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Journal of Clinical Medicine May 2021Presence of severe tricuspid regurgitation (TR) has a significant impact on assessment of right ventricular function (RVF) in transthoracic echocardiography (TTE). High...
BACKGROUND
Presence of severe tricuspid regurgitation (TR) has a significant impact on assessment of right ventricular function (RVF) in transthoracic echocardiography (TTE). High trans-valvular pendulous volume leads to backward-unloading of the right ventricle. Consequently, established cut-offs for normal systolic performance may overestimate true systolic RVF.
METHODS
A retrospective analysis was performed entailing all patients who underwent TTE at our institution between 1 January 2013 and 31 December 2016. Only patients with normal left ventricular systolic function and with no other valvular lesion were included. All recorded loops were re-read by one experienced examiner. Patients without severe TR (defined as vena contracta width ≥7 mm) were excluded. All-cause 2-year mortality was chosen as the end-point. The prognostic value of several RVF parameters was tested.
RESULTS
The final cohort consisted of 220 patients, 88/220 (40%) were male. Median age was 69 years (IQR 52-79), all-cause two-year mortality was 29%, median TAPSE was 19 mm (15-22) and median FAC was 42% (30-52). In multivariate analysis, TAPSE with the cutoff 17 mm and FAC with the cutoff 35% revealed non-significant hazard ratios (HR) of 0.75 (95%CI 0.396-1.421, = 0.38) and 0.845 (95%CI 0.383-1.867, = 0.68), respectively. TAPSE with the cutoff 19 mm and visual eyeballing significantly predicted survival with HRs of 0.512 (95%CI 0.296-0.886, = 0.017) and 1.631 (95%CI 1.101-2.416, = 0.015), respectively.
CONCLUSIONS
This large-scale all-comer study confirms that RVF is one of the main drivers of mortality in patients with severe isolated TR. However, the current cut-offs for established echocardiographic parameters did not predict survival. Further studies should investigate the prognostic value of higher thresholds for RVF parameters in these patients.
PubMed: 34073744
DOI: 10.3390/jcm10112266 -
The Journal of Veterinary Medical... Jul 2021A 12-year-old, 3.5-kg, intact female dog was presented with polyuria, polydipsia, and a pendulous abdomen. Laboratory examinations showed elevated hepatobiliary enzyme...
A 12-year-old, 3.5-kg, intact female dog was presented with polyuria, polydipsia, and a pendulous abdomen. Laboratory examinations showed elevated hepatobiliary enzyme levels and neutrophilic leukocytosis. The adrenocorticotropic hormone stimulation test confirmed hyperadrenocorticism (HAC). Trilostane therapy managed the clinical condition and cortisol concentration. However, lymphocytosis and nonregenerative anemia developed after HAC remission. Bone marrow aspiration analysis revealed a lymphoproliferative disorder with a clonal T-cell population. Accordingly, the patient was diagnosed with T-cell chronic lymphocytic leukemia (CLL) and concurrent HAC. Thereafter, chemotherapy was initiated, which improved the lymphocytosis. However, euthanasia was performed because of worsening quality of life at 45 weeks after the first presentation. These results suggested that CLL could be masked by excessive endogenous cortisol and discovered after HAC remission.
Topics: Adrenocortical Hyperfunction; Animals; Dog Diseases; Dogs; Female; Leukemia, Lymphocytic, Chronic, B-Cell; Pituitary ACTH Hypersecretion; Pregnancy; Quality of Life
PubMed: 34039785
DOI: 10.1292/jvms.21-0018 -
Translational Andrology and Urology Mar 2021To present our experience of transposing the penis to the perineum, with penile-prostatic anastomotic urethroplasty, for the treatment of complex bulbo-membranous...
BACKGROUND
To present our experience of transposing the penis to the perineum, with penile-prostatic anastomotic urethroplasty, for the treatment of complex bulbo-membranous urethral strictures.
METHODS
Between January 2002 and December 2018, 20 patients with long segment urethral strictures (mean 8.6 cm, range 7.5 to 11 cm) and scarred perineoscrotal skin underwent a procedure of transposition of the penis to the perineum and the penile urethra was anastomosed to the prostatic urethra. Before admission 20 patients had unsuccessful repairs (mean 4.5, range 2 to 12); five patients were associated urethrorectal fistula; 16 patients reported severe penile erectile dysfunction (PED) or no penile erectile at any time and four reported partial erections.
RESULTS
The mean follow-up period was 45.9 (range 12 to 131) months. Nineteen patients could void normally with a mean Qmax of 22.48 (range 15.6 to 31.4) mL/s. One patient developed postoperative urethral stenosis. After 1 to 10 years of the procedure, nine patients underwent the second procedure. Of the nine patients, four underwent straightening the penis and one-stage anterior urethral reconstruction using a penile circular fasciocutaneous skin flap, and five underwent straightening the penis and staged Johanson urethroplasty. Seven patients could void normally, one developed urethrocutaneous fistula and one developed urethral stenosis.
CONCLUSIONS
Transposition of the penis to the perineum with pendulous-prostatic anastomotic urethroplasty may be considered as a salvage option for patients with complex long segment posterior urethral strictures.
PubMed: 33850738
DOI: 10.21037/tau-20-1024 -
Journal of Applied Clinical Medical... Apr 2021Due to the limited height of commercial prone breast boards, large or pendulous breasts may contact the base layer of the board during simulation and throughout the...
Due to the limited height of commercial prone breast boards, large or pendulous breasts may contact the base layer of the board during simulation and throughout the course of treatment. Our clinic has historically identified and marked this region of contact to ensure reproducible setup. However, this situation may result in unwanted hotspots where the breast rests atop the board due to electron scatter. In this study, we performed in-vivo dosimetric measurements to evaluate the surface dose in regions of contact with the immobilization device. The average dose and hotspot were identified and evaluated to determine whether plan modifications were necessary to avoid excess skin toxicity at the skin/breast board interface. The film method results were validated against a commissioned in vivo OSLD dosimetry system. Radiochromic film measurements agreed with OSLD readings (n = 18) overall within 1%, σ = 6.4%, with one deviation of >10%. Pertinent information for the physician includes the average, maximum, and minimum doses received at the film interface. Future readings will not require OSLD verification. Physicians now have access to additional spatial data to correlate skin toxicity with doses delivered at the skin/breast board interface. This new technique is now an established procedure at our clinic, and can inform future efforts to model enhanced methods to calculate the dosimetric effects from the prone breast board in the treatment planning system.
Topics: Breast; Breast Neoplasms; Computer Simulation; Female; Humans; Radiometry; Radiotherapy Dosage; Radiotherapy Planning, Computer-Assisted; Skin
PubMed: 33760370
DOI: 10.1002/acm2.13229 -
Revista Espanola de Patologia :... 2021Genital filariasis is an uncommon infectious entity in the western world. It has characteristic clinical features and a well-recognized endemic area that causes typical...
Genital filariasis is an uncommon infectious entity in the western world. It has characteristic clinical features and a well-recognized endemic area that causes typical histological alterations. We report a case of a 32-year-old woman, a native of Mozambique, who presented with vulvar elephantiasis as a pendulous tumor with a maximum diameter of 15cm. A large part of the genital mass was resected. Microscopically, hyperkeratosis with irregular acanthosis, a notable thickening of dermis with dense fibrosis and inflammatory clusters of patchy distribution, mostly made up of plasma cells, was seen. Since the parasite was not observed, an exclusion diagnosis was made, as frequently happens with this lesion.
Topics: Adult; Elephantiasis, Filarial; Female; Humans; Photography; Vulva; Vulvar Diseases
PubMed: 33726892
DOI: 10.1016/j.patol.2019.10.002 -
Advances in Radiation Oncology 2021This study aimed to compare thermoplastic mask with bra in terms of setup reproducibility and immobilization of pendulous breasts during radiation therapy (RT).
Comparing Accuracy of Thermoplastic Mask versus Commercial Bra for the Immobilization of Pendulous Breast During Radiation Therapy Treatment: A Retrospective Cohort Study.
PURPOSE
This study aimed to compare thermoplastic mask with bra in terms of setup reproducibility and immobilization of pendulous breasts during radiation therapy (RT).
METHODS AND MATERIALS
Forty-two female patients with breast cancer treated with either intensity modulated RT or 3-dimensional conformal RT were retrospectively reviewed. Of these, 21 benefited from thermoplastic mask immobilization and 21 used a bra. Setup accuracy was evaluated using consecutive cone beam computed tomography/electronic portal imaging device sessions over the first 3 days before treatment (systematic setting), followed by weekly cone beam computed tomography/electronic portal imaging device (random settings), and compared with the reference image to calculate the corresponding translational shift (setup error) in the 3 planes. Average absolute shift values in both systematic and random settings were compared between the 2 groups. Accuracy was analyzed by comparing the percentage of pooled settings within ±0.05 and ±0.1 cm of the reference image.
RESULTS
Compared with a bra, use of the mask was associated with a smaller longitudinal shift in systematic settings (difference in mean: 0.27 cm; = .027; Mann-Whitney test) and a lesser lateral shift in random setting (difference in mean: 0.19 cm; = .005; Mann-Whitney test). In the pooled systematic settings, the mask performed relatively better than the bra in the lateral and longitudinal planes, with no statistical significance. In pooled random settings, mask showed greater accuracy than bra in the lateral plane with 86.0% versus 58.9% accuracy at ±0.5 cm ( < .001) and 48.8% versus 21.7% accuracy at ±0.1 cm ( < .001), respectively. There was no significant difference in the incidence of radiodermatitis between the 2 groups. However, a hypofractionation regimen was associated with a lower incidence of radiodermatitis, and the severity of skin reactions was positively correlated with treatment dose (unstandardized regression coefficient: B = .001; correlation coefficient: = .571; < .001).
CONCLUSIONS
Masks provide superior reproducibility compared with commercially available bras.
PubMed: 33665487
DOI: 10.1016/j.adro.2020.09.025 -
Heliyon Feb 2021Camelpox is a wide-spread infectious viral disease of camelids. An outbreak of camelpox was reported in 15 adult male dromedary camels aged between 10 to 16 years of an...
Camelpox is a wide-spread infectious viral disease of camelids. An outbreak of camelpox was reported in 15 adult male dromedary camels aged between 10 to 16 years of an organized herd in winter season. The infected camels showed clinical signs of fever, anorexia, lachrymation, pendulous lips, excessive salivation and pock lesions on the skin of head, neck, mouth, lips, extremities, thigh, abdomen, scrotum and inguinal region. Mortalities were recorded in three infected camels after 10-12 days of infection and showed systemic pox lesions characterized by vesicles, papules, ulcerations and raised pock lesions in the mucous membranes of the mouth, tongue, tracheal mucosa, lung, abomasum and liver. Histopathology study revealed characteristic pox lesions with intracytoplasmic eosinophilic inclusion bodies in tongue. Lung showed lesion of interstitial pneumonia ( 2) and bronchointerstitial pneumonia ( 1). Liver showed infiltration of mononuclear cells around central veins and degenerative changes of hepatocytes. The abomasum and intestine showed ulcerations, marked capillary congestion and areas of lymphocyte infiltration in mucosa and submucosa. The presence of camelpox virus (CMLV) was confirmed in viral DNA isolated from formalin fixed paraffin embedded (FFPE) tissues of tongue, lung, abomasum, liver, heart and intestine of infected camels by gene PCR. The sequencing of viral DNAs showed phylogenetic relatedness with other CMLV isolates from India and other countries. Thus, our study confirmed the rare severe form of systemic camelpox outbreak in adult male dromedary camels hence future attention should be given for studies on virulence, strain identification and molecular epidemiology of CMLV for planning of effective preventive and control strategies.
PubMed: 33598582
DOI: 10.1016/j.heliyon.2021.e06186 -
Aesthetic Plastic Surgery Jun 2021Breast ptosis is one of the most common complaints in the clinical setting. Simultaneous mastopexy via areola excision involves a reliable modified aesthetic technique...
BACKGROUND
Breast ptosis is one of the most common complaints in the clinical setting. Simultaneous mastopexy via areola excision involves a reliable modified aesthetic technique with distinctive features to correct mild and moderate pendulous breasts. The aim of this study is to determine whether the novel surgical approach is a safe and long-lasting technique for patients with breast ptosis.
METHODS
We performed a retrospective study of 48 patients who received simultaneous mastopexy through circumareolar excision and followed up for 12 months. Breast size, shape, fullness, symmetry, scar appearance, and sensitivity of nipple-areolar complex were evaluated.
RESULTS
Patients were satisfied with upper pole fullness, symmetry and scar less appearance. There were no cases of NAC deformity or sensation loss, neither sever capsular contracture was observed.
CONCLUSION
The new surgical technique, one-stage periareolar augmentation mastopexy, is a reliable and long-lasting operation for patients with mild and moderate breast ptosis.
LEVEL OF EVIDENCE IV
This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Topics: Breast; Esthetics; Humans; Mammaplasty; Nipples; Retrospective Studies; Surgical Flaps; Treatment Outcome
PubMed: 33219388
DOI: 10.1007/s00266-020-02049-7 -
Surgical Endoscopy Dec 2021The morphology of the major papilla affects the difficulty of endoscopic retrograde cholangiopancreatography (ERCP), but no associations with adverse events have...
BACKGROUND
The morphology of the major papilla affects the difficulty of endoscopic retrograde cholangiopancreatography (ERCP), but no associations with adverse events have previously been established. We aimed to assess whether papillary morphology predicts ERCP adverse events.
METHODS
A retrospective analysis was performed of a prospective registry of patients undergoing ERCP for biliary indications. The primary outcome was post-ERCP pancreatitis (PEP), with secondary outcomes including other adverse events and procedural outcomes such as inadvertent pancreatic duct cannulation, cannulation time, and attempts. Papillae were classified as normal (Type I), small or flat (Type II), bulging (Type IIIa), pendulous (Type IIIb), creased (Type IV), or peri-diverticular (Type D). Outcomes were ascertained prospectively at 30 days from index procedures.
RESULTS
A total of 637 patients with native papillae were included. Compared to Type I papillae, Type II and Type IIIb papillae were associated with PEP, with adjusted odds ratios (AOR) of 7.28 (95% confidence intervals, CI, 1.84-28.74) and 4.25 (95% CI 1.26-14.32), respectively. Type II and IIIb papillae were associated with significantly longer cannulation times by 5.37 (95% CI 2.39-8.35) and 4.01 (95% CI 1.72-6.30) minutes, respectively. Type IIIb papillae were associated with lower deep cannulation success (AOR 0.17, 95% CI 0.06-0.48).
CONCLUSION
Papillary morphology is an important factor influencing both ERCP success and outcomes. Understanding this is key for managing intraprocedural approaches and minimizing adverse events.
PROSPECTIVE REGISTRY REGISTRATION
Clinicaltrials.gov identifier NCT04259580.
Topics: Ampulla of Vater; Catheterization; Cholangiopancreatography, Endoscopic Retrograde; Humans; Retrospective Studies; Sphincterotomy, Endoscopic
PubMed: 33146812
DOI: 10.1007/s00464-020-08136-9 -
BMC Gastroenterology Sep 2020We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde... (Observational Study)
Observational Study
BACKGROUND
We investigated whether duodenal major papilla morphology could be a risk factor for failure of selective biliary cannulation (SBC) and post endoscopic retrograde cholangiography and pancreatography (ERCP) complications.
METHODS
A prospectively recorded database was reviewed retrospectively. Patients were included if they received therapeutic ERCP and had naïve major duodenal papilla. We used Haraldsson's classification for papilla morphology, as follows: Regular (Type 1), Small (Type 2), Protruding or Pendulous (Type 3) and Creased or Ridged (Type 4). Risk factors for failing SBC and post-ERCP complications were analyzed by multivariate analysis.
RESULTS
A total of 286 cases were included. Age, gender, indications and therapeutic procedures were not different among the four types of papillae. The failure rates of SBC with Type 3 papilla and Type 4 papilla were 11.11% and 6.25%, respectively. In the multivariate analysis, Type 2 papilla (odd ratio 7.18, p = 0.045) and Type 3 papilla (odd ratio 7.44, p = 0.016) were associated with greater SBC failure compared with Type 1 papilla. Malignant obstruction compared to stone (odds ratio 4.45, p = 0.014) and age (odd ratio = 1.06, p = 0.010) were also risk factors for cannulation failure. Type 2 papilla was correlated with a higher rate of post-ERCP pancreatitis (20%, p = 0.020) compared to the other types of papilla However, papilla morphology was not a significant risk factor for any complications in the multivariate analysis.
CONCLUSION
Small papilla and protruding or pendulous papilla are more difficult to cannulate compared to regular papilla. Small papilla is associated with a higher rate of post-ERCP pancreatitis.
Topics: Ampulla of Vater; Catheterization; Cholangiopancreatography, Endoscopic Retrograde; Humans; Pancreatitis; Retrospective Studies; Sphincterotomy, Endoscopic
PubMed: 32988368
DOI: 10.1186/s12876-020-01455-0