen's d = 0.28 [0.02, 0.53]), 3.96 cm greater for the hip circumference (p = 0.040; Cohen's d = 0.28 [0.02, 0.55]), 5.21° greater for the cervicomental angle (p = 0.020; Cohen's d = 0.31 [0.03, 0.59]), and 1.23° greater for maxillary-mandibular relationship angle (p < 0.001; Cohen's d = 0.47 [0.22, 0.72]) than the control group. The mandibular depth angle had a reduction of 1.86° (p = 0.001; Cohen's d = -0.36° [-0.65, -0.08]) in control than in patients with OSA. The BMI (p = 0.180), waist-to-hip ratio (p = 0.280), neck-to-waist ratio (p = 0.070), maxillary depth angle (p = 0.250), and upper/lower face height ratio (p = 0.070) showed no significant differences between groups. CONCLUSIONS Compared to the control group, the OSA group exhibited a greater mean difference in neck circumference, the only anthropometric measurement with high certainty of evidence.
Collapse
Affiliation(s)
- Luiza Lassi de Araújo Lopes
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Rua Monsenhor Furtado, 1273, Rodolfo Teófilo, Fortaleza, CE, Brazil
| | - Fábio Wildson Gurgel Costa
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Rua Monsenhor Furtado, 1273, Rodolfo Teófilo, Fortaleza, CE, Brazil.
| | | | - Paulo Goberlânio de Barros Silva
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Rua Monsenhor Furtado, 1273, Rodolfo Teófilo, Fortaleza, CE, Brazil
| | - Marcela Lima Gurgel
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Rua Monsenhor Furtado, 1273, Rodolfo Teófilo, Fortaleza, CE, Brazil
| | | | - Cauby Maia Chaves Júnior
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Rua Monsenhor Furtado, 1273, Rodolfo Teófilo, Fortaleza, CE, Brazil
| | - Thyciana Rodrigues Ribeiro
- Department of Dental Clinic, School of Dentistry, Federal University of Ceara, Rua Monsenhor Furtado, 1273, Rodolfo Teófilo, Fortaleza, CE, Brazil
| |
Collapse
|
49
|
Ghaderi S, Mohammadi S, Ghaderi K, Kiasat F, Mohammadi M. Marker-controlled watershed algorithm and fuzzy C-means clustering machine learning: automated segmentation of glioblastoma from MRI images in a case series. Ann Med Surg (Lond) 2024; 86:1460-1475. [PMID: 38463066 PMCID: PMC10923355 DOI: 10.1097/ms9.0000000000001756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024] Open
Abstract
Introduction and importance Automated segmentation of glioblastoma multiforme (GBM) from MRI images is crucial for accurate diagnosis and treatment planning. This paper presents a new and innovative approach for automating the segmentation of GBM from MRI images using the marker-controlled watershed segmentation (MCWS) algorithm. Case presentation and methods The technique involves several image processing techniques, including adaptive thresholding, morphological filtering, gradient magnitude calculation, and regional maxima identification. The MCWS algorithm efficiently segments images based on local intensity structures using the watershed transform, and fuzzy c-means (FCM) clustering improves segmentation accuracy. The presented approach achieved improved segmentation accuracy in detecting and segmenting GBM tumours from axial T2-weighted (T2-w) MRI images, as demonstrated by the mean characteristics performance metrics for GBM segmentation (sensitivity: 0.9905, specificity: 0.9483, accuracy: 0.9508, precision: 0.5481, F_measure: 0.7052, and jaccard: 0.9340). Clinical discussion The results of this study underline the importance of reliable and accurate image segmentation for effective diagnosis and treatment planning of GBM tumours. Conclusion The MCWS technique provides an effective and efficient approach for the segmentation of challenging medical images.
Collapse
Affiliation(s)
- Sadegh Ghaderi
- Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran
| | - Sana Mohammadi
- Department of Medical Sciences, School of Medicine, Iran University of Medical Sciences, Tehran
| | - Kayvan Ghaderi
- Department of Information Technology and Computer Engineering, Faculty of Engineering, University of Kurdistan, Sanandaj
| | - Fereshteh Kiasat
- Department of Information Technology and Computer Engineering, Faculty of Engineering, University of Kurdistan, Sanandaj
| | - Mahdi Mohammadi
- Department of Medical Physics and Biomedical Engineering, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
50
|
Walker Z, Markert T, Berzansky I, Lanes A, Srouji SS. Social media's impact on patient provider choice. J Assist Reprod Genet 2024; 41:649-659. [PMID: 38231286 PMCID: PMC10957839 DOI: 10.1007/s10815-023-03012-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/19/2023] [Indexed: 01/18/2024] Open
Abstract
OBJECTIVE This study aimed to investigate if social media (SM) impacts a patient's provider choice in the field of reproductive endocrinology and infertility (REI). METHODS This was a survey-based study completed in July 2022. A survey link was distributed using Amazon Mechanical Turk, which directed participants to a Qualtrics-based survey. Participants were 18-50 years old. The primary outcome was to identify the preferred method for finding a REI provider based on time spent on SM (< 1 h, 1-3 h, 3 + h). RESULTS A total of 336 responses were analyzed. Fifty-four percent of respondents used SM < 1 h, 33.33% used 1-3 h, and 12.80% used 3 + h. The majority (69.05%) of respondents stated that they would seek out a REI provider/clinic if they had difficulty conceiving. Most respondents identified asking their primary care physician (44.64%) as the primary means for finding an REI provider/clinic and did not prefer to use SM. Although Facebook (< 1 h: 30.94%, 1-3 h: 31.25%, 3 + h: 27.91%) was the most utilized SM platform among respondents, YouTube was the preferred SM platform if respondents were to follow a REI clinic with a preference for posts focusing on education (< 1 h: 55.68%, 1-3 h: 43.12%, 3 + h: 58.14%) or stress management (< 1 h: 17.61%, 1-3 h: 29.36%, 3 + h: 20.94%). CONCLUSION Most respondents utilize traditional methods when choosing their REI provider or clinic and would not utilize SM. However, SM, primarily through YouTube, may be helpful for educating infertility patients and providing support and stress relief while they undergo treatment.
Collapse
Affiliation(s)
- Zachary Walker
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, USA.
| | | | - Isa Berzansky
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - Andrea Lanes
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, USA
| | - Serene S Srouji
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Brigham & Women's Hospital, 75 Francis Street, Boston, MA, USA
| |
Collapse
|