Cm In Size Research Articles

Microwave Ablation of T1a and T1b Renal Masses: A Retrospective Study

AbstractThe aim of this study was to evaluate the efficacy and safety of microwave ablation (MWA) for the treatment of T1a and T1b renal masses, with size ranges between 1.2 and 6.5 cm. A retrospective review was performed at a single tertiary comprehensive cancer center between June 2019 and June 2023 of 49 consecutive patients (53 total procedures) who underwent MWA for renal masses. The Solero microwave tissue ablation system (Angiodynamics, Latham, NY, United States) was utilized. Patient demographics, renal mass characteristics, and procedural outcomes were collected. Serum creatinine and estimated glomerular filtration rate (eGFR) were utilized to assess renal functional outcomes. Oncologic outcomes were assessed using evidence of local tumor recurrence on contrast-enhanced cross-sectional imaging, local recurrence-free probability at 1 and 2 years, and overall survival (OS) using the Kaplan–Meier analysis.Forty-nine patients (57% males and 43% females) with a median age of 72 years (range, 38–84 years) underwent 53 MWA procedures. The mean renal mass size was 2.8 ± 0.94 cm (range, 1.2–6.5 cm). Most of the renal tumors were T1a. Three of the 53 total renal tumors were larger than 4 cm (T1b) and the remaining 50 were less than 4 cm in size (T1a). The largest tumor that was ablated was 6.5 cm in size. All the patients were placed under general anesthesia (intubated) before the MWA procedure. A median microwave energy of 100 W (range, 60–140 W) was used. The mean duration of the MWA was 3.9 ± 1.5 minutes, with a 100% technical success rate. Four patients (8.2%) experienced complications, two (4.1%) of whom experienced a major complication. There was no clinically significant change in renal function from pre- to postablation on day 1 or at 3 months. Furthermore, local tumor recurrence was observed in three (6.1%) patients at 2.5, 15, and 25 months postablation. Local recurrence-free probability was 98 and 93% at 1 and 2 years, respectively. The OS was 98 and 87% at 1 and 2 years, respectively. MWA continues to prove to be an effective technique that can be used to treat small renal masses including oncocytomas, with high technical success, low complication rate, low risk of adverse renal functional outcomes, and encouraging results for sustained tumor control.

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)

Pulmonary Valve Fibroelastoma, Still a Very Rare Cardiac Tumor: Case Report and Literature Review

Background and Clinical Significance: Primary cardiac tumors are among the rarest types of tumor, and until the mid-20th century, they were diagnosed only post-mortem or during other surgical interventions. With the rapid evolution of cardiovascular imaging and the widespread use of echocardiography, the incidence of cardiac fibroelastoma has increased, though it remains one of the rarest primary cardiac tumors. Papillary fibroelastoma is a benign primary cardiac tumor that develops from endocardial tissue, is usually solitary, and can have multiple locations, with the pulmonary valve being one of the rarest sites. The symptoms and complications depend on the tumor’s location, ranging from asymptomatic patients to cerebral ischemic embolism or pulmonary embolism. We analyzed the electronic databases PubMed, Web of Science, and Cochrane and conducted a systematic review of pulmonary valve papillary fibroelastoma (PVPF). Additionally, we included a case from the Adult and Pediatric Cardiovascular Surgery Clinic in Targu Mures. Case Presentation: We present the case of a 58-year-old patient who complained of exertional dyspnea. A transthoracic echocardiography (TTE) revealed a tumor mass attached to the pulmonary valve and coronary angiography identified severe coronary lesions. Following discussions within the Heart Team, surgical myocardial revascularization and tumor excision were decided upon due to the thromboembolic risk. Histopathological examination confirmed the diagnosis of papillary fibroelastoma. The postoperative course was uneventful, with an improvement in dyspnea. The mean age of the patients was 60 years, with half being men (n = 26, 50%). Regarding symptoms, 34% (n = 18) of cases were incidentally identified, while over 30% (n = 17) presented with dyspnea. Pulmonary embolism (PE) was reported in only two patients, and the most common associated comorbidities included high blood pressure (HBP) in 33% (n = 16) and dyslipidemia in 18%. Tumor size ranged from 0.7 cm to 3 cm with the initial benign cardiac tumor; its occurrence in the pulmonary valve remains exceedingly rare. Due to its frequent overlap with other cardiac pathologies, the clinical presentation is often a nonspecific diagnosis or suspicion of a tumor predominantly established via transthoracic echocardiography in 62% of patients. From a surgical perspective, 63% (n = 33) underwent tumor resection with valve sparing, 25% (n = 12) required pulmonary valve repair, and three patients necessitated pulmonary valve replacement. Conclusions: Although the incidence of papillary fibroelastoma is increasing, making it the most common, there is a need to highlight the indispensable role of echocardiography in diagnosis. Although papillary fibroelastoma is benign, surgical intervention is recommended, particularly in symptomatic patients, or if the tumor exceeds 1 cm in size, exhibits increased mobility, or is present alongside other cardiac surgical procedures.

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.

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 rm ∼ 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.

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.

Personalized treatment strategies for breast adenoid cystic carcinoma: A machine learning approach.

Breast adenoid cystic carcinoma (BACC) is a rare subtype of breast cancer that accounts for less than 0.1% of all cases. This study was designed to assess the efficacy of various treatment approaches for BACC and to create the first web-based tool to facilitate personalized treatment decisions. The Surveillance, Epidemiology, and End Results (SEER) database was used for this study's analysis. To identify the prognostic variables, we conducted Cox regression analysis and constructed prognostic models using five Machine Learning (ML) algorithms to predict the 5-year survival. A validation method incorporating the area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to validate the accuracy and reliability of ML models. We also performed a Kaplan-Meier (K-M) survival analysis. This study included 1212 patients. The median age was 60 years, with most tumors being localized and less than 2cm in size. The 5-year overall survival (OS) rates were highest for surgery+radiotherapy (RT) (94.9%) and lowest for surgery+chemotherapy (CTX)+RT (80.1%). Positive estrogen receptor (ER) status and younger age were associated with better survival outcomes. ML models identified key predictive features for survival, including age, nodal status, and ER status. Age, lymph node metastasis, and ER status are crucial prognostic indicators for BACC. Although postoperative RT enhances survival, the advantages of adjuvant CTX are uncertain, implying that it may be eschewed to avert adverse effects. Our online tool offers essential resources for prognostication and treatment optimization.

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.

Pelvic inlet closure with bladder peritoneal flap reduces postoperative ileus after abdominoperineal resection.

Abdominoperineal resection (APR) is the standard treatment for locally advanced distal rectal cancer (LADRC) following neoadjuvant treatment when sphincter-preserving procedures are inapplicable. However, complications such as perineal site infection, perineal hernia and postoperative ileus remain ongoing challenges. We aimed to compare the rate of postoperative ileus due to pelvic incarceration in APR patients with/without pelvic inlet closure. LADRC patients, who underwent APR with/without pelvic inlet closure between January 2016 and September 2022 at a comprehensive cancer center were analyzed retrospectively. After laparoscopic APR, the pelvic inlet was closed with a bladder peritoneal flap. A U-shaped peritoneal flap, up to approximately 15 × 20cm in size, was peeled off from the dome of the bladder with its base at the posterosuperior part of the bladder. Of the 80 patients included in the analysis, 27 (34%) underwent laparoscopic APR with pelvic inlet closure and 53 (66%) had no pelvic inlet closure. There was no significant difference in age, mean body mass index and American Society of Anesthesiologists score among both groups. Patients with a pelvic inlet closure had a significantly lower postoperative ileus rate because of incarceration [0 vs. 17%, n = 9/53; (P = 0.03)] and a shorter hospital stay [6.74 ± 4.21 vs. 9.00 ± 5.99days; P = 0.03]. The rate of perineal surgical site infection (SSI) [5/27 (18.5%) vs. 14/53 (26.4%); P = 0.61) was lower in the laparoscopic APR with pelvic inlet closure group, but this was not significant. Pelvic inlet closure using a bladder peritoneal flap following APR is a safe and feasible procedure associated with reduced postoperative ileus due to pelvic incarceration rates, emergent surgical interventions due to pelvic incarceration and shorter hospital stay.

The necessity of fine-needle aspiration biopsy in surgical decision-making for thyroid nodules larger than 3 cm.

Ultrasound-guided fine-needle aspiration biopsy (FNAB) is an essential diagnostic tool for detecting malignancy in thyroid nodules. The objective of this study was to evaluate the necessity of FNAB in the treatment decision-making process for thyroid nodules exceeding 3 cm in size. The records of patients who underwent thyroidectomy in our center between 2018 and 2023 were retrospectively reviewed. The study included patients with an index nodule size exceeding 3 cm. Exclusion criteria were missing data, treatment for a different oncological condition, recurrent disease, and purely cystic nodule. Patients were categorized into 2 groups based on the size of the index nodule: Group 1 included nodules measuring between 3 to 4 cm, and Group 2 included nodules 4 cm and larger. Demographic data, FNAB results, and histopathological findings were recorded. The specificity, sensitivity, false negative, and false positive rates of FNAB were calculated. There were 1935 patients who underwent thyroidectomy within the specified date range. In 359 of these patients, the index nodule size was 3 cm or more. There were 188 patients with nodule size between 3 and 4 cm. The mean age was 50.42 ± 13.34 years, and 257 patients were female (F/M ratio = 2.5/1). Fine needle aspiration biopsy was performed on 237 patients, resulting in 65 false negatives. Both the incidence of malignancy and the rate of FNAB false negatives were higher in nodules measuring 4 cm or larger. This study identified a high malignancy rate and a significant rate of false negatives in FNAB of thyroid nodules larger than 3 cm. These findings highlight the importance of carefully considering these factors in the surgical planning of such nodules.

Bifid Tongue and Cleft Palate: A Rare Congenital Malformation

Background: Congenital bifid tongue without other craniofacial abnormalities is a very rare malformation. Here, we discuss a case of the bifid tongue with cleft palate, reported in a 7-month-old girl with no other syndromes or craniofacial abnormalities. Case Reports: This case report described a 7-month-old girl with an anterior bifid tongue, separated medially by a soft, solitary sublingual mass measuring 3 cm x 2 cm in size. There was also an associated incomplete cleft palate. A soft solitary mass measuring 2 cm x 2 cm in size was also seen within the cleft palate. Results: Computed facial tomography (CT) revealed a midline hard palate defect with an intact alveolar process of the maxilla. Pedunculated cystic lesion suspected with epulis was noted to arise on premaxillary alveolar mucosa. Excision of the tongue and hard palate mass and repair of the bifid tongue were done. Summary: Congenital bifid tongue with a cleft is a very rare malformation with different variations. Early surgical intervention is critical to prevent speech impairment and swallowing disorders. A multidisciplinary approach, including well-planned staged operations and rehabilitation, is important to achieve favorable outcomes.

Symptomatic Giant Skene’s Gland Cyst During Second Trimester Pregnancy and Surgical Excision: A Case Report

Introduction: A Skene’s gland cyst is a rare gynecological disorder, and the cause of an adult onset is largely unknown. However, periurethral and perineal cystic lesions are common, causing often indistinguishable symptoms. Therefore, accurate diagnosis is crucial because it can significantly alter clinical management. Methods: A 27-year-old woman was gravida 2 para 1 with the onset of a unique, progressively large vulvar mass that began at approximately 6 weeks of gestation. At 22 weeks of gestation, the mass became more symptomatic and measured approximately 9 cm × 7 cm × 6 cm in size, with some areas of excoriation on the lateral surface. Results: The patient had a pelvic MRI without contrast, and it showed that the mass was most likely a giant Skene’s gland cyst. At 24 weeks, the mass was surgically removed under spinal anesthesia and followed by vulvar reconstruction. Histopathology showed a benign cyst lined by transitional and squamous epithelium cells, which was consistent with a benign Skene’s gland cyst. She recovered fully, continued with the pregnancy and delivered vaginally at 39 weeks and 3 days without complications. Conclusions: A case of excoriating giant Skene’s gland cyst in pregnancy that caused significant discomfort to the patient. To this day, there has been no reported literature of a Skene’s gland cyst this large, especially during pregnancy. Hence, Skene’s gland cysts should be part of the differential diagnosis of a large vulvar mass of this magnitude during pregnancy.

A Rare Case With a Review of Cutaneous Composite Hemangioendothelioma and the Role of Neuroendocrine Markers.

Composite hemangioendothelioma comprises permutations of different histological patterns few of which have been found to have specific genetic alteration and immunohistochemical expression. It comprises retiform or epithelioid hemangioendothelioma-like areas, with a variable proportion of hemangioma or low-grade angiosarcoma-like areas. It was found to express neuroendocrine markers and was seen to have a worse prognosis in recurrence or distant metastasis. A 29-year-old woman presented with a lesion of 22 cm in size in her right leg. Biopsy and wide local excision showed features of composite hemangioendothelioma. This is a recurrent lesion after initial resection 2 years back, along with a cutaneous metastasis in the thigh. We report this rare case with a literature review, highlighting the importance of uncommon histomorphology and neuroendocrine marker expression in predicting local recurrence and cutaneous metastasis.

An Analysis of Percutaneous Nephrolithotomy (PCNL) Performed at the Institute of Kidney Disease, Pakistan: Stone Clearance and Complications.

Percutaneous nephrolithotomy (PCNL) is the preferred treatment for large renal stones, yet variability in outcomes arises from patient-specific factors and institutional practices. Understanding complications and predictors of success is essential to improving procedural efficacy. This study aimed to evaluate stone clearance rates, complications classified using the Clavien-Dindo system, and predictors of PCNL outcomes, with a focus on improving lower calyx stone clearance. A retrospective analysis was conducted on 422 PCNL procedures performed from July 2021 to December 2023 at the Institute of Kidney Disease, Hayatabad Medical Complex, Peshawar, Pakistan. Patient demographics, stone characteristics, and postoperative outcomes were analyzed. Stone clearance rates were calculated, and complications were categorized by severity. Associations between patient and stone characteristics and outcomes were tested using Chi-square analysis, with significance set at p < 0.05. A total of 422 PCNL cases were analyzed, with an overall stone-free rate of 75.82% (320/422). The average patient age was 45.39 ± 12.43 years, with male patients comprising 56.87% of the cohort and a mean BMI of 27.82 ± 4.21 kg/m². Hypertension (21.43%), diabetes mellitus (18.95%), and chronic kidney disease (7.11%) were notable comorbidities. Stones averaged 3.21 ± 1.13 cm in size, predominantly composed of calcium oxalate (35.55%), and were most frequently located in the upper calyx (28.44%). Postoperative outcomes revealed a 21.33% complication rate, with 16.59% classified as minor (Clavien-Dindo Grades I-II) and 4.74% as major (Grades III-IV). Follow-up data showed that 11.83% of patients had residual stone fragments, and 9.48% experienced delayed complications, primarily minor. Stone size and location significantly influenced outcomes, with clearance rates of 80.00% for 2-3 cm stones versus 65.57% for stones >3 cm (p = 0.155). Lower calyx stones had markedly reduced clearance rates (50.00%, p < 0.001) compared to upper (75.00%) and mid-calyx (70.00%) stones, while stones in multiple locations also showed poor clearance (57.69%, p = 0.001). Key predictors of complications included higher BMI and prolonged operative times, emphasizing the need for tailored approaches, technical refinements, and institutional audits to optimize outcomes for anatomically or clinically complex cases. This study highlights the high efficacy of PCNL in managing large renal stones, achieving a stone-free rate of 75.82%. However, the findings underscore the significant challenges associated with lower calyx stones and larger stone sizes, both linked to reduced clearance rates. The Clavien-Dindo classification of complications shows that while minor complications are more frequent, major complications remain a concern, especially in patients with elevated BMI or prolonged operative times. To optimize outcomes, this study recommends refining surgical techniques and adopting technological advancements to improve lower calyx clearance, implementing institutional audits to standardize practices, and personalizing treatment strategies through preoperative risk stratification. Future multicenter prospective studies are needed to validate these findings, further explore predictors of outcomes, and develop comprehensive care protocols addressing anatomical and patient-specific challenges in PCNL procedures.

First report of basal stem rot on sugarcane (var. Badila) caused by Sclerotium rolfsii in China.

Badila (Saccharum officinarum) is one of the important chewing cane in south China. During the year 2019-2020, as much as 60.2%-87.5% of sugarcane plants stem showed red rot developments were observed in the fields of Yongning District, Nanning city, Guangxi province. Symptomatic plants showed red rot at basal stem nodes and sheath, when the disease serious, the epidermis and aerial roots decomposed and exfoliated, then formed sclerotiums, the upper stem also occurred the symptom. Infected plant tissues were dissected into small pieces with 0.1 × 0.1cm in size and surface sterilized in 0.1% HCl2 for 2 min, followed by 75% ethanol for 30 s, rinsed three times with sterile distilled water. Then the tissues were placed onto potato dextrose agar (PDA) plates and incubated at 25 °C for 3 days. Numerous white globoid sclerotia were formed on PDA after 5 days of growth. The sclerotia (2 to 3 mm in diameter) were white at first and then gradually turned dark brown. Aerial mycelia usually formed many narrow hyphal strands 4 to 9 μm wide. Five uniform isolates were obtained from diseased sugarcane plants. Pathogenicity of representative strain W1 was confirmed by inoculating 120-day-old Badila plants grown in field. Five plants were inoculated with colonized agar discs (6mm in diameter) by applying toothpick tips to the lower part of the stem. Five non-inoculated plants served as control. The inoculated and non-inoculated plants were sprayed sterile water then incubated with plastic film for maintained high moisture. All the plants were placed inside of a growth chamber at 26 ± 2°C with a 14-h photoperiod and 80% relative humidity. All inoculated plants showed red rot at stem and sheath after 2 weeks, whereas the control plants were symptomless. By the third week, mycelium and sclerotia developed on the crown on the inoculated plants. The fungus was re-isolated from the artificially inoculated plants. To confirm the species-level identification, partial of the ribosomal DNA internal transcribed spacer (ITS), mitocondrial small subunit (SSU), and nuclear ribosomal large subunit (LSU) regions of representative strain W1 were amplified and sequenced using the primers pairs ITS1/ITS4 (White et al. 1990), ITS-Fu-F /ITS-Fu-R and SRLSU1//SRLSU2 (Kumar et al., 2016), respectively. The resulting ITS, SSU and LSU sequences were deposited in GenBank (GenBank accession no. MW620994, MW617878, and MW617872) and shared 99.42%, 100% and 100% sequence identity with Athelia rolfsii isolate (JN017199, OM319631, and MT225781). Phylogenetic analysis conducted with neighbor-joining (NJ) method using MEGA6.0 revealed that the isolate share a common clade with reference sequence of A. rolfsii in GenBank Data Library. Based on morphological and molecular characteristics, the fungus was identified as A. rolfsii (anamorph: Sclerotium rolfsii) (Paul et al. 2017; Paparu et al. 2020). Although S. rolfsii has been reported causing sugarcane sett rot in Australia (Bhuiyan et al., 2019) and seedlings of sugarcane in Indian (Gopi et al., 2023), as we know, this is the first report of sugarcane basal stem rot disease caused by this fungus in China. This study will be helpful for the prevention and control sugarcane basal stem rot in the future.

Efficacy of the combination of tadalafil and tamsulosin versus tadalafil alone as a medical expulsive therapy for stone L1/3 ureter 10 mm or less: A prospective comparative placebo-controlled study

Abstract Background The lifetime occurrence of urinary stones is approximately 1%–15%, and the peak age of occurrence is 30 years. Approximately one fifths of urinary tract stones are found in the ureter, of which two thirds are in the distal ureter. Many drugs, including phosphodiesterase-5 inhibitors (PDE5Is) and α-blockers, are used to relax the smooth muscles in medical expulsive therapy (MET). We aimed to compare the combination of tadalafil and tamsulosin versus tadalafil alone as MET for stones in the L1/3 ureter of 10 mm or less. Materials and methods A total of 150 patients with L1/3 ureteric stones measuring 10 mm or less were enrolled in the study and randomly assigned to one of 3 equal groups using a computer-generated random number. Patients in group A prescribed tadalafil 10 mg/d. However, those in group B were prescribed tamsulosin 0.4 mg and tadalafil 10 mg/d, whereas those in group C received a placebo once daily. Stone expulsion rate and pain recurrence were evaluated after 14 days. Results The stone expulsion rate was significantly higher in the tadalafil and tamsulosin groups and the tamsulosin group than in the placebo group in the current study by 68% in the combination group, 64% in the tadalafil alone group, and 42% in the placebo group (p = 0.019). In the current study, a combination was associated with lower pain recurrence than tadalafil alone or placebo, with means of 1.06, 1.9, 2.98 (with a p value of 0.001). Stone size was not effective in any group. Conclusions The combination of PDE5Is and α-blockers effectively increases the expulsion of lower ureteric stones (5–10 mm), but with the same effect as PDE5Is alone, with the advantage of decreasing pain recurrence. Stone size did not affect the expulsion rate in patients who received MET for stones less than 1 cm in size.

Contrast-Enhanced Ultrasound Compared With Hepatobiliary Agent MRI for Differentiation of Focal Nodular Hyperplasia and Hepatic Adenoma: A Prospective Trial.

Magnetic resonance imaging (MRI) may be time-consuming, expensive, or poorly tolerated by patients with liver lesions. This is a prospective clinical trial designed to evaluate if contrast-enhanced ultrasound (CEUS) can be used to differentiate focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA) with similar accuracy compared with hepatobiliary agent MRI.Institutional review board approval was obtained (1805450097), and the trial was registered with ClinicalTrials.gov (NCT03652636). From 2018 through 2023, 40 patients who had lesions consistent with FNH or HCA on HBA-MRI underwent 1-time prospective CEUS of up to 2 hepatic lesions. Sonographic images obtained before and after intravenous administration of 2 mL sulfur hexafluoride lipid-type A microspheres (Lumason) per lesion totaling 59 lesions (27 FNHs/32 HCAs). Two blinded radiologists provided a diagnosis of FNH or HCA.Thirty-eight female and 2 male patients (age 36.7 ± 9.9) were scanned. Radiologists provided diagnosis of FNH or HCA with respective sensitivity (66.7/64.0%), specificity (71.9/90.6%), and accuracy (69.5/78.0%). For 38 lesions greater than or equal to 2 cm in size (17 FNHs/21 HCAs), readers had sensitivity (70.6/84.2%), specificity (70.6/84.2%), and accuracy (81.5/86.8%). Interobserver agreement for all lesions was fair (κ = 0.34), whereas agreement for lesions 2 cm or larger was substantial (κ = 0.67).Contrast-enhanced ultrasound can differentiate FNH from HCA with accuracy approaching that of hepatobiliary agent MRI for lesions 2 cm or greater. Interobserver agreement is improved with larger lesions. CEUS may have utility as an alternate diagnostic tool for FNH/HCA, especially in patients who cannot or do not desire to undergo MRI.