Distal Lesions Research Articles

Magnetic resonance imaging findings of synovial sarcoma in children: location-dependent differences.

While overall survival for children is greater than that for adults, synovial sarcoma remains an aggressive neoplasm with a potentially poor prognosis, and its magnetic resonance imaging (MRI) findings in children are not well described. We aimed to characterize the spectrum of MRI findings of synovial sarcoma in children with respect to anatomical location and outcome. Children with histologically confirmed synovial sarcoma and preoperative MRI performed within the past 11years (2009-2020) were included. Two radiologists retrospectively reviewed each MRI to categorize location, signal characteristics and associated findings. Chi-square and Fisher exact tests were used to assess associations with locations and outcomes. This study included 23 children (13 girls, 10 boys; mean age: 12.7±4.2years) with 7 axial, 8 proximal and 8 distal appendicular lesions. Kappa ranged from 0.53 to 1. MRI findings differed significantly between locations with axial lesions measuring larger (P=0.01) and more likely to contain fluid levels (P=0.02), triple sign (P=0.02), inhomogeneous signal (T1-weighted images, P=0.003; T2-weighted images, P=0.02, contrast-enhanced images, P=0.03) with all lesions containing partially solid composition (P=0.03). At a median follow-up of 14months (interquartile range: 7-33months), 39% relapsed. Predictors of relapse (P<0.05) included metastasis at presentation, larger lesions, axial lesions and MRI findings of fluid level, T1-weighted hyperintensity, inhomogeneous signal (T1- and T2-weighted images) and poorly circumscribed margins. A significant association was found between location and MRI findings in our cohort of children with synovial sarcoma. Axial lesions were more likely to be larger, appear heterogeneous and be associated with a worse outcome.

Transcatheter Intracerebral Laser Photobiomodulation Therapy for Treatment of the Consequences of Ischemic Stroke with Distal Atherosclerotic Lesion

The present research is dedicated to the application of intracerebral laser PBMT for the treatment of the consequences of ischemic stroke. The effectiveness of intracerebral laser PBMT is compared to that of the conservative therapy methods. Recent studies have demonstrated a high potential of laser technology PBMT in the treatment of various ischemic lesions of the brain. A total of 836 patients who had experienced ischemic strokes of different degrees of severity in the period ranging from 6 months to 6 years prior to the treatment were included in the research. The age of these patients ranged between 29 and 81 years (average age: 74.9 years). There were 593 men (70.93%) and 243 women (29.07%). The patients were divided into two groups - the Test Group and the Control Group. The Test Group comprised 511 (61.12%) patients with distal lesions of the intracerebral arteries. These patients underwent transcatheter intracerebral laser PBMT. The Control Group comprised 325 (38.88%) patients with similar distal lesions of the intracerebral arteries. These patients, however, received the conservative treatment. The Test Group patients exhibited good clinical results in 259 (87.21%) cases after small focal strokes, in 94 (60.26%) cases after medium focal strokes, and in 12 (20.69%) cases after macro-focal strokes. The Test Group patients exhibited satisfactory clinical results in 33 (11.11%) cases after small focal strokes, - in 39 (25.00%) cases after medium focal strokes, and- in 22 (37.93%) cases after macro-focal strokes. In the Control Group, 51 (21.07%) patients exhibited good clinical results after small focal strokes, while none of the patients exhibited good results after medium focal strokes and macro-focal strokes. In the Control Group, satisfactory clinical results were exhibited by 60 (24.79%) patients after small focal strokes and 8 (19.05%) patients after medium focal strokes, while none of the patients exhibited satisfactory results after macro-focal strokes. Transcatheter intracerebral laser PBMT is an effective, pathogenetically substantiated method for the treatment of the consequences of ischemic stroke. This method enables the restoration of daily-life activities and cognitive and mental functions, thereby enabling the patients to be fully active in their lives again.

Predictors and 3-year outcomes of compromised left circumflex coronary artery after left main crossover stenting.

BackgroundThere are few predictors of decreased fractional flow reserve (FFR) in the left circumflex coronary artery (LCx) after left main (LM) crossover stenting.ObjectivesWe aimed to determine the predictors for low FFR at LCx and possible treatment strategies for compromised LCx, together with their long‐term outcomes.MethodsAltogether, 563 patients who met the inclusion criteria were admitted to our hospital from February 2015 to November 2020 with significant distal LM bifurcation lesions. They underwent single‐stent crossover percutaneous coronary intervention (PCI) under intravascular ultrasound (IVUS) guidance with further LCx intervention based on the measured FFR.ResultsThe patients showed significant angiographic LCx ostial affection post‐LM stenting, but only 116 (20.6%) patients had FFR < 0.8. The three‐year composite major adverse cardiac events (MACE) rates were comparable between the high and low FFR groups (16.8% vs. 15.5; p = 0.744). In a multivariate analysis, low FFR at the LCx was associated with post‐stenting minimal luminal area (MLA) of LCx (odds ratio [OR]: 0.032, p < .001), post‐stenting LCx plaque burden (OR: 1.166, p < .001), poststenting LM MLA (OR: 0.821, p = .038), and prestenting LCx MLA (OR: 0.371, p = .044). In the low FFR group, those with compromised LCx managed with drug‐eluting balloon had the lowest three‐year MACE rate (8.1%), as compared to either those undergoing kissing balloon inflation (KBI) (17.5%) or stenting (20.5%) (p = 0.299).ConclusionUnnecessary LCx interventions can be avoided with FFR‐guided LCx intervention. Poststenting MLA and plaque burden of the LCx, and main vessel stent length are poststenting predictors of low FFR.

An implantable human stem cell-derived tissue-engineered rostral migratory stream for directed neuronal replacement

The rostral migratory stream (RMS) facilitates neuroblast migration from the subventricular zone to the olfactory bulb throughout adulthood. Brain lesions attract neuroblast migration out of the RMS, but resultant regeneration is insufficient. Increasing neuroblast migration into lesions has improved recovery in rodent studies. We previously developed techniques for fabricating an astrocyte-based Tissue-Engineered RMS (TE-RMS) intended to redirect endogenous neuroblasts into distal brain lesions for sustained neuronal replacement. Here, we demonstrate that astrocyte-like-cells can be derived from adult human gingiva mesenchymal stem cells and used for TE-RMS fabrication. We report that key proteins enriched in the RMS are enriched in TE-RMSs. Furthermore, the human TE-RMS facilitates directed migration of immature neurons in vitro. Finally, human TE-RMSs implanted in athymic rat brains redirect migration of neuroblasts out of the endogenous RMS. By emulating the brain’s most efficient means for directing neuroblast migration, the TE-RMS offers a promising new approach to neuroregenerative medicine.

Comparison Between Ultrasonographic and Standing Magnetic Resonance Imaging Findings in the Podotrochlear Apparatus of Horses With Foot Pain.

This prospective study aimed to blindly compare the ultrasonographic and standing magnetic resonance imaging (sMRI) findings in deep digital flexor tendon (DDFT), navicular bone, and navicular bursa in horses with foot pain, positive digital analgesia, and without definitive radiographic diagnosis. Ultrasonography detected more DDFT abnormalities (32/34 feet vs. 27/34 with sMRI) but identified less palmar navicular abnormalities (23/34 feet vs. 30/34 with sMRI). In suprasesamoidean DDFT lesions, which were mainly dorsally located, changes in echogenicity did not correspond to a particular pattern of sMRI signal change. Transcuneal ultrasonography did not allow assessment of morphology and extent of distal DDFT lesions, and sporadically discriminated the affected lobe compared to sMRI. Defects of the palmar compact bone were identified with both modalities except a parasagittal defect, which was only seen at sMRI.

Artificial intelligence and colonoscopy experience: lessons from two randomised trials

Background and aimsArtificial intelligence has been shown to increase adenoma detection rate (ADR) as the main surrogate outcome parameter of colonoscopy quality. To which extent this effect may be related...

Topical therapy of onychomycosis in patients with psoriasis

Objective — to study the effectiveness of the method of treating onychomycosis using only local agents in patients suffering from psoriasis and having contraindications to the use of systemic antifungal agents.&#x0D; Materials and methods. The study involved 52 patients with psoriasis and lesions of the nail plates, aged 21 to 67 years. The duration of the disease was from 1 to 27 years.To verify the fungal infection of the nail plates, a microscopic examination of nail scales with 20 % KOH and molecular genetic studies using pan-fungal primers were carried out.Among 52 examined patients with psoriasis who had clinical signs of lesions of the nail plates, there were 37 people with mycotic infection lesions of the nail plates.Due to the somatic burden, the use of systemic antifungal agents was contraindicated. Treatment of onychomycosis in such patients was carried out using only local therapy and sanitary-hygienic measures. As a topical antifungal therapy, 1 % solution and 1 % cream of naftifine hydrochloride were prescribed in combination with drugs that improve the structure of the nail plates (Volvit, 5 mg once a day and Cytoflavin, 2 tablets 2 times a day for 1.5 months).&#x0D; Results and discussion. 1 month after the beginning of the use of the proposed method for the treatment of nail fungal infection in case of psoriasis of the scales of the nail plates, mycelium and fungal spores were absent in 6 (16.2 %) patients with distal lesions of the nail plates. After 4 months of treatment they were absent in 16 (43.4 %) patients with distal-lateral lesions of the nail plates, after 6 months — in 21 (56.7 %) patients, after 9 months — in 26 (70.2 %) patients.&#x0D; Conclusions. The proposed complex method is quite effective and of higher priority for the treatment of onychomycosis in patients with comorbid conditions that make it impossible to treat a fungal infection with systemic antimycotics.

A new sequential two-stent strategy for treating true distal left main trifurcation lesion.

A new sequential two-stent strategy for treating true distal left main trifurcation lesion.

Deep digital flexor tendon lesions in the pastern are associated with the presence of distal tendinopathy.

Correct diagnosis and characterisation of deep digital flexor tendon (DDFT) lesions in equine athletes allows targeted treatment and improved prognostication. To assess the prevalence and character of pathological change within the DDFT in the pastern with concurrent tendon injury distally. It is hypothesised that tendon lesions in the pastern will be associated with tendinopathy within the hoof capsule. Retrospective descriptive case series. Cases with DDFT lesions in the pastern and magnetic resonance imaging (MRI) or ultrasonography of the foot were evaluated retrospectively. Lesion location and type were recorded. Odds ratios were calculated to determine the associations between more distal tendinopathy and the presence of different DDFT lesion types in the pastern. Thirty-four MRI scans of 33 horses and 64 ultrasonographic exams of 58 horses were analysed. Lesion location and type were recorded. Distal DDFT lesions were found in 75% (95% CI: 66.0-84.0) of total cases of pastern DDF tendinopathy and in 97% (95% CI: 91.6-100.0) of cases with core lesions of the DDFT in the pastern. A core lesion in the pastern was significantly more likely (OR=20.7, 95% CI: 2.2-191.0; P=.008) to be associated with injury in the foot than other types of pastern lesion. MRIs of the foot were not obtained on all included limbs which did not allow for fully inclusive evaluation of DDFT lesions distal to the navicular bone. DDFT pathological change in the pastern, particularly core lesions, is associated with additional tendinopathy within the hoof capsule. When a DDFT lesion is found in the pastern, further imaging of the tendon within the foot is indicated to direct appropriate treatment and improve prognostication.

Osteomyelitis caused by Aggregatibacter aphrophilus – a case report

Osteomyelitis in children is often secondary to haematogenous dissemination of bacteria into long bone metaphyses. Organisms causing osteomyelitis vary with age, and the virulence of different pathogens influences clinical presentation.1 Aetiological diagnosis is important in determining appropriate antibiotic therapy. This case involves an 11-year-old girl with 4 months worsening left knee pain and difficulty weight bearing. She had no fever, preceding trauma or recent dental procedures. Inflammatory markers were unremarkable, with radiological evidence of a Brodie’s abscess. She was trialled on oral cephalexin; despite transient clinical improvement, she re-presented with worsening symptoms. She was afebrile, with distal femoral point tenderness, no evidence of knee joint involvement and 1/6 mid-systolic murmur at the pulmonic area. Intravenous flucloxacillin was commenced, with debridement and washout of the distal femoral lesion. Surgical specimens grew Aggregetibacter aphrophilus sensitive to ampicillin, with negative blood cultures. Transthoracic echocardiography showed no valvular abnormalities. Her mobility improved, and she was transitioned to amoxicillin, with planned duration of 3 months. Aggregetibacter aphrophilus is a low virulence HACEK group bacterial pathogen with potential to cause osteomyelitis.2 This case of an uncommon, low-virulence pathogen causing osteomyelitis shows the importance of aetiological diagnosis to guide appropriate management, especially in cases with indolent presentations. 1.Arnold JC, Bradley JS. Osteoarticular infections in children. Infect Dis Clin North Am 2015; 29: 557–74.2.Norskov-Lauritsen N, Kilian M. Reclassification of Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, Haemophilus paraphrophilus and Haemophilus segnis as Aggregatibacter actinomycetemcomitans gen. nov., comb. nov., Aggregatibacter aphrophilus comb. nov. and Aggregatibacter segnis comb. nov., and emended description of Aggregatibacter aphrophilus to include V factor-dependent and V factor-independent isolates. Int J Syst Evolutionary Microbiol 2006; 56: 2135–46.

Role of 2-dimensional speckle tracking echocardiography in diagnosis of right ventricular involvement in patients with inferior wall myocardial infarction undergoing primary percutaneous coronary intervention.

Diagnosis of right ventricular (RV) infarction in the setting of acute inferior wall myocardial infarction (IWMI) has important prognostic implications. We sought to assess the role of 2-D speckle tracking echocardiography (2-D STE) for the assessment of RV involvement in acute IWMI.We included 100 consecutive patients with a diagnosis of recent IWMI, of which 73 had an RCA culprit lesion, undergoing primary percutaneous coronary intervention (PPCI). Patients (n = 73) were classified into 2 groups based on angiographic evidence of RV involvement (lesions proximal to or involving RV branch versus distal lesions). Echocardiographic features of RV dysfunction were assessed using conventional 2-D echocardiographic, and Tissue Doppler parameters as well as 2-D speckle tracking echocardiography.Out of the 73 patients, 42 had RCA lesion proximal to or involving RV branch, while 31 patients had RCA culprit distal to RV branch. Among different parameters assessing RV function, only RV-FWLS was significantly lower among the former group (- 14.2 ± 4.6 vs. - 17.7 ± 4.2, p = 0.026). Receiver-operator characteristic (ROC) analysis showed that RV-FWLS had the strongest discriminatory capability to identify RV infarction (AUC = 0.7, p = 0.02, 95% CI 0.53-0.78). A cut-off value of RV-FWLS ≤ - 20.5% had 88% sensitivity and 33% specificity for diagnosis of RV infarction.STE-derived RV-FWLS with cutoff ≤ - 20.5% could be a reliable and promising tool for prediction of RV involvement in the setting of acute IWMI, which could guide proper risk stratification and tailored acute management strategy.

Fluoroscopy-guided shaped endobiliary biopsy at endoscopic retrograde cholangiography can accurately diagnose biliary neoplasia: Results from a large cohort.

Background and study aims The sensitivity of using standard endobiliary forceps biopsy to diagnose neoplastic biliary lesions remains low. We have developed a unique biopsy approach, termed fluoroscopy-guided, shaped endobiliary biopsy (FSEB), in which the biopsy forceps are modified to improve diagnostic yield. In this study, we evaluate the diagnostic characteristics of FSEB for endobiliary lesions at endoscopic retrograde cholangiography (ERC). Patients and methods Consecutive patients undergoing FSEB between 1/2001 and 12/2014 were retrospectively enrolled. The identification of neoplastic lesions with FSEB, was the primary endpoint. The gold standard of neoplasia was histopathology, cytology or surgical histopathology. The benign cases were followed up for one year. Results A total of 204 patients undergoing 250 biopsy sessions by FSEB were analyzed. Per-patient analysis was performed and FSEB showed 81.1 % sensitivity and 88.2 % accuracy. FSEB detection of proximal biliary lesions was more sensitive (91.1 % vs 73.2 %, P < 0.01) and accurate (94.9 % vs 82.2 %, P < 0.01) compared to distal lesions. No complications from FSEB were reported. Conclusions FSEB shows high accuracy for diagnosis of neoplasia in biliary strictures, especially for proximal lesions. Future prospective randomized controlled studies are merited to further validate the role of FSEB as the first-line sampling tool for evaluation of biliary neoplasm.

Tissue Sampling through Endoscopic Ultrasound-Guided Fine Needle Aspiration versus Endoscopic Retrograde Cholangiopancreatographic Brushing Cytology Technique in Suspicious Malignant Biliary Stricture.

BACKGROUND Differentiation of benign and malignant biliary strictures plays a pivotal role in managing biliary strictures. Brush cytology via endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) are two diagnostic methods. In the present study, we aimed to compare the accuracy of the results of EUS-FNA and ERCP-based sampling of biliary strictures. METHODS In a prospective study, between January 2019 and March 2020, patients with indeterminate biliary strictures who had no history of hepatobiliary surgery, opium usage, cancer of pancratobiliary system, and acute liver disease were selected. They underwent EUS and ERCP in the same session. They were followed up for 6 months, and the sensitivity, specificity, positive and negative predictive values, and accuracy of these imaging modalities were compared. RESULTS A total of 60 patients were enrolled. 28 lesions were located in the distal and 32 lesions in the proximal parts of the biliary tree. 55 malignant and 5 benign lesions were diagnosed. The sensitivity and accuracy of EUS-FNA and ERCP tissue sampling were 78.2% and 80.0% versus 50.9% and 55.0%, respectively (p = 0.024). The combination of both methods improved the sensitivity and accuracy to 85.5% and 86.7%, respectively. Regarding the location, EUS-FNA is superior to ERCP-brush cytology in diagnosing proximal lesions with sensitivity and specificity of 73.3% and 75.0% vs. 50.0% and 53.1%, respectively (p = 0.04). CONCLUSION EUS-FNA is superior to ERCP brushing in the diagnosis of indeterminate biliary strictures, particularly in distal lesions. Combining ERCP brushing and EUS-FNA improves the diagnosis accuracy.

Anatomical repair of distal biceps brachial tendon lesions using double-incision surgical approach

Backgroundand objective The aim of this work was to evaluate clinical outcomes of patients with biceps brachii tendon rupture who underwent a surgical tendon reconstruction using our own modified double approach technique. PatientsThe study was performed in 20 patients (21 cases) with biceps brachii tendon rupture. Patients were treated with our own double-approach surgical technique consisting of 2 minimum incisions. After one year follow-up, functional evaluation was assessed using the mayo Elbow Performance Score, muscle strength was estimated with the Medical Research Council questionnaire and pain was evaluated with the Visual Analogic Scale. Range of motion was determined by measuring extension and flexion. ResultsOne year after surgery all patients had returned to sports at the same level they had previously. Visual Analogic Scale was 1.90±0.89 (mean±standard deviation) and median Mayo Elbow Performance Score was 90 (minimum–maximum: 80–100). Of them, 16 patients (76.2%) showed the highest Medical Research Council score, score 5, while 6 cases (26.1%) still scored 4+. Patients had a mean of 136.67° flexion (95% CI: 134.14°–139.19°) and −7.38° extension (95% CI: −10.04° to −4.72°). ConclusionsDouble-incision surgical approach for distal biceps brachial tendon rupture anatomical repair is a safe technique, providing results that allow patients muscle recovery and return to sports.

Surgical Treatment of Solitary Periarticular Osteochondromas About the Knee in Pediatric and Adolescent Patients: Complications and Functional Outcomes.

Solitary osteochondromas, or osteocartilaginous exostoses (OCEs), represent the most common benign bone tumor. Despite frequently causing symptoms about the knee in younger populations, there is minimal previous literature investigating surgical treatment. We retrospectively reviewed the records of patients <20 years old who had undergone surgical treatment of symptomatic, pathologically confirmed, solitary periarticular knee OCE at a single pediatric center between 2003 and 2016. The clinical course, radiographic and pathological features, and complications were assessed. Prospective outreach was performed to investigate patient-reported functional outcomes. Two hundred and sixty-four patients (58% male, 81% athletes) underwent excision of a solitary OCE about the knee at a mean age (and standard deviation) of 14.3 ± 2.24 years. Fifty-five percent of the procedures were performed by orthopaedic oncologists, 25% were performed by pediatric orthopaedic surgeons, and 20% were performed by pediatric orthopaedic sports medicine surgeons, with no difference in outcomes or complications based on training. Of the 264 lesions, 171 (65%) were pedunculated (versus sessile), 157 (59%) were in the distal part of the femur (versus the proximal part of the tibia or proximal part of the fibula), and 182 (69%) were medial (versus lateral). Postoperatively, 96% of the patients returned to sports at a median of 2.5 months (interquartile range, 1.9 to 4.0 months). Forty-two patients (16%) experienced minor complications not requiring operative intervention. Six patients (2%) experienced major complications (symptoms or disability at >6 months or requiring reoperation), which were more common in patients with sessile osteochondromas (p = 0.01), younger age (p = 0.01), and distal femoral lesions as compared with proximal tibial lesions (p = 0.003). Lesion recurrence was identified in 3 patients (1.1%). Overall, the median Pediatric International Knee Documentation Committee (Pedi-IKDC) and mean Hospital for Special Surgery Pediatric Functional Activity Brief Scale (HSS Pedi-FABS) scores were 97 (interquartile range, 93 to 99) and 16.7 ± 8.15, respectively, at a median duration of follow-up of 5.8 years. In our large cohort of pediatric patients who underwent excision of solitary knee osteochondromas, most patients were male adolescent athletes. Most commonly, the lesions were pedunculated, were located in the distal part of the femur, and arose from the medial aspect of the knee. Regardless of surgeon training or lesion location, patients demonstrated excellent functional outcomes, with minimal clinically important postoperative complications and recurrences, although patients with sessile lesions and younger age may be at higher risk for complications. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Sensitivity and Specificity of Ultrasonographic Compared with CT Angiography in Detecting Femoropopliteal and Infrapopliteal Arterial Lesions in Lower Extremity Arterial Disease in Dr. Mohammad Hoesin General Hospital Palembang

Background: Peripheral artery disease (PAD) is a chronic occlusive arterial disease of the extremities caused by atherosclerosis.1 It is estimated that 20-30% of the population worldwide suffered PAD.2 PAD is associated with a 1-year mortality and limb loss rate of 20%.7 Critical limb ischemia (CLI) is a late stage clinical presentation of PAD. Imaging of the entire artery is possible using CT angiography. However, CT angiography has its drawbacks because the contrast used can be nephrotoxic, the risk of allergies, expensive, and not all health services have it. Ultrasonographic’s (USG) sensitivity, specificity and accuracy were 96.55%, 61.53%, and 78.84% for detecting lower limb distal artery lesions.11 Ultrasonographic does not require the use of contrast, radiation, low cost and almost all health services have them.12 However, the Ultrasonographic examination has its limitations depending on the operator's capabilities. It is therefore necessary to conduct research that have never been previously studied in South Sumatra.&#x0D; Methods: This study is a diagnostic test study that examines the sensitivity and specificity of ultrasound in detecting LEAD artery lesions. The samples were 29 patients.&#x0D; Results: At the femoropopliteal level, the results obtained were 91% sensitivity and 86% specificity. At the infrapopliteal level, the results obtained were 95% sensitivity and 87% specificity.&#x0D; Conclusion: Ultrasonographic has high sensitivity and specificity in detecting LEAD’s lesions

Therapeutic Strategies for Targeting Ovarian Cancer Stem Cells.

Ovarian cancer is a fatal gynecological malignancy. Although first-line chemotherapy and surgical operation are effective treatments for ovarian cancer, its clinical management remains a challenge owing to intrinsic or acquired drug resistance and relapse at local or distal lesions. Cancer stem cells (CSCs) are a small subpopulation of cells inside tumor tissues, and they can self-renew and differentiate. CSCs are responsible for the cancer malignancy involved in relapses as well as resistance to chemotherapy and radiation. These malignant properties of CSCs are regulated by cell surface receptors and intracellular pluripotency-associated factors triggered by internal or external stimuli from the tumor microenvironment. The malignancy of CSCs can be attenuated by individual or combined restraining of cell surface receptors and intracellular pluripotency-associated factors. Therefore, targeted therapy against CSCs is a feasible therapeutic tool against ovarian cancer. In this paper, we review the prominent roles of cell surface receptors and intracellular pluripotency-associated factors in mediating the stemness and malignancy of ovarian CSCs.

Laparoscopic Resection for Lymphangioma Originating From Small Intestine: A Case Report

Background Lymphangioma originating from the small intestinal wall is a very rare finding. There have been only 15 case reports on the disease. Here, we report a case of lymphangioma in the small intestine that was resected laparoscopically. We also provide a literature review. Case Presentation A 37-year-old man came to our hospital with a chief complaint of abdominal pain. Physical examination showed mild tenderness in the lower abdomen, but rebound tenderness or guarding was absent. A contrast-enhanced computed tomography scan showed local poor enhancement in distal ileum, suggesting the possibility of mucous necrosis. Conservative therapy was started. On the eighth hospital day, although his abdominal symptoms improved, a follow-up computed tomography scan showed no improvement in the distal ileum lesion. Laparoscopic tumor resection was performed. The patient's postoperative course was unremarkable, and he was discharged on postoperative day 7. The pathologic result of the surgical specimen was lymphangioma of the ileum. The patient is still alive with no sign of recurrence 19 months after surgery. Conclusion Lymphangioma originating in the small intestinal wall is a very rare disease. Laparoscopic resection seems to be a preferable method for surgery.

Downstream Paclitaxel Released Following Drug-Coated Balloon Inflation and Distal Limb Wound Healing in Swine

The authors evaluated the presence of paclitaxel and healing of distal hind limb wounds created in 27 swine using biopsy punches followed by paclitaxel-coated balloon (PCB) use in the iliofemoral arteries of healthy swine. After 14 and 28days, no differences were seen in time course, appearance, and histopathology of wound healing between the single or triple PCB and uncoated balloon treatment despite clinically relevant paclitaxel concentrations in the skin adjacent to the healing wounds. Presence of paclitaxel downstream from the PCB treatment site does not impair the wound healing response of preexisting distal cutaneous lesions in healthy swine.

The Hook Test Is More Accurate Than the Trampoline Test to Detect Foveal Tears of the Triangular Fibrocartilage Complex of the Wrist

To evaluate the accuracy of the trampoline and hook tests, used in the arthroscopic assessment of triangular fibrocartilage complex (TFCC) tears compared with arthroscopic direct visualization of the radiocarpal joint (RCJ) and of the distal radial ulnar joint (DRUJ). In total, 135 patients (97 male, 38 female, mean age 43.5 years) were divided into 2 groups: (1) 80 patients with chronic ulnar-sided wrist pain and positive fovea sign and (2) 55 patients with other complaints. TFCC was assessed by RCJ and DRUJ arthroscopy and by the trampoline and hook tests to detect rupture of distal and proximal components of the TFCC. Accuracy, specificity, sensitivity, and likelihood ratio of the 2 diagnostic methods were measured and compared, using RCJ and DRUJ arthroscopy as reference. The trampoline and the hook tests showed an overall accuracy of 70.37% and 86.67%, respectively. The accuracy of the trampoline test was similar for distal (69%), proximal (66%), and complete (73%) TFCC tears. The hook test was more accurate when evaluating proximal (97%) and complete (98%) tears, rather than distal lesions (75%). Sensitivity for the trampoline and hook tests was 75.00% and 0.00% (P < .001) for distal tears and 78.85% and 100.00% (P < .001) and 58.33% and 100.00% (P < .001) for complete or isolated proximal tears, respectively. Specificity for the trampoline and hook tests was 67.27% and 96.36% (P < .001) respectively. The trampoline and hook tests can assure accurate diagnosis of peripheral TFCC tear. The hook test shows greater specificity and sensitivity to recognize foveal TFCC tears. Values of positive likelihood ratio suggest a greater probability to detect foveal laceration of peripheral TFCC for the hook test than for the trampoline test. These findings suggest that DRUJ arthroscopy is not necessary to confirm foveal incompetence of the TFCC, if the hook test is positive. Level II, retrospective diagnostic trial.