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Cureus May 2024We present a case report of a giant solitary fibrous tumor (SFT) with a review of the literature and discuss its biological features and diagnosis. A 43-year-old man...
We present a case report of a giant solitary fibrous tumor (SFT) with a review of the literature and discuss its biological features and diagnosis. A 43-year-old man presented to our emergency department with abdominal pain and distension with an evolution of two days. Contrast-enhanced computed tomography (CT) showed a large, well-circumscribed semisolid mass (12 cm x 10 cm x 12 cm) localized in the pancreatic head. The histological diagnosis obtained by endoscopic ultrasound-guided trans-duodenal tumor biopsy with fine-needle aspiration showed proliferating short spindle-shaped cells, suggesting a mesenchymal neoplasia of low grade. We proceeded to a Whipple surgical technique. The histopathological study of the resected tumor confirmed proliferating spindle-shaped cells in the tissue, and one mitotic figure was observed in 10 high-power fields (HPFs). Immunostaining was positive for CD34 and STAT-6. The histological diagnosis was a malignant pancreatic SFT. In the six months posterior to the surgical procedure, the patient has been free of recurrent disease. Preoperative diagnosis is difficult and requires comprehensive evidence including clinical, immunohistochemistry, and histological features. Since there are currently no recognized best practices, we advise total surgical excision and careful clinical monitoring.
PubMed: 38953073
DOI: 10.7759/cureus.61467 -
Cureus May 2024Tuberculosis is a disease with presentations both in the lungs and at other extrapulmonary sites. While pulmonary tuberculosis constitutes a significant proportion of...
Tuberculosis of the Cervical Vertebrae With Retropharyngeal and Parapharyngeal Abscesses Due to Staphylococcus aureus and Mycobacterium tuberculosis in an Adult: A Report of a Rare Case.
Tuberculosis is a disease with presentations both in the lungs and at other extrapulmonary sites. While pulmonary tuberculosis constitutes a significant proportion of total tuberculosis cases, extrapulmonary cases with infections at rare sites are also documented. Herein, an exceedingly rare case of tuberculosis of the cervical vertebrae with retropharyngeal and parapharyngeal abscesses due to and in a young Indian male is presented. The rarity of the locations of the lesions with coinfections with two bacteria made the diagnosis challenging. Besides, the potential for a retropharyngeal abscess to compress the airway is an emergency situation. However, the ultimate diagnosis was achieved with the help of a radiograph of the neck, contrast-enhanced computed tomography of the neck, fine-needle aspiration cytology, and a cartridge-based nucleic acid amplification test. He was initiated on appropriate antibiotics and antituberculous chemotherapy per his weight.
PubMed: 38953070
DOI: 10.7759/cureus.61412 -
Cureus Jun 2024Venous air embolism (VAE) represents a rare yet potentially life-threatening complication encountered during neurosurgical procedures, particularly craniotomy. Here, we...
Venous air embolism (VAE) represents a rare yet potentially life-threatening complication encountered during neurosurgical procedures, particularly craniotomy. Here, we present a case of a 30-year-old male undergoing excision of a cerebellar abscess who developed VAE midway through the procedure. Immediate recognition and intervention were paramount in managing the embolism effectively, ensuring a favorable surgical outcome. Vigilant monitoring, prompt cessation of the procedure, and implementation of preventive measures such as oxygen therapy and venous air aspiration were pivotal in mitigating the embolism's effects. This study underscores the critical importance of intraoperative vigilance, preparedness, and multidisciplinary teamwork in addressing rare but potentially catastrophic complications during neurosurgical interventions.
PubMed: 38952595
DOI: 10.7759/cureus.61484 -
Pakistan Journal of Medical Sciences Jul 2024Congenital vallecular cyst is one of the rare etiologies of upper airway obstruction. Due to the scarcity of literature review, the exact incidence is not known. We...
Congenital vallecular cyst is one of the rare etiologies of upper airway obstruction. Due to the scarcity of literature review, the exact incidence is not known. We report the case of a 10-month-old infant, who came to to Aga Khan University Hospital (AKUH) for the first time with signs of upper airway obstruction; was initially misdiagnosed as foreign body aspiration for which an emergency bronchoscopy was performed that did not reveal any foreign body. The patient was then managed in the pediatric intensive care unit, where he was diagnosed as a congenital vallecular cyst on a subsequent laryngoscopy after extubation failure. The cyst was aspirated and cauterized by the ENT team. The patient was successfully extubated without any signs of upper airway obstruction. In evaluating a child with signs and symptoms of upper airway obstruction, it is crucial to consider not only common causes like foreign body, acute epiglottitis, and croup, but also rare factors such as laryngeal cysts.
PubMed: 38952529
DOI: 10.12669/pjms.40.6.9433 -
Archives of Pathology & Laboratory... Jul 2024Unlike parotid fine-needle aspiration biopsy, standardized reporting for core needle biopsy (CNB) and incisional biopsy (IB) is not established.
Performance Characteristics of Incisional and Core Needle Biopsies for Diagnosis in Parotid Gland: Single-Institutional Experience and Assessment of the Value of a Milan System for Reporting Salivary Gland Cytopathology-Like Risk Stratification Model.
CONTEXT.—
Unlike parotid fine-needle aspiration biopsy, standardized reporting for core needle biopsy (CNB) and incisional biopsy (IB) is not established.
OBJECTIVE.—
To examine the value of risk stratification by a Milan System for Reporting Salivary Gland Cytopathology (MSRSGC)-like classifier for parotid CNB/IB.
DESIGN.—
Five hundred ninety-two parotid biopsy records (CNB = 356, IB = 236) were retrieved (1994-2022) along with clinicopathologic data. Diagnoses were transformed to an MSRSGC-like classifier and compared with end points including risk of malignancy.
RESULTS.—
Over time, CNB was progressively more used compared with IB. Overall malignancy call rate was 223 of 592 (37.7%). Common specific diagnoses included Warthin tumor, lymphoma subtypes, and metastatic squamous cell carcinoma for CNB and IB, in addition to pleomorphic adenoma for CNB. Descriptive diagnoses were still frequent. Nondiagnostic rates were higher in CNB (26 of 356; 7.30%) than IB (5 of 236; 2.12%; P <.001). Tissue volumes significantly influenced CNB adequacy, with minimum and optimal volumes of 4.76 mm³ (J index, receiver operating characteristic curve) and 12.92 mm³ (95th percentile of distribution), respectively. One hundred forty-four patients (112 CNBs) had follow-up resections; diagnoses were concordant for 66 of 73 adequate CNBs (90.41%). Our restructured risk grouping of MSRSGC categories performed robustly in terms of risk of malignancy (sensitivity = 85.5%, specificity = 100%, accuracy = 92.3%, area under the curve = 0.9677).
CONCLUSIONS.—
Although CNB and IB are amenable to a risk stratification system, there are some differences as compared with fine-needle aspiration biopsy, particularly given the high baseline prevalence of malignancy. Specific diagnoses are often feasible and concordant with resection. CNB tissue volume can inform optimal and minimal sampling recommendations for adequacy.
PubMed: 38952287
DOI: 10.5858/arpa.2024-0051-OA -
International Journal of Retina and... Jul 2024To report the results of using autologous Tenon patch grafts for managing giant full-thickness macular holes (FTMHs) when other alternatives are not applicable.
PURPOSE
To report the results of using autologous Tenon patch grafts for managing giant full-thickness macular holes (FTMHs) when other alternatives are not applicable.
METHODS
The same surgical technique was performed in all three cases. Briefly, a small fragment of Tenon's tissue was collected. The graft was introduced through a 23G trocar and released over the macular hole under a bubble of PFCL. The patch is delicately pushed towards the edges of the hole to slide underneath. The PFCL bubble is then actively aspirated next to the optic disc. Tamponade with gas or silicone oil is subsequently injected, with care taken to minimize fluid turbulence during the procedure.
RESULTS
The outcomes of autologous Tenon patch grafts in three giant FTMHs are reported. In the first case, silicone oil tamponade was injected, in the second, C2F6 gas was injected. And in the third case, that of a woman with advanced glaucoma, no tamponade was left in the eye. No adverse effects were observed during or after the procedures. Closure of the macular hole and functional improvement were documented during the follow-up period in all three cases.
CONCLUSION
With a follow-up of up to 6 months, the Tenon patch graft appeared to be a promising technique for managing complex cases of FTMH. Additional studies to investigate long-term outcomes and determine the most appropriate indications are warranted.
PubMed: 38951931
DOI: 10.1186/s40942-024-00561-5 -
Nature Communications Jun 2024The microgeometry of the cellular microenvironment profoundly impacts cellular behaviors, yet the link between it and the ubiquitously expressed mechanosensitive ion...
The microgeometry of the cellular microenvironment profoundly impacts cellular behaviors, yet the link between it and the ubiquitously expressed mechanosensitive ion channel PIEZO1 remains unclear. Herein, we describe a fluorescent micropipette aspiration assay that allows for simultaneous visualization of intracellular calcium dynamics and cytoskeletal architecture in real-time, under varied micropipette geometries. By integrating elastic shell finite element analysis with fluorescent lifetime imaging microscopy and employing PIEZO1-specific transgenic red blood cells and HEK cell lines, we demonstrate a direct correlation between the microscale geometry of aspiration and PIEZO1-mediated calcium signaling. We reveal that increased micropipette tip angles and physical constrictions lead to a significant reorganization of F-actin, accumulation at the aspirated cell neck, and subsequently amplify the tension stress at the dome of the cell to induce more PIEZO1's activity. Disruption of the F-actin network or inhibition of its mobility leads to a notable decline in PIEZO1 mediated calcium influx, underscoring its critical role in cellular mechanosensing amidst geometrical constraints.
Topics: Humans; Ion Channels; Mechanotransduction, Cellular; Actins; HEK293 Cells; Cytoskeleton; Calcium; Calcium Signaling; Finite Element Analysis; Animals; Microscopy, Fluorescence
PubMed: 38951553
DOI: 10.1038/s41467-024-49833-6 -
Dysphagia Jun 2024Around 80% of persons with Parkinson's disease (PD) present symptoms of dysphagia. Although cognitive impairment may contribute to dysphagia, few studies have...
Around 80% of persons with Parkinson's disease (PD) present symptoms of dysphagia. Although cognitive impairment may contribute to dysphagia, few studies have investigated the association between the PD neuropsychological profile and objective measures of swallowing dysfunction. Since the swallowing function comprises involuntary but also voluntary actions, we hypothesize that specific measures of attention and executive functions can be underlined in PD-related dysphagia. Therefore, the aim of this study was to extensively investigate the correlation and the relationship between attentive and executive functions and safety/efficiency of pharyngeal phase of swallowing in people with PD. All participants received a fiberoptic endoscopic evaluation of swallowing and were evaluated using the Penetration Aspiration Scale (PAS); the Yale Pharyngeal Residue Severity Rating Scale (IT-YPRSRS), and the Functional Oral Intake Scale (FOIS-IT). Participants also underwent a neuropsychological assessment covering global cognitive status, attention, and frontal executive functions. Correlations and associations between neuropsychological measures and swallowing components were calculated. Twenty-one participants with PD (mean age 69.38 ± 6.58 years, mean disease duration 8.38 ± 5.31 years; mean MDS-UPDRS III 43.95 ± 24.18) completed all evaluations. The most significant correlations were found between attentive functions (i.e., Stroop Time), and executive functions (i.e., Raven's Progressive Matrices, Digit Backward and Semantic Fluency), and FOIS-IT, PAS, and IT-YPRSRS sinuses and valleculae. These associations were not influenced by disease duration. These results suggest that a dysfunction to attentional processes and/or to executive functions can contribute to penetration and the presence of pharyngeal residue in participants with middle-stage PD.
PubMed: 38951235
DOI: 10.1007/s00455-024-10728-9 -
Journal of Vascular and Interventional... Jun 2024Although filtered blood reinfusion (FBR) can be implemented during aspiration thrombectomy for pulmonary embolism (PE), the effectiveness and risks of this technique...
OBJECTIVES
Although filtered blood reinfusion (FBR) can be implemented during aspiration thrombectomy for pulmonary embolism (PE), the effectiveness and risks of this technique remain unknown. The purpose of this study was to assess how utilization of FBR affects procedural outcomes.
MATERIALS AND METHODS
A total of 171 patients who underwent aspiration thrombectomy for intermediate-high or high risk PE between December 2018 and September 2022 were included, 84 of whom underwent thrombectomy with FBR and 87 without. Demographic data, vital signs, laboratory values, procedural details, pulmonary arterial pressures, transfusion needs, length of hospital stay, and procedure-related complications were recorded.
RESULTS
The groups did not differ at baseline, other than the FBR cohort having a higher percentage of females. There was no significant difference in post-procedural vitals or pulmonary arterial pressure. Mean fluoroscopy time and volume of IV contrast were lower in the FBR cohort. The drop in hemoglobin was lower in the FBR group at both 12 (FBR: -1.065; no FBR: -1.742, P: >0.001) and 24 hrs (FBR: -1.526; no FBR: -2.380, P: >0.001) post procedure; accordingly, fewer patients required transfusions in the FRB cohort (FBR: 8; no FBR: 20, P: 0.016). There was no difference in the number or severity of adverse events or duration of Intensive Care Unit or hospital admission.
CONCLUSIONS
FBR use during aspiration pulmonary thrombectomy reduces blood loss and transfusion requirements but has no significant effect on surrogate markers of procedural success or adverse event rates.
PubMed: 38950819
DOI: 10.1016/j.jvir.2024.06.026 -
PloS One 2024Although the overall burden of malaria is decreasing in Ethiopia, a recent report of an unpredictable increased incidence may be related to the presence of...
Although the overall burden of malaria is decreasing in Ethiopia, a recent report of an unpredictable increased incidence may be related to the presence of community-wide gametocyte-carrier individuals and a high proportion of infected vectors. This study aimed to reveal the current prevalence of gametocyte-carriage and the sporozoite infectivity rate of Anopheles vectors for Plasmodium parasites. A community-based cross-sectional study was conducted from May 01 to June 30/2019. A total of 53 households were selected using systematic random sampling and a 242 study participants were recruited. Additionally,515 adult female Anopheles mosquitoes were collected using Center for Diseases Control and Prevention (CDC) light traps and mouth aspirators. Parasite gametocytemia was determined using giemsa stain microscopy, while sporozoite infection was determined by giemsa staining microscopy and enzyme linked immunosorbent assay (ELISA). Among the total 242 study participants, 5.4% (95%, CI = 2.9-8.3) of them were positive for any of the Plasmodium species gametocyte. Furthermore, being female [AOR = 15.5(95%, CI = 1.71-140.39)], age group between 15-29 years old [AOR = 16.914 (95%, CI = 1.781-160.63)], no ITNs utilization [AOR = 16.7(95%, CI = 1.902 -146.727)], and high asexual parasite density [(95%, CI = 0.057-0.176, P = 0.001, F = 18.402)] were identified as statistically significant factors for gametocyte carriage. Whereas sporozoite infection rate was 11.6% (95%, CI = 8.2-15.5) and 12.7% (95%, CI = 9.6-16.3) by microscopy and ELISA, respectively. Overall, this study indicated that malaria remains to be an important public health problem in Gondar Zuria district where high gametocyte carriage rate and sporozoite infection rate could sustain its transmission and burden. Therefore, in Ethiopia, where malaria elimination program is underway, frequent, and active community-based surveillance of gametocytemia and sporozoite infection rate is important.
Topics: Animals; Ethiopia; Humans; Anopheles; Female; Adult; Sporozoites; Adolescent; Young Adult; Male; Cross-Sectional Studies; Mosquito Vectors; Child; Child, Preschool; Malaria; Middle Aged; Plasmodium; Infant; Plasmodium falciparum; Prevalence
PubMed: 38950022
DOI: 10.1371/journal.pone.0306289