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The American Surgeon Sep 2023Lymph nodes are common basins for cancer recurrence; however, during surgery, lymphatic tissue is often indistinguishable from surrounding tissue making local excision...
Lymph nodes are common basins for cancer recurrence; however, during surgery, lymphatic tissue is often indistinguishable from surrounding tissue making local excision difficult. Novel breast surgery techniques have utilized radioactive seed localization (RSL) to preoperatively tag tissue so it can be identified intraoperatively with a gamma probe. Our goal was to assess the use of RSL in non-breast tissues. This was a retrospective case series of non-breast cancer patients undergoing RSL. Overall, 42 patients met inclusion criteria. Pathology results indicated benign findings in 20 patients (47.62%), toxoplasma in 1 patient (2.38%), non-necrotizing granulomatous disease in 2 patients (4.76%), and malignant progression in 19 patients (45.24%). Two patients had non-lymphatic tissue removed: one in the abdominal wall and one in the lower lumbar region. Radioactive seed localization is an effective technique to localize and excise non-palpable lymph nodes and masses identified on imaging, highlighting its wide variety of uses in non-breast cancer cases.
Topics: Humans; Female; Retrospective Studies; Iodine Radioisotopes; Lymph Nodes; Reoperation; Mastectomy, Segmental; Neoplasms; Breast Neoplasms
PubMed: 37225666
DOI: 10.1177/00031348231177925 -
Annals of Surgical Oncology Oct 2023Breast-conserving surgery (BCS) still remains a blind surgery despite all available tumor localization methods. Intraoperative ultrasound (IOUS) allows real-time... (Randomized Controlled Trial)
Randomized Controlled Trial Observational Study
BACKGROUND
Breast-conserving surgery (BCS) still remains a blind surgery despite all available tumor localization methods. Intraoperative ultrasound (IOUS) allows real-time visualization during all resection phases.
METHODS
This was a prospective observational cohort study conducted at the Veneto Institute of Oncology between January 2021 and June 2022. Patients with ductal carcinoma in situ, T1-2 invasive cancer, or post-neoadjuvant tumors, suitable for BCS, were recruited. All breast cancer lesion types were included, i.e. solid palpable, solid non-palpable, non-solid non-palpable, and post-neoadjuvant treatment residual lesions. Eligible participants were randomly assigned to either IOUS or traditional surgery (TS) in a 1:1 ratio. The main outcomes were surgical margin involvement, reoperation rate, closest margin width, main specimen and cavity shaving margin volumes, excess healthy tissue removal, and calculated resection ratio (CRR).
RESULTS
Overall, 160 patients were enrolled: 80 patients were allocated to the TS group and 80 to the IOUS group. IOUS significantly reduced specimen volumes (16.8 cm [10.5-28.9] vs. 24.3 cm [15.0-41.3]; p = 0.015), with wider closest resection margin width (2.0 mm [1.0-4.0] vs. 1.0 mm [0.5-2.0] after TS; p < 0.001). Tumor volume to specimen volume ratio was significantly higher after IOUS (4.7% [2.5-9.1] vs. 2.9% [0.8-5.2]; p < 0.001). IOUS yielded significantly better CRR (84.5% [46-120.8] vs. 114% [81.8-193.2] after TS; p < 0.001), lower involved margin rate (2.5 vs. 15%; p = 0.009) and reduced re-excision rate (2.5 vs. 12.5%; p = 0.032).
CONCLUSIONS
IOUS allows real-time resection margin visualization and continuous control during BCS. It showed clear superiority over TS in both oncological and surgical outcomes for all breast cancer lesion types. These results disfavor the paradigm of blind breast surgery.
Topics: Humans; Female; Breast Neoplasms; Margins of Excision; Prospective Studies; Ultrasonic Surgical Procedures; Ultrasonography, Interventional
PubMed: 37606837
DOI: 10.1245/s10434-023-13900-x -
Cureus Jul 2023Leukocytoclastic vasculitis, also known as hypersensitivity angiitis, is a cutaneous, small vessel vasculitis of the dermal capillaries and venules. The predominant...
Leukocytoclastic vasculitis, also known as hypersensitivity angiitis, is a cutaneous, small vessel vasculitis of the dermal capillaries and venules. The predominant clinical presentation is palpable purpura. Multiple medications can cause leukocytoclastic vasculitis, as well as autoimmune diseases, infections, and malignancy. The disease process may be limited to only the skin or a manifestation of a systemic vasculitis or process. Treatment is centered on symptom management. Our patient is a 60-year-old female who presented with bilateral dry and wet tender ulcerations. She was previously treated with paclizumab.
PubMed: 37575740
DOI: 10.7759/cureus.41736 -
Revue Medicale de Liege Sep 2023In the context of low back pain of the posterior iliac crest, various etiologies can be evoked, in particular Maigne's syndrome in D12/L1, ilio-lumbar ligament syndrome...
In the context of low back pain of the posterior iliac crest, various etiologies can be evoked, in particular Maigne's syndrome in D12/L1, ilio-lumbar ligament syndrome or L5/S1 facet syndrome. Maigne's syndrome is a painful segmental vertebral dysfunction leading to a cellulo-periosto-myalgic syndrome. Propedeutic is essential to the diagnosis and is based on a rigorous segmental spinal examination and on the remote search for palpable changes in the texture of the skin, muscle and teno-periosteal tissues. The iliolumbar ligament is a powerful fibrous stabilising element of the lumbosacral hinge. Its tensioning by repeated movements of anteflexion and contralateral lateroflexion-rotation contributes to the expression of a painful symptomatology of the posteromedial iliac crest. Pain in the posterior inter-apophyseal joint L5-S1 is characterised by a more medial lumbosacral pain, accentuated on facet palpation and reproduced on combined heterolateral extension-rotation of the spine. Manual therapy centred on the dorsolumbar or lumbosacral hinge is recommended as a first-line treatment to control these different diagnoses. Rehabilitation of the motor control of the deep stabilising muscles of the dorsolumbar spine is essential. Various local infiltrations often complete the physiotherapy approach.
Topics: Humans; Low Back Pain; Ilium; Diagnosis, Differential; Medicine
PubMed: 37712160
DOI: No ID Found -
Cureus Jul 2023We report on the case of a Hispanic woman with necrobiotic xanthogranuloma (NBX) whose disease was managed based on her symptoms. She underwent a diagnostic and...
We report on the case of a Hispanic woman with necrobiotic xanthogranuloma (NBX) whose disease was managed based on her symptoms. She underwent a diagnostic and debulking surgical intervention and surveillance for hematologic malignancy. This 56-year-old patient presented with a six-year history of enlarging masses and swelling around her eyes, with intermittent inflammation, associated pain, and occasional redness. Her past medical history was remarkable for asthma and nasal polyps. Upon external examination, she had severe fullness of the upper lids with yellow plaques and palpable masses along them, nontender palpation, the absence of visible erythema, and blepharoptosis in both eyes. The patient presented with bilateral visual field constriction due to mechanical obstruction. An orbital computed tomography scan revealed a dense diffuse lesion involving the pre- and postseptal tissues and invading the orbit of the right eye. A facial magnetic resonance imaging scan revealed infiltration of the postseptal spaces within both orbits. A skin and soft tissue biopsy from the bilateral periorbital regions of both eyes confirmed the diagnosis of NBX. A workup for underlying hematologic malignancies, including plasma cell dyscrasias and lymphoproliferative disorders, was unremarkable. The patient underwent diagnostic and debulking surgery in an attempt to improve her visual function. Subsequently, she was scheduled for ongoing monitoring of her disease progression.
PubMed: 37637556
DOI: 10.7759/cureus.42477 -
European Journal of Surgical Oncology :... Aug 2023More than 5 central lymph nodes metastases (CLNM) or lateral lymph node metastasis (LLNM) indicates a higher risk of recurrence in low-risk papillary thyroid carcinoma...
CONTEXT
More than 5 central lymph nodes metastases (CLNM) or lateral lymph node metastasis (LLNM) indicates a higher risk of recurrence in low-risk papillary thyroid carcinoma (PTC) and may lead to completion thyroidectomy (CTx) in patients initially undergoing lobectomy.
OBJECTIVE
To screen potentially high-risk patients from low-risk patients by using preoperative and intraoperative clinicopathological features to predict lymph node status.
METHODS
A retrospective analysis of 8301 PTC patients in Wuhan Union Hospital database (2009-2021) was performed according to the 2015 American Thyroid Association (ATA) and 2021 National Comprehensive Cancer Network (NCCN) guidelines, respectively. Logistic regression and best subsets regression were used to identify risk factors. Nomograms were established and externally validated using the Differentiated Thyroid Cancer in China cohort.
RESULTS
More than 5 CLNM or LLNM was detected in 1648 (19.9%) patients. Two predictive models containing age, gender, maximum tumor size, free thyroxine (FT4) and palpable node (all p < 0.05) were established. The nomogram based on NCCN criteria showed better discriminative power and consistency with a specificity of 0.706 and a sensitivity of 0.725, and external validation indicated that 76% of potentially high-risk patients could achieve preoperative conversion of surgical strategy.
CONCLUSIONS
Models based on large cohorts with good predictive performance were constructed and validated. Preoperative low-risk (T1-2N0M0) patients with age younger than 40 years, male gender, large tumor size, low FT4 and palpable nodes may be at high risk of LLNM or more than 5 CLNM, and they should receive more aggressive initial therapy to reduce CTx.
Topics: Humans; Male; Adult; Thyroid Cancer, Papillary; Thyroidectomy; Nomograms; Retrospective Studies; Lymphatic Metastasis; Thyroid Neoplasms; Lymph Nodes; Risk Factors
PubMed: 37061404
DOI: 10.1016/j.ejso.2023.03.236 -
Hepatology (Baltimore, Md.) Mar 2024Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as NAFLD, has ascended to prominence as the predominant chronic liver disease in Western...
Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as NAFLD, has ascended to prominence as the predominant chronic liver disease in Western countries and now stands as a leading cause of liver transplantations. In the more advanced stage, Metabolic Dysfunction-Associated Steatohepatitis (MASH), may lead to fibrosis, a gateway to cirrhosis, liver cancer, and liver failure. Despite extensive research and exploration of various drug mechanisms, the anticipation for the inaugural approved drug to materialize by 2024 is palpable, marking a significant milestone. Numerous pathways have been investigated for MASH treatment, exploring thyroid hormone receptors, glucagon-like peptides 1, peroxisome proliferator-activated receptors, and agents influencing hepatic steatosis synthesis, inflammatory pathways, genetic components, fibrosis mechanisms, and an array of other avenues. Over time, key regulatory directions have crystallized, now manifesting in two primary endpoints under investigation: resolution of steatohepatitis without worsening fibrosis and/or improvement of fibrosis stage without worsening of steatohepatitis, especially used in Phase 3 clinical trials, while alternative non-invasive endpoints are explored in Phase 2 trials. The prospect of proving efficacy in clinical trials opens doors to combination therapies, evaluating the ideal combination of drugs to yield comprehensive benefits, extending beyond the liver to other organs. Certain combination drug trials are already underway. In this review, we discuss the forefront of MASH drug research as of 2023/2024, illuminating mechanisms, outcomes, and future trajectories. Furthermore, we tackle the challenges confronting MASH trials and propose potential strategies for surmounting them.
PubMed: 38502810
DOI: 10.1097/HEP.0000000000000860 -
Annals of Pediatric Cardiology 2023Tuberculous (TB) involvement of the vascular system has been reported in the preantibiotic era. We, hereby, report a case involving a teenage boy who presented to us...
Tuberculous (TB) involvement of the vascular system has been reported in the preantibiotic era. We, hereby, report a case involving a teenage boy who presented to us with left upper limb pain followed by gradually progressive motor and sensory deficit over 1 month with preceding history of tuberculosis. Examination revealed a palpable, noncompressible, nonpulsatile swelling superior to the lateral third of the clavicle. Imaging through ultrasonography, computed tomography, and magnetic resonance imaging confirmed the presence of a pseudoaneurysm with compression of the underlying nerves. The child underwent surgical thrombectomy with pseudoaneurysm repair and arteriorrhaphy along with antitubercular medications with complete recovery at 6 months. The tissue staining, nucleic acid amplification tests, and histopathology confirmed TB etiology. Tuberculosis continues to remain a major health concern, especially in the developing world. High index of suspicion is necessary to diagnose such manifestations to avoid catastrophic sequelae.
PubMed: 38766448
DOI: 10.4103/apc.apc_156_23