Case Of Effusion Research Articles

Early result of minimally invasive cardiac myxoma resection at University Medical Center, Ho Chi Minh City

Objective: The study aimed to evaluate various clinical and paraclinical characteristics, as well as early surgical outcomes of minimally invasive cardiac myxoma resection at University Medical Center HCMC. Subjects and methods: This is a retrospective descriptive case series study involving all patients diagnosed with cardiac myxomas who underwent minimally invasive surgery at University Medical Center HCMC from January 2020 to June 2024. Results: There were 31 patients, consisting of 22 females and 9 males. The mean age was 56,2 ± 10,7 years old (from 37 to 77 years old). The clinical manifestations were diverse: asymptomatic (45,2%), cerebral embolism (6,4%), fatigue (29,0%), dyspnea (35,5%), palpitations (12,9%), and dizziness (12,9%). Echocardiographic results: 90,3% left atrial myxoma, 9,7% right atrial myxoma. The tumor attachment sites: interatrial septum (93,6%), left atrial wall (6,4%). The average tumor size was 36,3 ± 15,1 mm. All tumors were completely resected (100%). Additional surgical procedures: mitral valve repair (3,2%), interatrial septum repair (6,4%). Cardiopulmonary bypass time was 82,4 ± 31,1 minutes (from 49 to 199 minutes), cross - clamp time was 39,2 ± 17,6 minutes (from 18 to 85 minutes), with 3 cases not requiring cardiac arrest. Ventilation time was 13,2 ± 6,3 hours (from 6,7 to 32,4 hours), intensive care unit stay was 52,6 ± 28,1 hours (from 13 to 113,7 hours), postoperative recovery time was 6,9 ± 2,3 days (from 4 to 16 days). Early outcomes: 3 cases of atrial fibrillation with rapid ventricular response, treated medically (9,7%), 1 case of acute kidney injury (3,2%), 4 cases of pleural effusion (12,9%), 3 cases of pneumothorax (9,7%), 1 case of right external iliac artery thrombosis requiring surgical thrombectomy (3,2%), and 2 cases of deep vein thrombosis (6,4%). No surgical site infections, cerebrovascular accidents, or mortality within 30 days post-surgery were reported. Conclusion: Minimally invasive cardiac myxoma resection demonstrates a low complication rate, with no reported tumor recurrence or early postoperative mortality. This technique offers a safe and effective alternative to traditional median sternotomy and may be gradually adopted and implemented in lower - level healthcare facilities.

Leadless pacemaker - lead parameters stability and battery longevity in the mid-term follow-up

Abstract Background A leadless pacemaker (L-PM) has been designed to avoid the need for a pacemaker pocket and transvenous lead. Long-term safety will largely depend on the need for replacements, mainly due to battery depletion (end-of-life). While the mean L-PM battery longevity predicted by the manufacturer is 12 years, real-world longevity data are still scarce. We aimed to describe L-PM parameters’ stability and battery longevity during the mid-term follow-up. Methods Single-center registry of consecutive patients undergoing L-PM implantation from May 2015 to November 2023. Procedural characteristics, lead parameters and battery longevity were collected immediately after implantation and during the most recent follow-up visit. Results Overall, 261 consecutive patients had a transcatheter L-PM implanted through a femoral vein (mean age 78±10 years; 66% male). Mean procedural duration was 44±28min and fluoroscopy time was 4,4±3,9min. The device was successfully implanted in all but one patient. The main indications for permanent pacing were high-degree atrioventricular block [N=130 (50%)], atrial fibrillation with pauses [N=78 (30%)], and sinus node disease [N=28 (11%)]. Immediately after implantation, three cases (1,2%) of pericardial effusion (one with tamponade) were reported. In one case (0,4%), a conventional pacemaker was implanted due to L-PM acute dysfunction. No other procedure-related complications, including dislodgment, were reported at discharge. After a mean follow-up of 2,8±1,7years, the pacing threshold and R-wave amplitude remained stable [0,67mV vs. 0,62mV (p=0,9); and 10,3mV vs. 16,1mV (p<0,001), respectively] and mean ventricular pacing was 54±38%. Expected battery longevity was >8 years (maximum value) in 84% of the patients. In the subgroup of patients with >5 years of follow-up (N=20; mean follow up of 6,3±1,8years), the expected battery longevity was >8 years in 85% (N=17) of the patients. In three cases, the L-PM was upgraded to cardiac resynchronization therapy or left bundle branch area pacing due to pacing-induced left ventricular dysfunction. There was one case of L-PM end-of-life 6 years after implant (pacing threshold 0,5mV; ventricular pacing 100%), in which a second L-PM was successfully implanted. Overall, 78 (31%) patients died, a mean of 2,2±1,9 years after L-PM implantation, none related to the device. Conclusion In this real-world cohort, L-PM maintained stable pacing parameters and, in the mid-term follow-up, only one battery depletion was observed while expected longevity remained above 8 years in the large majority of patients. Longer follow up will allow better understanding of both technical and clinical aspects relevant to manage end-of-life devices.Table 1Figure 1

A Case of Malignant Pleural Effusion Complicated by Klebsiella rhinoscleromatis

A Case of Malignant Pleural Effusion Complicated by Klebsiella rhinoscleromatis

Diagnostic Utility of Modified Method of AgNOR Staining in the Evaluation of Benign and Malignant Effusions

An exact identification of malignant cells in fluid by cytological examination is a well-known diagnostic challenge. One of the common problems is to distinguish reactive mesothelial cells from malignant cells. Conventional smears reported as ‘suspicious for malignancy’ indicate that the suspicious cases could not be classified with certainty as to whether they were reactive mesothelial cells or malignant cells. It poses problem in clinical staging of tumor, treatment and prognosis of malignancy. The purpose of the study was to determine the role of modified method of AgNOR staining in the evaluation of benign and malignant effusions. This cross-sectional study was conducted in the Department of Pathology, BIRDEM General Hospital, Dhaka, from July 2019 - June 2021. A total of 115 cases of effusion were included. All the samples were centrifuged and then smears were prepared from the deposit followed by staining with Hematoxylin & Eosin stain, Papanicolaou stain and AgNOR stain. At first the diagnosis was made on conventional smear method. Then the findings were compared and analyzed by modified AgNOR staining method. In malignant cells, the mean AgNOR count was 5.59±1.05 (±SD) and the AgNORs were multiple and irregular in shape. On the other hand, in benign cells the AgNORs were comparatively larger, single dots with a mean count of 1.31±0.48.The AgNOR count method has definite role in differentiating benign from malignant effusion. This method has supportive value which can be utilized in differentiating malignant effusions from the benign ones, especially in suspicious cases.

Outcomes of HeartMate 3 in pediatric patients with end-stage heart failure: a single-center preliminary experience from Turkey.

We aim to evaluate our initial experience with the HeartMate 3 (HM3) device (Abbott, USA) for palliating pediatric patients with end-stage heart failure (ESHF). We conducted a retrospective review of clinical data from pediatric patients (aged 7-18 years) who underwent HM3 implantation for ESHF at our institution between 2022 and 2024. Patient demographics and follow-up data were comprehensively analyzed. We identified 11 patients (45% males) with a median age of 14 years (IQR 11-17), a median weight of 47 kg (IQR 28-50), a median height of 159 cm (IQR 135-165), and a median body surface area of 1.36 m2 (IQR 1.07-1.53) at the time of the intervention. All patients were diagnosed with dilated cardiomyopathy and categorized with PEDIMACS profiles ranging from one to three. The median ICU stay was 14 days (IQR 6-32), with 11 patients receiving inotropic support for a median of four postoperative days (IQR 3-8). The median follow-up period was 150 days (IQR 90-210). Early complications included two cases of pleural effusion, 1 case of cardiac tamponade, 3 cases of polyuria, and one instance of positive blood cultures. One patient, who was non-compliant with warfarin therapy, developed a thrombus in the right atrium that was resolved with a revision of anticoagulant therapy, and did not experience pump thrombosis. During follow-up, one patient died after 28 days from sepsis, one underwent heart transplantation after 10 days, and nine patients remained alive on the device. Notably, there were no reported cases of pump thrombosis, ischemia, or stroke post- implantation. The HM3 device appears to be a safe and effective palliative option for pediatric patients with ESHF.

Resolution of choroidal effusion and serous retinal detachment after PASCAL photocoagulation in a patient with diabetic retinopathy.

To present a rare case of PASCAL photocoagulation-induced choroidal effusion and serous retinal detachment in a patient with diabetic retinopathy. A case report. A 68-year-old man with type 2 diabetes mellitus presented with decreased vision in both eyes. His best corrected visual acuity (BCVA) was 0.39 logMAR units in both eyes. The patient underwent panretinal photocoagulation (PRP) in two quadrants of both eyes on the same day according to his fundus fluorescein angiography. Three days after the first session of PRP, the BCVA in his left eye deteriorated by 2.0 logMAR units. Fundoscopic examination detected a significant choroidal effusion in inferonasal quadrant of the left eye. A macular Spectral-Domain Optical Coherence Tomography (SD-OCT) scan showed a large macular serous retinal detachment in the left eye. Topical steroid, topical cycloplegic, and 64 mg oral methylprednisolone were initiated. Two weeks later, his BCVA returned to the level of the first visit with a completely resolved choroidal effusion and no subretinal fluid. Considering the inflammatory and destructive mechanism of PRP, the laser operator should use the minimum power necessary to avoid possible chorioretinal complications.

Permanent left bundle branch area pacing improves mitral regurgitation and cardiac function in patients with right bundle branch block

BackgroundPermanent left bundle branch area pacing (LBBAP) has been established as an effective means to correct left bundle branch block. Right bundle branch block (RBBB), emerge as a distinct form of cardiac conduction abnormality, can be seen in the context of LBBAP procedure. However, the correction potential of LBBAP in patients with RBBB remains largely unexplored.ObjectiveThe objective of this study was to evaluate the efficacy and safety of permanent LBBAP in patients with RBBB.MethodsNinety-two consecutive patients who underwent successful permanent LBBAP were recruited from May. 2019 to Dec. 2022 in Fuwai Central China Cardiovascular Hospital. Among them, 20 patients with RBBB were included in our analysis. These patients were followed up at 1, 3, 6 and 12 months post-LBBAP. The QRS duration (QRSd) on the V1 lead of the 12-lead elctrocardiogram was measured and compared before and after the LBBAP procedure. Additionally, mitral regurgitation, tricuspid regurgitation and cardiac function were assessed using transthoracic echocardiography, specifically focusing on left ventricular ejection fraction (LVEF) and mitral regurgitation severity. The acute pitfills and delayed complications associated with the LBBAP procedure were recorded to evaluate its safety. SPSS 23.0 was used to perform statistical analysis with Student’s t test or one way ANOVA or nonparametric tests (paired Wilcoxon test). A p value less than 0.05 was defined as significant.ResultsThe demographic breakdown of the RBBB cohort revealed a mean age of 66.35 ± 11.55 years, 60% being male. Comorbidities were prevalent, including severe atrioventricular block (AVB) in 75%, sick sinus syndrome (SSS) in 20%, heart failure in 25%, atrial fibrillation in 30%, coronary heart diseases in 45%, hypertension in 35%, and diabetes mellitus in 15%. Regarding the LBBAP procedure, the average operation time was 106.53 ± 2.72 min, with 45% of patients (9 individuals) requiring temporary cardiac pacing during the surgery. Notably, the LBBAP procedure significantly narrow the QRS duration in RBBB patients, from 132.60 ± 31.49ms to 119.55 ± 18.58 ms (P = 0.046). Additionally, at the 12-month follow-up, we observed a marked improvement in LVEF, which increased significantly from 55.15 ± 10.84% to 58.5 ± 10.55% (P = 0.018). Furthermore, mitral regurgitation severity improved, with a median reduction from 4.46 (0.9, 7.3) to 2.29 (0, 3.49) cm2 (P = 0.033). Importantly, no cases of ventricular septum perforation or pericardial effusion were reported during the LBBAP procedure or during the follow-up period.ConclusionLBBAP provides an immediate reduction in QRS duration for patients suffering from RBBB, accompanied by improvements in mitral regurgitation and cardiac function as evident in the 12-month follow-up period.

Cytologic diagnosis and differential diagnosis of histiocytic signet ring cells in effusion specimens.

Benign histiocytic proliferation in effusion specimens can be found in a variety of diseases such as rheumatoid arthritis, systemic lupus erythematosus, microorganism infections, trauma, reactive eosinophilic pleuritis, and others. In addition, nodular histiocytic/mesothelial hyperplasia is another well-recognized rare cause. The previous studies have shown that proliferative histiocytes have raisinoid nuclei and abundant eosinophilic granular cytoplasm and can be confused with malignant lesions, especially metastatic carcinomas. In this study, we evaluated the cytomorphology of benign histiocytes, discussed the diagnosis and differential diagnosis, and the clinical significance of histiocytic signet ring cells in effusion cytology. Seven hundred and fifty-five benign effusion cases (433 pleural effusions and 322 abdominal fluids) were found over 1 year. Among benign cases, 35 cases (28 pleural effusions and seven abdominal fluids) were included with findings of dominantly histiocytic signet ring cell morphology as well as immunohistochemical (IHC) stains. The clinical findings were also correlated. In contrast to the well-documented cytomorphology of raisinoid nuclei and eosinophilic cytoplasm of proliferative histiocytes in previous studies, we find that these cells predominately presented as signet ring cell morphology with clear cytoplasm. The most characteristic findings of benign histiocytes in pleural effusions are: (1) cells are arranged in sheets and/or scattered individual cells, but no two- or three-dimensional cell clusters; (2) cells are intermediate in size and with normal N/C ratio; (3) cells have eccentric located nuclei and abundant clear cytoplasm, giving signet ring cell appearance; (4) nuclei have fine granular chromatin pattern, no hyperchromia or coarse chromatin pattern, no nuclear atypia; and (5) immunohistochemical (IHC) stains demonstrate a strongly positivity for macrophage-histiocyte lineage marker CD68, but negativity for epithelial markers and mesothelial markers. Clinically, these patients do not demonstrate nodularity or lesions in the mesothelial lining of serous cavities. Our study provides a detailed characterization of benign histiocytic signet ring cells in effusion cytology. The differential diagnosis of histiocytic signet ring cells is broad. The most important differential diagnoses are metastatic adenocarcinoma and epithelioid signet ring cell mesothelioma. The accurate diagnosis is critical for the appropriate clinical management of the patient. Cytopathologists should be aware of the diagnostic pitfalls of benign histiocytic signet ring cells in effusion samples in daily practice.

Application of cell blocks to assist in precise cytological diagnosis of serous effusion

Objective: To investigate the importance of cell block and immunohistochemistry in the accurate diagnosis of serous effusion. Methods: A retrospective study was conducted on 3 124 cases of serous effusion from the Department of Pathology, Beijing Hospital from 2018 to 2022, include 2 213 cases of pleural effusion, 768 cases of peritoneal effusion, 143 cases of pericardial effusion. There were 1 699 males (54.4%) and 1 425 females (45.6%), average age 69 years old. Of which 1 292 cases were prepared with cell blocks and examined with immunohistochemical stain. Results: The percentage of malignant diagnosis increased from 64.9% (839/1 292) to 84.0% (1 086/1 292) after cell block preparation, and 1 086 cases were accurately diagnosed with histological type and/or origin of primary tumor. The undetermined diagnosis of suspected malignancy decreased from 13.3% (172/1 292) to 0.1% (1/1 292) and that of atypical hyperplasia from 18.8% (243/1 292) to 0.4% (5/1 292). The negative result for malignancy rate increased from 3.0% (38/1 292) to 15.5% (200/1 292). The differences highlighted above were statistically significant (Pearson's chi-squared test=12.739, P<0.01). Conclusion: Application of immunohistochemistry based on cell block can significantly improve malignant diagnosis in serous effusion, identify tumor origin and histological type as well as decrease the uncertain diagnosis.

Lupus Pericardial Effusion successfully treated with methylprednisolone pulse

Pericardial effusion is a rare complication of SLE-related serositis (1). We are presenting a case of lupus pericardial effusion that was successfully managed with methylprednisolone pulse therapy. The patient, a 22-year-old diagnosed with SLE, presented with symptoms and signs suggestive of pericarditis. Transthoracic echocardiography showed mild pericardial effusion. Investigations, including elevated ESR and C-reactive protein, were high with normal procalcitonin, were indicative of SLE-related serositis. TSH was within the normal range and tuberculosis screening was negative. The patient was treated with an intravenous methylprednisolone pulse. Following the treatment, the patient’s pericardial effusion resolved, and inflammatory markers returned to the normal range. There are various treatment options for acute pericarditis in SLE, and methylprednisolone pulse therapy can be used in patients with associated pericardial effusion.

Study of liver abscess in pediatrics patients in tertiary health care institute

liver abscess is mostly occurring due to the infection of bacteria, parasite like amoeba. The incidence of amoebic liver abscess varies all over the world and most of cases found in developing countries remain unreported. study of liver abscess in pediatric patients in tertiary health care institute. This was a prospective study, carried out in 64 at our tertiary care center, J K Lon Hospital, SMS Medical College, Jaipur from May 2022 to April 2023. We collect all data related to patients like demography, clinical features, laboratory finding, and imaging records and recorded on a pre-decided proforma. There were 64 patients (36 male, 56.25% and 28 females, 43.75%), The male to female ratio was 1.25:1. The mean age of presentation was 7.5 years. The common presenting symptom was anorexia in 55 (85.93%) cases. Most common symptom was abdominal pain in 60 (93.75%) cases, fever 58 (90.625%), and vomiting in 40 (62.5%%) cases. Diarrhoea was present in 5 patients. Anemia was most common clinical sign in present in 40 (62.5%) patients, weight loss 38 (59.37%). Respiratory distress was present in 4 (6.25%) due to pleural effusion and peritonitis cases. Jaundice was present in 5 (7.81%) . 5 case [7.81%] of patients had raised bilirubin and 28 patients [43.75%] had raised alkaline phosphatase levels. Raised SGOT and SGPT was 43.75 %. 34 patients of Amoebic liver abscess and 30 of Pyogenic liver abscess. 53.12% (34 cases) patients had amoebic liver abscess in the right lobe. less than 50 cc size of abscess was present in 24 patients (37.5%) cases. Most of the patients have cavity size 50-150cc. more than 200cc cavity found only in 10 cases. Average cavity size is 166cc. peritoneal ruptured liver abscess in 2 cases [3.12%%] had features of peritonitis, pleural effusion in 2 cases with complain of respiratory difficulties. Conservative medical management was done in 2 patients, USG guided needle aspiration 20 patients and 40 patients underwent pigtail catheter insertion. 12 fr pigtail catheter insertion was done in 30 patients and 10 patients underwent double pigtail catheter insertion. Exploration and drainage of liver abscess was done in 2 patients. In present study, mean hospital stay was 10.28 days. Hospital stays ranges from 5 to 17 days. Most of the patients stays 5 to 10 days [56.25%]. all amoebic liver abscesses were sterile. Most commonly found organism on pus culture was Staphylococcus in 25% cases followed by E. coli in 21.87% cases in pyogenic liver abscesses. from this study we found that ultrasonography is the standard modality for diagnostic and therapeutic management as well as for drainage and follow up. We also found that USG guided pigtail catheter drainage is a superior therapeutic approach than needle aspiration for large liver abscess, and abscess cavity resolves better in case of pigtail catheter drainage. We also concluded that ruptured liver abscess can also be managed with two pig tail catheter insertion.

Isolation and identification of hoylesella marshii causing pleural infection: a case report

BackgroundHoylesella marshii can be isolated from human oral cavities affected by dental pulp and periodontal infections, as well as from the dental plaque of healthy individuals, making it a common bacterium within the oral microbiota. However, its role in causing pleural infections in humans is rare.Case presentationA case of purulent pleural effusion occurred shortly after discharge in an elderly patient who had undergone surgery for gastric cancer. The infection was identified as being caused by an obligate anaerobe through laboratory culture, and was further identified as Hoylesella marshii causing pleural infection through 16 S rRNA gene sequence analysis. Susceptibility testing guided precise treatment with cefoperazone-sulbactam and metronidazole. The patient’s clinical symptoms improved rapidly, laboratory test indicators gradually returned to normal, and the patient ultimately recovered.ConclusionHoylesella marshii can cause pleural infections in humans. Clinical microbiology laboratories should pay special attention to the cultivation of obligate anaerobes when routine aerobic cultures do not show bacterial growth but bacteria are visible on smear staining, and when conventional identification methods fail to identify the bacterium, analysis based on the highly conserved 16 S rRNA gene sequence can accurately and specifically identify the bacterium, guiding clinicians in formulating precise anti-infection strategies.

XRAInet: AI-based decision support for pneumothorax and pleural effusion management.

This study aimed to develop and assess the performance of an artificial intelligence(AI)-driven decision support system, XRAInet, in accurately identifying pediatric patients with pleural effusion or pneumothorax and determining whether tube thoracostomy intervention is warranted. In this diagnostic accuracy study, we retrospectively analyzed a data set containing 510 X-ray images from 170 pediatric patients admitted between 2005 and 2022. Patients were categorized into two groups: Tube (requiring tube thoracostomy) and Conservative (managed conservatively). XRAInet, a deep learning-based algorithm, was trained using this data set. We evaluated its performance using various metrics, including mean Average Precision (mAP), recall, precision, and F1 score. XRAInet, achieved a mAP score of 0.918. This result underscores its ability to accurately identify and localize regions necessitating tube thoracostomy for pediatric patients with pneumothorax and pleural effusion. In an independent testing data set, the model exhibited a sensitivity of 64.00% and specificity of 96.15%. In conclusion, XRAInet presents a promising solution for improving the detection and decision-making process for cases of pneumothorax and pleural effusion in pediatric patients using X-ray images. These findings contribute to the expanding field of AI-driven medical imaging, with potential applications for enhancing patient outcomes. Future research endeavors should explore hybrid models, enhance interpretability, address data quality issues, and align with regulatory requirements to ensure the safe and effective deployment of XRAInet in healthcare settings.

Management of pediatric pleural empyema: a national survey of pediatric surgeons in Brazil.

To identify how pediatric surgeons manage children with pneumonia and parapneumonic pleural effusion in Brazil. An online cross-sectional survey with 27 questions was applied to pediatric surgeons in Brazil through the Brazilian Association of Pediatric Surgery. The questionnaire had questions about type of treatment, exams, hospital structure, and epidemiological data. A total of 131 respondents completed the questionnaire. The mean age of respondents was 44 ± 11 years, and more than half (51%) had been practicing pediatric surgery for more than 10 years. The majority of respondents (33.6%) reported performing chest drainage and fibrinolysis when facing a case of fibrinopurulent parapneumonic pleural effusion. A preference for video-assisted thoracic surgery instead of chest drainage plus fibrinolysis was noted only in the Northeast region. Chest drainage plus fibrinolysis was the treatment adopted by most of the respondents in this Brazilian sample. There was a preference for large drains; in contrast, smaller drains were preferred by those who perform chest drainage plus fibrinolysis. Respondents would rather change treatment when facing treatment failure or in critically ill children.

Ten-Year Experience of Reconstructive Techniques After Resection of Hypopharyngeal Squamous Cell Carcinoma (SCC): Changing Trend from Gastric Pull up to Free Flaps

Background: Hypo-pharyngeal squamous cell carcinoma (H-SCC) is a rare type of head and neck malignancy often necessitating extensive surgical resection and subsequent reconstruction. Objectives: This study presented a 10-year retrospective analysis of reconstructive surgeries following the resection of H-SCC. Methods: A cross-sectional study was conducted on H-SCC patients who underwent reconstructive surgery after either laryngopharyngoesophagectomy (13 cases, 42%) or pharyngolaryngectomy (18 cases, 58%). Various reconstructive techniques were employed, including gastric pull up (12 cases, 39%), pectoralis major myo-cutaneous flap (PMMCF) (11 cases, 35%), and free flaps such as jejunum (2 cases, 6%), ileocecal (2 cases, 6%), or antero-lateral thigh (ALT) (4 cases, 13%). Results: The study included 31 patients with a mean age of 56.26 ± 3.98 years, predominantly male (64%). Smoking habit was observed in 22 (71%) patients. The total complication rate was 48% including 2 (6%) cases of flap loss, 2 (6%) cases of cervical anastomosis leak, 1 (3%) case of hematoma, 2 (6%) cases of neck wound infection, 5 (16%) cases of pneumonia, and 3 (10%) cases of pleural effusion, with a mortality rate of 16%. GPU and PMMCF had total number of post operative complications of 12 and 6, respectively. ALT flap, jejunal flap and ileocecal flap had 3, 2 and 1 total complications, respectively. Severe stenosis at cervical anastomosis was found in 4 (13%) patients after GPU and not other techniques. Conclusions: Advances in microvascular anatomy knowledge have led to the evolution of reconstructive techniques. The study suggests that in upcoming years, the free flap techniques hold promise as a preferred method for hypo-pharyngeal reconstruction.

Determining the optimal distal resection margin in rectal cancer patients by imaging of large pathological sections: An experimental study.

To determine the distal resection margin in sphincter-sparing surgery in patients with low rectal cancer based on imaging of large pathological sections. Patients who underwent sphincter-sparing surgery for ultralow rectal cancer at Guangxi Medical University Cancer Hospital within the period from January 2016 to March 2022 were tracked and observed. The clinical and pathological data of the patients were collected and analyzed. The EVOS fluorescence automatic cell imaging system was used for imaging large pathological sections. Follow-up patient data were acquired mainly by sending the patients letters and contacting them via phone calls, and during outpatient visits. A total of 46 patients (25 males, 21 females) aged 27 to 86 years participated in the present study. Regarding clinical staging, there were 9, 10, 16, and 10 cases with stages I, II, III, and IV low rectal cancer, respectively. The surgical time was 273.82 ± 111.51 minutes, the blood loss was 123.78 ± 150.91 mL, the postoperative exhaust time was 3.67 ± 1.85 days, and the postoperative discharge time was 10.36 ± 5.41 days. There were 8 patients with complications, including 3 cases of pulmonary infection, 2 cases of intestinal obstruction, one case of pleural effusion, and one case of stoma necrosis. The longest and shortest distal resection margins (distances between the cutting edges and the tumor edges) were 3 cm and 1 cm, respectively. The minimum length of the extension areas of the tumor lesions in the 46 images of large pathological sections was 0.1 mm, and the maximum length was 15 mm. Among the tumor lesions, 91.30% (42/46) had an extension area length of ≤5 mm, and 97.83% (45/46) had an extension area length of ≤10 mm. The length of the extension zone was not related to clinical pathological parameters (P > .05). In the vast majority of cases, the distal resection margin was at least 1 cm; thus, "No Evidence of Disease" could have been achieved. Additional high-powered randomized trials are needed to confirm the results of the present study.

The challenge of transseptal access for catheter ablation of left-sided arrhythmia substrate in infants and small children under 6 years of age

Abstract Background Young age and small cardiac dimensions are increased risk factors for catheter ablation (CA), therefore ablation below 15 kg should be recommended only in selected drug-refractory cases. The need for a transseptal puncture (TSP) may be an additional risk factor. Persistent foramen ovale (PFO) in infants can mitigate this risk and paradoxically, decrease the complication rate in the very young. Purpose This study aimed to compare the results of left-sided CA in infants under 1 year and in children between 1-6 years of age. Methods Between January 2010 and September 2023, 1703 pediatric CAs were performed, of which 17 left-sided ablations in children under 6 years without structural heart disease were retrospectively evaluated. CA results below 1 year and between 1-6 years of age were compared in terms of body size, procedural parameters, left atrial (LA) access, complication, and success rate. Results The patient group below 1 year (Group 1, n=5) has a mean age=0.13±0.03 years, mean body weight=3.6±1.1 kg, mean height=52.3±3.6 cm. Patients between 1-6 years (Group 2, n=12) have mean age=5.0±1.1 years, mean body weight=17.9±2.2 kg, mean height=111.2±7.4 cm. The arrhythmia substrate was an overt pathway in 3 pts (17.6%), concealed accessory pathway in 7 pts (41.2%), and focal LA tachycardia in 7 pts (41.2%). Foramen ovale was persistent in all 5 children in Group 1 and TSP was not required. In Group 2, only 2 pts (16.7%) had PFO, and, all other procedures required TSP. TSP was successful in 9/10 cases (90%). No complications related to LA access or other adverse events occurred in Group 1. In Group 2, there was one case of pericardial effusion that spontaneously regressed and one case of mechanical-induced advanced AV block that resolved after six days. There were no significant differences in procedure time, fluoroscopic time, and radiation dose between the two groups (Group 1: 126.4±47.0 min, 6.4±4.5 min, 4.0±5.3 cGycm2 vs. Group 2: 162.6±49.2 min, 7.9±9.4 min, 9.0±12.4 cGycm2, p&amp;gt;0.05). All CAs were performed with RF energy. The acute success rate of the procedures was 100%. Conclusion CA of left-sided arrhythmias in infants and small children may offer a safe and effective therapeutic option in selected cases. The high prevalence of PFO may explain the paradoxically less complication under 1 year of age.

The A2ml1-Knockout mouse as an animal model for non-syndromic otitis media

BackgroundInflammation and infection of the middle ear, known as otitis media (OM), is a leading cause of hearing loss and the most frequently diagnosed disease in children worldwide. Traditionally, mouse models for OM rely on inducing acute infection through inoculation of the middle ear, e.g. with the human otopathogen non-typeable Haemophilus influenzae (NTHi), and with very few genetic models with spontaneous or chronic OM. A2ML1 variants, including loss-of-function variants, were associated with susceptibility to OM in humans, but no animal model has been reported for A2ml1-related OM. Here, we report our middle ear findings in a mouse line with a CRISPR-induced knockout (KO) of A2ml1. MethodsMice were X-rayed prior to harvest to determine if there are craniofacial or skeletal abnormalities. Tissue from mouse middle ears, as well as other upper respiratory mucosal tissues, were harvested. The harvested middle ear bullae were examined under microscope and submitted for histologic preparation to study phenotypic indications of OM. RNA samples isolated from middle ear tissue were assayed for expression of genes correlated with A2ML1 expression in humans. ResultsData from a total of 119 mice (35 wildtype, 40 heterozygous, 44 homozygous) are presented here, with each analyses being performed on subsets of these mice. There were no significant craniofacial differences by genotype (n = 22). Findings in mice with the A2ml1-KO indicated an increased incidence of OM (n=29; odds ratio = 11; CI: 1.1, 573.6; Fisher exact two-sided p = 0.02) with tympanic membrane perforations or thickening, as well as cases of middle ear effusion, inflammatory cells, or fluid from histologic sections. Dsp was upregulated in the middle ear tissues of homozygous mice (Wilcoxon test p = 0.001). ConclusionThus far, our results in this A2ml1-KO mouse line indicate spontaneous occurrence of OM and dysregulation of Dsp in the middle ear as a potential disease mechanism for A2ml1-related OM.

Deciphering Serous Effusions Using the New International System for Reporting Serous Fluid Cytopathology.

Introduction Serous effusion cytopathology is a minimally invasive, cost-effective procedure and plays a crucial role in diagnosing a spectrum of pathological conditions, rangingfrom benign to malignant. The International System for Reporting Serous Fluid Cytopathology (ISRSFC) offers a standardized framework for reporting serous effusions, aiding in better communication and clinical decision-making. Aims and objectives This study aimed to categorize effusions using the ISRSFC reporting system. In addition, we sought to estimate the risk of malignancy (ROM) for each diagnostic category and evaluate the diagnostic performance of conventional smear versus cell block techniques. Materials and methods Thiscross-sectional study was conducted in the Department of Pathology over one year. We applied the ISRSFC criteria to serous effusions and categorized them accordingly. The ROM for each category was assessed with histopathology serving as the gold standard. Then, the diagnostic performanceincluding sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy was evaluated using conventional smear and cell block techniques. Results The study included185 serous effusion cases, with ages ranging from two months to 85 years. The male-to-female ratio was 1.1:1. Most effusions were pleural fluids constituting about 133 cases (71.9%), followed by peritoneal fluids (47 cases, 25.4%)and pericardial fluids (five cases, 2.7%). Among the fluids, four (2.2%) were diagnosed as non-diagnostic (ND), 152 (82.2%) as negative for malignancy (NFM), four (2.2%) as atypia of undetermined significance (AUS), nine (4.8%) as suspicious for malignancy (SFM), and 16 (8.6%) as malignant (MAL).The overall ROM was 25% for ND, 8.5% for NFM, 50% for AUS, 77% for SFM, and 100% for MAL. The sensitivity, negative predictive value (NPV), and diagnostic accuracy were superior when combining conventional smear with the cell block technique. Conclusions Our findings underscore the use of ISRSFC in categorizing effusion samples, assessing the ROM, and guiding clinical management. Moreover, our study highlights the benefits of employing a combined approach using conventional smears and cell blocks for enhanced diagnostic accuracy in serous effusions.

Focused assessment with sonography for trauma exam for diagnosis of pericardial effusion in penetrating thoracic trauma – A retrospective review from a level 1 trauma center

IntroductionPoint of care ultrasound has long been used in the trauma setting for rapid assessment and diagnosis of critically ill patients. Its utility for diagnosis of pericardial effusion in the setting of penetrating thoracic trauma has more recently been a topic of consideration, given the rapid decompensation that these patients can experience. ObjectivesThis study aims to identify the diagnostic accuracy of point of care ultrasound in the diagnosis of pericardial effusion among patients with penetrating thoracic trauma. MethodsRetrospective review of 2099 patients brought to the trauma bay between the years 2016 and 2021 were analyzed for diagnosis of pericardial effusion. Patients who were diagnosed with a pericardial effusion were investigated for point of care ultrasound findings. Descriptive statistics were performed to identify sensitivity, specificity, positive predictive value, and negative predictive value. ResultsPrevalence was calculated to be 26.7 cases of pericardial effusion per 1000 patients presenting with penetrating thoracic trauma. Incidence was estimated to be 3.8 cases of pericardial effusion per 1000 person-years. Calculation of diagnostic capabilities of ED POCUS revealed a sensitivity of 96.36 ​%, a specificity of 100 ​%, PPV of 100 ​%, and NPV of 99.90 ​%. ConclusionsPoint of Care cardiac ultrasonography is a reliable tool for the rapid diagnosis of pericardial effusion in penetrating thoracic trauma patients. Patients with ultrasound suggestive of this condition should receive rapid surgical management to prevent decompensation.