Abdominal Involvement Research Articles

Langerhans cell histiocytosis misdiagnosed as cow protein allergy: a case report

BackgroundLangerhans cell histiocytosis (LCH) is a heterogeneous disease with diverse clinical manifestations. Abdominal organ involvement is rare. Early diagnosis and active treatment are needed. The purpose of this article is to enable readers to have a better knowledge of LCH and prevent misdiagnosis.Case presentationA 2-month-old boy had diarrhea, hematochezia, and a rash, and was diagnosed as having a cow milk protein allergy (CMPA). He was given an amino acid-based formula, but there was no sign of improvement in his condition.The patient then had a skin biopsy and was diagnosed as having multisystem Langerhans cell histiocytosis (MS-LCH). The general condition of the child deteriorated after the first two doses of chemotherapy, and the child died.ConclusionsMS-LCH is a protracted and progressive condition with poor prognosis. Early diagnosis and treatment are essential for survival. If a child has chronic diarrhea and hematochezia in the presence of a characteristic rash, the pediatrician should consider the possibility of this disease to avoid misdiagnosis.

Limited benefit of additional contrast-enhanced CT to end-of-treatment PET/CT evaluation in patients with follicular lymphoma

Despite follicular lymphoma (FL) is frequently characterized by a moderate increase of glucose metabolism, PET/CT examinations provides valuable information for staging and response assessment of the disease. The aim of the study was to assess and compare the diagnostic performance of PET/ldCT and PET/ceCT, respectively, in evaluating FL patients at the end of treatment. Fifty FL consecutive patients who underwent end-of-therapy PET/CT with both ldCT and ceCT were analyzed. Two blinded observers independently assessed PET/ldCT and PET/ceCT applying the Deauville score (DS) and Lugano classification criteria. PET imaging obtained after the end-of-treatment (EoT) was classified as showing PET and ce-CT matched response (concordant imaging group, CIG) or PET and ce-CT unmatched response (discordant imaging group, DIG). Relapse rate and Event-Free Survival (EFS) were compared between CIG and DIG patients. Overall, no differences in metabolic response classification were observed between PET/ldCT and PET/ceCT. In 13 (26%) patients PET/ceCT identified additional FDG-negative nodal lesions in mesenteric, retroperitoneal and iliac regions. However, in all cases, final DS remained unchanged and the additional results did not modify the following therapeutic decision. Among patients, who obtained complete metabolic response a comparable rate of relapse was registered in DIG 3/13 (23%) and CIG subgroups 5/20 (25%) [p = 0.899]. In all 3 DIG cohort patients who relapsed the recurrent disease involved also, but not exclusively, PET negative lymph nodes detected by ceCT. In overall population metabolic response defined by PET/ldCT predicted EFS [76% (group of patients with metabolic response) vs 35% (group of patients with residual disease), p = 0.0013] significantly better than ceCT-Based response assessment [75% (group of patients with complete response) vs 53% (group of patients with residual disease), p = 0.06]. Our study demonstrates a negligible diagnostic and predictive value of ceCT performed in addition to standard 18FDG PET/ldCT for EoT response evaluation in FLs. PET/ldCT should be performed as first-line imaging procedure, also in patients with prevalent abdominal and pelvic involvement, limiting the acquisition of ceCT in selected cases. This tailored approach would contribute to avoid useless radiation exposure and preserve renal function of patients.

Burkitt’s Lymphoma of the Right Jaw in a Child: The Radiographic Features and Case Report

Burkitt’s lymphoma is a tumor that most often affects the jaws, most commonly seen in endemic areas of Africa, although the jaws are affected in about 15-18% in non-endemic regions, with prevalence in boys aged between 4-7 years. This is a 12-year-old male child that presented with right jaw painful swelling for more than six-months duration of onset. He was referred for plain radiographs of the jaw from a peripheral healthcare center. The jaw radiograph was done in anterior-posterior and oblique views of both sides respectively. The radiographs demonstrated a soft tissue density mass on the right, with associated destructive lytic lesion involving the right maxilla severelyand the right mandibleto a lesser extent. There is associated loss of lamina dura with severe dental anarchy involving the maxilla. The mandible showed lytic and expansile areas in its body with marked periosteal reaction; the sunray appearance. The contralateral maxilla and mandible have normal appearances. Complementary abdominal ultrasonography revealed normal appearances excluding abdominal involvement. Histology revealed the classic diffuse starry-sky appearance with benign histiocytes containing abundant, clear cytoplasm dispersed among a background of homogeneous, basophilic tumor cells, in keeping with Burkitt’s lymphoma. We report this case to describe the radiographic appearance of Burkitt’s lymphoma of the jaw bones.

Preoperative extent of peritoneal metastases affects overall survival in ovarian cancer despite complete interval cytoreductive surgery

Objectives: We investigated whether the extent of peritoneal metastases, as expressed by the 7 Region Count (7RC), and other surgical findings are predictive of the completeness of interval cytoreductive surgery (CRS) and overall survival in patients with advanced ovarian cancer. Methods: This single center retrospective cohort study included consecutive patients with FIGO stage III-IV epithelial ovarian, fallopian tube, or primary peritoneal cancer who had received neoadjuvant chemotherapy and were planned for interval CRS between January 2013 to April 2019. The gynecological oncologists routinely recorded the 7RC during surgical exploration to systematically quantify the extent of peritoneal metastases. Baseline, treatment and follow-up data were extracted from the local electronic patient database. Logistic regression analysis was performed to predict surgical outcome and cox regression analysis for survival. Results: 317 patients were included for analysis. At exploratory laparotomy with intent to perform interval CRS, the median 7RC was 4 (interquartile range: 2-6). Complete CRS was achieved in 58% of patients and optimal CRS was achieved in 30% of patients. The 7RC showed an AUC 0.81 (95% CI: 0.74-0.88) for predicting at least optimal CRS. After multivariate logistic regression, non-bowel abdominal organ involvement, preoperative CA-125 levels, and involvement of the small bowel or mesentery were shown predictive of complete or optimal CRS additionally to the 7RC. From this model an AUC was achieved of 0.902 (95% CI: 0.85-0.95), which was significantly higher than the 7RC alone (p<0.001). The most effective model of overall survival included the 7RC with a hazard radio of 1.14 (95% confidence interval: 1.05-1.24) as well as surgical outcome with a hazard radio of 1.78 (95% confidence interval: 1.40- 2.27). Other important factors that were included were FIGO stage, age, involvement of the colon, involvement of the small bowel or mesentery and ASA physical status. The median follow-up was 21 months (interquartile range: 12-34 months). Conclusions: The extent of peritoneal metastases, as expressed by the 7RC, is not only a strong predictor for complete or optimal interval CRS but also has an independent prognostic value regardless of the completeness of cytoreduction. Currently, the 7RC is being evaluated on preoperative imaging to incorporate in preoperative decision making. We investigated whether the extent of peritoneal metastases, as expressed by the 7 Region Count (7RC), and other surgical findings are predictive of the completeness of interval cytoreductive surgery (CRS) and overall survival in patients with advanced ovarian cancer. This single center retrospective cohort study included consecutive patients with FIGO stage III-IV epithelial ovarian, fallopian tube, or primary peritoneal cancer who had received neoadjuvant chemotherapy and were planned for interval CRS between January 2013 to April 2019. The gynecological oncologists routinely recorded the 7RC during surgical exploration to systematically quantify the extent of peritoneal metastases. Baseline, treatment and follow-up data were extracted from the local electronic patient database. Logistic regression analysis was performed to predict surgical outcome and cox regression analysis for survival. 317 patients were included for analysis. At exploratory laparotomy with intent to perform interval CRS, the median 7RC was 4 (interquartile range: 2-6). Complete CRS was achieved in 58% of patients and optimal CRS was achieved in 30% of patients. The 7RC showed an AUC 0.81 (95% CI: 0.74-0.88) for predicting at least optimal CRS. After multivariate logistic regression, non-bowel abdominal organ involvement, preoperative CA-125 levels, and involvement of the small bowel or mesentery were shown predictive of complete or optimal CRS additionally to the 7RC. From this model an AUC was achieved of 0.902 (95% CI: 0.85-0.95), which was significantly higher than the 7RC alone (p<0.001). The most effective model of overall survival included the 7RC with a hazard radio of 1.14 (95% confidence interval: 1.05-1.24) as well as surgical outcome with a hazard radio of 1.78 (95% confidence interval: 1.40- 2.27). Other important factors that were included were FIGO stage, age, involvement of the colon, involvement of the small bowel or mesentery and ASA physical status. The median follow-up was 21 months (interquartile range: 12-34 months). The extent of peritoneal metastases, as expressed by the 7RC, is not only a strong predictor for complete or optimal interval CRS but also has an independent prognostic value regardless of the completeness of cytoreduction. Currently, the 7RC is being evaluated on preoperative imaging to incorporate in preoperative decision making.

Abdominal and gastrointestinal manifestations in COVID-19 patients: Is imaging useful?

Coronavirus disease 2019 (COVID-19) can be considered a systemic disease with a specific tropism for the vascular system, in which the alterations of the microcirculation have an important pathogenetic role. The lungs are the main organ involved in COVID-19, and severe progressive respiratory failure is the leading cause of death in the affected patients; however, many other organs can be involved with variable clinical manifestations. Concerning abdominal manifestations, the gastrointestinal tract and the hepatobiliary system are mainly affected, although the pancreas, urinary tract and spleen may also be involved. The most common gastrointestinal symptoms are loss of appetite, followed by nausea and vomiting, diarrhea and abdominal pain. Gastrointestinal imaging findings include bowel wall thickening, sometimes associated with hyperemia and mesenteric thickening, fluid-filled segments of the large bowel and rarely intestinal pneumatosis and ischemia. Hepatic involvement manifests as an increase in the enzymatic levels of alanine aminotransferase, aspartate aminotransferase, serum bilirubin and γ-glutamyl transferase with clinical manifestations in most cases mild and transient. The most frequent radiological features are hepatic steatosis, biliary sludge and gallstones. Edematous acute pancreatitis, kidney infarct and acute kidney injury from acute tubular necrosis have been described more rarely in COVID-19. Lastly, splenic involvement is characterized by splenomegaly and by the development of solitary or multifocal splenic infarcts with classic wedge-shaped or even rounded morphology, with irregular or smooth profiles. In summary, the abdominal radiological findings of COVID-19 are nonspecific and with poor pathological correlation reported in the literature. Ultrasound and particularly computed tomography with multiphasic acquisition are the diagnostic methods mainly utilized in COVID-19 patients with abdominal clinical symptoms and signs. Although radiological signs are not specific of abdominal and gastrointestinal involvement, the diagnostic imaging modalities and in particular computed tomography are helpful for the clinician in the management, evaluation of the severity and evolution of the COVID-19 patients.

Appendiceal pseudomyxoma peritonei: predictors of recurrence and iterative surgery.

Appendiceal pseudomyxoma peritonei (PMP) is a rare entity, with recurrence rates up to 26% despite optimal cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC). Evidence specific to PMP originating from non-infiltrative appendiceal mucinous neoplasms (low grade - LAMN and high grade - HAMN) is lacking. The aim of this study was to identify patterns of recurrence and predictive factors for patients appropriate for iterative surgery. A bi-institutional retrospective analysis was performed on patients undergoing complete cytoreduction and HIPEC for PMP derived from perforated LAMN or HAMN. Multivariate logistic regression was performed to identify independent predictors for re-do CRS. Five-year overall survival (OS) was stratified according to surgical intervention, and 5-year disease-free survival (DFS) was stratified according to histological PMP grade. Cox regression analysis was performed to identify independent predictors for OS and DFS. Sixty of 239 (25.1%) patients developed peritoneal recurrence between 2007 and 2020. The median time to recurrence was 20.7months. The risk of disease recurrence was highest with high-grade PMP (P <0.001) and increasing PCI (P <0.001). Patients with high-grade histology from their index procedure and aged over 60years were less likely to be offered iterative surgery on multivariate analysis. Patients who underwent iterative CRS and HIPEC had a 5-year survival of 100%. Iterative CRS and HIPEC is feasible in selected patients with recurrent PMP, displaying good oncological outcomes. Age, index histology and level of abdominal quadrant involvement are predictive of proceeding to re-do surgery.

A Study on Prognostic Indicators of Severe Dengue Fever in Children

Dengue is the most important emerging tropical viral disease of humans and leading cause of death in SEAR after diarrhea and acute respiratory infections. It is a significant public health concern with its geographical distribution becoming worldwide, involving nearly all the tropical and subtropical regions of the world with significant morbidity and mortality. This study mainly aims at finding out the factors which were associated with severe dengue fever that helps determining the prognosis in children. This case control study was done during November 2017 to October 2018 from the children admitted in Pediatric ward, Vijayanagar institute of medical sciences, Ballari. Among the 201 study subjects, the factors like presence of bleeding manifestations(p˂0.001), low pulse pressue˂20 mmhg(p˂0.001), prolonged capillary refill time(p&lt;0.001), low O2 saturation(p&lt;0.001), Hyponatremia(p=0.008), elevated SGOT/SGPT levels(p&lt;0.001), Prolonged PT/APTT/INR levels(p&lt;0.001), respiratory and abdominal involvement in the form of pleural effusion, pneumonia and ascites(p&lt;0.001) were significantly associated with severe dengue fever with mortality of 15%. Leucopenia, thrombocytopenia and raising hematocrit was not found to have significant association with the severity of dengue fever in this study. These parameters may be used to predict, to forecast disease severity in patients suspected of dengue infection and to manage it early in the course of the illness. Various measures for early diagnosis and prompt intervention with emphasis on the warning signs and good supportive care would help decrease the fatality and morbidity associated with Dengue.

DESMOPLASTIC SMALL ROUND CELL TUMOR: A CASE REPORT

Desmoplastic small round cell tumor is a rare, highly malignant neoplasm originating from mesenchymal tissue which was initially described in 1 1991 by Gerald and Rosai. It is composed of small round tumor cells of uncertain histogenesis associated with prominent stromal desmoplasia and 2 polyphenotypic differentiation. It typically occurs in adolescents and young adults. Usually presents with widespread abdominal, serosal, and mesenteric involvement with poor prognosis.

Interessamento genitale della porpora di Schönlein-Henoch

Henoch-Schönlein purpura (HSP) is a paediatric vasculitis, affecting several organs. Purpura is typically found on posterior surface of lower limbs and is more often associated with joint, abdominal and kidney involvement. The paper reports a case of HSP with mild cutaneous and abdominal manifestations, with genital involvement (haemorrhagic oedema of the penis that is more rarely described in literature), which was treated with oral steroid therapy that led to an optimal clinical response.

Abdominal radiology involvement in image-guided procedures: a perspective from the society of abdominal radiology Cross-Sectional Interventional Radiology Emerging Technology Commission.

Abdominal radiology as a field has historically played an important role in the training, research, and performance of image-guided procedures. With the emphasis on increased subspecialization and the more formal and rigorous interventional radiology training programs, the question of the future of image-guided procedures within abdominal radiology is explored. A survey conducted by the Cross-Sectional Interventional Radiology Emerging Technology Commission on members ofthe Society of Abdominal Radiology showed that image-guided procedures are overwhelmingly being performed by abdominal radiology groups, and the vast majority ofprograms aretraining their fellows in this regard. We explore some of the challenges radiology and health care in general may face should abdominal radiologists no longer perform procedures and outlinestrategies departments can employ to meet the needs of both abdominal and interventional radiologists.

An unexpected pathogen causing multiple intra-abdominal abscesses in an immunocompetent patient

Streptococcus constellatus is a member of the group now called Streptococcus anginosus. This microorganism is part of the normal oropharyngeal, gastrointestinal and genitourinary microbiota. However, it may cause serious infections such as pharyngitis, bacteremia and invasive pyogenic infections in immunocompromised patients. We report the first case in Colombia of an adult male with no relevant medical history and with an unusual presentation of infection by S. constellatus and whose laboratory results showed an important systemic inflammatory response and radiographic evidence of abdominal involvement with poor response to medical and surgical management. Since there are few reports in international medical journals about intra-abdominal infection by S. constellatus and taking into consideration the need of a multidisciplinary intervention, this report may be of interest for both clinical and surgical practitioners.

Treatment Response to Idiopathic Retroperitoneal Fibrosis-associated Hydronephrosis With a Focus on IgG4/IgG3 Serum Concentration Ratio.

Hydronephrosis, a common complication of idiopathic retroperitoneal fibrosis (iRPF), may lead to poor renal outcomes unless resolved in a timely manner IgG4-related diseases characterized by elevated serum IgG4 levels are responsible for a few iRPF cases However, the underlying immunologic features of most iRPF cases have not been clearly defined, and these cases exhibit varied responses to medical treatment Thus, we investigated the predictive factors for hydronephrosis-associated outcomes among iRPF patients. We retrospectively included 18 iRPF patients with hydronephrosis in a tertiary referral hospital from 2012 to 2019 Hydronephrosis improvement was assessed on images taken 6 months after diagnosis Categorical variables were compared using chi-square or Fisher's exact test Continuous variables were compared using Mann-Whitney U-test. On follow-up images, 8 patients (444%) showed an improvement in hydronephrosis Patients with improvement more frequently had reverse serum IgG4/IgG3 ratio (875% vs 30%, p=0025), abdominal aorta involvement (875% vs 30%, p=0025) and glucocorticoid treatment administration (875% vs 30%, p=0025) than those without improvement The proportion of elevated serum IgG4 level did not differ between the two groups Even in the 14 cases with normal serum IgG4 levels, reverse serum IgG4/IgG3 ratio was more frequently observed in patients with improvement than in those without improvement (833% vs 125%, p=0026). The reverse serum IgG4/IgG3 ratio was associated with hydronephrosis improvement in iRPF patients, suggesting it to be a suitable serologic marker for predicting favourable responses to glucocorticoid treatment.

A rare case of tubercular collarstud abscess of anterior abdominal wall

Tuberculosis (TB) is considered as a ubiquitous disease, as it can involve any organ or a part of the body. Commonly, it involves the lungs and the abdomen. Muscle involvement is rare. In most cases, it is secondary to tubercular costochondritis or TB of the spine. Autopsy studies have revealed the abdominal wall involvement in <1% of patients who died of TB. A high index of suspicion is necessary to diagnose tubercular lesions in unusual anatomical locations. Antitubercular therapy is the main form of treatment; however, some patients may require surgical intervention. We are hereby presenting a case of tubercular anterior abdominal wall abscess secondary to wet peritonitis in a 40-year-old apparently healthy male with no past history of TB. The objective is to alert the clinicians and radiologists to the possibility of TB when considering such cystic lesions of the anterior abdominal wall.

Imaging of abdominal complications of COVID-19 infection.

Coronavirus disease 2019 (COVID-19) is a respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first described in Wuhan, Hubei Province, China in the last months of 2019 and then declared as a pandemic. Typical symptoms are represented by fever, cough, dyspnea and fatigue, but SARS-CoV-2 infection can also cause gastrointestinal symptoms (vomiting, diarrhoea, abdominal pain, loss of appetite) or be totally asymptomatic. As reported in literature, many patients with COVID-19 pneumonia had a secondary abdominal involvement (bowel, pancreas, gallbladder, spleen, liver, kidneys), confirmed by laboratory tests and also by radiological features. Usually the diagnosis of COVID-19 is suspected and then confirmed by real-time reverse-transcription-polymerase chain reaction (RT-PCR), after the examination of the lung bases of patients, admitted to the emergency department with abdominal symptoms and signs, who underwent abdominal-CT. The aim of this review is to describe the typical and atypical abdominal imaging findings in patients with SARS-CoV-2 infection reported since now in literature.

Acute hemorrhagic edema: Uncommon features

Acute hemorrhagic edema: Uncommon features

Abdominal Tuberculosis: Experience from Two Tertiary-Care Hospitals in the Paris Region.

Abdominal tuberculosis (ATB) is uncommon and not very well known by clinicians. We describe the characteristics, evolution, and treatment of patients with ATB in two large hospitals in the Paris region. We reviewed all records of patients treated for ATB, from January 01, 2010 to December 01, 2016, diagnosed by bacteriological and/or histological methods or highly suspected because of clinical/radiological features. We included 80 patients, with a median (IQR) age of 39 (29-50) years, with 56.2% being males. Among them, 63.7% had African origins, 15% Asian, and 11.2% European. Twenty-nine had a cause of immunosuppression (n = 21 HIV infection). The main abdominal localizations were lymph nodes (72.5%), peritoneum (62.5%), and solid organs (25%). Extra-abdominal localizations were recorded in 65 (81.2%) patients. Tuberculosis was proven bacteriologically in 71%, histologically in 50%, and solely clinical/radiological in 10% of cases. Patients received standard therapy for a median duration of 9 months, with a favorable outcome. Corticosteroid therapy was used in 15 cases, either for paradoxical reaction or to prevent complications. Abdominal TB was mainly represented by lymphatic and peritoneal localizations, proven bacteriologically, and associated with extra-abdominal localizations in most cases. The use of steroids remains controversial, but it does not seem systematically needed in case of abdominal involvement.

Thrombocytopenia as a preoperative risk assessment tool in patients with type B aortic dissection after thoracic endovascular aortic repair

Abstract Background Postoperative thrombocytopenia has been reported to be correlated with adverse events, but the prognostic value of baseline thrombocytopenia is unclear. This study was undertaken to evaluate the relationship between preoperative thrombocytopenia and adverse outcomes in patients with type B aortic dissection who underwent thoracic endovascular aortic repair (TEVAR). Methods A total of 825 patients with acute and sub-acute type B aortic dissection undergoing were TEVAR at a multidisciplinary aortic center were enrolled between January 2010 and December 2017. Patients were stratified on the basis of presence (n=149) or absence (n=676) of thrombocytopenia (platelet count, &amp;lt;150x109/L), according to preprocedural platelet counts. The primary outcome of interest was in-hospital mortality. Secondary outcomes of interest was long-term death. Results In the enrolled cohort, thrombocytopenia occurred in 149 (18.1%) patients. Patients with thrombocytopenia were older, were more commonly acute stage of TBAD, higher D-dimer level and had higher rates of abdominal vessel involvement and pericardial effusion. During the hospitalization period, 26 patients (3.2%) died, which was significantly higher in the thrombocytopenic group (8.1% versus 2.1%; P=0.001) Multivariate analyses revealed that thrombocytopenia was independently associated with in-hospital mortality (Table). During long-term follow-up (median duration 44.2 months), A total of 62 deaths were reported after discharge, including 40 (64.5%) aortic-related and unknown deaths, of which 12 and 50 patients for thrombocytopenia and non-thrombocytopenia group, respectively. Kaplan-Meier estimated rates of long-term all-cause mortality were higher for thrombocytopenia (log-rank test, P=0.014). Similar results were observed in a subset of aortic-related death (P=0.004) as well as aortic-related and unknown death (P=0.006), not non-aortic related death (P=0.878) (Figure 1). Conclusion Platelet counts, as simple and inexpensive indexes, were reliable to be used as a preoperative risk assessment tool for patients with type B aortic dissection undergoing thoracic endovascular aortic repair. Figure 1. Long-term Mortality Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): This research was supported by grant DFJH201807 from High-level Hospital Construction Project of Guangdong Provincial People's Hospital.

Non-Hodgkin lenfomanın farkı mukozal görünümleri: Olgu serisi

Non-Hodgkin lymphoma has an incidence 8% of all childhood malignancies in the world. Non-Hodgkin lymphoma typically invades the liver, lungs, spleen and mediastinum. The most common symptoms include pain and coughing due to enlarged lymph nodes, shortness of breath due to thoracic masses, and bowel obstruction and acid in abdominal involvement. In this study, we have discussed cases of lymphoma with different mucosal presentations. The age of the patients varied from 3.5-16 years, and included three females and two males. The cases include patients with lymphoblastic lymphoma referring with a preliminary diagnosis of eosinophilic granuloma; with lymphoblastic lymphoma, with a preliminary diagnosis of odontogenic cyst; with Burkitt lymphoma, with lower gastrointestinal system bleeding-acute gastroenteritis; with Burkitt lymphoma, with a preliminary diagnosis of ovarian tumor and with diffuse large B-cell lymphoma, with a diagnosis of anemia. Clinical, laboratory and radiological diagnostic methods can guide diagnosis of lymphoma, histopathologic examination is important for the final diagnosis. In conclusion, it is important to make a systemic evaluation rather than focusing only on the referral complaints and radiological imaging in patient assessment.

Sarcopenia in Hodgkin's lymphoma evaluated with 18-FDG PET/CT, focus on age, performance, and treatment.

Sarcopenia is defined as a progressive and generalized muscle disorder associated with certain physiological and pathological conditions. We aimed to evaluate the prevalence of sarcopenia in patients with HL using 18-fluoro deoxyglucose (FDG) PET/CT, which would provide a data of muscle mass with the CT compartment and also data of muscle metabolism with the 18-FDG compartment of the imaging modality. Fifty-nine patients diagnosed with HL were included in the study. PET/CT images before and after treatment were evaluated with regard to lumbar muscle mass and metabolism. Mean lumbar muscle evaluation with CT before treatment was 92, 40 HU, and after treatment was 89, 41 HU. Mean metabolic tumor volume (MTV) evaluated with FDG PET before treatment was 4, 13mm3 while after treatment was 4, 10mm3. The lumbar muscle mass in terms of HU which was evaluated with CT was observed to be decreased after treatment. Likewise, the metabolic evaluation was observed to be also decreased after treatment. Despite the decline in muscle mass after treatment in the whole group, this decline was particularly observed in the better initial performance group. In patients with BMI > 32, there was a significant decline in muscle mass. Abdominal nodal involvement was related with poorer muscle mass and quality. In HL care, particular attention should be given to patients who are younger and with better physical condition in terms of preserving the muscle reserves and preventing sarcopenia.

The technique of fourth jejunal artery-based jejunal conduit for oesophagojejunostomy after thoracolaparoscopic oesophagogastrectomy for locally advanced Siewert type II tumour.

Background:Locally advanced long Siewert type II tumor requires total gastrectomy and D2 lymphadenectomy with distal esophagectomy and mediastinal lymphadenectomy for curative resection. In this scenario, a laparoscopic transhiatal approach is not feasible, and the conventional left thoracoabdominal approach is associated with increased morbidity.Aims and Objectives:To describe a novel technique of fourth jejunal artery based jejunal conduit for thoracoscopic esophagojejunostomy after laparoscopic esophagogastrectomy.Materials and Methods:The laparoscopic total gastrectomy with distal esophagectomy specimen is extracted through the periumbilical incision. A pedicled jejunal conduit based on the fourth jejunal artery is prepared, and the jejunal conduit is placed in the mediastinum under laparoscopic guidance. Using the thoracoscopic approach in a prone position, additional esophageal clearance and subcarinal lymphadenectomy are performed. Handsewn end to side esophagojejunostomy is performed at the level of the carina.Results:Three patients with long Siewert type II underwent this procedure after neoadjuvant chemotherapy. None of the patients had conduit related complications. All three patients had abdominal lymph node involvement and two patients had mediastinal lymph node involvement.Conclusion:Pedicled jejunal conduit based on the fourth jejunal artery is safe for intrathoracic anastomosis after minimally invasive esophagogastrectomy for locally advanced Siewert type II tumor.