Balloon-assisted endoscopic submucosal dissection for treating small intestinal lipomas: Report of two cases

paythelady.612 shared this article with you from Inoreader Balloon-assisted endoscopic submucosal dissection for treating small intestinal lipomas: Report of two cases Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 6;9(7):1631-1638. doi: 10.12998/wjcc.v9.i7.1631. ABSTRACT BACKGROUND: Most small intestinal lipomas are treated surgically, and some require repeated surgeries for multiple lipomas. However, application of endoscopic submucosal dissection (ESD) technology in the deep small intestine is rarely reported owing to the special anatomical structure of the small intestine, medical equipment limitations, and the lack of relevant experience among endoscopists. CASE SUMMARY: Two patients with small intestinal lipomas treated at the Air Force Medical Center from November 2015 to September 2019 were selected to undergo balloon-assisted ESD to treat the lipomas and explore the technical feasibility and safety of ESD for treating small intestinal lipomas. The two patients successfully underwent balloon-assisted ESD to treat four small intestinal lipomas, with a complete resection rate of 100% (4/4), without intraop erative or postoperative bleeding, perforation, or other complications. After 3-6 mo of postoperative follow-up, the clinical symptoms caused by the lipomas were significantly relieved or disappeared after treatment. CONCLUSION: Balloon-assisted ESD is a safe and reliable new method for treating deep intestinal lipomas and shows good clinical feasibility. PMID:33728306 | PMC:PMC7942049 | DOI:10.12998/wjcc.v9.i7.1631 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Reconstructing abdominal wall defects with a free composite tissue flap: A case report

paythelady.612 shared this article with you from Inoreader Reconstructing abdominal wall defects with a free composite tissue flap: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 6;9(7):1734-1740. doi: 10.12998/wjcc.v9.i7.1734. ABSTRACT BACKGROUND: Reconstructive repair of huge full-thickness abdominal wall defects following debridement for abdominal electric burns remains a clinically challenging task. An ideal abdominal wall repair means a re-closure of the defected abdominal wall with pedicled neurovascular myofascial flaps, restoration of the abdominal wall integrity, and maintenance of the abdominal wall muscle tension to prevent the occurrence of abdominal wall hernia. When treating huge full-thickness defects, composite autologous tissue flaps are a good option for the repair. CASE SUMMARY: This study reported the case of a 43-year-old male patient suffering from full-thickness abdominal wall defects complicated with necrosis of multiple bowel segments and duodenal leak following high-voltage burns involving the left upper limb and abdomen. After debridement for abdomin al electric burns and end-to-end anastomosis for the necrotic bowels, reconstruction with acellular dermal matrix grafting and vacuum sealing drainage were performed for temporary abdominal closure. The remaining 18 cm × 15 cm full-thickness abdominal wall defect was repaired using a combined anterolateral thigh and tensor fascia lata free flap. The proposed method achieved the functional reconstruction of the abdominal wall. CONCLUSION: This approach restored the abdominal wall integrity, maintained certain muscle tension, avoided abdominal hernia, reached satisfactory aesthetic effect, and resulted in no complications in the grafting regions. PMID:33728319 | PMC:PMC7942038 | DOI:10.12998/wjcc.v9.i7.1734 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Efficacy and safety of short duration radiotherapy combined with chemotherapy for advanced rectal cancer

paythelady.612 shared this article with you from Inoreader Efficacy and safety of short duration radiotherapy combined with chemotherapy for advanced rectal cancer Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 6;9(7):1524-1531. doi: 10.12998/wjcc.v9.i7.1524. ABSTRACT BACKGROUND: Radiotherapy or chemoradiotherapy is widely used for the treatment of rectal cancer preoperatively. Although the combination of radiotherapy and chemotherapy as an established preoperative neoadjuvant therapy shows high efficacy in the treatment of rectal cancer, some patients experience a response of poor tolerance and outcomes due to the long duration radiotherapy. The study compared short duration radiotherapy plus chemotherapy vs long duration radiotherapy plus chemotherapy for rectal cancer to determine whether short duration radiation treatment should be considered to diminish complications, reduce risk of recurrence and improve survival in patients with rectal cancer. AIM: To evaluate the efficacy and safety of short duration radiotherapy combined with chemotherapy for the treatment of advanced rectal cancer. MET HODS: One hundred patients with stage IIIB or higher severe rectal cancer were selected as the study subjects at The First Affiliated Hospital of Hebei North University between December 2018 and December 2019. The patients were assigned to different groups based on the treatment regimens. Fifty patients who received preoperative short durations of radiotherapy plus chemotherapy were enrolled in an observation group and fifty patients who received conventional radiotherapy and chemotherapy were enrolled in a control group. Colonoscopic biopsy was performed for all patients with pathological diagnosis of rectal cancer. The expression of tumor-related factors such as RUNX3 and Ki-67 was quantitatively analyzed using immunohistochemistry in the tissues of the patients before and after treatment. Moreover, the duration of procedure, the amount of bleeding during the operation, the anus-conserving rate, the incidence of postoperative complications (wound infection, anastomotic leakage, po stoperative intestinal obstruction, etc.) and postoperative pathology were compared between the two groups. The overall survival rate, recurrence rate and distant metastasis rate were also compared through postoperative reexamination and regular follow-up. RESULTS: There was no significant difference in the positive expression rate of RUNX3 and Ki-67 between the two groups before the treatment (P > 0.05). Compared with the pretreatment value, the positive rate of RUNX3 was increased and the positive rate of Ki-67 was decreased in both groups after the treatment (all P < 0.05). The incidence of leukopenia, thrombocytopenia, neutropenia and diarrhea were higher in the observation group than in the control group (all P < 0.05). There was no significant difference in the incidence of anemia, fatigue, neurotoxicity and nausea and vomiting between the two groups (all P > 0.05). No significant difference was observed in the duration of p rocedure, intraoperative bleeding, the anus-conserving rate and the incidence of postoperative complications between the two groups (P > 0.05). After 1 year of follow-up, the 1-yr survival rate was 80.0% in the observation group and 68.0% in the control group, the recurrence rate was 8.0% in the observation group and 10.0% in the control group, the distant metastasis rate was 6.0% in the observation group and 8.0% in the control group difference (all P < 0.05). CONCLUSION: Short duration radiotherapy combined with chemotherapy can improve the cure rate, prolong the survival time and reduce the incidence of complications in patients with advanced rectal cancer. PMID:33728296 | PMC:PMC7942029 | DOI:10.12998/wjcc.v9.i7.1524 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Mononeuropathy multiplex associated with systemic vasculitis: A case report

paythelady.612 shared this article with you from Inoreader Mononeuropathy multiplex associated with systemic vasculitis: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 6;9(7):1741-1747. doi: 10.12998/wjcc.v9.i7.1741. ABSTRACT BACKGROUND: Vasculitis, a systemic disorder with inflammation of blood vessel walls, can develop broad spectrum of signs and symptoms according to involvement of various organs, and therefore, early diagnosis of vasculitis is challenging. We herein describe a patient who developed a special case of systemic vasculitis with mononeuropathy multiplex, rectal perforation and antiphospholipid syndrome (APS) presented with pulmonary embolism. CASE SUMMARY: A 61-year-old woman visited hospital with complaints of myalgia and occasional fever. She was initially diagnosed as proctitis and treated with antibiotics, however, there was no improvement. In addition, she also complained right foot drop with hypesthesia, and left 2nd and 3rd finger tingling sensation. She underwent nerve conduction study for evaluation, and it revealed sen sorimotor polyneuropathy in the left arm and bilateral legs. Subsequent sural nerve biopsy strongly suggested vasculitic neuropathy. Based on nerve biopsy and clinical manifestation, she was diagnosed with vasculitis and treated with immuno-suppressive therapy. During treatment, sudden rectal perforation and pulmonary thromboembolism occurred, and further laboratory study suggested probable concomitant APS. Emergency Hartmann operation was performed for rectal perforation, and anti-coagulation therapy was started for APS. After few cycles of immunosuppressive therapy, tingling sensation and weakness in her hand and foot had been partially recovered and vasculitis was considered to be stationary. CONCLUSION: Vasculitis can be presented with a variety of signs and symptoms, therefore, clinicians should always consider the possibility of diagnosis. PMID:33728320 | PMC:PMC7942042 | DOI:10.12998/wjcc.v9.i7.1741 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Effects of cooperative nursing and patient education on postoperative infection and self-efficacy in gastrointestinal tumors

paythelady.612 shared this article with you from Inoreader Effects of cooperative nursing and patient education on postoperative infection and self-efficacy in gastrointestinal tumors Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 6;9(7):1610-1618. doi: 10.12998/wjcc.v9.i7.1610. ABSTRACT BACKGROUND: Gastrointestinal tumors have a high incidence rate. The application value of the cooperative nursing care system of medical care has received widespread attention in recent years. However, there are few studies on the value of the joint application of collaborative nursing care and self-efficacy education. AIM: To explore the effect of cooperative nursing care management/self-efficacy education on postoperative infection and self-efficacy in gastrointestinal tumor surgery patients. METHODS: A total of 102 patients with gastrointestinal tumors treated in our hospital from October 2018 to February 2020 were selected and divided into a conventional group (n = 51) and a combined group (n = 51) according to the nursing plan. The routine group adopted routine nursing, and the joint group adopted the medical care cooper ative responsibility system nursing management combined with self-efficacy education. The self-efficacy scores, coping style scores, self-experience burden scores, and postoperative complication rates of the two groups before and after intervention were counted. RESULTS: After intervention, the daily life behavior management, cognitive symptom management, and disease management scores of the two groups were higher than those before the intervention, and those of the combined group were higher than those of the conventional group (all P = 0.000). After the intervention, the positive response scores of the two groups were higher than those before the intervention, the negative response scores were lower than those before the intervention, and the combined group was better than the conventional group (all P = 0.000). After the intervention, the two groups' emotional, economic, and physical factor scores were lower than those before the intervention, and the combined group was lower than the conventional group (all P = 0.000). The incidence of infection in the combined group (1.96%) was lower than that in the conventional group (15.69%) (P = 0.036). CONCLUSION: Cooperative nursing care management and self-efficacy education improved the physical and mental states of gastrointestinal cancer surgery patients, change the response to disease, and reduce the risk of postoperative infection. PMID:33728304 | PMC:PMC7942033 | DOI:10.12998/wjcc.v9.i7.1610 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Congenital fiber-type disproportion presenting with type II respiratory failure after delivery: A case report

paythelady.612 shared this article with you from Inoreader Congenital fiber-type disproportion presenting with type II respiratory failure after delivery: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 6;9(7):1748-1754. doi: 10.12998/wjcc.v9.i7.1748. ABSTRACT BACKGROUND: Congenital fiber-type disproportion (CFTD) is a form of congenital myopathy. CFTD is rare, especially when presenting in patients with critical illnesses. Here, we report a case of CFTD presenting with type II respiratory failure after delivery and provide a review of the literature on CFTD. CASE SUMMARY: A 30-year-old woman was admitted to the obstetrics department of our hospital with premature rupture of the fetal membrane and with 7 h of regular contractions. After delivery, the patient experienced a refractory type II respiratory failure. Physical examination along with diagnostic procedures such as electromyography and biopsy confirmed CFTD. Use of invasive ventilator followed by intermittent use of noninvasive ventilator attenuated her symptoms. The patient recovered after ventilator-assisted respiration and was weaned off th e noninvasive ventilator on the seventh day postpartum. CONCLUSION: Congenital myopathy should be considered a differential diagnosis for type II respiratory failures that cannot be attributed to other diseases. PMID:33728321 | PMC:PMC7942053 | DOI:10.12998/wjcc.v9.i7.1748 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Construction of a clinical survival prognostic model for middle-aged and elderly patients with stage III rectal adenocarcinoma

paythelady.612 shared this article with you from Inoreader Construction of a clinical survival prognostic model for middle-aged and elderly patients with stage III rectal adenocarcinoma Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 6;9(7):1563-1579. doi: 10.12998/wjcc.v9.i7.1563. ABSTRACT BACKGROUND: Nomograms for prognosis prediction in colorectal cancer patients are few, and prognostic indicators differ with age. AIM: To construct a new nomogram survival prediction tool for middle-aged and elderly patients with stage III rectal adenocarcinoma. METHODS: A total of 2773 eligible patients were divided into the training cohort (70%) and the validation cohort (30%). Optimal cutoff values were calculated using the X-tile software for continuous variables. Univariate and multivariate Cox proportional hazards regression analyses were used to determine overall survival (OS) and cancer-specific survival (CSS)-related prognostic factors. Two nomograms were successfully constructed. The discriminant and predictive ability and clinical usefulness of the model were also assessed by multiple methods of analysis. RESULTS: The 95%C I in the training group was 0.719 (0.690-0.749) and 0.733 (0.702-0.74), while that in the validation group was 0.739 (0.696-0.782) and 0.750 (0.701-0.800) for the OS and CSS nomogram prediction models, respectively. In the validation group, the AUC of the three-year survival rate was 0.762 and 0.770, while the AUC of the five-year survival rate was 0.722 and 0.744 for the OS and CSS nomograms, respectively. The nomogram distinguishes all-cause mortality from cancer-specific mortality in patients with different risk grades. The time-dependent AUC and decision curve analysis showed that the nomogram had good clinical predictive ability and decision efficacy and was significantly better than the tumor-node-metastases staging system. CONCLUSION: The survival prediction model constructed in this study is helpful in evaluating the prognosis of patients and can aid physicians in clinical diagnosis and treatment. PMID:33728300 | PMC:PMC7942048 | DOI:10.12998/wjcc.v9.i7.1563 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Autologous scalp skin grafting to treat toxic epidermal necrolysis in a patient with a large skin injury: A case report

paythelady.612 shared this article with you from Inoreader Autologous scalp skin grafting to treat toxic epidermal necrolysis in a patient with a large skin injury: A case report Μέσω pubmed: "world j clin cases"... World J Clin Cases. 2021 Mar 6;9(7):1646-1653. doi: 10.12998/wjcc.v9.i7.1646. ABSTRACT BACKGROUND: Toxic epidermal necrolysis (TEN) is often associated with skin wounds affecting large areas. Healing of this type of wound is difficult because of pressure, infection and other factors. It can increase the length of hospital stay and result in wound sepsis and even death. CASE SUMMARY: A 49-year-old woman developed a skin lesion covering 80% of the total body surface area after using a kind of Chinese medicinal ointment on a burn wound on her back; she developed life-threatening wound sepsis and septic shock. Methicillin-resistant Staphylococcus aureus, carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa and other bacteria were cultured from wound tissue, deep venous catheter and blood samples. Imipenem cilastatin sodium, tigecycline and teicoplanin were used for anti-infect ion therapy. Finally, the patient was transferred to the burn department because of severe wound sepsis. In the burn intensive care unit, pain-free dressing changes and autologous scalp skin grafting were performed to heal the wound in addition to reasonable and effective antibacterial treatment according to microbial susceptibility test results. After three operations within 2 wk, the wound healed and sepsis resolved. CONCLUSION: TEN patients with large areas of skin injury may develop wound infection and life-threatening wound sepsis. Autologous scalp skin grafting may be beneficial for rapid wound healing and reducing the risk of sepsis in TEN patients, and it leaves no scar at the donor site. PMID:33728308 | PMC:PMC7942035 | DOI:10.12998/wjcc.v9.i7.1646 View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Debulking obstructing laryngeal cancers to avoid tracheotomy

xlomafota13 shared this article with you from Inoreader Debulking obstructing laryngeal cancers to avoid tracheotomy Via Brazilian Journal of Otorhinolaryngology Abstract Introduction: Upper airway obstruction, secondary to neoplasms presenting with stridor, is traditionally treated by tracheostomy. However, this common procedure can potentially have an impact on the long-term outcome, with tumor implantation into the tracheostomized wound leading to peristomal recurrence after laryngectomy, with the risk of stomal recurrence. Objective: To describe our clinical experience with tumor debulking as an alte rnative treatment choice of tracheotomy in patients with advanced larynx cancer at a tertiary referral center. Methods: A retrospective chart review of 87 subjects who had advanced larynx cancer (T3/4) with airway obstruction from our institutional database was conducted. Medical records including demographics, daily notes during hospitalization, and operative notes were used for clinical data of patients. The strategy for maintaining the airway patency was tracheotomy (emergency or awake) and tumor debulking (laser or coblation). Endophytic and exophytic laryngeal tumors were also noted. Results: In 41/87 (47.1%) patients, a tracheotomy was performed as an initial treatment (11 were emergency, 30 were planned) to maintain airway patency. Tumor debulking was performed in 28 exophytic and 18 endophytic lesions by laser or coblation (17 and 29 patients, respectively). Tracheotomy was performed in 5 patients (4 endophytic, 1 exophytic) who could not tolerate debulking surgery due to aspiration, edema and dyspnea. Three of the them who required subsequent tracheotomy was in the laser group and two in the coblation group. The success rate of laser debulking was 82.35% (14/17) and 93.1% (27/29) for coblation. Conclusion: Tumor debulking is a safe and effective method to avoid awake tracheotomy in patients suffering from airway obstruction due to advanced larynx cancer. Resumo Introdução: A obstrução das vias aéreas superiores com estridor, secundária a neoplasias, é tradicionalmente tratada com traqueotomia. No entanto, este procedimento comum pode potencialmente ter um impacto sobre o desfecho a longo prazo, com a implantação do tumor na ferida cirúrgica da traqueotomia, o que leva à recorrência peristomal após laringectomia, com o risco de recorrência do estoma. Objetivo: Descrever nossa experiência clínica com a redução do volume tumoral como tratamento alternativo à traqueotomia em pacientes com câncer avançado de laringe em um centr o de referência terciário. Método: Foi realizada uma revisão retrospectiva de prontuários de 87 indivíduos com câncer avançado de laringe (T3/T4) com obstrução das vias aéreas em nosso banco de dados institucional. Registros médicos incluindo dados demográficos, anotações diárias durante a hospitalização e anotações operacionais foram utilizados como dados clínicos dos pacientes. A estratégia para manter a patência das vias aéreas foi a traqueotomia (emergência ou em pacientes acordados) e redução do volume tumoral (por laser ou coblation). Tumores endofíticos e exofíticos da laringe também foram anotados. Resultados: Uma traqueotomia foi realizada como tratamento inicial em 41/87 (47,1%) pacientes (11 foram de emergência, 30 foram eletivas) para manter a patência das vias aéreas. A redução do volume tumoral foi realizada em 28 lesões exofíticas e 18 endofíticas por laser ou coblation (17 e 29 pacientes, respectivamente). A traqueotomia foi re alizada em 5 pacientes (4 endofíticos, 1 exofítico) que não podiam tolerar a cirurgia de redução de volume devido à aspiração, edema e dispneia. Três deles que necessitaram de uma traqueotomia subsequente estavam no grupo de laser e dois no grupo coblation. A taxa de sucesso da redução tumoral foi de 82,35% (14/17) para o laser e 93,1% (27/29) para coblation. Conclusão: A redução do volume tumoral é um método seguro e eficaz para evitar a traqueotomia com paciente acordado, nos casos de obstrução das vias aéreas devido ao câncer de laringe avançado. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Comprehensiveness, readability, and reliability of Brazilian websites available for lay people’s guidance on adenotonsillectomy

xlomafota13 shared this article with you from Inoreader Comprehensiveness, readability, and reliability of Brazilian websites available for lay people’s guidance on adenotonsillectomy Via Brazilian Journal of Otorhinolaryngology Abstract Introduction: Adenotonsillectomy is an invasive surgical procedure, which may encourage the search for information by the lay population through online search engines. The quality of this information, however, requires an evaluation due to the wide diversity of the available content. Objective: To evaluate the quality, in terms of ethical principles, readability and comprehensiveness, of the most accessed websites concerning guidance to parents/guardians related to their children's recommended adenotonsillectomy. Methods: The websites mentioned on the first 10 pages obtained after the search using "removal", "tonsils" and "adenoids" as keywords, after applying the inclusion and exclusion criteria, were selected. All were assessed using the Flesch Readability Index and Health on the Net Code tools, in addition to an evaluation of the content by two independent evaluators. The data were described, and the inter-rater agreement was calculated by the Kappa coefficient. Results: 34 websites were found, of the 100 assessed ones, which met the inclusion and exclusion criteria using the Google and Yahoo! Tools. Sixteen (47%) pages were considered reasonably difficult/difficult to read according to the Flesch Readability Index. Most of them met less than half of the analyzed ethical requirements according to the Health on the Net Code, and the overall comprehensiveness average was considered insufficient. Conclusion: A deficit of overall quality (comprehensiveness, readability, and ethical principles) was demonstrated for the websites available to parents or guardians about the adenotonsillectomy procedure in children. Resumo Introdução: A adenotonsilectomia é um procedimento que, por ser invasivo, pode incentivar a busca de informações pela população leiga por meio de ferramentas de busca online. A qualidade dessas informações, no entanto, requer uma avaliação devido à grande diversidade do conteúdo disponível. Objet ivo: Avaliar a qualidade dos websites de maior acesso voltados à orientação de pais/responsáveis de crianças às quais a adenotonsilectomia é indicada, em termos de princípios éticos, legibilidade e abrangência. Método: Os websites contidos nas primeiras 10 páginas obtidas pela busca das palavras-chave "retirada", "amígdalas" e "adenoides" foram selecionados sob critérios de inclusão e de exclusão e avaliados com as ferramentas Teste de Facilidade de Leitura Flesch e Health on the Net Code (HON Code). Também foi feita avaliação de conteúdo por dois avaliadores independentes. Os dados foram descritos, a concordância interavaliador foi calculada pelo coeficiente Kappa. Resultados: Foram encontrados 34 websites, dos 100 analisados, que se adequavam aos critérios de inclusão e exclusão com as ferramentas Google e Yahoo! Pelo Índice de Facilidade de Leitura Flesch 16 (47%) páginas foram consideradas de leitura razoavelmente difícil/difícil. A maio ria atendeu a menos da metade dos quesitos éticos analisados e a média de abrangência geral foi considerada como insuficiente. Conclusão: Demonstrou-se uma realidade deficitária em termos de qualidade geral (abrangência, legibilidade e princípios éticos) associada aos websites disponíveis para pais ou cuidadores sobre o procedimento da cirurgia das tonsilas em crianças. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.