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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 -
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 -
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 -
Journal of Surgical Case Reports Dec 2022Ventriculoperitoneal (VP) shunts are the main treatment modality for patients with hydrocephalus. The complications arising in patients with VP shunts are well...
Ventriculoperitoneal (VP) shunts are the main treatment modality for patients with hydrocephalus. The complications arising in patients with VP shunts are well documented. We present a case of infertility in a patient with a long-standing VP shunt. Her infertility is thought to be the result of pelvic adhesions due to factors related to the distal end of her VP shunt. A 22-year-old female with a 1-year history of infertility was referred due to bilateral hydrosalpinges. Diagnostic laparoscopy revealed multiple adhesions surrounding the distal end of the fallopian tubes. The distal portion of a VP shunt, which was placed over the course of her childhood, was found to be grossly inflamed and densely adherent to the pelvic viscera. VP shunts may produce abdominal adhesions and can cause mechanical infertility.
PubMed: 36540299
DOI: 10.1093/jscr/rjac590 -
Cureus Jan 2023An isolated perforation of the duodenum is rare in cases of blunt abdominal trauma, and diagnosis is often delayed due to subtle clinical signs. We present the case of a...
An isolated perforation of the duodenum is rare in cases of blunt abdominal trauma, and diagnosis is often delayed due to subtle clinical signs. We present the case of a 13-year-old male patient who presented to the hospital with an alleged history of being run over in the abdomen by a vehicle and a complaint of severe abdominal pain. Radiography of the abdomen in the standing position showed air under the diaphragm, and ultrasonography revealed free fluid in the pelvic and peritoneal cavities, clinching the diagnosis of hollow viscus perforation. The patient was resuscitated and underwent an exploratory laparotomy under general anesthesia. On exploration, no perforation was found in the intraperitoneal organs. The retroperitoneum was opened, and the Cattell-Braasch maneuver was used to approach the duodenum. A single perforation was discovered in the fourth part, and a modified graham patch repair was done. As soon as the patient's bowel sounds returned, a low-fat diet was started through a nasojejunal tube placed distal to the perforation site. The patient was discharged in good condition and is doing well with regular follow-ups. This case emphasizes the need for a high index of suspicion for gut perforation of both intra- and retroperitoneal organs after blunt trauma. This will help in early diagnosis and timely management to reduce perforation-associated mortality. Damage control surgery, with primary closure of the perforation, is well-suited and preferred in an emergency and resource-limited setting.
PubMed: 36788890
DOI: 10.7759/cureus.33571 -
Annals of Medicine and Surgery (2012) Feb 2022Transmesenteric hernia is a subtype of internal abdominal hernia (IAH) and a rare cause of small bowel obstruction in adults. Difficulty in reaching a definitive...
BACKGROUND
Transmesenteric hernia is a subtype of internal abdominal hernia (IAH) and a rare cause of small bowel obstruction in adults. Difficulty in reaching a definitive diagnosis due to non-specific clinical and imaging findings often cause life-threatening bowel ischemia.
CASE REPORT
We report a case of a 37-year-old female who presented with clinical and imaging features of small bowel obstruction. She underwent an emergency laparotomy where the diagnosis of transmesenteric hernia causing closed-loop obstruction was made. The non-viable portion of the intestine was resected, anastomosis of the ileum along with the closure of the mesenteric defect was performed.
DISCUSSION
IAH is the protrusion of abdominal viscera, most commonly small bowel loops through a peritoneal or mesenteric defect into the abdominal or pelvic cavity. Considered common in children, it is rare in adults and is most common after abdominal surgeries like Roux-en-Y gastric bypass surgery. Clinical features and imaging findings are non-specific causing delay in the diagnosis.
CONCLUSION
A high index of suspicion is required while assessing the patient with symptoms suggestive of acute bowel obstruction as the preoperative diagnosis of a transmesenteric hernia is challenging.
PubMed: 35106152
DOI: 10.1016/j.amsu.2022.103256 -
Cureus Feb 2023Seat belts with shoulder restraints have decreased the frequency of life-threatening severe chest trauma caused by car accidents. However, the introduction of seat belt...
Seat belts with shoulder restraints have decreased the frequency of life-threatening severe chest trauma caused by car accidents. However, the introduction of seat belt legislation has led to an increase in a specific pattern of blunt trauma known as seat belt syndrome, which includes rib, clavicle, spine, and sternum fractures, as well as rupture of hollow pelvic and abdominal viscera, mesenteric tears, and major vessel injuries. The shoulder restraint part of the three-point seat belt commonly rests near or over the female and male breast. A 54-year-old female presented to our emergency department complaining of swelling and pain in her left breast immediately after a traffic accident. The patient had used a seat belt with a shoulder restraint. Bruising was noted along her chest where there had been seat belt contact. Her breast hematoma was most likely caused by breast tissue compression between her rib and the seat belt. Contrast-enhanced computed tomography demonstrated a sizable breast hematoma with active arterial contrast material extravasation, as well as multiple left rib fractures. The patient was conservatively treated with analgesic and anti-inflammatory drugs. Complete resolution was achieved, and her breast returned to its normal appearance. Although endovascular treatment and surgical hemostasis have been proposed for the treatment of breast injuries with active bleeding, conservative treatment such as compression hemostasis may be feasible.
PubMed: 36994269
DOI: 10.7759/cureus.35440 -
Journal of Neurochemistry Feb 2023Chronic pelvic pain (CPP) is the primary symptom of endometriosis patients, but adequate treatments are lacking. Modulation of ion channels expressed by sensory nerves...
Chronic pelvic pain (CPP) is the primary symptom of endometriosis patients, but adequate treatments are lacking. Modulation of ion channels expressed by sensory nerves innervating the viscera has shown promise for the treatment of irritable bowel syndrome and overactive bladder. However, similar approaches for endometriosis-associated CPP remain underdeveloped. Here, we examined the role of the voltage-gated sodium (Na ) channel Na 1.7 in (i) the sensitivity of vagina-innervating sensory afferents and investigated whether (ii) Na 1.7 inhibition reduces nociceptive signals from the vagina and (iii) ameliorates endometriosis-associated CPP. The mechanical responsiveness of vagina-innervating sensory afferents was assessed with ex vivo single-unit recording preparations. Pain evoked by vaginal distension (VD) was quantified by the visceromotor response (VMR) in vivo. In control mice, pharmacological activation of Na 1.7 with OD1 sensitised vagina-innervating pelvic afferents to mechanical stimuli. Using a syngeneic mouse model of endometriosis, we established that endometriosis sensitised vagina-innervating pelvic afferents to mechanical stimuli. The highly selective Na 1.7 inhibitor Tsp1a revealed that this afferent hypersensitivity occurred in a Na 1.7-dependent manner. Moreover, in vivo intra-vaginal treatment with Tsp1a reduced the exaggerated VMRs to VD which is characteristic of mice with endometriosis. Conversely, Tsp1a did not alter ex vivo afferent mechanosensitivity nor in vivo VMRs to VD in Sham control mice. Collectively, these findings suggest that Na 1.7 plays a crucial role in endometriosis-induced vaginal hyperalgesia. Importantly, Na 1.7 inhibition selectively alleviated endometriosis-associated CPP without the loss of normal sensation, suggesting that selective targeting of Na 1.7 could improve the quality of life of women with endometriosis.
PubMed: 36840383
DOI: 10.1111/jnc.15795