Cm In Size Research Articles

Clusters of tribocharged dust aggregates as pebbles in protoplanetary disks

In recent years, the tribocharging of colliding and bouncing submillimeter (submm) particles has been studied as a possible mechanism promoting the formation of large pebbles on centimeter (cm) to decimeter (dm) scales in protoplanetary disks. Here, we observe, for the first time, that it is not only monolithic, spherical particles, but also real dust aggregates, that become tribocharged and end up forming large clusters. For aggregates of ~0.4 mm consisting of ~1 micrometer (µm) sized dust, we determined net charge densities up to 10−7 C/m2 during our drop tower experiments. These charged aggregates form compact clusters up to 2 cm in size via collisions with other clusters and aggregates at collision velocities on the order of 1 cm/s. Size and speed are the only lower limits for growth, currently set by the limits of the experiment. However, these clusters already form under conditions that are well beyond the expected transition to bouncing for uncharged aggregates and clusters. Our findings further support the idea that collisional charging can leapfrog the traditional bouncing barrier and form larger clusters that then serve as large pebbles. These cm-sized clusters are more susceptible to further evolutionary steps via particle trapping, concentration, and planetesimal formation.

P-1281. A Novel Substance Use Disorder-Focused Infectious Diseases Consultation Service: Our Experience with Xylazine-Related Ulcers

Abstract Background Xylazine is a non-opioid analgesic that has become a prevalent additive in the illicit drug supply due to its low cost and synergistic effect with opioids. It is associated with soft tissue ulcers that become necrotic and can lead to infection, amputation, and death. Our hospital created a novel Infectious Diseases (ID) consultation service to help manage xylazine-related ulcers and other infectious sequelae of substance use disorder (SUD). Herein we describe characteristics of patients with SUD who presented to our hospital with xylazine-related soft tissue ulcers. Methods Using data extracted from our electronic health record, we generated a database of patients seen on our ID-SUD service between October 10, 2023 and January 1, 2024. We identified patients ≥ 18 years with documented SUD and conducted a retrospective chart review to identify patients with ulcers. Ulcers were defined based on documentation within the physical examination of a provider’s note or under the photographic media section. Patient demographics and clinical characteristics were collected and described using simple counts and frequencies. Results We identified 193 patients with SUD seen by the ID consult team during the study period. 73 patients (38%) had skin ulcers. The ulcer group was younger with a median age of 40, more likely to be white (78%) or Hispanic (18%), more likely to have tested positive for fentanyl (96%), more likely to inject (99%), and more likely to leave the hospital against medical advice (38%) compared to the non-ulcer patients, as shown in Table 1. Of patients with ulcers, 39 (53%) had ulcers >10cm in size, 55 (75%) had multiple ulcers, 10 (14%) had fever on admission, 17 (23%) developed bacteremia during hospitalization, and 72 (99%) received antibiotics during hospitalization, as shown in Table 2. Conclusion Xylazine-related skin ulcers have become common in patients with SUD, in particular intravenous opioid use. In our adult population in a large city with high rates of SUD, we demonstrated that many patients develop multiple large ulcers. Additionally, many patients with ulcers had evidence of systemic infection with fever, leukocytosis, and/or bacteremia. We anticipate an improvement in clinical outcomes as more is learned about pathophysiology and treatment of xylazine-related ulcers. Disclosures All Authors: No reported disclosures

P-04 A PATIENT WITH A GIANT ADRENAL MASS DETECTED DURING PREGNANCY

Abstract Introduction Although the frequency of adrenal incidentalomas is increasing, they are rarely detected due to lack of imaging during pregnancy. Here, we present a case of adrenal incidentaloma diagnosed during pregnancy. Clinical Case A 32-year-old female patient was diagnosed with a mass in the liver during obstetric ultrasonography performed in the 4th month of pregnancy and was referred to gastroenterology clinic for further examination, but any additional intervention could not be made because of patient’s refusion. She underwent an emergent caesarean section at 36th weeks of pregnancy. A mass approximately 15 cm in size, thought to be of adrenal origin, was detected in the retroperitoneal area posterior to the liver at the surgery. Abdominal MRI revealed a 188*121*113 mm non-adenomatous lesion, at right adrenal gland, containing cystic necrotic areas, and not suppressed in fat-suppressed series (figure 1A). At initial assesment by endocrinology, the patient denied any paroxysmal or persistent hypertension, weakness, weight gain and hirsutism. Physical examination was found normal, no signs of Cushing’s syndrome was observed. Laboratory testing including 24-hour urine catecholamines, basal cortisol, dehydroepiandrosterone sulfate (DHEA-S), adrenocorticotropic hormone (ACTH) were in reference ranges. The cortisol levels were supressed following the low-dose dexamethasone test. Adrenal carcinoma was suspected based to radiological features of the lesion. FDG uptake of the mass with a SUVmax: 16.9 was reported at PET-scan (figure 1B). Laparotomy for right adrenal gland was planned, but the patient disapproved once again. She underwent to adrenalectomy 18 months later after the mass was detected. Surprisingly, the pathology resulted as adrenocortical adenoma. Ki67 labeling index was found to be 3-4%, immunohistochemical staining of tissue specimens showed that synaptophysin and chromogranin A negative ( - ), but CD56 positive (++). The patient was lost for approximately 1 year and then aplied to our clinic with another unplanned pregnancy. She is doing well at the 32nd week of her second pregnancy. Conclusion Large and non-adenomatous masses detected during pregnancy are likely to be malignant and these masses are usually known with poor-prognosis. Rarely, as seen in our patient, huge adrenal masses may exhibit a benign behavior compatible with an uncomplicated long process despite suspicious radiological imaging features.Figure 1A:Abdominal MRI revealed a 188*121*113 mm non-adenomatous lesion, at right adrenal gland containing cystic necrotic areas. B:Increased uptake of FDG in the right adrenal region (SUVmax: 16.9)

A rare case of primary pulmonary embryonal rhabdomyosarcoma in children

Rhabdomyosarcoma is one of the most common soft tissue sarcomas in adolescence and young adults. Histologically, rhabdomyosarcoma has many subgroups, including embryonal, alveolar, pleomorphic, and spindle cell/sclerosing rhabdomyosarcomas. More than 50% of embryonal rhabdomyosarcomas occur in the head and neck region. The retroperitoneum and pelvis are less common sites of involvement. Primary pulmonary embryonal rhabdomyosarcoma is extremely rare. A 3-year-old girl presented with symptoms of cough and shortness of breath. A mass lesion with regular contours, approximately 3x3 cm in size, containing millimetric air densities within, and having soft tissue density was detected in the upper lobe of the right lung. According to the results of bronchoscopy and biopsy, a right thoracotomy and right upper lobectomy were performed with the diagnosis of embryonal rhabdomyosarcoma. We present a case whose pathology confirmed the diagnosis of embryonal rhabdomyosarcoma.

Aggressive Digital Papillary Adenocarcinoma: A Meta-Analysis of the Presentation, Treatment, and Outcomes of a Rare Hand Tumor.

Aggressive digital papillary adenocarcinoma (ADPA) is a rare skin adnexal tumor with a predilection for the hand. The presentation, treatment, and outcomes of ADPA remain poorly defined due to the scarcity of reports and low-level evidence of published findings. We performed a meta-analysis following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines with the intent to provide hand surgeons a better understanding of the diagnosis and treatment of the disease. Three additional cases of ADPA from our institution were combined with the results from the systematic review. A total of 238 cases were included in the meta-analysis. Most ADPAs were painful, evolving, and less than 2 cm in size. Regional sentinel lymph node biopsies were performed in 55 patients, of which 25.5% were positive. Overall cohort recurrence and distant metastasis rates were 24.3% and 18.1%, respectively. Patients who obtained clear margins within 6 months of diagnosis had significantly lower rates of recurrence, metastasis, and mortality (P < .001, P = .04, P = .003, respectively). There were no differences in recurrence or metastasis rates in those who obtained clear margins by excision or amputation (P = .27 and P = .07, respectively). In patients who died from disease (6.0%), 5.0 years was the average time to death. Aggressive digital papillary adenocarcinoma should be included in the differential diagnosis of hand lesions with unusual presentations or lack of response to other therapies. Clear margins should be obtained within 6 months of diagnosis, and routine surveillance should be provided by an oncologic physician familiar with ADPA as these tumors have high recurrence rates.

Case Report of an Intermuscular Thenar Lipoma with a Literature Review

Summary. Lipomas are the most common benign tumors found in the hand, with those exceeding 4 cm in size classified as giant lipomas. However, large lipomas in the hand are rare due to their visibility and limited subcutaneous tissue in this area. When they do occur, they can interfere with hand function. Typically, lipomas in the dominant hand are detected early and surgically removed. We present a case of a giant lipoma in the hand, notable for its unusually large size and the fact that it remained asymptomatic until the time of presentation.

Preoperative CT-based radiomics nomogram to predict the micropapillary pattern in lung adenocarcinoma of size 2 cm or less.

To develop and validate a radiomics nomogram model for predicting the micropapillary pattern (MPP) in lung adenocarcinoma (LUAD) tumors of ≤2 cm in size. In this study, 300 LUAD patients from our institution were randomly divided into the training cohort (n = 210) and an internal validation cohort (n = 90) at a ratio of 7:3, besides, we selected 65 patients from another hospital as the external validation cohort. The region of interest of the tumor was delineated on the computed tomography (CT) images, and radiomics features were extracted. A nomogram model was established using radiomics features, clinical features and conventional radiographic features. The nomogram model was compared with the radiomics model and the clinical model alone to test its diagnostic validity. Receiver operating characteristic (ROC) curves, areas under the ROC curves and decision curve analysis (DCA) results were plotted to evaluate the model performance and clinical application. The nomogram model exhibited superior performance, with an AUC of 0.905 (95% confidence interval [CI]: 0.857-0.951) in the training cohort, which decreased to 0.817 (95% CI: 0.698-0.936) in the external validation cohort. The clinical model had AUCs of 0.820 (95% CI: 0.753-0.886) and 0.730 (95% CI: 0.572-0.888) in the training and external validation cohorts, respectively. The radiomics model had AUCs of 0.895 (95% CI: 0.840-0.949) and 0.800 (95% CI: 0.675-0.924) for training and external validation, respectively. DCA confirmed that the nomogram model had the better clinical benefit. The nomogram model achieved promising prediction efficiency for identifying the presence of the MPP in LUAD tumors ≤2 cm, allowing clinicians to develop more rational and efficacious personalized treatment strategies.

Thyroid Leiomyosarcoma: A Rare Case Report

Background Primary thyroid leiomyosarcoma is a very rare tumor. The incidence is less than 0.01% of all primary thyroid tumors. Thyroid leiomyosarcoma are tumours showing smooth muscle differentiation, originating from thyroid gland vascular smooth muscle. Case Description Female, 47 years old, with lump on the left neck since 1 year ago, getting bigger in the last 3 months, no shortness of breath, no history of previous surgery. Physical examination revealed a mass was 13x6 cm in size, solid, firm. Cytological features from fine needle aspiration biopsy (FNAB) showed cellular spindle cells with atypical, pleomorphic, hyperchromatic nuclei and several normal thyroid follicles among them, sugesting malignant thyroid tumor (Bethesda VI). Total thyroidectomy was performed, followed by histopathological examination. Microscopically showed proliferation of atypical, pleomorphic, hyperchromatic spindle cells with eosinophilic cytoplasm. The spindle cells arranged in fascicular and interlacing pattern. Several follicular thyroid are entrapped within this atypical spindle cells. Based on these finding, this case was diagnosed as anaplastic thyroid carcinoma. To confirm the diagnosis, immunohistochemical examination with cytokeratin, desmin and Ki-67 were performed and the result showed negative for cytokeratin, positive for desmin and Ki-67 was highly positive. Based on these results, a diagnosis of thyroid leiomyosarcoma was made. Discussion and Conclusion Differential diagnosis with other primary mesenchymal thyroid tumors should be considered in the cases with atypical spindle cells microscopic appearance. The diagnosis of thyroid leiomyosarcoma based on cytology and histopathology is difficult to establish, therefore immunohistochemical staining is required to establish the accurate final diagnosis.

Treatment of Post-COVID-19 Pulmonary Aspergilloma: Insights from a Clinical Case.

BACKGROUND This report presents the case of a 49-year-old man with pulmonary aspergilloma 6 months after hospitalization and mechanical ventilation for COVID-19 who was treated with robot-assisted lobectomy. COVID-19-associated pulmonary aspergillosis is a life-threatening complication of SARS-CoV-2 infection. Aspergilloma, a delayed complication of COVID-19, is rare. Major risk factors for pulmonary aspergilloma include neutropenia, solid organ transplantation, prolonged high-dose corticosteroid therapy, hematological malignancy, cytotoxic therapy, acquired immunodeficiency syndrome, and chronic granulomatous disease. Common symptoms include cough, shortness of breath, fatigue, wheezing, weight loss, fever, and chest pain. Hemoptysis is the most severe complication of pulmonary aspergilloma. Treatment options include antifungals, bronchial artery embolization, and surgery. Surgical treatment is considered definitive for patients who do not respond to antifungal medications. CASE REPORT We describe the case of a 49-year-old man with pulmonary aspergilloma who developed a delayed sequela of SARS-CoV-2 infection. He presented to a pulmonary clinic 6 months after a severe COVID-19-related hospitalization, with symptoms of mild hemoptysis, cough, and shortness of breath. A computed tomography scan of the chest revealed a right upper lobe cavitary lesion approximately 9.6×6.1 cm in size. Bronchoalveolar lavage during bronchoscopy revealed Aspergillus fumigatus. The patient did not respond to antifungal treatment and was successfully treated with a robotic-assisted lobectomy. CONCLUSIONS Aspergillus infection should be considered in COVID-19 survivors with pulmonary symptoms. Minimally invasive robotic lobectomy is a feasible option for high-risk patients with post-COVID-19 aspergilloma and hemoptysis who are resistant to medical treatment.

Indications, Surgical Technique and Outcomes of Laparoscopic Splenectomy: A Retrospective Descriptive Study from Srinagar, India

Introduction: Laparoscopic splenectomy has become the preferred approach because it offers several advantages over traditional open surgery, including smaller incisions, decreased postoperative pain, reduced blood loss and shorter hospital stays. For mild to moderately enlarged spleens, it has become the procedure of choice. Although it can be more challenging for massively enlarged spleens, with proper planning and surgical expertise, the procedure can be performed safely. Aim: To assess the indications and outcomes of laparoscopic splenectomy across a range of spleen sizes, from normal to massively enlarged spleens, in a tertiary care hospital. Materials and Methods: A retrospective descriptive study was conducted in the Department of Surgery, Government Medical College, Srinagar, Jammu and Kashmir, India, from May 2018 to May 2023. A total of 41 patients were included in the study. Patients aged 18 to 65 years who had undergone elective laparoscopic splenectomies, with no cutoff for spleen size, were included. The endpoints of the study were to measure perioperative parameters such as operative time, blood loss, postoperative complications, hospital stay and analysis of indications. Continuous variables were expressed as mean±SD and categorical variables were summarised as frequencies and percentages. Results: The study group consisted of 20 (48.80%) males and 21 (51.20%) females. The mean age was 43.42±11.28 years. The most common indication for splenectomy was Immune Thrombocytopenic Purpura (ITP) (n=15), followed by hereditary spherocytosis (n=7). The mean spleen size of 26 patients was 12±1.62 cm; in seven patients, it was 17±0.76 cm; and in eight patients, it was 23.5±2.29 cm. The largest spleen operated on measured 28 cm in size. One patient required conversion to open surgery due to bleeding. Conclusion: Laparoscopic splenectomy is a safe method associated with a low risk of perioperative complications. Proper planning and a reproducible operative technique are critical for success in laparoscopic splenectomy, even for massive spleens.

Management of a Surgical Site Infection using Herbal Fumigation (Vrana Dhoopan) and Ayurvedic Interventions: A Case Report

Abstract INTRODUCTION: Infection occurring within 30 days after the operation if no implant is left in place or within 1 year if an implant is in place is described as a surgical site infection. It clinically presents with delayed wound healing, pain, profuse discharge, and foul smell from the wound site. In Ayurveda, surgical-infected wounds can be correlated with Shastrakrita Dushta Vrana (surgical site-infected wound). Dhoopan Karma (~herbal fumigation) is one of the effective treatment modalities mentioned among Shashtiupakrama (60 procedures for wound management) for Dushta Vrana (~infected wound). Hence, the case study presents a surgical site-infected wound that has been managed with herbal fumigation along with Ayurvedic oral medications. PATIENT INFORMATION: An 18-year-old female presented with persistent pain, itching, foul smell, and profuse discharge from a post-surgical wound following a previous surgical intervention for a pilonidal sinus for 3 months. There was no history of fever or any signs of systemic infection. The wound measured approximately 5 cm × 3 cm × 2 cm in size and lacked proper granulation tissue. Based on clinical findings, it was diagnosed as a non-healing surgical site infection. MATERIALS AND METHODS: The patient was treated with herbal fumigation with Guggul (Commiphora wightii Arnott), Manjishta (Rubia cordifolia Linn), Rala (Shorea robusta Gaertner f), Nimba (Azadirachta indica A. Juss), and Goghrita (clarified cow butter), followed by sterile dressing once in the morning hours and other during the evening hours for 10 days along with oral administration of Triphala Guggul (500 mg) 2 tablets, Samshamani Vati (140 mg) 5 tablets, and Gandhak Rasayan Vati (330 mg) 2 tablets twice a day internally for 15 days. RESULTS: After ten days of herbal fumigation, sterile dressing, and Ayurvedic oral medications, the patient’s symptoms, including pain, itching, purulent discharge, and foul odor from the natal cleft wound, had significantly reduced. On the follow-up, after 15 days, the wound had healed completely without any complications. CONCLUSION: Based on this case study, it can be concluded that the combination of herbal fumigation along with sterile dressing and oral Ayurvedic drugs can be used as an effective treatment modality for managing infected surgical site wounds. A comprehensive wound care protocol incorporating herbal fumigation (Vrana Dhoopan) and Ayurvedic oral interventions presents a potential treatment approach for infected wounds. The therapeutic efficacy of this integrative approach can be further validated through well-designed clinical trials.

Large atypical lipomatous tumours of the limbs: A report of three cases

Atypical lipomatous tumours (ALT) are rare adipocytic neoplasms classified under well-differentiated liposarcomas. Although they have low metastatic potential, their progressive growth and anatomical location can lead to significant functional impairments. Complete surgical excision remains the primary treatment; however, challenges arise when these tumours are located near critical neurovascular structures. This study presents three clinical cases of large ALT in the limbs, analysing the diagnostic, surgical and prognostic aspects. This study reports on three patients (ages 64, 70 and 69) who presented with large, slowly growing lipomatous masses in the limbs, evolving over several years. The tumours, ranging from 25 to 60 cm in size, were assessed using imaging techniques, including MRI and CT scans. Surgical excision was performed in all cases, ensuring complete tumour resection while preserving adjacent neurovascular structures. Histopathological analysis confirmed the diagnosis of ALT. Postoperative functional recovery and recurrence were monitored over a follow-up period of 24 months. All patients experienced significant clinical improvement, with full restoration of joint mobility and resolution of sensory disturbances. No local tumour recurrence was observed. Postoperative imaging demonstrated effective tissue regeneration without excessive fibrosis or adhesions. The quality-of-life assessment using the Toronto Extremity Salvage Score (TESS) indicated a marked improvement in motor function and autonomy. ALT, despite being a low-grade tumour, requires a multidisciplinary approach for optimal management. Complete surgical excision ensures excellent long-term outcomes, but extended clinical and radiological surveillance remains crucial. Advancements in molecular pathology and imaging techniques may further refine treatment strategies and enhance patient prognosis.

Unraveling Major Questions in Micronekton Ecology and Their Role in the Biological Carbon Pump Through Integrative Approaches and Autonomous Monitoring

Micronekton consist of crustaceans, cephalopods, gelatinous organisms, and fishes that are 2–20 cm in size (Figure 1). These organisms have unique functional traits that impact their vertical migration patterns and ecosystem processes (Aparecido et al., 2023). Our understanding of their potential carbon transport and sequestration from the epipelagic (upper 200 m) to mesopelagic zones (200–1,000 m) or deeper (e.g., Boyd et al., 2019; Le Moigne, 2019; Cavan et al., 2019) is limited by the tools traditionally used to assess their biomass, diversity, and varied migration patterns (e.g., Annasawmy et al., 2019, 2024; Barbin et al., 2024; Eduardo et al., 2024). These knowledge gaps are notable considering that micronekton are ubiquitous throughout the world ocean.

Miniperc percutaneous nephrolithotomy versus retrograde intrarenal surgery in the treatment of juxta uretero-pelvic junction upper ureteric calculi: A prospective, randomized control study.

Treatment of upper ureteric calculi has always remained a challenge for urologists. Treating the juxta-UPJ stones has been even more challenging. Difficulties in access, the possibility of up migration of stones, higher chances of leaving behind residual fragments, and the need for ancillary procedures like ESWL or relook URS have been a few inherent limitations in treating such stones. Offering PCNL for smaller stones was considered an overkill by many urologists. However, with the advent of miniaturized PCNL and improvisations in RIRS techniques, more and more of such stones are tackled with ease. To compare the safety and efficacy of mini-percutaneous nephrolithotomy (Miniperc PCNL) and retrograde intrarenal surgery (RIRS) in the management of juxta pelvi-ureteric junction (PUJ) calculi, located between 1 and 2 cm from PUJ. A prospective, randomized study was done on 100 patients with upper ureteric stones up to 2 cm in size and within 2 cm from PUJ. Patients with odd numbers were assigned Group A (Miniperc PCNL, n = 50) and even numbers were assigned to Group B (RIRS, n = 50). Stone-free rates were 92% for Group A and 72% for Group B (P < 0.0174). Mean operative time was significantly shorter in Group A than Group B (53.2 min vs. 68.52 min, P < 0.001). Hospital stay was longer for Group A (47.42 h) compared to Group B (29.36 h, P < 0.001). Lasing time was more with RIRS than with PCNL (10.18 min vs. 3.24 min, P < 0.001). The complications were more in Group A than Group B, but not significant (P = 0.160). Postoperative pain and time to return to normal activities were significantly better in Group B RIRS (P < 0.001). Both Miniperc PCNL and RIRS are the effective treatments for upper ureteric stones. Miniperc PCNL has advantages in terms of shorter operative time, lesser lasing time, and better stone free rates. RIRS demonstrated reduced hospital stay, reduced postoperative pain, and quicker recovery. Miniperc PCNL showed a higher stone-free rate for treating upper ureteric stones up to 2 cm. RIRS is effective for treating stones up to 2 cm in upper ureter reducing the complications associated with Miniperc PCNL.

Isolated muscular cysticercosis in the child: A case report with a review of the literature

Abstract Isolated muscular cysticercosis is a rare entity and deserves a note. A 4-year-old male child presented with swelling on the left shoulder region and was clinically diagnosed to have cystic swelling approximately 3 cm × 4cm in size with mild tenderness. On ultrasonography, it appeared to be a cystic swelling in the muscle most probably resembling muscular cysticercosis. The patient was investigated thoroughly for any additional cysts elsewhere in the body and was given medical treatment with oral albendazole and steroids for 6 months but the swelling kept on gradually increasing in size and became painful, hence it needed surgical excision. Intraoperatively, meticulous dissection of the cyst was done to prevent any anaphylactic reaction. Therefore, initial medical management followed by surgical excision was the modality of treatment, done in this rare case. Here, we aim to enhance the existing scanty literature and the rarity of this case and emphasize the timely medical and surgical management of the same.

[Lesões papilares da glândula mamária canina: descrição e casuística]

ABSTRACT The purpose of the study was to identify the casuistry of papillary mammary neoplasms in female dogs, describe their epidemiological (age, breed) and morphological characteristics, and determine the survival of patients. Overall survival was estimated using Kaplan-Meier curves and comparisons between groups were performed using the Cox Mantel log-rank test (p &lt; 0.05 were considered significant). A study was carried out between 2005 and 2020 at the Laboratory of Comparative Pathology of the Institute of Biological Sciences of the Federal University of Minas Gerais. The study identified 288 female dogs with 353 papillary neoplasms, 36.93% benign (papilloma, sclerosing papilloma, and papilloma with carcinomatous areas in situ) and 63.06% malignant (non-invasive papillary carcinoma, invasive papillary carcinoma, invasive papillary carcinomas with micropapillary areas and micropapillary areas in situ, and solid papillary carcinoma). Papilloma (53.1%) and invasive papillary carcinoma (46.64%) were the most frequent. Most papillary neoplasms were smaller than 3.0 cm in size and presented no metastases in lymph nodes and no distant metastases. However, the invasive papillary carcinomas’ average size was larger than the papillomas and non-invasive carcinomas. Papillary neoplasms are often associated with other types of mammary neoplasms; thus the survival of most female dogs is difficult to determine.

Surgical treatment of pleurocutaneous fistula in a patient 20 years after radiation therapy and breast-conserving surgery

Introduction. Radiation therapy after breast-conserving surgery substantially reduces the risk of local disease recurrence and moderately reduces the risk of cancer-related death. However, long-term side effects are related to numerous factors, including patient age, comorbidities, total radiation dose, fraction size, and extent of disease. Case report. We present the case of a 61-year-old female patient who developed an ulceration at the center of a postoperative scar, accompanied by progressive tissue destruction that eventually reached 6 ? 3 cm in size, resulting in rib exposure. Twenty years ago, she had a conservative surgery of the right breast due to invasive ductal carcinoma with postoperative radiation therapy to the right chest wall and the draining lymphatics. A simple mastectomy with operative removal of all sclerotic and calcified tissue, with reconstruction of the right thoracic wall, was performed by a multidisciplinary team comprising a surgical oncologist, thoracic surgeon, and plastic surgeon. The right rib cage defect of 12 ? 12 cm was reconstructed with Mersilene? mesh. A large 21 ? 15 cm island musculocutaneous latissimus dorsi flap was raised and transposed for reconstruction of the soft tissue defect. One thoracic and one wound drain were set in place. The postoperative course was uneventful, and the patient was discharged on the 12th postoperative day. She had no complications after a six-month follow-up. Conclusion. Long-term complications of radiation therapy are rare, but they are usually accompanied by severe consequences that require a multidisciplinary approach in complex surgical treatment.

Characteristics and Therapy of Patients with Bartholin's Cysts in An Indonesian Tertiary Hospita

A blocked duct of the Bartholin gland causes mucus accumulation and a fluid-filled sac, i.e., a Bartholin cyst, that can develop into an abscess when infected. This study specifically explored the characteristics and treatment Bartholin cysts or abscesses in patients registered at the obstetrics and gynecology clinic of Dr. Cipto Mangunkusumo National General Hospital, a tertiary hospital in Indonesia. This retrospective and descriptive study utilized data from patients registered at the hospital from July 2021 to July 2023. Bartholin cysts were found to be more common in patients aged 40 to 45 (57.1%) with a non-working status (71.4%), and married (90.5%). Cysts were found to be 1 to 3 cm in size (52.4%) and occured unilaterally (95.2%). Four of the fourteen patients complained of recurring Bartholin cysts. On history and clinical examinations, 20 (95.2%) patients reported the presence of lumps. Antibiotics were the most commonly used treatment, with 15 of 21 Bartholin cyst patients (71.4%) receiving them. Obtaining data on the demographic of patient characteristics is essential when providing appropriate health care. Clinical considerations such as cyst size, patient age, symptoms, and history of recurrent Bartholin cysts or abscesses influence the choice of comprehensive medical and surgical management.

Appendiceal Neuroendocrine Tumor: Clinicopathologic Characteristics of Six Cases and Review of the Literature.

Appendiceal neuroendocrine tumors (ANETs) are the most prevalent type of appendiceal neoplasm and the fifth most common neuroendocrine tumor in the gastrointestinal tract. In this study, we described the clinicopathological features of patients with ANET. We reviewed the clinicopathological findings and histopathological reports of six patients diagnosed with ANET between January 2014 and December 2023 at Korea University Medical Center, Anam Hospital. Six cases, comprising three males and three females, were diagnosed during procedures for lower abdominal pain or other medical reasons. Most tumors were less than 1 cm in size and located at the tip of the appendix. One patient had a large tumor (4.1 cm) with lymph node metastasis. Four tumors extended to the muscularis propria, whereas two infiltrated the subserosal soft tissue. The tumor cells exhibited a typical trabecular and nested pattern with monotonous round or oval nuclei. All patients had a mitotic count of less than 2 per 10 high-power fields and a Ki-67 labeling index of less than 1%, classifying them as having G1 well-differentiated tumors. Immunohistochemical staining showed that all cases were positive for CD56 and synaptophysin, and four were positive for chromogranin A. No recurrence or distant metastasis was observed during follow-up. ANETs are relatively uncommon and mostly benign in terms of prognosis. Because of their malignant potential, meticulous examination of appendectomy specimens is warranted to identify the presence of ANETs.

A rare cause of acute abdomen in children: a torsioned giant mature cystic teratoma in an 11-year-old girl

Ovarian torsion, which is an uncommon cause of abdominal pain, is usually caused by dermoid and benign functional cysts in pre-menarcheal girls. Therefore, their diagnosis is difficult, as seen in this case. This case is the case of an 11-year-old pre-menarcheal girl who was admitted to our hospital due to abdominal pain and bilious vomiting. During the abdominal examination of the patient, who was in the premenstrual period, she had abdominal pain in both lower quadrants. There was significant tenderness. During rectal examination, a perirectal mass was palpated on the right. Leukocyte count (17,000 /mm³) and tumor markers AFP and beta HCG were at normal levels. Ultrasonography (US) showed a peripherally located, hard lesion with millimetric cystic areas, 12x9x8 cm in size, with a heterogeneous internal structure, in the right ovary region. During the surgery, serohemorrhagic fluid was detected in the abdomen and 720° clockwise right adnexal torsion was detected. The right ovary was deformed. A sample was taken with a syringe for cytology. The mass in the right ovary was approximately 12x9x8 cm in size and contained cystic and solid components. There were necrotic and occasionally hemorrhagic areas in the right ovary and fimbria. Due to the gangrenous appearance of the ovary, a right salpingo-oophorectomy was performed. The patient was discharged with recommendations on the 5th postoperative day. Surgical intervention should be performed early to reduce the risk to the patient's future fertility. In this way, we can prevent losing the ovary after infarction that occurs after ischemia and necrosis.