Actual Pathology Research Articles

Radiologist Accuracy in Predicting Pathology in Breast Imaging

Introduction: Breast cancer, the most prevalent cancer in women and second only to lung cancer in female mortality, has seen rising incidence, especially during the 1980s and 1990s due to increased mammography screening. Screening’s primary goal is early tumor detection, reducing mortality by over 40%. Yet, it has downsides, including false-positive cases of benign biopsies and potential increased patient anxiety and stress. The average recall rate from screening mammograms is 5-10%. Among women requiring biopsy, the anticipated rate of malignant findings range between 30-50%. With the evolution of image-guided breast biopsy techniques, concerns have risen regarding the escalating frequency of breast biopsies. The possible causes are overlapping imaging characteristics of benign and malignant pathologies, patients’ anxiety, litigation risk and radiologist years of experience. A radiologists’ ability to predict breast histology from imaging findings remains an understudied domain. This study’s core purpose is to comprehensively analyze the ability of a radiologist to predict benign versus malignant results to provide guidance in reducing the number of benign biopsies. Methods: This prospective study involved radiologists completing survey sheets when recommending biopsies and when performing the biopsy, predicting benign vs malignant, specific pathology, with confidence interval. Predictions were compared to the final biopsy results to determine accuracy. All patients who underwent biopsy at our institutions were included in the data. Data was categorized as either concordant or discordant when comparing predicted pathology results to actual. Results: The accuracy of radiologist prediction from initial diagnostic imaging when compared to actual pathology results in the study population is 71% (95% CI,61.8%-79.37%) with a sensitivity of 75 % (95% CI, 60.4%-86.36%). The accuracy of radiologist prediction at biopsy when compared to actual pathology results is 80.79% (95% CI, 75.89%-85.08%) with sensitivity of 79.77% (95% CI, 73%-85.49%). The accuracy of less to moderately experienced radiologists to highly experienced radiologists is similar, 78.2% vs 81.0%. Further analysis of specific pathology prediction reveals that fibroadenoma is the most common benign pathology encountered, the prediction of which by imaging alone/at biopsy is 65%/68%. In the malignant category, invasive ductal carcinoma is the most common pathology encountered where the prediction is 68%/85%. Conclusions: This data will potentially help radiologists gain confidence in watching likely benign lesions based on imaging features (assigned as BIRADS 3) to reduce benign biopsies.

Medical Students' Perception of Pathology in Saudi Arabia.

Pathology is the bridge between basic science and clinical practice. An inadequate perception of pathology leads to an incomplete understanding of diseases, which consequently affects its management. This study aims to identify medical students' perceptions of pathology in medical colleges around Saudi Arabia and use their feedback to improve teaching strategies. A validated online self-structured questionnaire form was distributed to medical students in basic and clinical years, including private and governmental universities in all regions of Saudi Arabia. The study comprised a total of 476 medical students. It revealed that n = 226 (48%) of the participants were not aware of pathologists' roles, and n = 262 (55%) of students reported that the main reason was insufficient exposure to actual pathology practice. A total of n = 209 (44%) students believed the current teaching methods in the basic years were insufficient to provide clear perceptions of pathology. The majority of participants n = 366 (77%) chose practical sessions as the most effective strategy in teaching pathology. Our study demonstrated that medical students require more engagement in laboratories to improve their perception. We suggest that Saudi medical schools need to deliver more comprehensive and practical teaching methods that reflect the actual practice of pathology.

Tumor sound, auditory cues, and tissue pathology in glioma surgery: a proof-of-concept study.

Visual, tactile, and auditory cues are used during surgery to differentiate tissue type. Auditory cues in glioma surgery have not been studied previously. The objectives of this study were 1) to evaluate the feasibility of recording sound generated by the suction device during glioma surgery in matched tissue samples, and 2) to characterize the acoustic variation that occurs in different tissue samples. This was a prospective observational proof-of-concept study. Recordings were attempted in 20 patients in order meet the accrual target of 10 patients with matched sound and tissue data. For each patient, three 30- to 60-second recordings were made at these sites: normal white matter, infiltrative margin, and tumor. Tissue samples at each site were then reviewed by experienced neuropathologists, and agreement with surgical identification was estimated with the kappa statistic. Acoustic parameters were characterized for each sample. Data from 20 patients were analyzed. Patient-related or technical issues resulted in missing data for 10 patients, but the final 10 patients had both audio and tissue data for analysis. Among all tissue samples, fair agreement was observed between surgeon identification and actual pathology (κ = 0.24, standard error 0.096, p = 0.006). Acoustic data suggested that 1) the acoustic stimulus is broadband, 2) acoustic features are somewhat consistent within cases, 3) high-entropy values indicate irregularity of sound over time, and 4) bimodal pitch distributions could differentially reflect cues of interest. This study supports the feasibility of collecting intraoperative data on acoustic features during glioma surgery, and it provides an example of how an analysis could be performed to compare different types of tissues.

PO-02-178 ABLATION TISSUE HISTOLOGY AND CORRELATION WITH MAGNETIC RESONANCE IMAGING WITH A DIAMOND-BASED, TEMPERATURE-CONTROLLED RADIOFREQUENCY ABLATION

A new catheter has been developed which uses diamonds embedded in the catheter tip to enable temperature-guided ablation. The degree to which subsequent Magnetic Resonance (MR) findings correlate with actual tissue pathology has never been assessed. To evaluate the correlation between MR imaging and lesions assessed by Gross pathology. 20 canines underwent evaluation, after ablation. 4 were studied acutely 4-6 hours after ablation, 8 animals were studied at a time of chronic assessment 4 weeks later, and 8 were studied at a time of chronic assessment 4 weeks later myocardial infarction creation. MR lesions were followed by intravenous gadolinium and 8-10% triphenyl tetrazolium chloride administration. Ex-vivo delayed contrast enhancement MR imaging on a 3 Tesla scanner (Signa HDxt, GE Healthcare) was performed followed by pathology examination after fixation in 10% formalin solution. Total of 111 lesions were created in LV and RV tissue. In the acute animals 30 deliveries were made to a temperature set-point of 50 or 60°C. The target temperatures were set at 60°C with 32 deliveries to healthy myocardium, and 8 to post-infarcted myocardium. Lesion size and characteristic are shown in table 1. The correlation between the actual lesion size and the MR contoured size is shown in Fig 1. In all animals taken together, MR proved to be an exceptional means of determining actual lesion size. While tissue histology, seen in the table, is more useful and accurate. Overall, the correlation R2 value is 0.72±0.11 (p<0.0001) in all groups. In individual groups, the correlation was 0.94±0.54 (p<0.0001) for acute, 0.48±0.13 (p<0.0001) for chronic healthy, and 0.97± 0.35 (p=0.0006) in infarcted tissue. Even with infarctions, the MR correlation remained consistent but lesions were smaller in infarcted myocardium. These data showed the characteristics of lesion size of correlation to energy delivered. MR with gadolinium is a very useful means of identifying actual lesion size in situ. This correlates well with actual tissue findings and disclose that heat penetration in infarcted tissue is less robust as seen with other catheter systems.

Colorectal cancer: analysis of morbidity and mortality in the Republic of Tatarstan

Introduction. Colorectal cancer is one of the topical cancers, the incidence of which is growing significantly. &#x0D; Purpose: is analysis of incidence and mortality from colorectal cancer in the Republic of Tatarstan. &#x0D; Material and methods. The study was conducted using data from official statistical reporting forms, linear regression, cluster analyzes. For statistical data processing there were used MS Excel and Statistica Trial 13.&#x0D; Results. During the studied period in the Republic of Tatarstan, there has been a tendency towards an increase in the incidence of colon cancer (R2 = 0.98) and cancer of the rectosigmoid junction, rectum and anus (R2 = 0.91). The overall gain in the incidence of colon cancer over 2018 compared to 2014 was 21.6%, an average annual increase of 6.2% (t = 12.5; p = 0.001); cancer of the rectum, rectosigmoid junction and anus — 32.4%, the average annual growth rate — 7.9% (t = 5.53; p = 0.011). Against the background of an increase in morbidity, mortality rates from CRC are relatively stable. The share of CRC in 2018 in the structure of the incidence of the population of the Republic of Tatarstan with cancer was 13.4%, in the structure of mortality — 15%. The conducted cluster analysis made it possible to identify in the territory of the Republic of Tatarstan four clusters which have statistically significant differences between the indicators of colorectal cancer incidence and mortality from it.&#x0D; Limitations of the study. The analysis of morbidity and mortality from CRC of the population was carried out both for the entire territory of the Republic of Tatarstan and for individual regions, for the period from 2014 to 2018, which seemed sufficient to achieve the set goal.&#x0D; Conclusion. In modern conditions, CRC is an actual oncological pathology, the share of which in the morbidity structure of the population of the Republic of Tatarstan cancer in 2018 was 13.4%, mortality — 15%. To change the negative trends in morbidity and mortality of the population of the Republic of Tatarstan from CRC, it is necessary to conduct research on the scale of the republic aimed at assessing the impact of various risk factors and early diagnosis of this pathology.

Phlebosclerosis of Great Saphenous Vein-Series of Cases During Coronary Artery Bypass Grafting (CABG)

Phlebosclerosis is defined as the fibrous degeneration of the venous wall, though in history, it has been defined from endophlebitis to hyalinzation of the intima of the venous wall, the actual pathology is obscure. We present a case series of three different cases from three different decades of life, 5th, 6th, 7th respectively with varied co-morbidities, in which we encountered phlebosclerosis, while harvesting GSV for coronary artery bypass grafting (CABG). To authors’ knowledge, this is the first ever indigenous study on phlebosclerosis of GSV, the study would give an excerpt into the continuum on the natural history of the disease. The literature is reviewed and the case is presented.

A study of clinical and histopathological correlation of sinonasal masses

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Nasal masses are finding in an ENT (Ear, nose, throat) outpatient department. Most patient present with complaints of nasal obstruction.Other symptoms are nasal discharge, epistaxis and disturbances of smell. Sinonasal mass may be neoplastic (benign or malignant) or non-neoplastic (congenital, inflammatory) in nature. It is difficult to determine actual pathology underneath every nasal masses so, histopathological evaluation is mandatory for definitive diagnosis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The present study is prospective observational study of symptomatology, demographic profile and histopathological correlation of sinonasal masses in samplw size 80, these are the total number of patients presenting at tertiary health care centre from 1&lt;sup&gt;st &lt;/sup&gt;Jan 2019 to 30&lt;sup&gt;th &lt;/sup&gt;June 2020 (18 months) the study include, patients of any age and sex presenting with nasal symptoms&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Majority of patients with sinonasal masses where in the age group 2&lt;sup&gt;nd&lt;/sup&gt; decade. Male female ratio was 1.28:1. Nasal obstruction was the most common presentation. Most common non neoplastic lesion was ethmoidal polyposis and most common benign lesion was hemangioma. Most common malignant lesion was squamous cell carcinoma.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Presenting features of all sinonasal masses may be indistinguishable and post diagnostic dilemma. Correlation of clinical and histo-pathological modalities is of utmost importance for accurate diagnosis.&lt;/p&gt;

Proportion of psoriasis among the patients with psoriasiform disorders

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Psoriasis is a prevalent chronic inflammatory skin disease with several clinical symptoms. Psoriasis has clinical forms that resemble a variety of dermatological disorders and may necessitate histological confirmation of the diagnosis. The aim of the study was to assess the proportion of psoriasis among patients with psoriasiform disorders.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This cross-sectional observational study was carried out at the department of dermatology and venereology, Shahid Syed Nazrul Islam Medical College, Kishoreganj during the period from January 2021 to December 2021 on 200 patients with psoriasiform disorders was enrolled in this study. Detailed history along with relevant family history and drug history was obtained. All the patients underwent skin biopsy followed by a histopathological examination to reveal the actual pathology of dermal lesions. Statistical analyses of the results were obtained by using window-based computer software devised with statistical packages for social sciences (SPSS-25).&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The proportion of psoriasis among the patients with psoriasiform disorders was found at 53.5%. The majority of patients (72.0%) had extensor surfaces and a well-demarcated border was found in 166 (83.0%) patients. Subungual hyperkeratosis was found in 30 (28.0%) and 16 (17.3%) in psoriasis and non-psoriasis groups respectively. Regular epidermal hyperplasia was 2 (1.9%) in psoriasis but not found in non-psoriasis. Spongiosis was 45 (42.1%) in psoriasis and 30 (32.3%) in non-psoriasis. The vertical orientation of the collagen bundle was 2 (1.9%) and 2 (2.2%) in psoriasis and non-psoriasis respectively. Perivascular lymphocyte infiltration was 75 (70.1%) in psoriasis and 63 (67.7%) in non-psoriasis. The difference was not statistically significant (p&amp;gt;0.05) between the two groups.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; All clinical features were significantly associated with psoriasis in patients who presented with psoriasiform disorders except subungual hyperkeratosis. In histopathology, all features were significantly associated with psoriasis excluding regular epidermal hyperplasia, spongiosis, vertical orientation of collagen bundle, and perivascular lymphocyte infiltration.&lt;/p&gt;

MYOFASCIAL NECK PAIN SYNDROME IN WRESTLING ATHLETES: PREVENTION AND RECOVERY

Abstract. Early sports specialization, increased professional load, technical complexity of motor elements, lack of adequate means of rehabilitation in the training process have become the main triggers in the emergence of MNPS. The aim of the study was to study the mechanisms of development, clinical manifestations and development of the etiological system of treatment of cervical myofascial pain in the absence of actual organic pathology of the spine. Promising treatment is the use of reflexology. Effects of reflexology: analgesia, psychiatric (depression, sedation), nutrition, recovery, muscle relaxation. Conclusions: Athletes are mainly characterized by pain in the muscles that provide static work, as well as different options for the distribution of MNPS, depending on the sport. The upper and lower extremities are involved in performing active motor functions characteristic of sports. In general, local symptoms of pain were observed in 52.5% of athletes, and common - in 40.6%. At the same time, MNPS was most common in 63.4% of cases of cervical wrestlers and 58.4% of cases of lumbosacral region; in athletes, the development of myofascial disorders increases the bioelectrical activity of muscles at rest; Athletes with common symptoms have reduced control processes in the central nervous system [1]. It is characterized by an increase in multisynaptic reflex excitability at the level of the brain stem; emotional disorders in athletes in the presence of myofascial pain are characteristic in the presence of the third stage of the pathological process; the occurrence of general symptoms of MNPS according to the study leads to an increase in the average time of sensorimotor response, deterioration of motor processes and increased fatigue when performing a series of tests; MNPS treatment, which includes reflexology and PIR programs based on clinical and instrumental studies, significantly improves the athlete's condition during 12 months of follow-up.

Early-onset CTCL, localized and unilateral – case review

A 39-year-old man attended with an itchy single rounded red non-scaly skin lesion, with slightly raised edge, on his left leg that was unresponsive to topical steroids for the past two-weeks (figure-1). Apart from that, he had no other complaint. He was fit and well. Examination showed a unilateral localised red slightly-scaly, non-blanchable skin plaque on his lower left leg. Other skin parts were not affected. Physical examination was otherwise unremarkable without any detectable lymhadenopathies. Based on the clinical examination I could not align this skin lesion to any other dermatological disease. However; I agreed with the patient to take a punch biopsy from the skin lesion that he had presented with, in order to find out the actual pathology. The histology reading showed perivascular and periadnexal lymphocytic infiltration in the dermis. Some lymphoid cells were larger and neomorphic. There was no exocytosis. Histopathlogy with immune histochemical profile showed CD-3 positive and CD-20 negative. The report concluded by the histopatholgist that the immunohistochemical profile is consistent with T-cell proliferation and the picture suggests cutaneous T-cell lymphoma. This diagnosis should not be missed. When the condition at its earlier stage, usually it shows erythematous patches with fine scales, however, when it starts to infiltrate, it can involve blood, lymph nodes and many viscera ultimately. It is abnormal lymphocytes proliferation and mostly males predominan with an incidence of 1 per 100,000 per year.

Physical Medicine and Medical Rehabilitation in “Restorative” Ophthalmology: Historical Stages and Development Prospects

An overview of the historical stages of “restorative ophthalmology” is presented, taking into account the main directions of the concept of “Wellness of Healthy Eyes” in order to prevent and correct asthenopia in patients with visually strenuous work, based on a three-level system of prevention and correction of functional visual disorders. The first level is aimed at increasing the patient’s awareness of issues of vision protection and hygiene. The second level is aimed at reducing the adverse effects of environmental factors on the state of vision. The third level is realized in the form of methods of specific and nonspecific stimulation of the organ of vision. The urgency of considering a new scientific problem in ophthalmology related to the development of the concept of diagnostics and assessment of the therapeutic measures effectiveness from the standpoint of modern requirements for medical rehabilitation has been substantiated. It is proposed that a practical solution to this problem should be carried out through the development of qualificatory signs of the international classification of functioning, adequate questionnaires for assessing the “quality of life” in actual eye pathology (asthenopia,cataract), as well as an assessment of traditional (conservative, surgical) treatment from the standpoint of modern basic characteristics of medical rehabilitation (rehabilitation goal, rehabilitation diagnosis, rehabilitation prognosis, etc.). Conclusion. The most important task of medical focus is to preserve the functional state of the human operator’s visual analyzer at a level that allows performing professional activities with the required reliability and quality indicators.

Recognition Rate Advancement and Data Error Improvement of Pathology Cutting with H-DenseUNet for Hepatocellular Carcinoma Image.

Due to the fact that previous studies have rarely investigated the recognition rate discrepancy and pathology data error when applied to different databases, the purpose of this study is to investigate the improvement of recognition rate via deep learning-based liver lesion segmentation with the incorporation of hospital data. The recognition model used in this study is H-DenseUNet, which is applied to the segmentation of the liver and lesions, and a mixture of 2D/3D Hybrid-DenseUNet is used to reduce the recognition time and system memory requirements. Differences in recognition results were determined by comparing the training files of the standard LiTS competition data set with the training set after mixing in an additional 30 patients. The average error value of 9.6% was obtained by comparing the data discrepancy between the actual pathology data and the pathology data after the analysis of the identified images imported from Kaohsiung Chang Gung Memorial Hospital. The average error rate of the recognition output after mixing the LiTS database with hospital data for training was 1%. In the recognition part, the Dice coefficient was 0.52 after training 50 epochs using the standard LiTS database, while the Dice coefficient was increased to 0.61 after adding 30 hospital data to the training. After importing 3D Slice and ITK-Snap software, a 3D image of the lesion and liver segmentation can be developed. It is hoped that this method could be used to stimulate more research in addition to the general public standard database in the future, as well as to study the applicability of hospital data and improve the generality of the database.

Организационные аспекты оказания скорой медицинской помощи пострадавшим в дорожно-транспортных происшествиях с повреждениями лицевого скелета

The aim of the study is to investigate the organizational aspects of providing emergency medical care to victims of road traffic accidents with injuries of the facial skeleton. Materials and research methods. The study included 75 victims of road accidents that occurred in the city of Saratov in 2010–2019. In the total number of injured men – 42 (56.0%), women – 33 (44.0%). The age of the victims is 18–70 years, the average age is (37.5 ± 6.0) years. The study did not include: victims under the age of 18; victims with neck trauma, damage to the cerebral section of the skull and to other parts of the body. All the victims got medical assistance from the personnel of the ambulance brigades. Covering sheets, outpatient cards and medical records were used as primary documentation. Study criteria: time during which the ambulance was provided; who provided emergency medical care; correctness of its rendering. Research results and their analysis. Analysis of injuries to the facial skeleton showed: injuries of the facial skeleton are an actual pathology in victims of road traffic accidents in Saratov; victims of road accidents got open and closed injuries of the facial skeleton. With closed injuries, moderate and severe injuries were found in 23 (30.7%) victims, with open injuries — in 19 (23.3%) victims; majority (90.7%) of victims of road accidents got high-quality emergency medical aid in a timely manner. In 9.3% of cases, the quality of care was insufficient due to an incorrect assessment of severity of the victims’ condition and, as a consequence, due to non-fulfillment of anti-shock measures; scope of the provision of emergency medical care to victims of road accidents included temporary hemostasis, treatment of wounds and anti-shock measures; from the accident site were evacuated: to level III trauma centers — 24.0% of victims; to level II — 48.0; to level I trauma centers — 28.0% of victims; complications in the form of purulent-septic processes were observed in 16.0% of victims; competent and timely implementation of anti-shock measures determined an insignificant mortality rate — 4.0%.

IMPROVED DIAGNOSIS OF FOOT OSTEOARTHRITIS IN ELEPHANTS (ELEPHAS MAXIMUS, LOXODONTA AFRICANA) USING STEREORADIOGRAPHY.

Diagnosis of foot disease in elephants is challenging. Owing to their large size, the available diagnostic tools and the expense of imaging are diagnostically limiting. Stereoradiography is the preparation of paired radiographs that form a three-dimensional (3D) image when viewed stereoscopically. Clinicians and veterinary students graded osteoarthritis in the feet of African (Loxodonta africana) and Asian (Elephas maximus) elephants taken postmortem with standard 2D radiographs, as well as 3D stereoradiographs. These gradings were compared with the actual gross pathology identified in the specimens. Although veterinary students diagnoses were no better than chance from 2D radiographs, 83.6% of the students could correctly differentiate severity between joints on stereoradiography; this is an absolute improvement of 30.1% (95% confidence interval [CI] = 19.6%-40.6%). Overall, participants were 27.4% (95% CI = 18.4%-36.3%) more successful at diagnosing pathology on stereoradiographs. Half of participants were shown standard 2D radiographs first, the others stereoradiographs first, but the difference in gradings between the two groups was not statistically significant. Stereoradiography appears to hold the potential to improve diagnosis of osteoarthritis in elephant feet, particularly by less experienced clinicians, and the technique is low-cost and applicable under field conditions.

A119 THE LOCATION-BASED RESECT AND DISCARD STRATEGY FOR DIMINUTIVE COLORECTAL POLYPS: A PROSPECTIVE CLINICAL STUDY

Abstract Background Replacing histopathology evaluation of diminutive polyps with optical polyp diagnosis is considered a cost-effective approach. However, the widespread use of optical diagnosis is limited due to concerns about making incorrect optical diagnoses and the requirements of training, credentialing and auditing of performance. Aims This prospective study aimed to evaluate a simplified resect and discard strategy that is not operator dependent. Methods The study evaluated a resect and discard strategy that uses anatomical polyp location to classify colon polyps into non-neoplastic or low-risk neoplastic. All rectosigmoid diminutive polyps were considered hyperplastic and all polyps located proximally to the sigmoid colon were considered neoplastic. Surveillance interval assignments based on these a priori assumptions were compared with those based on actual pathology results and optical diagnosis, respectively. The primary outcome was ≥90% agreement with pathology in surveillance interval assignment. Results Overall, 1117 patients undergoing complete colonoscopy were included and 482 (43.1%) had at least one diminutive polyp. Surveillance interval agreement between the location-based resect and discard strategy and pathological findings using the 2020 US Multi-Society Task Force guideline was 97.0% (95% CI = 0.96 - 0.98), surpassing the ≥90% benchmark. Optical diagnoses using NICE and Sano classifications reached 89.1% and 90.01% agreement, respectively (p &amp;lt;0.0001), and were inferior to the location-based strategy. The location-based resect and discard strategy allowed a 69.7% (95% CI = 0.67 - 0.72) reduction in pathology examinations compared with 55.3% (95% CI = 0.52 - 0.58) (NICE and Sano) and 41.9% (95% CI = 0.39 - 0.45) (WASP) with optical diagnosis. Conclusions The location-based resect and discard strategy achieved very high surveillance interval agreement with pathology-based surveillance interval assignment, surpassing the ≥90% quality benchmark and outperforming optical diagnosis in surveillance interval agreement and the number of pathology examinations avoided. Funding Agencies None

Choosing Optimal Microcarcinoma Patients for Active Surveillance Study (Compass): Effectiveness Evaluation of a Preoperative Clinical Framework

ObjectiveActive surveillance (AS) is a management alternative for patients with low-risk papillary thyroid microcarcinoma (PTMC). To decide the best candidates for AS, clinicians can use a framework to classify PTMC patients as ideal, appropriate, or inappropriate. This study aimed to explore the correlation between the framework categories and surgical pathology. MethodsThis multicenter retrospective study was conducted between 2014 and 2016. We included 1997 patients who underwent thyroid surgery for the first time due to suspected PTMC and were confirmed as PTMC by postoperative pathology. The consistency of modified preoperative risk stratification and the pathologic condition were evaluated using a consistency ratio and the Kappa coefficient. Stratified analysis was also performed to test consistency in different age groups. ResultsBased on the decision-making framework, 558 (27.9%) patients could receive AS while 810 (40.6%) patients did not require immediate surgery according to the actual postoperative pathology. The sensitivity, false-positive rate, specificity, false-negative rate, and consistency rate were 82.39%, 56.91%, 43.09%, 17.61%, and 66.45%, respectively. The Kappa value was 0.268. Stratified analysis showed that the sensitivity was 87.7% among patients aged 18 to 59 years. In the group aged ≥60 years, the specificity was up to 87.5%, but the sensitivity was low. ConclusionThe results of the modified risk-stratified clinical decision-making framework did not have a high consistency with the postoperative results. However, the framework showed a good effect in selecting patients for immediate surgery in the younger group and patients for AS in the older group.

Presentation, treatment and outcomes of pediatric anterior urethral strictures: 28 years’ experience from a referral center

Pediatric urethral strictures are an uncommon entity, with the anterior urethra being the most common affected location, similar to adults. The, literature on outcomes in these strictures is limited, especially in the non-traumatic group, as most of the studies have included hypospadias related "neourethral" strictures and posterior strictures, thereby making interpretation difficult. It is for these reasons we decided to search our database to identify the different surgical procedures used and analyze the outcomes of interventions in these children and adolescents with anterior urethral strictures. To report the treatment strategies and outcomes in a series of 119 pediatric anterior urethral strictures, identified in a 28-year period in a high-volume tertiary center. A retrospective case-note review of all cases of pediatric anterior urethral strictures was done. Data on the clinical presentation including age at presentation, characteristics of strictures identified, primary intervention and additional secondary procedures and outcomes were collected. We identified 119 boys with anterior urethral strictures with commonest location being the bulbar urethra (60.5%). Sixty patients (50.4%) in this cohort underwent minimally invasive intervention in the form of dilatation or direct visual internal urethrotomy (DVIU) with the rest undergoing open intervention. The primary success rate was 87.1% (101/116) at a median follow-up of 29 (IQR 21-38) months. Idiopathic urethral stricture and iatrogenic strictures had better success rate of 92.5% and 82.1% than traumatic strictures (78.9%) and it was lowest for those traumatic strictures that were treated with DVIU (66.7%). Multifocal strictures had comparatively poorer outcomes (62.5%) compared with penile or bulbar strictures, with worst outcomes (44.4%) in those treated with substitution urethroplasty. Length >1cm, multifocality and treatment with substitution urethroplasty were significantly associated with recurrence. Three boys with strictures associated with anorectal malformations were a particularly difficult group and needed multiple intervention and had poor outcomes. Based on our study, we recommend a minimally invasive approach for short segment, bulbar strictures, especially of idiopathic etiology. For other locations and longer strictures, we recommend urethroplasty. Caution must be exercised to avoid underestimation of the actual pathology of the stricture. Caretakers of children with complete bulbar level blockage associated with anorectal malformations undergoing urethroplasty should be explained about the need for multiple interventions and possibility of poor voiding outcomes.

Contributions to the study of common artifacts and errors in conventional and three-dimensional radio-imaging used in the evaluation of odontal, endodontic and periodontal pathology.

Abstract Introduction: X-ray radio imaging is commonly used because most diseases in the oral area can only be diagnosed by using this method. Proper identification of elements on a radiological image may also be difficult due to errors that may occur before, during or after the X-ray. These errors are called artifacts. Aim of the study: The aim of our study is to distinguish the artifacts that can occur on two-dimensional and three-dimensional dental X-rays (intraoral or extraoral) from the actual pathology of the investigated area, by performing control X-rays. Material and Methods: In our study we viewed, assessed and compared a number of 80 retroalveolar X-rays, 45 orthopantomographs (OPG) and 35 Cone Beam Computer Tomography (CBCT). In case of artifacts or errors, X-rays were repeated within 5 days or a CBCT was performed. In the case of OPGs, another option was to perform retroalveolar X-rays to establish the final diagnosis. Results: From a total of 80 retroalveolar X-rays, in 13 cases (16.25%) we found artifacts. Of these, in only 4 cases (5%) diagnosis and treatment plan were changed following a clinical examination or a CBCT. In the case of OPGs, out of a total of 45 OPGs, 17 (37.7%) presented artifacts, but only in a percentage of 17.7% (8 cases) they affected the diagnosis. Of the 35 CBCTs, in 10 of them (28.57%) prosthetic works with a metal component or implants were present, with specific artifacts found, but their presence did not influence the diagnosis. Conclusion: It is necessary for doctors to know the anatomy of the oral region, the most fervent appearance of the components and the different types of artifacts that may occur. Control X-ray is a very commonly used possibility, but there are cases where radiation exposure needs to be minimized.

Livedo Racemosa – The Pathophysiology of Decompression-Associated Cutis Marmorata and Right/Left Shunt

Decompression sickness and arterial gas embolism, collectively known as decompression illness (DCI), are serious medical conditions that can result from compressed gas diving. DCI can present with a wide range of physiologic and neurologic symptoms. In diving medicine, skin manifestations are usually described in general as cutis marmorata (CM). Mainly in the Anglo-American literature the terms cutis marmorata, livedo reticularis (LR), and livedo racemosa (LRC) are used interchangeably but actually describe pathophysiologically different phenomena. CM is a synonym for LR, which is a physiological and benign, livid circular discoloration with a net-like, symmetric, reversible, and uniform pattern. The decompression-associated skin discolorations, however, correspond to the pathological, irregular, broken netlike pattern of LRC. Unlike in diving medicine, in clinical medicine/dermatology the pathology of livedo racemosa is well described as a thrombotic/embolic occlusion of arteries. This concept of arterial occlusion suggests that the decompression-associated livedo racemosa may be also caused by arterial gas embolism. Recent studies have shown a high correlation of cardiac right/left (R/L) shunts with arterial gas embolism and skin bends in divers with unexplained DCI. To further investigate this hypothesis, a retrospective analysis was undertaken in a population of Austrian, Swiss, and German divers. The R/L shunt screening results of 18 divers who suffered from an unexplained decompression illness (DCI) and presented with livedo racemosa were retrospectively analyzed. All of the divers were diagnosed with a R/L shunt, 83% with a cardiac shunt [patent foramen ovale (PFO)/atrium septum defect (ASD)], and 17% with a non-cardiac shunt. We therefore not only confirm this hypothesis but when using appropriate echocardiographic techniques even found a 100% match between skin lesions and R/L shunt. In conclusion, in diving medicine the term cutis marmorata/livedo reticularis is used incorrectly for describing the actual pathology of livedo racemosa. Moreover, this pathology could be a good explanation for the high correlation of livedo racemosa with cardiac and non-cardiac right/left shunts in divers without omission of decompression procedures.

How do high preoperative pain scores impact the clinical course and outcomes for patients undergoing lumbar microdiscectomy?

Preoperative pain assessment is often used to gauge the amount of disability in patients with lumbar disc herniation. How high preoperative pain scores impact the clinical course and outcomes of patients after lumbar microdiscectomy is not always clear. Here, the authors aimed to determine whether patients reporting higher preoperative pain scores have worse outcomes after lumbar microdiscectomy than those reporting lower preoperative scores. The authors performed a retrospective review of patients with symptomatic lumbar disc herniations that had failed to improve with nonsurgical methods and who had undergone tubular lumbar microdiscectomy. Health-related quality of life (HRQOL) scores had been collected in the preoperative and postoperative period. The anatomical severity of disease was graded based on lumbar disc health (Pfirrmann classification), facet degeneration, thecal sac cross-sectional area, and disc herniation grade. Data on each patient's narcotic consumption and length of stay were collected. A Student t-test and chi-square test were used to compare patients with high preoperative pain scores (HP cohort) and those with lower preoperative scores (non-HP cohort). One hundred thirty-eight patients were included in this analysis. The 47 patients in the HP cohort had taken more preoperative opioids (12.0 ± 21.2 vs 3.6 ± 11.1 morphine equivalent doses, p = 0.01). However, there was no statistically significant difference in Pfirrmann classification (p > 0.15), facet grade (p > 0.11), thecal sac cross-sectional area (p = 0.45), or disc herniation grade (p = 0.39) between the HP and non-HP cohorts. The latter cohort had statistically significant higher preoperative PROMIS scores (36.5 ± 7.0 vs 29.9 ± 6.4, p < 0.001), SF-12 mental component summary scores (48.7 ± 11.5 vs 38.9 ± 16.1, p < 0.001), and SF-12 physical component summary scores (PCS; 32.4 ± 8.6 vs 27.5 ± 10.0, p = 0.005), but a lower Oswestry Disability Index (56.4 ± 22.1 vs 35.4 ± 15.5, p < 0.001). There were only two time points after microdiscectomy when the HP cohort had worse HRQOL scores: at the 2-week follow-up for SF-12 PCS scores (32.4 ± 8.6 vs 29.3 ± 7.1, p = 0.03) and the 12-week follow-up for PROMIS scores (45.2 ± 9.5 vs 39.5 ± 7.1, p = 0.01). All other postoperative HRQOL measurements were similar between the two cohorts (p > 0.05). A patient's perceived severity of disease often does not correlate with the actual clinical pathology on imaging. Although patients who report high pain and have a symptomatic lumbar disc herniation may describe their pain as more extreme, they should be counseled that the outcomes of microdiscectomy are positive.