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Journal of Neurological Surgery Reports Oct 2023CIC-DUX4 sarcoma is a rare, aggressive tumor that is difficult to diagnose. Although it is closely related to Ewing's sarcoma, each is a distinct pathologic entity...
CIC-DUX4 sarcoma is a rare, aggressive tumor that is difficult to diagnose. Although it is closely related to Ewing's sarcoma, each is a distinct pathologic entity and both have been previously reported in the skin, lymph nodes, and viscera. We report the first description of CIC-DUX4 involving the posterior cranial fossa and review the distinctive symptomatology, morphology, immunoprofile, and genetic signature that differentiate this rare tumor. A 32-year-old man presented with an enlarging right lateral neck mass, progressive hoarseness, and orofacial pain. Biopsy revealed a high-grade undifferentiated malignant neoplasm. Imaging demonstrated an 8-cm mass in the right neck extending to the skull base and abutting the carotid sheath, in addition to pulmonary nodules and pelvic lymphadenopathy. Despite initial response to chemotherapy, he experienced disease progression and underwent surgical resection, radical neck dissection, and brachytherapy. Definitive pathologic diagnosis was achieved with next-generation sequencing. Within weeks of treatment, he developed symptoms reflecting progression of disease involving the neck, posterior cranial fossa, and lung. Adjuvant chemotherapy was planned, but the patient succumbed to his disease prior to initiation of further therapy. CIC-DUX4 sarcomas are uncommon and can progress rapidly. Diagnosis requires either fluorescence in situ hybridization or next-generation sequencing. Due to its rarity, there is no standard-of-care treatment for this tumor and further investigations are needed to understand disease behavior and develop targeted therapeutic modalities.
PubMed: 37842548
DOI: 10.1055/a-2166-5688 -
RoFo : Fortschritte Auf Dem Gebiete Der... Apr 2020Development of a fully evidence-based guideline including all aspects of child abuse.
AIM
Development of a fully evidence-based guideline including all aspects of child abuse.
METHODS
In a case-based procedure, 144 primary PICO questions were generated from 476 presented cases of child abuse. Literature research was performed in 5 databases (Pubmed, CINHAL, Embase, PsycInfo, Eric) and in the Cochrane Library. The literature was evaluated according to SIGN and AGREE II.
RESULTS
137 recommendations were developed. Those related to imaging procedures are presented and discussed in this article.
CONCLUSION
The first fully evidence-based German guideline concerning all aspects of child abuse has been established. For imaging, several relevant new approaches have been proposed.
KEY POINTS
· The average radiation exposure is significantly reduced for the whole group of examined children.. · The pelvic view and lateral spine are no longer basic views of the skeletal survey but are only performed additionally in the case of a positive survey.. · Oblique views and a follow-up survey are performed in the case of a negative skeletal survey and ongoing suspicion of child abuse..
CITATION FORMAT
· Born M, Schwier F, Stoever B et al. The German Evidence-Based Child Protection Guideline - Imaging in Suspected Child Abuse. Fortschr Röntgenstr 2020; 192: 343 - 348.
Topics: Algorithms; Child; Child Abuse; Child Protective Services; Child, Preschool; Evidence-Based Medicine; Fractures, Bone; Germany; Humans; Infant; Infant, Newborn; Magnetic Resonance Imaging; Radionuclide Imaging; Siblings; Skull Fractures; Viscera; Whole Body Imaging; Wounds and Injuries
PubMed: 31747703
DOI: 10.1055/a-1019-8018 -
The Cochrane Database of Systematic... May 2020Uterine leiomyomas, also referred to as myomas or fibroids, are benign tumours arising from the smooth muscle cells of the myometrium. They are the most common pelvic... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Uterine leiomyomas, also referred to as myomas or fibroids, are benign tumours arising from the smooth muscle cells of the myometrium. They are the most common pelvic tumour in women. The estimated rate of leiomyosarcoma, found during surgery for presumed benign leiomyomas, is about 0.51 per 1000 procedures, or approximately 1 in 2000. Treatment options for symptomatic uterine leiomyomas include medical, surgical, and radiologically-guided interventions. Laparoscopic myomectomy is the gold standard surgical approach for women who want offspring, or otherwise wish to retain their uterus. A limitation of laparoscopy is the inability to remove large specimens from the abdominal cavity through the laparoscope. To overcome this challenge, the morcellation approach was developed, during which larger specimens are broken into smaller pieces in order to remove them from the abdominal cavity via the port site. However, intracorporeal power morcellation may lead to scattering of benign tissues, with the risk of spreading leiomyoma or endometriosis. In cases of unsuspected malignancy, power morcellation can cause unintentional dissemination of malignant cells, and lead to a poorer prognosis by upstaging the occult cancer. A strategy to optimise women's safety is to morcellate the specimens inside a bag. In-bag morcellation may avoid the dissemination of tissue fragments.
OBJECTIVES
To evaluate the effectiveness and safety of protected in-bag extracorporeal manual morcellation during laparoscopic myomectomy compared to intra-abdominal uncontained power morcellation.
SEARCH METHODS
On 1 July 2019, we searched; the Cochrane Gynaecology and Fertility Group Specialized Register of Controlled Trials, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, LILACS, PubMed, Google Scholar, and two trials registers. We reviewed the reference lists of all retrieved full-text articles, and contacted experts in the field for additional and ongoing trials.
SELECTION CRITERIA
We included all randomised controlled trials comparing in-bag extracorporeal manual morcellation versus intracorporeal uncontained power morcellation during laparoscopic myomectomy in premenopausal women.
DATA COLLECTION AND ANALYSIS
We followed standard Cochrane methods. Two review authors independently reviewed the eligibility of trials, extracted data, and evaluated the risk of bias. Data were checked for accuracy. The summary measures were reported as risk ratios (RR) or mean differences (MD) with 95% confidence interval (CI). The outcomes of interest were a composite of intraoperative and postoperative complications, operative times, ease of morcellation, length of hospital stay, postoperative pain, conversion to laparotomy, and postoperative diagnosis of leiomyosarcoma. Results for the five main outcomes follow.
MAIN RESULTS
We included two trials, enrolling 176 premenopausal women with fibroids, who underwent laparoscopic myomectomy. The experimental group received in-bag manual morcellation, during which each enucleated myoma was placed into a specimen retrieval bag, and manually morcellated with scalpel or scissors. In the control group, intracorporeal uncontained power morcellation was used to reduce the size of the myomas. No intraoperative complications, including accidental morcellation of the liver, conversion to laparotomy, endoscopic bag disruption, bowel injury, bleeding, accidental injury to any viscus or vessel, were reported in either group in either trial. We found very low-quality evidence of inconclusive results for total operative time (MD 9.93 minutes, 95% CI -1.35 to 21.20; 2 studies, 176 participants; I² = 35%), and ease of morcellation (MD -0.73 points, 95% CI -1.64 to 0.18; 1 study, 104 participants). The morcellation operative time was a little longer for the in-bag manual morcellation group, however the quality of the evidence was very low (MD 2.59 minutes, 95% CI 0.45 to 4.72; 2 studies, 176 participants; I² = 0%). There were no postoperative diagnoses of leiomyosarcoma made in either group in either trial. We are very uncertain of any of these results. We downgraded the quality of the evidence due to indirectness and imprecision, because of limited sites in high-income settings and countries, small sample sizes, wide confidence intervals, and few events.
AUTHORS' CONCLUSIONS
There are limited data on the effectiveness and safety of in-bag morcellation at the time of laparoscopic myomectomy compared to uncontained power morcellation. We were unable to determine the effects of in-bag morcellation on intraoperative complications as no events were reported in either group. We are uncertain if in-bag morcellation improves total operative time or ease of morcellation compared to control. Regarding morcellation operative time, the quality of the evidence was also very low and we cannot be certain of the effect of in-bag morcellation compared to uncontained morcellation. No cases of postoperative diagnosis of leiomyosarcoma occurred in either group. We found only two trials comparing in-bag extracorporeal manual morcellation to intracorporeal uncontained power morcellation at the time of laparoscopic myomectomy. Both trials had morcellation operative time as primary outcome and were not powered for uncommon outcomes such as intraoperative complications, and postoperative diagnosis of leiomyosarcoma. Large, well-planned and executed trials are needed.
Topics: Adult; Female; Humans; Intraoperative Complications; Laparoscopy; Leiomyoma; Length of Stay; Middle Aged; Morcellation; Operative Time; Postoperative Complications; Randomized Controlled Trials as Topic; Specimen Handling; Uterine Myomectomy; Uterine Neoplasms; Young Adult
PubMed: 32374421
DOI: 10.1002/14651858.CD013352.pub2 -
Veterinary Research Forum : An... 2018Immune system plays crucial role in body and lymph nodes are essential parts of this system for combating pathogens. However, no study has ever been conducted on...
Immune system plays crucial role in body and lymph nodes are essential parts of this system for combating pathogens. However, no study has ever been conducted on morphometric development of sheep lymph nodes in fetal period. Thus, this study attempted to examine the morphometric characteristics of a number of important lymph nodes of some lymphocenters of sheep during fetal period. To this end, 60 pieces of sheep fetuses collected from Ahvaz slaughterhouse were fixated in 10% formalin and then divided into four categories based on crown-rump length (CRL) following gender and weight determinations. Mandibular, caudal superficial cervical (prescapular), caudal mediastinum, jejunal mesenteric and popliteal lymph nodes were evaluated in five lymphocenters of head, neck, thoracic cavity, abdominal viscera and pelvic limbs, respectively. In each sample, nodes formation was visually checked and in cases of nodes formation, they were measured in terms of weight, length, width and thickness and collected data were statistically analyzed. The longest and shortest fetal CRLs were found to be 48.50 cm and 3.50 cm, respectively. Gender had no effect on study parameters in 32 male and 28 female fetuses. Study of sheep fetuses' lymph nodes revealed no macroscopic lymph node development by day 45, while all nodes were observable after the day 59. The shortest lymph node was mandibular node and the longest one was caudal mediastinum. Based on the results, it seemed that although the size of lymph nodes grows by age, this increase is not the same for all nodes and groups.
PubMed: 30065800
DOI: 10.30466/VRF.2018.30833 -
World Journal of Gastroenterology Oct 2016A 68-year-old man presented with progressive right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo.... (Review)
Review
Limited, local, extracolonic spread of mucinous appendiceal adenocarcinoma after perforation with formation of a malignant appendix-to-sigmoid fistula: Case report and literature review.
A 68-year-old man presented with progressive right lower quadrant abdominal pain and tenderness without rebound tenderness, and with constipation during the prior 9 mo. Abdomino-pelvic computed tomography and magnetic resonance imaging demonstrated a dilated appendix forming a fistula to the sigmoid colon. Open laparotomy revealed a bulky abdominal tumor involving appendix, cecum, and sigmoid, and extending up to adjacent viscera, without ascites or peritoneal implants. The abdominal mass was removed en bloc, including resection of sigmoid colon, cecum (with preservation of ileocecal valve), appendix, right vas deferens, testicular vessels, and minimal amounts of anterior abdominal wall; and shaving off of small parts of the walls of the urinary bladder and small bowel. Gross and microscopic pathologic examination revealed an appendix-to-sigmoid malignant fistula secondary to perforation of mucinous adenocarcinoma of the appendix with minimal local spread (stage T4). However, the surgical margins were clear, all 13 resected lymph nodes were cancer-free, and pseudomyxoma peritonei or peritoneal implants were not present. The patient did well during 1 year of follow-up with no clinical or radiologic evidence of local recurrence, metastases, or pseudomyxoma peritonei despite presenting with extensive stage T4 cancer that was debulked without administering chemotherapy, and despite presenting with malignant appendiceal perforation. This case illustrates the non-aggressive biologic behavior of this low-grade malignancy. The fistula may have prevented free spillage of cancerous cells and consequent distant metastases by containing the appendiceal contents largely within the colon.
Topics: Adenocarcinoma; Aged; Appendiceal Neoplasms; Appendix; Colon, Sigmoid; Fistula; Humans; Laparotomy; Magnetic Resonance Imaging; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Tomography, X-Ray Computed
PubMed: 27784975
DOI: 10.3748/wjg.v22.i38.8624 -
Animals : An Open Access Journal From... Jul 2020The present study was designed to evaluate the relationship between the body measurements (BMs) and carcass characteristics of hair sheep lambs. Twenty hours before...
The present study was designed to evaluate the relationship between the body measurements (BMs) and carcass characteristics of hair sheep lambs. Twenty hours before slaughter, the shrunk body weight (SBW) and BMs were recorded. The BMs involved were height at withers (HW), rib depth (RD), body diagonal length (BDL), body length (BL), pelvic girdle length (PGL), rump depth (RuD), rump height (RH), pin-bone width (PBW), hook-bone width (HBW), abdomen width (AW), girth (GC), and abdomen circumference (AC). After slaughter, the carcasses were weighed and chilled for 24 h at 1 °C, and then were split by the dorsal midline. The left-half was dissected into total soft tissues (muscle + fat; TST) and bone (BON), which were weighed separately. The weights of viscera and organs (VIS), internal fat (IF), and offals (OFF-skin, head, feet, tail, and blood) were also recorded. The equations obtained for predicting SBW, HCW, and CCW had an ranging from 0.89 to 0.99, and those for predicting the TST and BON had an ranging from 0.74 to 0.91, demonstrating satisfactory accuracy. Our results indicated that use of BMs could accurately and precisely be used as a useful tool for predicting carcass characteristics of hair sheep lambs.
PubMed: 32727056
DOI: 10.3390/ani10081276 -
Pain Physician 2015The superior hypogastric plexus (SHGP) carries afferents from the viscera of the lower abdomen and pelvis. Neurolytic block of this plexus is used for reducing pain...
BACKGROUND
The superior hypogastric plexus (SHGP) carries afferents from the viscera of the lower abdomen and pelvis. Neurolytic block of this plexus is used for reducing pain resulting from malignancy in these organs. The ganglion impar (GI) innervats the perineum, distal rectum, anus, distal urethra, vulva, and distal third of the vagina. Different approaches to the ganglion impar neurolysis have been described in the literature.
OBJECTIVES
To assess the feasibility, safety, and efficacy of combining the block of the SHGP through the postero-median transdiscal approach with the GI block by the trans-sacro-coccygeal approach for relief of pelvic and/or perineal pain caused by pelvic and/or perineal malignancies or any cancer related causes.
METHODS
Fifteen patients who had cancer-related pelvic pain, perineal pain, or both received a combined SHGP neurolytic block through the postero-median transdiscal approach using a 20-gauge Chiba needle and injection of 10 mL of 10% phenol in saline plus a GI neurolytic block by the trans-sacro-coccygeal approach using a 22-gauge 5 cm needle and injection of 4 - 6 mL of 8% phenol in saline. Pain intensity (measured using a visual analogue scale) and oral morphine consumption pre- and post-procedure were measured.
RESULTS
All patients presented with cancer-related pelvic, perineal, or pelviperineal pain. Pain scores were reduced from a mean (± SD) of 7.87 ± 1.19 pre-procedurally to 2.40 ± 2.10 one week post-procedurally (P < 0.05). In addition, the mean consumption of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from 98.00 ± 34.89 mg to 32.00 ± 28.48 mg after one week (P < 0.05). No complications or serious side effects were encountered during or after the block.
LIMITATIONS
This study is limited by its small sample size and non-randomized study.
CONCLUSION
A combined neurolytic SHGP block with GI block is an effective and safe technique for reducing pain in cancer patients presented with pelvic and/or perineal pain. Also, a combined SHGP block through a posteromedian transdiscal approach with a GI block through a trans-sacrococcygeal approach may be considered more effective and easier to perform than the recently invented bilateral inferior hypogastric plexus neurolysis through a transsacral approach.
Topics: Adult; Aged; Autonomic Nerve Block; Feasibility Studies; Female; Ganglia, Sympathetic; Humans; Hypogastric Plexus; Male; Middle Aged; Morphine; Neoplasms; Neuralgia; Pain Management; Pain Measurement; Pelvic Pain
PubMed: 25675070
DOI: No ID Found -
Case Reports in Women's Health Apr 2020Pneumoperitoneum seen on an X-ray or computed tomography (CT) image points to a diagnosis of ruptured viscus and immediate surgery is warranted. A case of tubo-ovarian...
Pneumoperitoneum seen on an X-ray or computed tomography (CT) image points to a diagnosis of ruptured viscus and immediate surgery is warranted. A case of tubo-ovarian abscess (TOA) presenting with pneumoperitoneum is unusual. Very few cases have been reported where the pneumoperitoneum is caused by an abscess involving the adnexa. We present the case of a 17-year-old patient who presented with acute abdomen and raised inflammatory markers and had laparoscopy for suspected bowel perforation based on the finding of pneumoperitoneum on CT scan. Bowel perforation was ruled out and the findings were consistent with TOA. She had drainage of the abscess, subsequently received intravenous antibiotics and postoperatively recovered well. The pneumoperitoneum could have been due to coinfection with , as the patient had had a urinary tract infection due to three weeks before presentation, or slow leakage of the TOA. In conclusion, gas under the diaphragm can be related to non-bowel-related gynaecological pathology, but it vital to rule out sinister causes.
PubMed: 32082993
DOI: 10.1016/j.crwh.2020.e00181 -
BMC Medical Imaging Apr 2017Computed Tomography (CT) contributes up to 50% of the medical exposure to the United States population. Children are considered to be at higher risk of developing... (Comparative Study)
Comparative Study
BACKGROUND
Computed Tomography (CT) contributes up to 50% of the medical exposure to the United States population. Children are considered to be at higher risk of developing radiation-induced tumors due to the young age of exposure and increased tissue radiosensitivity. Organ dose estimation is essential for pediatric and adult patient cancer risk assessment. The objective of this study is to validate the VirtualDose software in comparison to currently available software and methods for pediatric and adult CT organ dose estimation.
METHODS
Five age groups of pediatric patients and adult patients were simulated by three organ dose estimators. Head, chest, abdomen-pelvis, and chest-abdomen-pelvis CT scans were simulated, and doses to organs both inside and outside the scan range were compared. For adults, VirtualDose was compared against ImPACT and CT-Expo. For pediatric patients, VirtualDose was compared to CT-Expo and compared to size-based methods from literature. Pediatric to adult effective dose ratios were also calculated with VirtualDose, and were compared with the ranges of effective dose ratios provided in ImPACT.
RESULTS
In-field organs see less than 60% difference in dose between dose estimators. For organs outside scan range or distributed organs, a five times' difference can occur. VirtualDose agrees with the size-based methods within 20% difference for the organs investigated. Between VirtualDose and ImPACT, the pediatric to adult ratios for effective dose are compared, and less than 21% difference is observed for chest scan while more than 40% difference is observed for head-neck scan and abdomen-pelvis scan. For pediatric patients, 2 cm scan range change can lead to a five times dose difference in partially scanned organs.
CONCLUSIONS
VirtualDose is validated against CT-Expo and ImPACT with relatively small discrepancies in dose for organs inside scan range, while large discrepancies in dose are observed for organs outside scan range. Patient-specific organ dose estimation is possible using the size-based methods, and VirtualDose agrees with size-based method for the organs investigated. Careful range selection for CT protocols is necessary for organ dose optimization for pediatric and adult patients.
Topics: Absorption, Radiation; Adolescent; Aging; Algorithms; Child; Child, Preschool; Computer Simulation; Female; Humans; Infant; Infant, Newborn; Male; Models, Biological; Models, Statistical; Monte Carlo Method; Organ Specificity; Radiation Dosage; Radiation Exposure; Radiographic Image Interpretation, Computer-Assisted; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed; Viscera; Whole-Body Counting
PubMed: 28446130
DOI: 10.1186/s12880-017-0199-3