Comprehensive clinicopathologic characteristics of intraabdominal neurogenic tumors: Single institution experience

paythelady.612 shared this article with you from Inoreader Comprehensive clinicopathologic characteristics of intraabdominal neurogenic tumors: Single institution experience Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2218-2227. doi: 10.12998/wjcc.v9.i10.2218. ABSTRACT BACKGROUND: Neurogenic tumors are rare but represent an important consideration in the differential diagnosis of abdominal mesenchymal tumors. Reports on their incidence, pathological features and clinical characteristics are scarce. AIM: To advance the overall knowledge on the histologic, immunohistochemical, clinical and radiologic characteristics of neurogenic tumors through this case series. METHODS: An established database of a nationwide tertiary referral center, covering a 15-year period (2005 and 2020), was retrospectively re-evaluated. Diagnoses of neurogenic tumor cases were confirmed by two experts following review of the macroscopic, histological and immunohistochemical records along with findings from analysis of archived tissue sections for each included patient. Tissue microarrays were constructed for cases lacking necess ary immunohistochemical studies. Clinical data and follow-up information were collected from the hospital records and the patients themselves, when available. RESULTS: The study included 19 cases of intraabdominal neurogenic tumors, representing 12 women and 7 men, between 18 and 86 years of age (median: 51 years). Final confirmed diagnoses were 12 schwannomas, 2 diffuse submucosal neuro-fibromatoses, 2 ganglioneuromas, 2 malignant peripheral sheath nerve tumors, and 1 mucosal Schwann cell hamartoma. Sizes of the tumors were variable, with a median diameter of 4 cm; the two largest (> 10 cm) were schwannomas. The majority of cases were asymptomatic at presentation, but the most frequent symptom was abdominal pain. Gastrointestinal tract lesions were detected with endoscopy and extra-luminal lesions were detected with cross-sectional imaging. All cases were S100-positive and CD117-negative; most cases were negative for desmin, epithelial membrane antigen, smooth muscle actin and CD34. In all but 5 cases, the Ki67 proliferation index was ≤ 1%. CONCLUSION: Re-evaluation of 19 cases of abdominal neurogenic tumors demonstrated con-siderable variability in clinicopathologic characteristics depending on location, dimension and histological features. PMID:33869597 | PMC:PMC8026837 | DOI:10.1 2998/wjcc.v9.i10.2218 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

SARS-CoV-2, surgeons and surgical masks

paythelady.612 shared this article with you from Inoreader SARS-CoV-2, surgeons and surgical masks Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2170-2180. doi: 10.12998/wjcc.v9.i10.2170. ABSTRACT The exact risk association of coronavirus disease 2019 (COVID-19) for surgeons is not quantified which may be affected by their risk of exposure and individual factors. The objective of this review is to quantify the risk of COVID-19 among surgeons, and explore whether facemask can minimise the risk of COVID-19 among surgeons. A systematised review was carried out by searching MEDLINE to locate items on severe acute respiratory syndrome coronavirus 2 or COVID-19 in relation to health care workers (HCWs) especially those work in surgical specialities including surgical nurses and intensivists. Additionally, systematic reviews that assessed the effectiveness of facemask against viral respiratory infections, including COVID-19, among HCWs were identified. Data from identified articles were abstracted, synthesised and summarised. Fourteen primary studi es that provided data on severe acute respiratory syndrome coronavirus 2 infection or experience among surgeons and 11 systematic reviews that provided evidence of the effectiveness of facemask (and other personal protective equipment) were summarised. Although the risk of COVID-19 could not be quantified precisely among surgeons, about 14% of HCWs including surgeons had COVID-19, there could be variations depending on settings. Facemask was found to be somewhat protective against COVID-19, but the HCWs' compliance was highly variable ranging from zero to 100%. Echoing surgical societies' guidelines we continue to recommend facemask use among surgeons to prevent COVID-19. PMID:33869593 | PMC:PMC8026839 | DOI:10.12998/wjcc.v9.i10.2170 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Innovative chest wall reconstruction with a locking plate and cement spacer after radical resection of chondrosarcoma in the sternum: A case report

paythelady.612 shared this article with you from Inoreader Innovative chest wall reconstruction with a locking plate and cement spacer after radical resection of chondrosarcoma in the sternum: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2302-2311. doi: 10.12998/wjcc.v9.i10.2302. ABSTRACT BACKGROUND: Chondrosarcoma, a cartilage matrix producing tumor, is the second most commonly observed primary bone tumor after osteosarcoma, accounting for 15% of all chest wall malignancies. We herein report the case of a patient with chondrosarcoma of the sternum and our management of the chest wall defects that presented following radical tumor resection. CASE SUMMARY: A 31-year-old patient presented to our hospital with dull pain and a protruding mass overlying the chest for 3 mo. The presence of nocturnal pain and mass size progression was reported, as were overhead arm elevation-related limitations. Computed tomography showed a focal osteoblastic mass in the sternum with bony exostosis and adjacent soft tissue calcification. Positron emission tomography-computed tomography revealed hypermetabolic activity with a mass located over the upp er sternum. Magnetic resonance imaging showed a focal ill-defined bony mass of the sternum with cortical destruction and periosteal reaction. Preoperative biopsy showed a consistent result with chondrosarcoma with immunohistochemical positivity for S100 and focal positivity for IDH-1. The grade II chondrosarcoma diagnosis was confirmed by postoperative pathology. The patient underwent radical tumor resection and chest wall reconstruction with a locking plate and cement spacer. The patient was discharged 1 wk after surgery without any complications. At the 1-year follow-up, there was no local recurrence on imaging. The functional scores, including Constant Score, Nottingham Clavicle Score, and Oxford Shoulder Score, showed the absence of pain in the performance of daily activities or substantial functional disabilities. CONCLUSION: The diagnosis of chondrosarcoma must be considered when chest wall tumors are encountered. The surgical reconstructive materials, with a locking pla te and cement spacer, used in our study are cost-effective and readily-available for the sternum defect. PMID:33869607 | PMC:PMC8026833 | DOI:10.12998/wjcc.v9.i10.2302 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Factors associated with overall survival in early gastric cancer patients who underwent additional surgery after endoscopic submucosal dissection

paythelady.612 shared this article with you from Inoreader Factors associated with overall survival in early gastric cancer patients who underwent additional surgery after endoscopic submucosal dissection Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2192-2204. doi: 10.12998/wjcc.v9.i10.2192. ABSTRACT BACKGROUND: Controversy exists about the benefit of additional surgery after endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). AIM: To examine risk factors for overall survival (OS) after additional surgery in patients with EGC who initially underwent ESD. METHODS: This was a retrospective analysis of patients with EGC who underwent additional surgery after ESD at the Beijing Friendship Hospital affiliated to Capital Medical University between August 2012 and August 2019. OS was the primary outcome. Lymph node metastasis and residual tumor were secondary outcomes. Logistic regression models and Kaplan-Meier curves were used for further analysis. RESULTS: Forty-two patients were evaluated, including 35 (83.3%) males and 7(16.7%) females. The mean age was 62 (range, 32-82) years. Male sex [hazard ratio (HR) = 21 .906, 95% confidence interval (CI): 3.762-229.250; P = 0.039), T1b invasion (HR = 3.965, 95%CI: 1.109-17.432; P = 0.047), undifferentiated tumor (HR = 9.455, 95%CI: 0.946-29.482; P = 0.049), lymph node metastasis (HR = 2.126, 95%CI: 0.002-13.266; P = 0.031), and residual tumor (HR = 4.275, 95%CI: 1.049-27.420; P = 0.043) were independently associated with OS. The follow-up duration was 4-81 mo (median: 50.7 mo). OS was 77.0 ± 12.1 mo (95%CI: 53.3-100.7 mo). The 3-year and 5-year OS rates were 94.1% and 85%, respectively. CONCLUSION: Male sex, T1b invasion, undifferentiated tumor, lymph node metastasis, and residual tumor are independently associated with OS in patients with EGC who underwent additional surgery after ESD. PMID:33869595 | PMC:PMC8026836 | DOI:10.12998/wjcc.v9.i10.2192 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Changes in sleep parameters following biomimetic oral appliance therapy: A case report

paythelady.612 shared this article with you from Inoreader Changes in sleep parameters following biomimetic oral appliance therapy: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2312-2319. doi: 10.12998/wjcc.v9.i10.2312. ABSTRACT BACKGROUND: Mandibular advancement devices (MADs) are used to treat mild to moderate obstructive sleep apnea (OSA), but there is a risk that the underlying condition can worsen in the long-term. Therefore, this case report is based on biomimetic oral appliance therapy as an alternative to MADs, which was found to be beneficial in the treatment of a case with severe OSA. CASE SUMMARY: An overnight sleep study was undertaken in a 50-year-old male with excessive daytime sleepiness that lead to a diagnosis of severe OSA as the apnea-hypopnea index (AHI) was found to be 32.8/h. Since the patient was unable to comply with continuous positive airway pressure therapy and declined surgical intervention, treatment with a MAD was initiated. Approximately 10 years later, another sleep study was performed with no MAD in the mouth, which revealed an AHI of 67.9/h. In view of the deterioration in sleep quality, the patient sought alternative treatment and elected on biomimetic oral appliance therapy, using a mandibular repositioning nighttime appliance (mRNA appliance®, Vivos Therapeutics, Inc., United States). After 10 mo, another sleep study was performed with no device in the patient's mouth, which revealed an AHI of 11.8/h, a mean oxygen saturation of 94% and a mean oxygen desaturation index of 5.3% while sleeping. Finite-element analysis of the pre- and post-treatment study models of the upper jaw showed localized size increases of 15%-17% in the premolar regions and 15%-23% in the molar regions. CONCLUSION: In adults with severe OSA that are unable to accept continuous positive airway pressure or surgical treatment, biomimetic oral appliance therapy may be preferable over MADs since biomimetic oral appliance therapy may be able to prevent worsening of sleep parameters by remodeling the nasomaxillary complex. Lo ng-term follow up studies are required to verify these novel findings. PMID:33869608 | PMC:PMC8026823 | DOI:10.12998/wjcc.v9.i10.2312 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Acquired haemophilia in patients with malignant disease: A case report

paythelady.612 shared this article with you from Inoreader Acquired haemophilia in patients with malignant disease: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2409-2418. doi: 10.12998/wjcc.v9.i10.2409. ABSTRACT BACKGROUND: Acquired haemophilia is a rare coagulation disorder characterized by autoantibodies against coagulation factor VIII leading to severe and potentially life-threatening haemorrhages. The underlying disorder causing the development of an autoimmune phenomenon is not always known, but 10%-15% could be linked to malignancies. Patients with cancer who require surgical resection represent a treatment challenge not solely due to increased risk of bleeding but also due to adverse events of immunosuppressive therapy. CASE SUMMARY: We present the case of a 67-year-old man with non-metastatic adenocarcinoma of the distal bile duct who developed concomitant acquired haemophilia a month after having been diagnosed with malignant disease. Haemostasis was established with recombinant activated factor VII, and immunosuppressive therapy was started immediately. An extensive surgical procedure was performed in order to remove the cancer and, therefore, eliminate the inhibitory autoantibodies. Due to a complicated postoperative course, relatively short period of treatment and likelihood of micrometastases, no improvement in the patient's status was observed. Diagnosis and treatment of acquired haemophilia as well as other coagulation disorders in patients with cancer are discussed. CONCLUSION: Prompt diagnosis of acquired haemophilia is required in order to start appropriate treatment and reduce mortality. Among patients with cancer, other causes of abnormal bleeding related to malignancy should be considered. PMID:33869621 | PMC:PMC8026824 | DOI:10.12998/wjcc.v9.i10.2409 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Bone remodeling in sigmoid sinus diverticulum after stenting for transverse sinus stenosis in pulsatile tinnitus: A case report

paythelady.612 shared this article with you from Inoreader Bone remodeling in sigmoid sinus diverticulum after stenting for transverse sinus stenosis in pulsatile tinnitus: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2320-2325. doi: 10.12998/wjcc.v9.i10.2320. ABSTRACT BACKGROUND: Pulsatile tinnitus (PT) is a potentially disabling symptom that has received increasing attention. Multiple causes of PT have been confirmed by targeted treatment. However, dynamic changes of related structures in PT patients with multiple causes after stenting for ipsilateral transverse sinus stenosis (TSS) have not been previously reported. We report such a case and present postoperative computed tomography venography (CTV) follow-up findings to demonstrate the decreased sigmoid sinus diverticulum and bone remodeling. CASE SUMMARY: A 45-year-old man suffered from left-sided PT for 15 years that was occasionally accompanied by headache and dizziness. Pre-operative CTV revealed left-sided sigmoid sinus wall anomalies (SSWAs), TSS, outflow dominance, large posterior condylar emissary vein, and an empty sella turcica. A cerebrospina l fluid pressure of 270 mmH2O was further detected. The sound disappeared immediately after stenting for ipsilateral TSS, with no recurrence during 2 years of follow-up. After the procedure, the patient underwent four consecutive CTV examinations. The diverticulum decreased 6 mo after the procedure with new bone remodeling. The density of the remodeled bone was further increased 1 year later, and a hardened edge was formed 2 years later. CONCLUSION: PT associated with SSWAs, TSS, and idiopathic intracranial hypertension can be cured by stenting for TSS alone. And bone remodeling around SSWAs is a more significant finding. PMID:33869609 | PMC:PMC8026850 | DOI:10.12998/wjcc.v9.i10.2320 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Impact of simethicone on bowel cleansing during colonoscopy in Chinese patients

paythelady.612 shared this article with you from Inoreader Impact of simethicone on bowel cleansing during colonoscopy in Chinese patients Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2238-2246. doi: 10.12998/wjcc.v9.i10.2238. ABSTRACT BACKGROUND: Four-liter polyethylene glycol (PEG) solutions are effective for bowel cleansing, but their large volume might hinder patient compliance. Due to the unique features of Asians, 4 L PEG might be a suboptimal bowel preparation in predominantly ethnically Asian countries. In view of this, a balance should be achieved between the volume and effectiveness. The ideal bowel cleansing regimen for a colonoscopy has yet to be determined in a Chinese population. AIM: To compare the cleansing efficacy of 3 L PEG plus simethicone with 4 L PEG. METHODS: A total of 291 patients were randomly allocated to two groups: Group 1 (n = 145) received 4 L split-dose PEG (4-P); group 2 (n = 146) received 3 L split-dose PEG plus simethicone (3-PS). Bowel-cleansing efficacy was evaluated by endoscopists using the Boston bowel preparation scale (BBPS) and the bubbles score. RESULTS: Although there were no significant differences in the total BBPS score or the adequate rate of bowel preparation between the two groups, the BBPS score of the right-side colon was significantly higher in the 3-SP group (2.37 ± 0.54 vs 2.21 ± 0.78; P = 0.04). Moreover, the use of simethicone significantly reduced bubbles in all colon segments (P < 0.001). The mean withdrawal time was significantly shorter in the 3-PS group (8.8 ± 3.4 vs 9.6 ± 2.3; P = 0.02). Furthermore, significantly more proximal adenomas were detected in the 3-PS group (53.6% vs 45.7%; P = 0.03). In addition, the proportions of patients with nausea and bloating were significantly lower in the 3-SP group (P < 0.01 for both). More patients in the 3-PS group expressed willingness to repeat the bowel preparation (87.7% vs 76.6%, P = 0.01). CONCLUSION: Three-liter PEG shows satisfacto ry bowel cleansing despite the decrease in dosage, and addition of simethicone with better bubble elimination and enhanced patient acceptance offers excellent potential impact on the detection of proximal adenomas in Chinese patients. PMID:33869599 | PMC:PMC8026841 | DOI:10.12998/wjcc.v9.i10.2238 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Prolonged use of bedaquiline in two patients with pulmonary extensively drug-resistant tuberculosis: Two case reports

paythelady.612 shared this article with you from Inoreader Prolonged use of bedaquiline in two patients with pulmonary extensively drug-resistant tuberculosis: Two case reports Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2326-2333. doi: 10.12998/wjcc.v9.i10.2326. ABSTRACT BACKGROUND: Bedaquiline is among the prioritized drugs recommended by the World Health Organization for the treatment of extensively drug-resistant tuberculosis (XDR-TB). Many patients have not achieved better clinical improvement after bedaquiline is stopped at 24 wk. However, there is no recommendation or guideline on bedaquiline administration beyond 24 wk, which is an important consideration when balancing the benefit of prognosis for XDR-TB against the uncertain safety concerning the newer antibiotics. CASE SUMMARY: This paper reported 2 patients with XDR-TB (a female of 58 years of age and a female of 18 years of age) who received bedaquiline for 36 wk, as local experience to be shared. The 2 cases had negative cultures after 24 wk of treatment, but lung imaging was still positive. After discussion among experts, the consensus was made to bedaquiline prolongation by another 12 wk. The 36-wk prolonged use of bedaquiline in both cases achieved a favorable response without increasing the risk of cardiac events or new safety signals. CONCLUSION: Longer regimen, including 36-wk bedaquiline treatment, might be an option for patients with XDR-TB. More studies are needed to explore the effectiveness and safety of prolonged use of bedaquiline for 36 wk vs standard 24 wk in the treatment of multidrug-resistant/XDR-TB or to investigate further the biomarkers and criteria indicative for extension of bedaquline to facilitate clinical use of this novel drug. PMID:33869610 | PMC:PMC8026830 | DOI:10.12998/wjcc.v9.i10.2326 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Turner syndrome with positive SRY gene and non-classical congenital adrenal hyperplasia: A case report

paythelady.612 shared this article with you from Inoreader Turner syndrome with positive <em>SRY</em> gene and non-classical congenital adrenal hyperplasia: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Apr 6;9(10):2259-2267. doi: 10.12998/wjcc.v9.i10.2259. ABSTRACT BACKGROUND: Co-morbidity of SRY gene turner syndrome (TS) with positive SRY gene and non-classical congenital adrenal hyperplasia (NCAH) is extremely rare and has never been reported to date. CASE SUMMARY: In this article, we present a 14-year-old girl who was referred to our hospital with short stature (weight of 43 kg and height of 143 cm, < -2 SD) with no secondary sexual characteristics (labia minora dysplasia). Laboratory tests indicated hypergonadotropic hypogonadism with significantly increased androstenedione and 17-hydroxyprogesterone (17-OHP) levels. This was accompanied by the thickening of the extremity of the left adrenal medial limb. The patient's karyotype was 45,X/46,X, +mar, and cytogenetic analysis using multiplex ligation-dependent probe amplification and high-throughput sequencing indicated that the SRY gene was positive with compound heterozygous mutations in CYP21A2 as the causative gene for congenital adrenal hyperplasia. The sites of the suspected candidate mutations were amplified and verified using Sanger sequencing. The patient was finally diagnosed as having SRY positive TS with NCAH. The patient and her family initially refused medical treatment. At her most recent follow-up visit (age = 15 years old), the patient presented facial hair, height increase to 148 cm, and weight of 52 kg, while androstenedione and 17-OHP levels remained high. The patient was finally willing to take small doses of hydrocortisone (10 mg/d). CONCLUSION: In conclusion, upon evaluation of the patient mentioned in the report, we feel that 17-OHP measurement and cytogenetic analysis are necessary for TS patients even in the absence of significant virilization signs. This will play a significant role in guiding diagnosis and treatment. PMID:33869601 | PMC:PMC8026834 | DOI:10.12998/wjcc.v9.i10.2259 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.