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Ugeskrift For Laeger Jun 2024Pseudomonas aeruginosa, a Gram-negative bacterium known to induce severe infections, is seldomly reported in scientific literature as a contributor of osteomyelitis. In...
Pseudomonas aeruginosa, a Gram-negative bacterium known to induce severe infections, is seldomly reported in scientific literature as a contributor of osteomyelitis. In this case report, a 71-year-old woman exhibited recurring infections and enduring forearm pain. A subsequent MRI revealed osteomyelitis in the distal ulna, linked to an arterial blood gas sample taken months earlier. Despite undergoing multiple extended courses of antibiotic treatment, the patient eventually underwent surgery on her left forearm. Biopsy cultures conclusively confirmed the presence of P. aeruginosa.
Topics: Humans; Female; Aged; Pseudomonas aeruginosa; Pseudomonas Infections; Osteomyelitis; Ulna; Anti-Bacterial Agents; Magnetic Resonance Imaging; Punctures
PubMed: 38903032
DOI: 10.61409/V01240062 -
International Journal of Surgery Case... Jul 2024Pseudoangiomatous stromal hyperplasia (PASH) is a rare breast stromal lesion that typically manifests clinically as a palpable unilateral, painless lump that is freely...
Innovative technique for managing extreme relapsing bilateral pseudoangiomatous stromal hyperplasia (PASH) in a young woman: A case report highlighting a novel intervention in reconstruction.
INTRODUCTION
Pseudoangiomatous stromal hyperplasia (PASH) is a rare breast stromal lesion that typically manifests clinically as a palpable unilateral, painless lump that is freely movable and has a rubbery or firm consistency. The diagnosis can be confirmed by a core needle biopsy (CNB) or surgical excision. Treatment options include medical treatment with hormonal management for asymptomatic patients or local excision and breast reduction in rare cases.
CASE PRESENTATION
We reported the case of a 24-year-old woman with a history of taking contraceptive pills for about a year. Examination revealed extremely enlarged, sore, and swollen breasts, particularly the right side, marking her third PASH relapse. The patient underwent a surgical skin-reducing mastectomy (SRM) using a novel technique with an immediate prepectoral implant covered by a dermal flap to reconstruct the breast shape due to the large PASH lesions and aiming for optimal cosmetic outcomes. The procedure was complication-free with no recurrence after 18 months of follow-up.
DISCUSSION
Mastectomy followed by immediate implantation offers benefits such as prompt restoration of breast shape with fewer surgeries.
CONCLUSION
This case report highlights the successful use of immediate implantation in reconstructing large recurrent benign breast diseases. The outcomes indicate that immediate implantation shows promise as a suitable choice for carefully selected patients managing large, relapsing bilateral benign breast diseases. However, due to common complications such as infection and implant loss, it is not generally recommended for benign lesions. The decision should be made on a case-by-case basis, considering the size, recurrence, and individual suitability.
PubMed: 38901382
DOI: 10.1016/j.ijscr.2024.109873 -
The New Zealand Medical Journal Jun 2024There are no data on the performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the staging and diagnosis of lung cancer in New...
AIM
There are no data on the performance of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the staging and diagnosis of lung cancer in New Zealand. We aimed to assess the performance of EBUS-TBNA for lung cancer staging and diagnosis at our institution before and after the commencement of regular performance monitoring with comparison to published EBUS quality indicators.
METHODS
The performance of EBUS-TBNA in the staging and diagnosis of lung cancer was assessed in two phases. Phase 1 consisted of a retrospective review of all lung cancer EBUS performed over a 2-year period. Published quality indicators were determined from the literature with relevant indicators being extracted and used to determine EBUS performance. Local reporting and education were undertaken and prospective data collection was commenced. Phase 2 consisted of prospective assessment of all lung cancer EBUS over the subsequent year. Performance of EBUS was then compared between phases 1 and 2 in order to determine the effect of performance monitoring and identify areas for service improvement.
RESULTS
A total of 115 staging EBUS and 117 diagnostic EBUS were performed during the study period. Staging EBUS demonstrated good performance across phases 1 and 2 with high sensitivity and negative predictive values (NPV) for the detection of N2/3 disease, meeting published quality standards. During phase 2 there was evidence of a transition towards more guideline-concordant practice evidenced by more detailed nodal sampling during staging EBUS; however, this did not affect overall sensitivity or NPV. Diagnostic EBUS resulted in high rates of pathological confirmation meeting published quality standards across both phases. Pathway times were similar between phases 1 and 2, with reporting of molecular profiling being the predominant factor in delayed pathway times.
CONCLUSION
Monitoring and reporting of local performance allows critical assessment of practice and can identify areas for quality improvement. This review demonstrated good overall performance but prompted a move towards more guideline-concordant practice with increased mediastinal nodal sampling during staging procedures. Consideration should be given to the adoption of routine EBUS performance monitoring within local and/or regional networks, which could be incorporated alongside the newly proposed Lung Cancer Clinical Quality Registry.
Topics: Humans; Lung Neoplasms; Neoplasm Staging; New Zealand; Quality Indicators, Health Care; Male; Female; Retrospective Studies; Aged; Middle Aged; Endoscopic Ultrasound-Guided Fine Needle Aspiration; Prospective Studies; Bronchoscopy; Aged, 80 and over; Endosonography; Adult
PubMed: 38901049
DOI: 10.26635/6965.6452 -
International Journal of Surgical... Jun 2024. SMARCA4-deficient undifferentiated tumors are rare and pose a diagnostic challenge. This study delves into the intricate diagnostic terrain of SMARCA4-deficient...
Delayed Diagnosis of SMARCA4-Deficient Undifferentiated Tumor in a Heavy Smoker Male Patient: Discovered Through Bone Sampling, with Extensive Distant Metastases and Concurrent Granulomatous Disease, Leading to Patient Fatality.
. SMARCA4-deficient undifferentiated tumors are rare and pose a diagnostic challenge. This study delves into the intricate diagnostic terrain of SMARCA4-deficient undifferentiated tumors, providing insights into their diverse clinical presentations and diagnostic approaches. . A 69-year-old heavy-smoker man with adalimumab-treated rheumatoid arthritis presented with multiple lesions. A CT scan revealed a spiculated lung mass, enlarged mediastinal lymph nodes, and hepatic lesions. A whole-body FDG-PET/CT scan revealed heterogeneous hypermetabolic lesions in the lung, liver, and bone. Initial two core needle liver biopsies and a left upper lobe lung wedge resection initially indicated steatohepatitis and granulomatous formation with no evidence of malignancy. Several months later, the patient returned with left-sided flank pain and significant weight loss. CT scan identified a thigh mass, adrenal lesion, and extensive multiple skeletal lesions. A biopsy of the thigh mass revealed an extensively necrotic, epithelioid-to-spindled cell neoplasm with positive staining for pan keratin, focal staining for CD56, and a loss of nuclear expression of SMARCA4. A final diagnosis of SMARCA4-deficient undifferentiated tumor was rendered. Unfortunately, the patient's condition deteriorated, and he died a few weeks after receiving the final diagnosis. SMARCA4-deficient undifferentiated tumors have emerged as recent subjects of medical study, distinguished by their unique morphology and SMARCA4-deficient immunohistochemistry. These tumors present diverse clinical manifestations, affecting multiple organ systems. This report underscores the diagnostic complexities associated with complex clinical presentation and highlights the importance of multidisciplinary collaboration in addressing challenging clinical scenarios, particularly among heavy smoker male patients and intricate radiological presentations.
PubMed: 38899907
DOI: 10.1177/10668969241260215 -
World Journal of Clinical Cases Jun 2024Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor, and also a potential malignant tumor that may develop into a primary malignant giant...
BACKGROUND
Giant cell tumor of bone is a locally aggressive and rarely metastasizing tumor, and also a potential malignant tumor that may develop into a primary malignant giant cell tumor.
AIM
To evaluate the role of multimodal imaging in the diagnosis of giant cell tumors of bone.
METHODS
The data of 32 patients with giant cell tumor of bone confirmed by core-needle biopsy or surgical pathology at our hospital between March 2018 and March 2023 were retrospectively selected. All the patients with giant cell tumors of the bone were examined by X-ray, computed tomography (CT) and magnetic resonance imaging (MRI), and 7 of them were examined by positron emission tomography (PET)-CT.
RESULTS
X-ray imaging can provide overall information on giant cell tumor lesions. CT and MRI can reveal the characteristics of the internal structure of the tumor as well as the adjacent relationships of the tumor, and these methods have unique advantages for diagnosing tumors and determining the scope of surgery. PET-CT can detect small lesions and is highly valuable for identifying benign and malignant tumors to aid in the early diagnosis of metastasis.
CONCLUSION
Multimodal imaging plays an important role in the diagnosis of giant cell tumor of bone and can provide a reference for the treatment of giant cell tumors.
PubMed: 38899310
DOI: 10.12998/wjcc.v12.i16.2722 -
The Annals of Otology, Rhinology, and... Jun 2024Ultrasound (US)-guided procedures can be used in the evaluation and treatment of neck masses. However, these procedures need to be practiced before being executed on...
OBJECTIVES
Ultrasound (US)-guided procedures can be used in the evaluation and treatment of neck masses. However, these procedures need to be practiced before being executed on humans. The aim of this study is to evaluate the efficacy of a training program using a gelatin phantom to practice US-guided procedures.
METHODS
This program included a lecture and practice with a gelatin phantom. We recruited doctors from different hospitals to practice US-guided procedures, including fine-needle aspiration (FNA), core needle biopsy (CNB), percutaneous ethanol injection (PEI), and radiofrequency ablation (RFA). We used a questionnaire with a 5-point scale to evaluate the effectiveness of practicing US-guided procedures under a gelatin phantom.
RESULTS
Forty-four doctors participated, and 37 of them completed the questionnaires. After training, the mean (SD) scores of the doctors were 4.68 (0.47) for "Satisfaction with this course," 4.54 (0.61) for "Ease in practicing FNA&CNB using the phantom," 4.49 (0.61) for "Ease in practicing PEI using the phantom," 4.49 (0.65) for "Ease in practicing RFA using the phantom," and 4.57 (0.55) for "The course effectively familiarizing participants with US-guided procedures." Participants without experience in US examination had higher scores than those with previous US experience, but the difference was not statistically significant.
CONCLUSION
A combination of lectures and hands-on practice of US-guided procedures using a gelatin phantom is an effective educational method for doctors interested in head and neck US. After the training program, doctors gained a better understanding of the necessary steps and skills required for these procedures. They can correctly insert the instruments into the target lesion and perform different US-guided procedures.
PubMed: 38898810
DOI: 10.1177/00034894241262113 -
Cardiovascular and Interventional... Jun 2024The visibility of biopsy needles in contrast-specific imaging mode can be improved by priming them with an ultrasound contrast agent (previously demonstrated in a...
PURPOSE
The visibility of biopsy needles in contrast-specific imaging mode can be improved by priming them with an ultrasound contrast agent (previously demonstrated in a phantom model/ex vivo). The purpose of this study was to validate this priming method in a porcine in vivo model.
MATERIALS AND METHODS
Using a small syringe, full-core biopsy needles were primed with sulfur hexafluoride, an ultrasound contrast agent, with non-primed needles serving as controls (n = 30 + 30). Liver punctures were performed in a porcine model following intravenous administration of the same ultrasound contrast agent. Needle visibility, both in their entirety and at the tips, was evaluated in split-screen mode using contrast-specific imaging and B-mode (low mechanical index). The assessment included quantitative analysis, calculating the contrast-to-noise ratio, and qualitative evaluation through structured grading by three radiologists.
RESULTS
After needle priming, the contrast-to-noise ratio was superior for the needle in its entirety in contrast-specific imaging mode (p < 0.001) and slightly inferior in B-mode (p = 0.008). No differences were observed for the needle tips in either imaging mode. Qualitatively, the needle visibility was deemed clinically superior after needle priming throughout in contrast-specific imaging mode (p < 0.001), whereas no clinically relevant differences in B-mode for either the needle in its entirety (p = 0.11) or the needle tip (p = 1) were observed.
CONCLUSION
In this in vivo porcine liver model experiment, priming biopsy needles with ultrasound contrast agent improved needle visibility in contrast-specific imaging mode but slightly reduced it in B-mode. These findings support the method's use for biopsies requiring target visualization in contrast-specific imaging mode.
PubMed: 38898149
DOI: 10.1007/s00270-024-03758-1 -
Endocrinologia, Diabetes Y Nutricion May 2024It is suggested to wait at least 3 months to repeat a fine needle aspiration cytology (FNAC) to avoid possible inflammatory cytological changes induced by a previous...
INTRODUCTION
It is suggested to wait at least 3 months to repeat a fine needle aspiration cytology (FNAC) to avoid possible inflammatory cytological changes induced by a previous procedure. This study evaluated the influence of the interval between 2 FNACs in a cohort with a previous non-diagnostic (ND) FNAC. We analysed the occurrence of ND or atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) results in the second FNAC, based on the intervals between procedures.
PATIENTS AND METHODS
Retrospective study (2017-2020) including thyroid nodules with a ND result, subjected to another FNAC. Demographic, clinical and echographic data, interval between FNACs and their results were collected. We considered the intervals: ≤/>3 months and ≤/>6 months. Second FNAC results were classified as ND, AUS/FLUS or diagnostic (including the other Bethesda categories).
RESULTS
Included 190 nodules (190 patients - 82.1% women, mean age 60±13.7 years) with a first ND FNAC. The second FNAC results were: ND in 63 cases, AUS/FLUS in 9 and diagnostic in 118 cases. There were no statistical differences in FNAC results performed≤3 months (13 ND, 2 AUS/FLUS, 19 diagnostic) vs >3 months (50 ND, 7 AUS/FLUS, 99 diagnostic; p=0.71). Similarly, there were no statistical differences considering a longer time interval: ≤6 months (32 ND, 3 AUS/FLUS, 59 diagnostic) vs >6 months (31 ND, 6 AUS/FLUS, 59 diagnostic; p=0.61).
CONCLUSIONS
Time interval between FNACs was not relevant to the final cytological result. Early FNAC repetition did not increase the cases of ND or AUS/FLUS.
Topics: Humans; Female; Biopsy, Fine-Needle; Retrospective Studies; Male; Middle Aged; Thyroid Nodule; Time Factors; Aged; Thyroid Gland; Thyroid Neoplasms; Cytology
PubMed: 38897705
DOI: 10.1016/j.endien.2024.03.018 -
The American Journal of Pathology Jun 2024Lung cancer is an increasingly serious health problem worldwide, and early detection and diagnosis are crucial for successful treatment. With the development of...
Lung cancer is an increasingly serious health problem worldwide, and early detection and diagnosis are crucial for successful treatment. With the development of artificial intelligence and the growth of data volume, machine learning techniques can play a significant role in improving the accuracy of early detection in lung cancer. This study proposes a deep learning-based segmentation algorithm for rapid on-site cytopathological evaluation (ROSE) to enhance the diagnostic efficiency of endobronchial ultrasound-guided transbronchial needle aspiration biopsy (EBUS-TBNA) during surgery. By utilizing the CUNet3+ network model, cell clusters, including cancer cell clusters, can be accurately segmented in ROSE-stained pathological sections. The model demonstrated high accuracy, with an F1-score of 0.9604, recall of 0.9609, precision of 0.9654, and accuracy of 0.9834 on the internal testing data set. It also achieved an area under the receiver-operating characteristic curve of 0.9972 for cancer identification. The proposed algorithm provides time savings for on-site diagnosis, improves EBUS-TBNA efficiency, and outperforms classical segmentation algorithms in accurately identifying lung cancer cell clusters in ROSE-stained images. It effectively reduces over-segmentation, decreases network parameters, and enhances computational efficiency, making it suitable for real-time patient evaluation during surgical procedures.
PubMed: 38897537
DOI: 10.1016/j.ajpath.2024.05.011 -
Annals of Surgical Oncology Jun 2024Surgical resection, the only potentially curative treatment for gallbladder cancer (GBC), entails an extended cholecystectomy with portal lymphadenectomy. Lymph node...
BACKGROUND
Surgical resection, the only potentially curative treatment for gallbladder cancer (GBC), entails an extended cholecystectomy with portal lymphadenectomy. Lymph node dissection is a key staging procedure, but its therapeutic value is unclear. Additionally, it is technically challenging and potentially harmful. Methods for better assessment of lymph node status are needed. This report presents a case of indocyanine green (ICG)-guided sentinel lymph node biopsy (SNLB) for a patient with a gallbladder mass suspicious for GBC.
METHODS
An 81-year-old woman consulted for abdominal discomfort. Abdominal ultrasound showed an intraluminal gallbladder mass suspicious for GBC. Staging imaging did not show liver invasion, lymphadenopathy, or distant metastasis. Given the woman's advanced age and limited extent of disease, a laparoscopic extended cholecystectomy with an ICG-guided SLNB was performed. Injection of 1 ml of ICG (0.125 mg/mL) into the gallbladder bed was performed using a 22-gauge needle, avoiding direct injection into the gallbladder wall.
RESULTS
A near-infrared camera was used to visualize real-time ICG flow through the lymphatic vessels of the gallbladder toward the cystic node. Then, a sentinel lymph node posterolateral to the bile duct (station 12b) was identified. The node was resected and sent for permanent section. The procedure continued with an extended cholecystectomy. Pathology showed an intracholecystic papillary neoplasm with high-grade dysplasia. Cystic and sentinel lymph nodes were negative for malignancy.
CONCLUSION
For patients with gallbladder neoplasms, ICG-guided SLNB is a feasible technique that could allow for treatment de-escalation. Further evaluation in clinical trials is needed.
PubMed: 38896224
DOI: 10.1245/s10434-024-15625-x