Abdominopelvic Region Research Articles

Actinomyces Associated with Radicular Cyst: Case Report

Actinomycosis is an infectious disease that rarely settles in the jaw. It is most commonly located in the cervicofacial, thoracic, abdominopelvic, and cerebral regions. Actinomycosis is mainly caused by Actinomyces israelii, a gram-positive facultative anaerobic bacterium. Surgical excision and antibiotic therapy are also required in the treatment approach. We present a rare case of surgical and medical treatment of Actinomycosis, which is rarely seen in the maxillary intraoral region. Actinomyces may be associated with a radicular cyst. The intraoral lesion of a 70-year-old diabetic female patient who applied to our clinic with long-term bleeding in the maxillary anterior region was surgically removed. The excised tissue was evaluated microscopically. Actinomyces associated with radicular cysts were seen. Short-term antibiotic therapy was then administered. An uneventful recovery was observed in the controls. J Microbiol Infect Dis 2022; 12(3):127-129.

A vital and disregarded anatomical landmark: Descending sigmoid colon flexure

Background: During the colonoscopy, colon tortuosity is a vital factor to complete the procedure successfully. Endoscopy can be difficult in cases with acute angle bending of adjacent colon segments. Aim: To assess the relationship of descending sigmoid colon flexure to vital anatomical points on CT in adult subjects. Methods: 114 adult subjects with CT examination of the abdominopelvic region were retrospectively analyzed. In 114 subjects, the angle between proximal sigmoid and descending colon was evaluated in degrees along with descending-sigmoid flexure position concerning the anterior aspect of the 5th lumbar vertebra, the median plane, and left anterior superior iliac spine. Results: Descending sigmoid flexure was seen in all 114 subjects. the LV-DSF was significantly higher in male subjects, with a distance of 123.7±23.1mm compared to female subjects where it was 115.6±21.2. This was statistically significant with p<0.005. MP-DSF in male subjects was 97.8±15.6mm which was significantly higher than the female subjects having MP-DSF of 88.8±14.0mm. The minimum to maximum for males and females respectively were 52-149 and 44-116 which was a statistically significant difference with p<0.001. However, for ASIS-DSF, the distance did not differ significantly between males and females with p=0.54 Conclusions.

Preoperative Computed Tomography Morphological Features Indicative of Incisional Hernia Formation After Abdominal Surgery.

To investigate key morphometric features identifiable on routine preoperative computed tomography (CT) imaging indicative of incisional hernia (IH) formation following abdominal surgery. IH is a pervasive surgical disease that impacts all surgical disciplines operating in the abdominopelvic region and affecting 13% of patients undergoing abdominal surgery. Despite the significant costs and disability associated with IH, there is an incomplete understanding of the pathophysiology of hernia. A cohort of patients (n=21,501) that underwent colorectal surgery was identified, and clinical data and demographics were extracted, with a primary outcome of IH. Two datasets of case-control matched pairs were created for feature measurement, classification, and testing. Morphometric linear and volumetric measurements were extracted as features from anonymized preoperative abdominopelvic CT scans. Multivariate Pearson testing was performed to assess correlations among features. Each feature's ability to discriminate between classes was evaluated using 2-sided paired t testing. A support vector machine was implemented to determine the predictive accuracy of the features individually and in combination. Two hundred and twelve patients were analyzed (106 matched pairs). Of 117 features measured, 21 features were capable of discriminating between IH and non-IH patients. These features are categorized into three key pathophysiologic domains: 1) structural widening of the rectus complex, 2) increased visceral volume, 3) atrophy of abdominopelvic skeletal muscle. Individual prediction accuracy ranged from 0.69 to 0.78 for the top 3 features among 117. Three morphometric domains identifiable on routine preoperative CT imaging were associated with hernia: widening of the rectus complex, increased visceral volume, and body wall skeletal muscle atrophy. This work highlights an innovative pathophysiologic mechanism for IH formation hallmarked by increased intra-abdominal pressure and compromise of the rectus complex and abdominopelvic skeletal musculature.

CT features associated with underlying malignancy in patients with diagnosed mesenteric panniculitis

PurposeThe purpose of this study was to identify abdominal computed tomography (CT) features associated with underlying malignancy in patients with mesenteric panniculitis (MP). Materials and methodsThis single-institution retrospective longitudinal cohort study included patients with MP and a minimum 1-year abdominopelvic CT follow-up or 2-year clinical follow-up after initial abdominopelvic CT examination. Two radiologists, blinded to patients’ medical records, conjointly reviewed CT-based features of MP. Electronic medical records were reviewed for newly diagnosed malignancies with the following specific details: type (lymphoproliferative disease or solid malignancy), location (possible mesenteric drainage or distant), stage, time to diagnosis. An expert panel of three radiologists and one hemato-oncologist, who were blinded to the initial CT-based MP features, assessed the probability of association between MP and malignancy based on the malignancy characteristics. ResultsFrom 2006 to 2016, 444 patients with MP were included. There were 272 men and 172 women, with a median age of 64 years (age range: 25–89); the median overall follow-up was 36 months (IQR: 22, 60; range: 12–170). A total of 34 (8%) patients had a diagnosis of a new malignancy; 5 (1%) were considered possibly related to the MP, all being low-grade B-cell non-Hodgkin lymphomas. CT features associated with the presence of an underlying malignancy were the presence of an MP soft-tissue nodule with a short axis >10 mm (P < 0.0001) or lymphadenopathy in another abdominopelvic region (P < 0.0001). Associating these two features resulted in high diagnostic performance (sensitivity 100%; [95% CI: 57–100]; specificity 99% [95% CI: 98–100]). All related malignancies were identified. ConclusionFurther workup to rule out an underlying malignancy is only necessary in the presence of an MP soft-tissue nodule >10 mm or associated abdominopelvic lymphadenopathy.

The Optimal Axial Anatomical Site for a Single-Slice Area to Quantify the Total Volume of Visceral Adipose Tissue in Quantitative CT.

PurposeDetermine the association between cross-sectional visceral adipose tissue (VAT) area of different anatomic locations and total abdominopelvic VAT volume; identify the optimal measurement site in a single-slice to quantify the total VAT volume.MethodParticipants who underwent non-contrast abdominal scan by quantitative CT (QCT) were enrolled from May 2021 to October 2021. The VAT area (cm2) at different anatomic sites as upper-pole, lower-pole, and hilum of the kidney, intervertebral disc of L2/L3 and L5/S1, and umbilical level were measured on QCT PRO BMD workstation (Mindways QCT PRO workstation). The total VAT volume (cm3) from the upper pole of kidney to the L5/S1 intervertebral disc of the pelvis (abdominopelvic region) was obtained by using Siemens Healthineers Syngo via Frontier cardiac risk assessment. Regression models were used to identify the optimal single-slice in different gender for estimating VAT volume. Statistical significance was established at P < 0.05.ResultsTotal of 311 Chinese participants including 179 men [age, 55.1 ± 14.9 years; body mass index (BMI), 24.2 ± 3.2 kg/m2; total VAT volume, 2482.6 ± 1276.5 mL] and 132 women [age, 54.3 ± 14.9; BMI, 23.5 ± 2.9; total VAT volume, 1761.5 ± 876.4]. Pearson’s correlation analysis revealed a strong association between the VAT area and total abdominopelvic VAT volume at the hilum of the kidney in both men (r=0.938, P<0.001) and women (r=0.916, P<0.001). Adjust for covariates including age, BMI, and waist circumference make a relatively small effect on predicting the total VAT volume.ConclusionsMeasurement of cross-sectional areas at the hilum of the kidney in both genders showed a strongest relation to TVAT volume. Our results may provide an identifiable and valuable axial landmark for measuring visceral adipose tissue in clinical practice.

EPIPLOIC APPENDAGITIS: AN UNCOMMON CASE OF ACUTE ABDOMINAL PAIN WITH CHARACTERISTIC IMAGING FINDINGS.

Introduction: th th Epiploic appendagitis is an uncommon cause of abdominal pain and is frequently undiagnosed. Obese men in their 4 and 5 decade of life are most affected. It generally mimics other serious causes of acute abdomen and thus the denitive diagnosis relies on cross-sectional imaging primarily computed tomography ndings. Most often the condition is caused due to torsion of an epiploic appendage or spontaneous venous thrombosis of a draining appendageal vein. Appendices epiploicae are small (0.5-5 cm long), fat lled pouches of peritoneum projecting from the external surface of colon and are supplied by blood vessels that protrude through the bowel wall. They are present commonly over distal colon particularly numerous at the rectosigmoid junction. Case: We are reporting a case of 42 years old male patient, who presented to the surgical OPD at Dr. RPGMC Tanda with chief complaint of acute abdominal pain localized in the left iliac fossa with tenderness in the region. The ultrasonography report was inconclusive and the patient was further evaluated using biochemical investigations and contrast enhanced CT of the abdominopelvic region. The CECT revealed fat dense ovoid shaped lesion in the left iliac fossa with surrounding fat stranding and hyperdense rim suggestive of intraperitoneal focal fat infarction. The condition was managed conservatively with empirical antibiotics and analgesics. Conclusion: Epiploic appendagitis is a self-limiting disease but persistence of symptoms or recurrence requires surgical management with laparoscopic appendage excision. The anatomical and surgical knowledge of epiploic appendagitis is very important to raise awareness about this clinical condition and to manage it appropriately.

Peritoneal metastases from colorectal cancer in the absence of lymph node metastases show a high survival rate despite unfavorable prognostic indicators

BackgroundPatients with colorectal cancer die as a result of metastases to liver, lymph nodes or the peritoneal surfaces. The primary is almost always controlled by colon or rectal cancer resection. MethodsConsecutive patients with isolated metastases to peritoneal surfaces (no lymph node, liver or systemic metastases) were referred to the Washington Cancer Institute from all over the United States and abroad. The study of this particular group of patients was to determine the impact of clinical and histologic features on overall survival. These variables were collected from the primary colorectal cancer resection performed at the referring institute and from the cytoreductive surgery (CRS) performed at the Washington Hospital Center. The data was prospectively accumulated and retrospectively analyzed. ResultsThirty-one consecutive patients had a complete cytoreduction. This restricted cohort of patients was studied in an attempt to eliminate confounding variables. The median age was 47 years (range 19–80). There were 14 (45%) males. The median overall survival following CRS was 67.9 months with a 5-year and 10-year survival of 51.9% and 43.6%, respectively. None of the clinical or histologic features, including peritoneal cancer index (PCI) and presence of signet ring cells, significantly predicted survival except for carbohydrate antigen 19-9 (CA19-9) (p = 0.0033). None of the involved abdominopelvic regions predicted a guarded outcome. ConclusionsIn this restricted group of lymph node negative colorectal PM patients with a complete cytoreduction, a high PCI or the presence of signet ring cells should not exclude patients from CRS and perioperative chemotherapy.

Adhesion-related small bowel obstruction: deep learning for automatic transition-zone detection by CT

BackgroundTo train a machine-learning model to locate the transition zone (TZ) of adhesion-related small bowel obstruction (SBO) on CT scans.Materials and methodsWe used 562 CTs performed in 2005–2018 in 404 patients with adhesion-related SBO. Annotation of the TZs was performed by experienced radiologists and trained residents using bounding boxes. Preprocessing involved using a pretrained model to extract the abdominopelvic region. We modeled TZ localization as a binary classification problem by splitting the abdominopelvic region into 125 patches. We then trained a neural network model to classify each patch as containing or not containing a TZ. We coupled this with a trained probabilistic estimation of presence of a TZ in each patch. The models were first evaluated by computing the area under the receiver operating characteristics curve (AUROC). Then, to assess the clinical benefit, we measured the proportion of total abdominopelvic volume classified as containing a TZ for several different false-negative rates.ResultsThe probability of containing a TZ was highest for the hypogastric region (56.9%). The coupled classification network and probability mapping produced an AUROC of 0.93. For a 15% proportion of volume classified as containing TZs, the probability of highlighted patches containing a TZ was 92%.ConclusionModeling TZ localization by coupling convolutional neural network classification and probabilistic localization estimation shows the way to a possible automatic TZ detection, a complex radiological task with a major clinical impact.

Revised prognostic indicators for treatment of lymph node positive colorectal peritoneal metastases

Peritoneal metastases from colon and rectal cancer presents a new target for a regional approach to treatment. Proper patient selection requires an understanding of the natural history of the disease progression. Data from colorectal cancer patients treated for peritoneal metastases by cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy and the records from the primary colon or rectal cancer surgery were analyzed to assess their impact on survival. Data regarding the anatomic sites of colorectal peritoneal metastases was gathered at the time of a complete CRS. A cohort of 73 patients with peritoneal metastases and lymph node metastases but no liver metastases provided the information. All patients had a complete cytoreduction. Left-sided primary cancer and a complete or near complete response to neoadjuvant chemotherapy (NAC) indicated improved survival. Tumor progression within the abdominal incision, carcinoembryonic antigen (CEA) >10, peritoneal cancer index >9 and peritoneal metastases present in the abdominopelvic regions 6 and 11 carried an especially guarded prognosis. Reduced survival occurred with a right-sided or rectal primary cancer, a CEA >10, tumor cell entrapment, and involvement of abdominopelvic regions 6 and 11. Effective NAC showed a favorable outcome.

The investigating of clinical and radiological findings of hepatic actinomycosis

Actinomycosis is a rare chronic suppurative granulomatous infection of the oropharynx, gastrointestinal, and urogenital tract. Infection most commonly manifests as a cervicofacial disease but less frequently in the thoracic and abdominopelvic region. Hepatic actinomycosis (HA) is rare and usually secondary to abdominal actinomycosis. It can mimic hepatic malignant tumors. There is not enough information in the literature about HA. In this study, radiological and clinical findings of HA cases were investigated. Between January 2013 and February 2021, a total of 12 patients diagnosed with HA were retrospectively analyzed. Significant clinical and laboratory findings and radiological findings related to current pathology were noted. The mean age of the patients ranged from 23 to 75 years (mean age, 52.2 years). There were 7 male and 5 female patients. 85% of these patients had fever, 67% anemia, and 53% weight loss. Peripheral blood leukocytes were increased in all patients. 8 of the patients (66%) had a secondary infection of HA in the lungs, and pelvis organs. Radiologically, they were mostly low-intensity changes (66%), making them easily misdiagnosed as metastatic cancer and primary liver cancer. 17% seen acute bacterial abscess-like changes. A few cases exhibited cystic mass-like changes. In 64% of the patients, a single lesion was found. The right lobe of the liver was the most common infection area. A definitive diagnosis was made by histopathological examination. The diagnosis of primary HA is difficult to diagnose because of the nonspecific clinical and radiological findings. Differential diagnoses should be made with diseases that include both benign and malignant conditions.

Demonstration of the epigastric vessels surface anatomy with equation model: An anatomical feasibility study

Introduction: The objective of this study is to design a patient-specific model to predict the location of epigastric vessels on the abdominal surface and to show clinicians safe areas before surgical intervention. Material and Methods: A total of 200 patients who underwent color Doppler ultrasound evaluation of the deep epigastric vessel before gynecological laparoscopic surgery were recruited in the study. The deep epigastric vessels were identified at three equal levels between the xiphoid and umbilicus, and five equal levels between the umbilicus and the symphysis pubis. The distance between the epigastric vessels and the midline was measured bilaterally at each level. Linear mixed effect modeling was used to assess the anatomical location of the epigastric vessels. Results: The model with waist circumference term was found to be the model with best performance metric. This model included waist circumferences as a covariate, the region of the epigastric vessel as a categorical variable, and random effects for patients. The model that calculates the expected distance from the midline of the epigastric vessels for different regions and waist circumferences are presented as “Distance to midline (cm) = 2.57 + Region A + Region B × Waist Circumference.” Discussion and Conclusion: With the equation model, we proposed, the location of the epigastric vessels can be determined specifically for the patient and the abdominopelvic regions. This model can be a guide to prevent vascular injury.

Association between High Diffusion-Weighted Imaging-Derived Functional Tumor Burden of Peritoneal Carcinomatosis and Overall Survival in Patients with Advanced Ovarian Carcinoma.

ObjectiveTo investigate the association between functional tumor burden of peritoneal carcinomatosis (PC) derived from diffusion-weighted imaging (DWI) and overall survival in patients with advanced ovarian carcinoma (OC).Materials and MethodsThis prospective study was approved by the local research ethics committee, and informed consent was obtained. Fifty patients (mean age ± standard deviation, 57 ± 12 years) with stage III–IV OC scheduled for primary or interval debulking surgery (IDS) were recruited between June 2016 and December 2021. DWI (b values: 0, 400, and 800 s/mm2) was acquired with a 16-channel phased-array torso coil. The functional PC burden on DWI was derived based on K-means clustering to discard fat, air, and normal tissue. A score similar to the surgical peritoneal cancer index was assigned to each abdominopelvic region, with additional scores assigned to the involvement of critical sites, denoted as the functional peritoneal cancer index (fPCI). The apparent diffusion coefficient (ADC) of the largest lesion was calculated. Patients were dichotomized by immediate surgical outcome into high- and low-risk groups (with and without residual disease, respectively) with subsequent survival analysis using the Kaplan-Meier curve and log-rank test. Multivariable Cox proportional hazards regression was used to evaluate the association between DWI-derived results and overall survival.ResultsFifteen (30.0%) patients underwent primary debulking surgery, and 35 (70.0%) patients received neoadjuvant chemotherapy followed by IDS. Complete tumor debulking was achieved in 32 patients. Patients with residual disease after debulking surgery had reduced overall survival (p = 0.043). The fPCI/ADC was negatively associated with overall survival when accounted for clinicopathological information with a hazard ratio of 1.254 for high fPCI/ADC (95% confidence interval, 1.007–1.560; p = 0.043).ConclusionA high DWI-derived functional tumor burden was associated with decreased overall survival in patients with advanced OC.

Multispectral label-free Raman spectroscopy can detect ovarian and endometrial cancer with high accuracy.

Up to 70% of ovarian cancer patients are diagnosed with advanced-stage disease and the degree of cytoreduction is an important survival prognostic factor. The aim of this study was to evaluate if Raman spectroscopy could detect cancer from different organs within the abdominopelvic region, including the ovaries. A Raman spectroscopy probe was used to interrogate specimens from a cohort of nine patients undergoing cytoreductive surgery, including four ovarian cancer patients and three patients with endometrial cancer. A feature-selection algorithm was developed to determine which spectral bands contributed to cancer detection and a machine-learning model was trained. The model could detect cancer using only eight spectral bands. The receiver-operating-characteristic curve had an area-under-the-curve of 0.96, corresponding to an accuracy, a sensitivity and a specificity of 90%, 93% and 88%, respectively. These results provide evidence multispectral Raman spectroscopy could be developed to detect ovarian cancer intraoperatively.

Therapeutic Radiation in Genetically Engineered Mouse Models of Cancer

Some drugs that target tumor metabolism are minimally effective in vitro but limit proliferation in vivo. Our goal was to develop a preclinical platform enabling us to test drugs that target cancer cell metabolism in combination with radiation therapy in vivo. Here we report the initial results of preclinical studies in autochthonous mouse models of prostate and colorectal cancer using radiation as monotherapy.A dose escalation study was performed in C57BL/6 wild-type mice using 1-5 fraction regimens with a BED of 90, 130, 180, and 250 (a/b = 3). Flank xenograft models of prostate cancer (22Rv1 and PC3 cells) were treated with 24 Gy in 4 fractions or sham irradiated (n = 10 animal per group, 40 animals total). Pb-Cre;Ptenfl/fl;p53fl/fl mice (autochthonous prostate cancer model) age 5 months were randomly assigned to two dose regimens (37.5 Gy in 5 fractions or 45 Gy in 5 fractions) or sham irradiation (n = 11-14 per group). Survival was estimated by Kaplan-Meier Analysis. Colorectal tumors were induced in male and female Villin-CreER;Apcfl/fl mice by intramucosal tamoxifen injection. Mice were assigned 2:1 to 37.5 Gy or sham irradiation (n = 10-15 per group). Treatment effect was measured as percent survival 6 months after tumor induction. In all cases pathologic response rate was determined using serial histologic sections and proliferation by Ki-67 immunohistochemistry.For a 2 cm field directed at the low abdomen and pelvis of mice, the maximum tolerated dose of radiation was 45 Gy delivered in 5 fractions. The intestinal tract was identified as the dose limiting organ for abdominopelvic radiation. In irradiated flank xenografts, growth delay was observed for all tumors compared with 100% progression in unirradiated controls. Pathologic complete response was observed in 1 of 10 (10%) 22Rv1 xenografts and 4 of 10 (40%) PC3 xenografts. In the autochthonous prostate cancer model, median survival was significantly improved in the 45 Gy (236 days, P < 0.0001) and 37.5 Gy (227 days, P = 0.0007) arms relative to control (206 days). Irradiated tumors were also smaller relative to control (mean difference -2.637 grams [95% CI -4.617 to -0.6563, P = 0.0153); however, all mice eventually died of local tumor progression. In the autochthonous colorectal cancer model, survival at 6 months was significantly improved in the radiation group relative to control (100% vs 40%, P = 0.0012). In both prostate and colorectal cancer autochthonous models the proliferation index at time of death (prostate) or 6 months after tumor induction (colorectal) was similar in irradiated and control cohorts.Hypofractionated radiation therapy can be safely administered to the abdominopelvic region in mice and improves survival in autochthonous mouse models of prostate and colorectal cancer. Radiation can induce pathologic complete responses in flank xenografts, but not autochthonous tumors, suggesting the presence of radioresistant persister cells in these models.

The Interference of Gamma Rays With Bone Mineral Density Measurements in 177Lu-PSMA and DOTATATE Therapy

The main purpose was to describe the interference of gamma radiation emitted by 177Lu with simultaneous bone mineral density BMD measures for patients undergoing 177Lu-PSMA and 177Lu DOTATATE therapy. A cohort of 9 patients underwent 177Lu-PSMA therapy were randomly selected to speculate the activity in the abdominopelvic region. So that, SPECT/CT scan at 24 h was used with attenuation and scatter correction. The activities were derived from the delineated ROIs over the abdominopelvic zone showing a range of 34−274 MBq. Next, a water path was placed under spine phantom mimicking L1-L4 vertebrae and followed by consecutive DEXA scans made by Hologic 4500 W and GE-Lunar DPX-NT systems. Five scans were performed without/and with different Lu-177 activities 37, 185, 370 and 555 MBq under the same geometric conditions. The obtained BMD readings of L1-L4 by the Hologic device were 1.027, 1.024, 1.021, 1.013, and 1.006 g/cm2 with presence of 0, 37, 185, 370, and 555 MBq 177Lu activity, respectively. Whereas, in Lunar device, it was found as higher as 1.163, 1.121, 1.09, 1.072, and 1.043, respectively. There was no statistically significant difference between both devices (pvalue ≥ 0.05). The fluctuation ranges in the L1-L4 BMD readings at the presence of 37−555 MBq were 0.3%−2%, and 3.6%−10.3% for Hologic and Lunar systems, respectively. It was emphasized that gamma radiation emitted by 177Lu relatively influence DEXA scans and the yielded BMD measures. Postponing DEXA scans as early as 8 d after 177Lu-PMSA and 11 d after 177Lu-DOTATATE therapies is recommended to avoid the erroneous contribution of gamma radiation and provide precise bone assessment.

Clinical features of actinomycosis: A 20-year experience of a single institute in Southern China

BackgroundActinomycosis is a rare indolent infectious disease with nonspecific clinical presentations that delay diagnosis. Although actinomycosis is thought to be more prevalent in developing countries, data from developing countries are scarce. This study aimed to profile actinomycosis in developing countries and identify how it differed from profiles of developed countries. MethodsPatients fulfilling the inclusion criteria for actinomycosis from Nanfang Hospital in southern China between January 1999 and December 2018 were retrospectively analyzed. We described clinical characteristics, diagnostic procedures, differential diagnosis, and management of actinomycosis of clinical significance. ResultsThirty‑one patients were included in this study. The disease was diagnosed predominately in the orocervicofacial (n = 14), cardiothoracic (n = 11), abdominopelvic (n = 5), and soft tissue (n = 1) regions. Diagnosis was obtained by either histopathology (n = 29, 94%) or microbiology (n = 2, 6%). Only one-third of patients presented with general symptoms, such as fever and weight loss. Ten were lost during follow-up, and the median duration of antibiotic use was 93.5 days (interquartile range 28–300), whereas the median follow-up time was 34 months (interquartile range 9–132). Ten patients receiving complete resection of the lesion were cured without postoperative use of antibiotics. Only one patient relapsed during the follow-up period. ConclusionsActinomycosis is a rare disease even in developing countries, and both misdiagnosis and missed diagnosis are common. Diagnosis was often delayed and was obtained postoperatively from histopathology in developing countries. Hence, clinicians should be aware of this disease in patients with high risk factors. In the future, specific molecular methods may help to improve early diagnosis and treatment.

Castleman disease: A single-center case series

BackgroundCastleman disease (CD) is a rare lymphocytic disorder. Unicentric CD (UCD) has an excellent long-term prognosis after surgical excision; however, multicentric CD (MCD) has a severe clinical course with poor outcomes. Study designWe analyzed the clinical presentation of 28 patients treated at a single institution from 1995 to 2017. Demographics, clinical variables, anatomical site, centricity, histopathology, immunochemistry, and surgical approach were reviewed. We evaluated the 5-year recurrence and survival for patients with UCD and MCD. ResultsOf the 28 patients, 57 % (n = 16) were female, with a mean age of 41.6 ± 15.6 years. CD was asymptomatic in 57 % (n = 16) of patients, 21 % (n = 6) presented with local symptoms such as pain, and 21 % (n = 6) of patients also had systemic symptoms, including weight loss and fever. CD was unicentric in 64 % (n = 18) and multicentric in 36 % (n = 10). The hyaline vascular variant was noted in 57 % (n = 16) of the tumors, plasmacytoid variant in 36 % (n = 10), and mixed variants in 7% (n = 2) of tumors. Anatomical distributions included: head and neck (20 %), thorax and axilla (24 %), retroperitoneal (13 %), abdominopelvic (30 %) regions, and other (13 %). Complete surgical resection was performed in 95 % of patients with UCD. Surgical biopsy and medical therapy were provided to all patients with MCD. The recurrence rate for UCD and MCD was 6 % (n = 1) and 14 % (n = 1), respectively. The five-year disease-free survival rate for UCD was 95 % (n = 19) and MCD was 33 % (n = 2). We found 100 % survival in patients with UCD and histology demonstrating the HV variant. ConclusionCD is rare and often misdiagnosed due to the absence of specific clinical symptoms. Surgeons should include CD in their differential diagnoses when evaluating patients with lymph node hyperplasia. Surgery can be curative in nearly all patients with UCD. Patients with MCD require a combination of surgical therapy, chemotherapy, and immunotherapy; however, cytoreductive surgery benefits for patients with MCD have not been established.

Reducing margins for abdominopelvic tumours in dogs: Impact on dose-coverage and normal tissue complication probability.

Image‐guided, intensity modulated radiation therapy (IG‐IMRT) reduces dose to pelvic organs at risk without losing dose coverage to the planning target volume (PTV) and might permit margin reductions potentially resulting in lower toxicity. Appropriate PTV margins have not been established for IG‐IMRT in abdominopelvic tumours in dogs, and herein we explore if our usual PTV 5 mm margin can be reduced further. Datasets from dogs that underwent IG‐IMRT for non‐genitourinary abdominopelvic neoplasia with 5 mm‐PTV expansion were included in this retrospective virtual study. The clinical target volumes and organs at risk (OAR) colon, rectum, spinal cord were adapted to each co‐registered cone‐beam computed tomography (CBCT) used for positioning. New treatment plans were generated and smaller PTV margins of 3 mm and 4 mm evaluated with respect to adequate dose coverage and normal tissue complication probability (NTCP) of OAR. Ten dogs with a total of 70 CBCTs were included. Doses to the OAR of each CBCT deviated mildly from the originally planned doses. In some plans, insufficient build‐up of the high dose‐area at the body surface was found due to inadequate or missing bolus placement. Overall, the margin reduction to 4 mm or 3 mm did not impair dose coverage and led to significantly lower NTCP in all OAR except for spinal cord delayed myelopathy. However, overall NTCP for spinal cord was very low (<4%). PTV‐margins depend on patient immobilization and treatment technique and accuracy. IG‐IMRT allows treatment with very small margins in the abdominopelvic region, ensuring appropriate target dose coverage, while minimizing NTCP.

Morphological Alterations of the Rat Testicles Following Administration of Graded Doses of Leaves of Guava (Psidium guajava Linn.) Aqueous Extract

The current study design to assess the dose-response effect of administering an aqueous extract of guava leaves on the microstructure of the testicles due to the growing use of this plant in complementary and alternative medicine practice. Twenty-four male albino Wistar rats with an average body weight of 160 g apportion to four groups (n=6 each). Group, I served as the control and received distilled water; group II gave a lower dose of 500 mg/kg body weight of guava leaf extract; group III received a medium dose of 750 mg/kg; while group IV administer a higher amount of 1000 mg/kg per day. Treatments were given once daily by gavage and lasted for 14 days, while the stock solution prepares by dissolving 50 g of the extract in 30 ml of water. The cervical dislocation method used to euthanize the rats, dissect the abdominopelvic region to obtain tissue specimens from the testes for histological processing. The outcome exhibited the extract to cause moderate to severe (dose-dependent) morphological alterations with the seminiferous tubules' fibrotic appearance, strict spermatogenic arrest, and necrosis of both the interstitial cells of Leydig and the Sertoli cells. The ingestion of guava leaves at the investigated concentration and doses is harmful to the testicle, the primary reproductive organ in males. It should therefore be consumed with caution when being used primarily in folklore-traditional medicine.

A survey of perioperative complications with Clavien-Dindo classification: A cross-sectional study.

To determine the incidence of complications in elective surgeries and to grade them according to the Clavien-Dindo Classification System. The cross-sectional study was conducted in the General Surgery Operation Theatre of Holy Family Hospital, Rawalpindi, Pakistan, from February to April 2018, and comprised patients undergoing elective surgeries. Age, gender, region of surgery, type and grade of complications, were recorded using Clavien-Dindo Classification proforma. Data was analysed using SPSS 23. Of the total 212 patients, 36(16.9%) had some complication. There were significantly more complications in people aged 40 years or above compared to those <40 years (p<0.05). Of the total surgeries, 126(59.43%) were in the abdomino-pelvic region. Peri-operative complications were found to be significantly related with age of the patient and the type of surgery.