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International Journal of Surgery Case... Jun 2024Omental torsion is a rare cause of acute abdominal pain caused by twisting of the omentum along its long axis, thus compromising its vascularity. Its presentation is...
INTRODUCTION
Omental torsion is a rare cause of acute abdominal pain caused by twisting of the omentum along its long axis, thus compromising its vascularity. Its presentation is non-specific and can mimic other common pathologies, making its pre-operative diagnosis challenging.
PRESENTATION OF CASE
A 44-year-old female presented for periumbilical abdominal pain. Her laboratory results showed no leukocytosis and CRP was within normal range. CT scan of the abdomen and pelvis with oral and IV contrast showed a well demarcated pericecal mass at the right side, mostly suggestive of transmesenteric internal herniation with strangulation. The patient eventually required laparoscopic surgical intervention.
DISCUSSION
The acute abdominal manifestations in patients with omental torsion are due to the development of edema and necrotic tissue distal of the torsion after the arterial supply and venous drainage have been obstructed. Rotation around the right gastroepiploic artery is considered to be the most common cause of omental torsion. Primary torsion is considered to be idiopathic, while secondary torsion occurs due to an identifiable predisposing pathology such as omental cysts, hernias, adhesions, or intra-abdominal tumors. Since symptoms of omental torsion are non-specific, it is crucial to consider the differential diagnosis and rule out other causes of acute abdomen. Surgical intervention is the mainstay treatment when there is uncertainty in the diagnosis, or when the patient's clinical, radiological, and laboratory findings worsen with conservative treatment.
CONCLUSION
Early surgical intervention in cases of omental torsion reduces the incidence of formation of abscesses, adhesions, and omental necrosis. In cases of non-operative candidates, conservative treatment is the best option; therefore, the choice of treatment of omental torsion should be considered on a case-by-case basis.
PubMed: 38906039
DOI: 10.1016/j.ijscr.2024.109917 -
ArXiv May 2024Multi-parametric MRI (mpMRI) studies are widely available in clinical practice for the diagnosis of various diseases. As the volume of mpMRI exams increases yearly,...
Multi-parametric MRI (mpMRI) studies are widely available in clinical practice for the diagnosis of various diseases. As the volume of mpMRI exams increases yearly, there are concomitant inaccuracies that exist within the DICOM header fields of these exams. This precludes the use of the header information for the arrangement of the different series as part of the radiologist's hanging protocol, and clinician oversight is needed for correction. In this pilot work, we propose an automated framework to classify the type of 8 different series in mpMRI studies. We used 1,363 studies acquired by three Siemens scanners to train a DenseNet-121 model with 5-fold cross-validation. Then, we evaluated the performance of the DenseNet-121 ensemble on a held-out test set of 313 mpMRI studies. Our method achieved an average precision of 96.6%, sensitivity of 96.6%, specificity of 99.6%, and F1 score of 96.6% for the MRI series classification task. To the best of our knowledge, we are the first to develop a method to classify the series type in mpMRI studies acquired at the level of the chest, abdomen, and pelvis. Our method has the capability for robust automation of hanging protocols in modern radiology practice.
PubMed: 38903740
DOI: No ID Found -
Frontiers in Oncology 2024To explore the value of 3D amide proton transfer weighted imaging (APTWI) in the differential diagnosis between benign and malignant bone tumors, and to compare the...
PURPOSE
To explore the value of 3D amide proton transfer weighted imaging (APTWI) in the differential diagnosis between benign and malignant bone tumors, and to compare the diagnostic performance of APTWI with traditional diffusion-weighted imaging (DWI).
MATERIALS AND METHODS
Patients with bone tumors located in the pelvis or lower limbs confirmed by puncture or surgical pathology were collected from January 2021 to July 2023 in the First Affiliated Hospital of Zhengzhou University. All patients underwent APTWI and DWI examinations. The magnetization transfer ratio with asymmetric analysis at the frequency offset of 3.5 ppm [MTRasym(3.5 ppm)] derived by APTWI and the apparent diffusion coefficient (ADC) derived by DWI for the tumors were measured. The Kolmogorou-Smirnou and Levene normality test was used to confirm the normal distribution of imaging parameters; and the independent sample t test was used to compare the differences in MTRasym(3.5 ppm) and ADC between benign and malignant bone tumors. In addition, the receiver operating characteristic (ROC) curve was used to evaluate the diagnostic performance of different imaging parameters in differentiation between benign and malignant bone tumors. P<0.05 means statistically significant.
RESULTS
Among 85 bone tumor patients, 33 were benign and 52 were malignant. The MTRasym(3.5 ppm) values of malignant bone tumors were significantly higher than those of benign tumors, while the ADC values were significantly lower in benign tumors. ROC analysis shows that MTRasym(3.5 ppm) and ADC values perform well in the differential diagnosis of benign and malignant bone tumors, with the area under the ROC curve (AUC) of 0.798 and 0.780, respectively. Combination of MTRasym(3.5 ppm) and ADC values can further improve the diagnostic performance with the AUC of 0.849 (sensitivity = 84.9% and specificity = 73.1%).
CONCLUSION
MTRasym(3.5 ppm) of malignant bone tumors was significantly higher than that of benign bone tumors, reflecting the abnormal increase of protein synthesis in malignant tumors. APTWI combined with DWI can achieve a high diagnostic efficacy in differentiation between benign and malignant bone tumors.
PubMed: 38903728
DOI: 10.3389/fonc.2024.1402628 -
Cureus May 2024Reno alimentary fistula, a rare illness characterized by improper connection between the kidney and digestive tract, can lead to urinary tract infections, abscesses, and...
Reno alimentary fistula, a rare illness characterized by improper connection between the kidney and digestive tract, can lead to urinary tract infections, abscesses, and severe sepsis. It can also be caused by various factors such as chronic infections, malignancy, cryoablation, or abdominal surgical procedures. We present a case of a 60-year-old man with bilateral staghorn stones who was diagnosed with reno-duodenal fistula and underwent a right simple nephrectomy and fistula closure. The histopathology revealed a well-differentiated squamous cell carcinoma that originated from the renal pelvis.
PubMed: 38903351
DOI: 10.7759/cureus.60739 -
PloS One 2024Pelvic Floor Rehabilitation (PFR) is effective in a selection of patients with low anterior resection syndrome (LARS) after rectal cancer surgery. This study aimed to...
BACKGROUND
Pelvic Floor Rehabilitation (PFR) is effective in a selection of patients with low anterior resection syndrome (LARS) after rectal cancer surgery. This study aimed to identify barriers and enablers to prepare for successful implementation into clinical practice.
METHODS
A qualitative study was performed, guided by the Consolidated Framework for Implementation Research (CFIR). Individual interviews (n = 27) and two focus groups were conducted to synthesize the perspectives of rectal cancer patients, pelvic floor (PF) physiotherapists, and medical experts.
RESULTS
Barriers were found to be the absence of guidelines about LARS treatment, underdeveloped network care, suboptimal patient information, and expectation management upfront to PFR. Financial status is frequently a barrier because insurance companies do not always reimburse PFR. Enablers were the current level of evidence for PFR, the positive relationship between patients and PF physiotherapists, and the level of self-motivation by patients.
CONCLUSION
The factors identified in our study play a crucial role in ensuring a successful implementation of PFR after rectal cancer surgery.
Topics: Humans; Rectal Neoplasms; Female; Qualitative Research; Pelvic Floor; Male; Middle Aged; Aged; Focus Groups; Adult
PubMed: 38900764
DOI: 10.1371/journal.pone.0301518 -
World Journal of Clinical Cases Jun 2024While diverticular disease is prevalent in the West, the formation of giant colonic diverticula is rare. To date, approximately 200 cases have been reported, with only a...
BACKGROUND
While diverticular disease is prevalent in the West, the formation of giant colonic diverticula is rare. To date, approximately 200 cases have been reported, with only a handful treated surgically using a minimally invasive approach. Furthermore, the natural history of giant colonic diverticula is not well documented.
CASE SUMMARY
This report describes the case of a 66-year-old man who developed a giant colonic diverticulum with primary symptoms including dull and chronic pain in the right lower quadrant at presentation. The patient had undergone several computed tomography scans of the abdomen and pelvis over the previous two years, through which the natural history of this rare entity could be retrospectively observed. The patient was successfully treated with a robot-assisted sigmoid colectomy and had an uneventful recovery with resolution of symptoms during the follow-up.
CONCLUSION
This rare case demonstrates the natural history of giant colonic diverticulum formation and supports the feasibility of robot-assisted surgery.
PubMed: 38898867
DOI: 10.12998/wjcc.v12.i17.3151 -
Journal of Cellular and Molecular... Jun 2024Exosomes derived from bone marrow-derived mesenchymal stem cells (BMSCs) can alleviate the symptoms of pelvic floor dysfunction (PFD) in rats. However, the potential...
Exosomes derived from bone marrow-derived mesenchymal stem cells (BMSCs) can alleviate the symptoms of pelvic floor dysfunction (PFD) in rats. However, the potential therapeutical effects of exosomes derived from BMSCs treated with tumour necrosis factor (TNF)-α on the symptoms of PFD in rats are unknown. Exosomes extracted from BMSCs treated with or without TNF-α were applied to treat PFD rats. Our findings revealed a significant elevation in interleukin (IL)-6 and TNF-α, and matrix metalloproteinase-2 (MMP2) levels in the vaginal wall tissues of patients with pelvic organ prolapse (POP) compared with the control group. Daily administration of exosomes derived from BMSCs, treated either with or without TNF-α (referred to as Exo and TNF-Exo), resulted in increased void volume and bladder void pressure, along with reduced peak bladder pressure and leak point pressure in PFD rats. Notably, TNF-Exo treatment demonstrated superior efficacy in restoring void volume, bladder void pressure and the mentioned parameters compared with Exo treatment. Importantly, TNF-Exo exhibited greater potency than Exo in restoring the levels of multiple proteins (Elastin, Collagen I, Collagen III, IL-6, TNF-α and MMP2) in the anterior vaginal walls of PFD rats. The application of exosomes derived from TNF-α-treated BMSCs holds promise as a novel therapeutic approach for treating PFD.
Topics: Animals; Exosomes; Mesenchymal Stem Cells; Female; Tumor Necrosis Factor-alpha; Rats; Humans; Pelvic Organ Prolapse; Matrix Metalloproteinase 2; Rats, Sprague-Dawley; Interleukin-6; Pelvic Floor; Disease Models, Animal; Bone Marrow Cells; Vagina; Mesenchymal Stem Cell Transplantation; Pelvic Floor Disorders; Middle Aged
PubMed: 38898783
DOI: 10.1111/jcmm.18451 -
Arquivos Brasileiros de Cirurgia... 2024Lower urinary tract abnormalities are directly implicated in the etiology of renal dysfunction in 6 to 24% of dialytic patients. These patients require bladder capacity... (Review)
Review
Lower urinary tract abnormalities are directly implicated in the etiology of renal dysfunction in 6 to 24% of dialytic patients. These patients require bladder capacity and compliance readjustment before being considered viable candidates for renal transplantation. Vesical augmentation surgeries often involve the use of intestinal segments. Although these procedures can effectively restore bladder capacity and compliance, they present various issues related to maintaining mucous absorption and secretion capacity. Acidosis, recurrent urinary tract infections, and stone formation are extremely common, leading to frequent hospitalizations and graft function loss. Urinary tissue is certainly ideal for these reconstructions; however, bladder augmentation using ureter and renal pelvis are feasible only in a minority of cases. Experimental studies have been conducted to establish the groundwork for vascularized bladder transplantation. Last year, for the first time, this procedure was performed on a brain-dead patient. During this intervention, cystectomy was performed with preservation the vascular pedicle, followed by organ reimplantation. The graft remained viable for a period of 12 hours post-transplant. However, this intervention utilized a robotic platform, making it less reproducible in a multi-organ procurement setting as well as for most transplant centers. Moreover, it is debatable whether the benefits of exclusive bladder transplantation outweigh the risks associated with immunosuppression. For patients needing renal transplantation and requiring lower urinary tract reconstruction, however, utilizing the donor's bladder may offer an attractive alternative, avoiding the inherent complications of enterocystoplasty without increasing immunological risk. Combined kidney and bladder transplantation has the potential to emerge as the next frontier in abdominal organ transplants.
Topics: Humans; Urinary Bladder; Kidney Transplantation; Organ Transplantation
PubMed: 38896703
DOI: 10.1590/0102-6720202400015e1808 -
Cureus May 2024Uterine leiomyomas (ULs) are common benign tumors seen in a large percent of women that can be classified based on their location within the uterus. They can cause a...
Uterine leiomyomas (ULs) are common benign tumors seen in a large percent of women that can be classified based on their location within the uterus. They can cause a number of pelvic complications and can be managed medically, but more often surgically. Uterine pyomyomas often occur postpartum, possibly from infarction, and can lead to degeneration and sepsis. Our patient presents with a two-month development of a potential pyomyoma, found initially on computed tomography (CT). Office exam reveals a protruding mass from the cervical os, and removal was attempted but ultimately postponed for general anesthesia exam due to pain. The leiomyoma was removed and shown to be necrosing. Pyomyomas are often insidious and can often mimic other concerning pathologies. Modern imaging can show lesions within the pelvis but struggle to determine between fluid collection and possible infarcted masses. The importance of quality care measures in cases like this deserve to be emphasized to prevent serious complications.
PubMed: 38894786
DOI: 10.7759/cureus.60622 -
Cureus May 2024Primary squamous cell carcinoma (SCC) of the renal pelvis is one of the extremely rare tumors encountered in the kidney. It poses a diagnostic challenge for both the...
Primary squamous cell carcinoma (SCC) of the renal pelvis is one of the extremely rare tumors encountered in the kidney. It poses a diagnostic challenge for both the clinician and pathologist alike due to the sheer rarity of its occurrence and the multitude nature of its clinical presentation. A review of the literature over the last few decades shows just a countable number of cases documented, each bearing the testimony of the aggressive nature of this subtype. We hereby report three cases of SCC of the renal pelvis origin received at a tertiary care hospital in North India.
PubMed: 38894774
DOI: 10.7759/cureus.60568