Large Pericardial Cyst Mimicking Recurrent Unilateral Pleural Effusion on CT Scan: A Case Report and Literature Review

Pericardial cysts are an uncommon, benign condition that can manifest with diverse clinical symptoms influenced by their size and position within the body. Detecting pericardial cysts typically relies on imaging studies for a conclusive diagnosis. Surgical removal remains the definitive treatment approach for addressing pericardial cysts. This case report presents the clinical course of a 56-year-old female with a known case of asthma, and rheumatoid arthritis (RA) which exhibited recurrent symptoms such as shortness of breath and cough with recurrent pleural effusion to be investigated for suspected empyema, encysted effusion, TB, or malignancy, leading to diagnostic challenges. Through a combination of reviewing the case's clinical history, imaging modalities, and diagnostic procedures, including serial computed tomography (CT) and x-rays, the accurate diagnosis of a pericardial cyst sized 4.4 cm x 10.5 cm x 6.2 cm was achieved. In this specific case, recurrent percutaneous pleural aspirations were attempted as a treatment approach for three years. However, despite these efforts, this method proved unsuccessful in effectively managing the patient's condition. Using minimally invasive techniques, video-assisted thoracoscopic surgery (VATS) proved valuable in providing effective diagnostic and therapeutic options with reduced invasiveness. Timely diagnosis, proper monitoring, and patient education contributed to the patient's overall recovery.

Cecal Volvulus: A Report of a Challenging Case

Cecal volvulus represents a rare form of acute intestinal obstruction caused by an axial twist of the terminal ileum, ascending colon, and cecum surrounding the mesenteric pedicle. It is responsible for 1%-1.5% of all intestinal obstruction cases in adults. Radiological imaging assists in the diagnosis of cecal volvulus, particularly a CT scan with contrast as the gold standard for both diagnosis and risk assessment. In this case report, we present a challenging case of cecal volvulus seen in a 75‑year‑old male patient with multiple comorbidities who presented with abdominal guarding/tenderness and high WBC and lactate, which evolved into septic shock. The purpose of this study is to underline the significance of early diagnosis and effective treatment of this uncommon condition in abdominal surgeries.

Trends and Challenges in the Development of 3D-Printed Heart Valves and Other Cardiac Implants: A Review of Current Advances

This article provides a comprehensive review of the current trends and challenges in the development of 3D-printed heart valves and other cardiac implants. By providing personalized solutions and pushing the limits of regenerative medicine, 3D printing technology has revolutionized the field of cardiac healthcare. The use of several organic and synthetic polymers in 3D printing heart valves is explored in this article, with emphasis on both their benefits and drawbacks. In cardiac tissue engineering, stem cells are essential, and their potential to lessen immunological rejection and thrombogenic consequences is highlighted. In the clinical applications section, the article emphasizes the importance of 3D printing in preoperative planning. Surgery results are enhanced when surgeons can visualize and assess the size and placement of implants using patient-specific anatomical models. Customized implants that are designed to match the anatomy of a particular patient reduce the likelihood of complications and enhance postoperative results. The development of physiologically active cardiac implants, made possible by 3D bioprinting, shows promise by eliminating the need for artificial valves. In conclusion, this paper highlights cutting-edge research and the promise of 3D-printed cardiac implants to improve patient outcomes and revolutionize cardiac treatment.

Advances in Understanding and Managing Autoimmune Hepatitis: A Narrative Review

Autoimmune hepatitis (AIH) is a chronic liver disease characterized by immune-mediated destruction of hepatocytes, leading to inflammation and fibrosis. In recent years, significant advances have been made in understanding the pathogenesis, epidemiology, diagnosis, and treatment of AIH. This comprehensive narrative review aims to provide an up-to-date overview of these advances. The review begins by outlining the historical background of AIH, dating back to its initial recognition in the 1940s, and highlights the evolution of diagnostic criteria and classification based on autoantibody profiles. The epidemiology of AIH is explored, discussing its varying prevalence across different regions and the role of genetic predisposition, viral infections, and drug exposure as risk factors. Furthermore, the review delves into the pathogenesis of AIH, focusing on the dysregulated immune response, involvement of T cells, and potential contribution of the gut microbiome. Clinical presentation, diagnostic criteria, and liver biopsy as crucial tools for diagnosis are also discussed. Regarding management, the review provides an in-depth analysis of the standard first-line treatments involving glucocorticoids and azathioprine, as well as alternative therapies for non-responsive cases. Additionally, emerging second and third-line treatment options are examined. In conclusion, this narrative review highlights the complexity of AIH and underscores the importance of early diagnosis and individualized treatment approaches to improve patient outcomes. Further research and clinical trials are needed to optimize AIH management and ensure a better long-term prognosis for affected individuals.

Primary Cardiac Angiosarcoma: A Review

Primary cardiac angiosarcoma is a rare and aggressive malignancy originating from the endothelial lining of cardiac blood vessels. This review covers various aspects of the disease, including its pathogenesis, clinical presentation, diagnosis, treatment, and prognosis. The primary characteristic of cardiac angiosarcoma is the rapid growth of abnormal blood vessels that invade the heart muscle, leading to the destruction of healthy tissue. Due to its infiltrative nature and early spread, diagnosing and treating cardiac angiosarcoma present significant challenges. Transesophageal echocardiography (TEE) plays a crucial role in diagnosing cardiac tumors such as angiosarcoma due to its high sensitivity. Additional imaging techniques such as computed tomography (CT) and cardiac magnetic resonance imaging (MRI) help assess tumor anatomy and identify metastases. Histopathological examination and immunohistochemistry are essential for confirming the diagnosis, as they reveal distinct histological features and specific endothelial markers associated with primary cardiac angiosarcoma. Targeted therapies directed at the angiogenic mechanisms and molecular abnormalities hold promise for improving treatment outcomes. Early detection of primary cardiac angiosarcoma remains challenging due to its rarity, and the prognosis is generally poor due to advanced disease at the time of diagnosis. The review emphasizes the importance of a multidisciplinary approach and collaboration among different specialties to optimize the diagnosis, treatment, and follow-up care of patients with primary cardiac angiosarcoma. The ultimate goal is to enhance diagnostic methods and therapeutic approaches by advancing knowledge and promoting further research into this aggressive malignancy.

Surgical Technique: Abductor Reconstruction With Gluteus Maximus and Tensor Fascia Lata in Revision Total Hip Arthroplasty

BACKGROUND

Abductor deficiency in revision total hip arthroplasty (THA) is a common problem that can lead to pain, limping, and instability. Repair and reconstruction of the abductors is challenging, with a high rate of failure reported in the literature. The purpose of this study is to describe a simplified technique of abductor repair augmented with the transfer of gluteus maximus (Gmax) and the tensor fascia lata (TFL).

METHODS

We describe a novel abductor reconstruction with transfer of the anterior 30% of Gmax and the posterior 70% of TFL to the vastus lateralis origin. These transfers can be used in isolation or to augment repair of torn abductors to the greater trochanter. The technique is simple and quick to perform via a lateral approach, requiring dissection of only two muscle slips and minimal additional soft tissue dissection.

RESULTS

We describe the use and outcomes of this technique on three patients undergoing revision THA with severe and irreparable abductor deficiency. Although these patients reported improved function after the reconstruction, there was persistence of mild to moderate limping.

CONCLUSION

Abductor reconstruction with partial transfers of Gmax and TFL is a promising approach to manage abductor deficiency in revision THA. Larger series are required to determine the efficacy of this technique for restoring abductor function and improving patient reported outcomes.

Offloading Plantar Pressures in Healthy Adults: Stirrup Cast vs Total Contact Cast

BACKGROUND

Diabetic foot ulcers are associated with significant morbidity and mortality while posing a challenge for healthcare professionals. Offloading is considered the mainstay of treatment. Total contact casting (TCC) is widely used but does not effectively offload the hindfoot. Some studies suggest that a metal stirrup is effective at offloading midfoot and hindfoot ulcers. The primary purpose of this study is to compare the offloading mechanism of TCC to a stirrup cast.

METHODS

A pilot observational study assessing 12 healthy volunteers who underwent casting with a TCC or stirrup cast. A sensor (Pedar; Novel GmbH) that measures maximum force, peak pressure, and contact time and area of each foot region, was placed inside the cast to assess the offloading mechanisms of the 2 interventions.

RESULTS

We measured a reduction in all plantar foot loading parameters from the TCC to the stirrup cast. The highest reductions of 85% to 96% (±5%-13%) were noted in maximum force and peak pressure under the forefoot (P < .0001) and found reductions in maximum force, the contact area of all regions of the foot, peak pressure and contact time of the forefoot and midfoot, and contact area of the hindfoot (P < .05).

CONCLUSION

In this experimental trial of healthy adults, the stirrup cast was more effective than the TCC by offloading the foot mostly in the forefoot and midfoot.

Two-Year Outcomes After Total Ankle Replacement With a Novel Fixed-Bearing Implant

BACKGROUND

The Integra Cadence total ankle replacement (TAR) is a fourth-generation anatomic, fixed-bearing implant requiring minimal tibial and talar resection, which has been in clinical use since June 2016. The primary purpose of this study is to assess its short-term clinical and radiographic outcomes after TAR using this prosthesis.

METHODS

This is a prospective case series of consecutive patients that underwent TAR using this novel fourth-generation prosthesis between June 2016 and November 2017. The primary outcome of interest was the Ankle Osteoarthritis Scale (AOS). Secondary outcomes included Short Form Health Survey-36 (SF-36) scores, radiographic alignment, complications, reoperations, and revisions.

RESULTS

In total, 69 patients were included in our study. Fifty-one patients (73.9%) required a total of 91 ancillary procedures. Postoperatively, AOS pain scores decreased significantly by an average of 17.8±30.1 points from 45.9±18.2 to 28.4±27.3 (P < .001). AOS disability scores also decreased significantly following surgery by an average of 22.0±30.5 points from 53.9±18.5 to 32.5±27.9 (P < .001). The SF-36 physical component summary score improved 10.4±9.8 points from 33.1±9.1 to 42.6±9.1 (P < .001). Radiographic analysis demonstrated significant improvement to neutral coronal plane alignment, which was achieved in 97% of patients (P < .01) with no cyst formation at 2 years. There was 1 reported complication, 9 reoperations, and no metal or polyethylene component revisions. Overall, the 2-year implant survivorship was 100% in our cohort. Eighteen patients (26.1%) demonstrated fibrous ingrowth of the tibial component. However, outcome scores for these patients did not demonstrate any negative effects.

CONCLUSION

In our hands, this TAR system demonstrated excellent early clinical and radiographic outcomes. Patients reported improved physical health status, pain, and disability in the postoperative period. Total ankle instrumentation allowed for accurate and reproducible implantation with correction of coronal and sagittal plane deformities. Early results for the clinical use of this TAR system are promising, but further long-term prospective outcome studies are necessary.

LEVEL OF EVIDENCE

Level IV, case series.

Inhibition of methylnitrosourea (MNU) induced oxidative stress and carcinogenesis by orally administered bee honey and Nigella grains in Sprague Dawely rats

We studied the protective effect of bee honey and Nigella grains as nutraceuticals on the oxidative stress and carcinogenesis induced by methylnitrosourea (MNU) in Sprague Dawely rats. Four groups of animals were used and fed ad-libitum. The first group was a control (n=8), the second (n=8), the third (n=15) and the fourth groups (n=12) were injected MNU (single i.v. dose 50 mg/kg body weight). After one week the third and fourth groups were given orally 0.2 g ground Nigella grains and 0.2 g Nigella with 5 g honey/rat/day, respectively. After six months all animals were sacrificed except two from the second group (MNU-injected rats) that died one-week before the end of the experiment. We observed that MNU injected in the second group produced a variety of oxidative stresses ranging from severe inflammatory reaction in lung and skin to colon adenocarcinoma in four out of six animals. There was an associated elevation of malondialdehyde (MDA) and nitric oxide (NO) in sera obtained from animals of this group compared to the control one. Nigella sativa grains given orally protected against MNU-induced oxidative stress and carcinogenesis by 80% (12/15) and combated this effect by lowering MDA and NO. Whereas honey from bees and Nigella sativa together protected 100% (12/12) against MNU-induced oxidative stress, carcinogenesis and abolished the NO and MDA elevations shown in sera of animals who did not receive these nutrients. These results showed that supplementation of diet with honey and Nigella sativa has a protective effect against MNU-induced oxidative stress, inflammatory response and carcinogenesis.

Cytotoxic quaternary alkaloids from the flowers of Narcissus tazetta

Intensive chromatographic separation of the polar fraction of an ethanolic extract of the fresh flowers of Narcissus tazetta L. (Amaryllidaceae) yielded two new quaternary alkaloids with a phenanthrene skeleton, N-methyl-8,9-methylenedioxy-phenantridinium methylsulfate (1) and N-methyl-8,9-methylenedioxy-phenantridinium malate (2). The structure determination of the alkaloids was based on one- and two-dimensional NMR studies including HMQC, and HMBC studies, and mass spectroscopic analysis. The existence, in 1, of the methylsulfate group was confirmed by X-ray diffraction analysis. Cytotoxic activities for 1 and 2 against a panel of cancer cell lines are also reported.

The heliangolide dihydrohirsutolide from Arctotis fastuosa and dichloromethyldihydrohirsutolide

Three of ten sesquiterpene lactones isolated from the herb of Arctotis fastuosa (Asteraceae) belong to the heliangolide series. The first was identified as hirsutolide, the second is new and named dihydrohirsutolide, and the third, dichloromethyldihydrohirsutolide, is an artifact. The known degraded carotenoid loliolide was also isolated. Structures were established by spectroscopic methods including IR, 1D-/2D-1H-NMR, 13C-NMR, GHSQC, GHMBC, HREIMS and CD.

Triterpenoidal saponins from Cornulaca monacantha

From the aerial parts of Cornulaca monacantha, three new triterpenoidal saponins have been isolated and their genuine structures were identified as 3-O-[beta-xylopyranosyl-(1-->3)-beta- glucuronopyranosyl]-30-methylphytolaccagenate (2), 3-O-[beta-xylopyranosyl- (1-->3)-beta-glucuronopyranosyl]-30-methylphytolaccagenate 28-O-beta-gluco-pyranoside (3) and 3-O-[beta-xylopyranosyl-(1-->3)-beta- glucurono-pyranosyl]-30-methylserjanate 28-O-beta glucopyranoside (4) together with nine known saponins of oleanolic acid (5-9), hederagenin (1, 10, 11) and 30-methyl phytolaccagenate (12).

Evaluation of risk factors for intrafamilial transmission of HCV infection in Egypt

The objectives of this study were to define the prevalence of intrafamilial transmission of HCV and evaluate the risk factors in this setting. A cross-sectional, family-based seroepidemiological study was performed in Cairo Liver Center and Oncology Diagnostic Unit, Ain Shams University. A total of 102 index patients (72 males and 30 females) with type C chronic liver disease and their 305 family contacts were studied. Only 265 family contacts were eligible for the study as they showed no previous history of exposure to risk factors. Overall, 15 family contacts (5.7%) were positive for anti-HCV, indicating a lower anti-HCV prevalence among family contacts than the general population in Egypt. Spouses were at higher risk of infection (16.7%) than family members (2.6%). Among the repeatedly positive samples for anti-HCV, only 3 samples were HCV-RNA positive (1.1%), all were spouses. Logistic regression analysis revealed that spouses reporting promiscuous sexual relations were at higher risk than those with normal sexual relations. Contacts sharing personal objects were also at higher risk to develop HCV infection. Index cases reporting previous blood transfusion (18.6%), i.v. antibilharzial therapy (33.3%), multiple sex partners (1.0%) or advanced liver diseases were more infective to their family contacts. The contacts of index cases had increasing risk of HCV infection with increase in age and duration of contact. The prevalence rate of intrafamilial spread of HCV infection is low compared to the rate among general population, emphasizing its limited role in transmitting HCV infection. Long duration of sexual contact and promiscuous sexual activities were major risk factors in this setting.

Leiomyosarcoma of the rectum. Report of a case and review of the literature

A case of leiomyosarcoma of the rectum is presented and followed by a review of 135 cases from the literature. The five- and ten-year survival figures were the same whether the patient was treated by radical or local excision; however, local excision was followed by 67.5 percent recurrence. Abdominoperineal resection is still the procedure of choice. Local excision might be considered for small tumors of low-grade malignancy in a poor-risk patient.

Collagen production by cultured retinal capillary pericytes

The cells that proliferate from microvessels isolated from calf retinas and placed in tissue culture have been found to derive from the intramural pericytes. When these cells were cultured in medium supplemented with ascorbate and pulsed for 24 hr with [14C]proline, about 2% of the [14C]proline in the nondialyzable protein secreted into the culture medium by these cells was hydroxylated, and about 10% of the incorporated [4C]proline was solubilized by purified collagenase. Agarose gel chromatography of the postculture media showed that unreduced [14C]collagen polypeptides were recovered in large-molecular-weight aggregates (greater than 300,000 daltons) which were largely converted to chains of approximately 95,000 molecular weight and some dimers and trimers of MW approximately 180,000 and 270,000 when the medium was subjected to reduction and alkylation prior to chromatography. The findings indicate that cultured retinal pericytes elaborate collagen and suggest the production of type III collagen. Retinal microvessel cells in culture may facilitate study of abnormalities in retinal pericyte function and collagen synthesis that occur in retinal vascular diseases.