Extensive Lesions Research Articles

Clinical manifestations and magnetic resonance imaging features of spinal cord infarction

Background and ObjectiveSpinal cord infarction (SCI) is a rare type of stroke, with no proposed classification or diagnostic criterium widely accepted and used in daily clinical practice currently. We try to explore the clinical manifestations and MRI features of SCI for improving the accurate diagnosis of SCI. MethodsRetrospectively analyzed the clinical data, MRI features, laboratory findings and outcomes of 40 patients who had been consecutively diagnosed with SCI in our hospital from June 2016 to January 2022. ResultsMost of the SCI (92.5%) occurred at the level of T8-L2 and C4-T4. Transverse infarction (52.5%) and ASA territory infarction (27.5%) were the most common patterns. Longitudinally extensive lesions were noticed in 67.5% of the SCI and it might be a risk factor of poor prognosis (OR=21.11, 95%CI 2.14-208.29). Restricted diffusion of the SCI lesion occurred in 8h and a few lasted up to 60 days. All SCI showed spinal cord edema, accompanied by enhancement of the ventral cauda equina (13.8%), weakened enhancement of the dorsal venous plexus (44.8%), and vertebral infarction (25%). Most patients developed a stroke-like onset (92.5%) after movement (57.5%), with definite pain in the trunk or limbs (67.5%) and dissociative sensory disturbance (60.0%). The main etiologies of them include vascular abnormalities (45%) and iatrogenic injuries (15%). ConclusionAn MRI classification of SCI based on the spinal cord blood supply was proposed. Restricted diffusion and co-existing abnormality of vertebral body and cauda equina may be the key neuroimaging feature for SCI diagnosis. Detailed history of vascular diseases or triggering factors are also helpful.

Multifocal epithelial hyperplasia confined to the interdental papilla of an adult Chinese man: a rare case report and literature review

BackgroundMultifocal epithelial hyperplasia (MEH), or focal epithelial hypertension (FEH), or Heck’s disease, is an uncommon, benign oral mucosal disease associated with human papillomavirus infection. It is mostly observed in indigenous populations of the world, and has been rarely reported in China. However, previous research suggested there might be a greater prevalence of MEH in the Chinese population. While predominantly involves the lips, buccal mucosa and tongue, MEH was occasionally reported to affect the hard palate and gingiva as well.Case presentationThis paper reports a case of extensive MEH lesions that confined to the interdental papilla of a Chinese male without detection of HPV, and summarizes the published gingiva-involved MEH reports from 1966 until present. The lesions were excised with an Er: YAG laser after scaling and root planning, no recurrence was observed after 6-month follow-up.ConclusionsThe present report illustrates the need for clinicians to be aware of rare presentations of MEH to facilitate a prompt diagnosis and proper management. More reports are encouraged to determine a correct prevalence rate of MEH in China.

Limitations of ALA-PDT as a reliable therapy for AK in clinical practice

BackgroundNumerous clinical studies have demonstrated the effectiveness of 5-aminolevulinic acid (ALA)-mediated photodynamic therapy (PDT) in treating actinic keratosis (AK). This therapy has achieved an average lesion clearance rate of approximately 80 % and has also shown to produce satisfactory cosmetic outcomes. However, in our clinical practice, the utilization and adherence to ALA-PDT treatment among AK patients has been lower than anticipated, possibly due to various factors. ObjectiveThe objectives of this study are twofold: (1) To analyze the actual therapeutic effects of ALA-PDT treatment on AK lesions in clinical practice; and (2) To identify the factors that hinder acceptance of ALA-PDT therapy among AK patients with large area or multiple lesions situated on the head and face. MethodThis study included a group of 20 AK patients, comprising 15 females and 5 males, with an age range of 57–87 years. All patients received a complete course of ALA-PDT therapy, consisting of 3–6 treatments. The study analyzed various factors, including the cure rate, recurrence rate, cosmetic effects, and adverse reactions following treatment. To investigate the factors affecting the acceptance of ALA-PDT treatment among AK patients with large or multiple lesions on the head and face, we also examined a separate group of 43 AK patients. This group included individuals who either had incomplete courses of ALA-PDT treatment or declined the therapy for the first time. The factors potentially influencing patients’ acceptance of PDT were analyzed based on the outcomes of these investigations. ResultAmong the 20 patients who completed the full course of ALA-PDT treatment, the cure rate was 95 % (19/20). The recurrence rates at 1 month, 3 months, and 6 months were 0 %, 5 %, and 10 %, respectively. Out of the 19 cured patients, only 2 experienced heavy pigmentation, and no scarring was reported 1–3 months post-treatment. Based on the survey of 43 patients who either had an incomplete course of ALA-PDT treatment or declined the therapy initially, several factors were identified as limiting their choice of PDT therapy. These factors include: (1) Intolerable adverse effects of treatment. (2) Higher treatment cost than expected. (3) Inconvenient transportation. (4) Coexistence of other senile diseases. (5) Unsatisfactory clinical efficacy observed. (6) Inadequate understanding of AK. (7) Lost to follow-up. ConclusionThe study concludes that ALA-PDT is a beneficial and aesthetically pleasing treatment for AK patients, particularly those with extensive or multiple lesions on the head and face. However, various factors can impede the selection of ALA-PDT therapy, potentially depriving patients of the most suitable option. The study aims to assist dermatologists and AK patients in considering treatment plans and exploring alternative options. Overall, the findings of this study may provide valuable guidance for improving treatment outcomes and patient satisfaction.

Understanding tumor localization in multiparametric MRI of the prostate-effectiveness of 3D printed models.

Understanding tumor localization in multiparametric MRI (mpMRI) of the prostate is challenging for urologists but of great importance in mpMRI-fused prostate biopsy or radical prostatectomy. The aim was to evaluate the effectiveness of 3D printed models of the prostate to help urologists to locate tumors. 20 urologists from University Medical Center Mainz (Germany) were asked to plot the location of a cancer suspicious lesion (PI-RADS ≥ 4) on a total of 30 mpMRI on a prostate sector diagram. The following 3 groups (as matched triplets) were divided into: mpMRI only, mpMRI with radiological report and mpMRI with 3D printed model (scaled 1:1). Statistical analysis was performed using one-way and two-way ANOVA (with bonferroni post-test). Overall, localization of the suspicious lesion was superior with the radiological report (median of max. 10 [IQR]: MRI 2 [IQR 1;5], MRI + report: 8 [6.3;9], MRI + 3D model 3 [1.3;5.8]; p < 0.001). Residents with <1 year of experience had a significantly higher detection rate using a 3D printed model [5 (5;5.8)] compared to mpMRI alone [1.5 (1;3.5)] (p < 0.05). Regarding the estimation of index lesion extension, the 3D model showed a significant benefit (mean percentage difference [95% CI]: MRI alone 234% [17.1;451.5], MRI + report 114% [78.5;149.6], MRI + 3D model 17% [-7.4;41.3] (p < 0.01). Urologists still need the written radiological report for a sufficient understanding of tumor localization. The effectiveness of the 3D printed model regarding tumor localization is particularly evident in young residents (<1 year) and leads to a better overall assessment of the tumor extension.

Genome-wide association study identifies novel caries-associated loci showing sex-specificity-A study on the Northern Finland Birth Cohort 1966.

A genome-wide association study was performed in sex-stratified groups representing three different caries phenotypes among adults. The study sample consisted of 46-year-old participants of the Northern Finland Birth Cohort 1966 study (n=1481). The phenotypes for analyses were the dentin caries phenotype (persons having at least one tooth with dentin caries lesion), and the enamel caries phenotype (those having teeth with more than 10 enamel caries lesions), while the control group had<10 enamel caries lesions and no teeth with dentin caries, respectively. A third phenotype dubbed the caries severity phenotype had a below-average number of teeth with initial lesions and at least one extensive dentin caries lesion; their controls had an above-average number of teeth with initial caries lesions and no teeth with extensive dentin caries lesions. All analyses were performed for the whole group and for sex-stratified subgroups. In females, loci in chromosomes 2, 5, and 15 showed a statistically significant association with caries severity. In males, there was a novel association between chromosome 5 and dentin caries. The results of this study may suggest a genetic background of caries among adults. In the future, the detection of genetic predisposing variants may allow the identification of patients at risk for caries, even in the absence of behavioral and environmental risk factors.

Extensive Proliferative Skin Lesions in a Patient With Varicose Veins

Extensive Proliferative Skin Lesions in a Patient With Varicose Veins

The Distinct Pattern of Granulomatous Lobular Mastitis with Erythema Nodosum: More Severe Conditions and Extensive Lesions

Purpose Granulomatous lobular mastitis (GLM) is a benign inflammatory disease of the mammary gland with unknown etiology. Erythema nodosum (EN) is a rare, extramammary symptom of GLM. The purpose of this article was to investigate the clinical features of EN associated with GLM. Methods We recruited 102 GLM patients diagnosed between December 2018 and December 2021 at Renmin Hospital of Wuhan University. The clinical characteristics and laboratory indices of the EN group (n = 12) and the non-EN group (n = 90) were compared. Results The proportion of GLM patients with lesions involving ≥2 quadrants and high peripheral white blood cell count, absolute neutrophil count and neutrophil-to-lymphocyte ratio (NLR) was larger in the EN group than in the non-EN group (p = 0.002, 0.025, 0.014, 0.002, respectively). The duration of EN was longer in GLM patients with EN than in GLM patients without EN (p = 0.005). GLM patients with EN had more abscesses and sinus tracts than those without EN (p = 0.003, 0.038). Lesions involving ≥2 quadrants and the NLR were positively associated with the occurrence of EN (R = 0.304, 0.0302, p = 0.002, 0.002). Receiver operating characteristic curve analysis revealed that the area under the curve of the NLR was 0.770. When NLR > 5.73, the sensitivity and specificity of predicting EN were 66.67% and 87.78%, respectively. Conclusion Our findings suggest that GLM concomitant with EN suggests the presence of a more severe condition and extensive lesions.

Acute genitale ulcera en Lipschütz-ulcus: differentiaaldiagnose en behandeling

Acute genital ulcerations and Lipschütz ulcus: differential diagnosis and treatment Lipschütz ulcus is a rare cause of acute genital ulceration. It mostly occurs in female patients of adolescent age and even in young children. In contrast to some of the more frequent causes of genital ulcerations, it is non-sexually related. It presumably occurs as a reaction to a non-genital infection and may thus also occur in virgins. It is mostly associated with an Epstein-Barr virus infection, but other pathogens such as influenza or the coronavirus can also cause this kind of reaction. When a patient presents with acute genital ulcerations, Lipschütz ulcus should be considered in the differential diagnosis. It is a diagnosis by exclusion since no specific diagnostic test is available. In order to distinguish between the different causes of genital ulcerations, it is important to perform a thorough sexual anamnesis, to be alert for possible signs of sexual abuse, to ask the patient about recent flu-like symptoms and to screen for the presence of extragenital lesions. It is a self-limiting condition. The lesions heal spontaneously after a couple of weeks. The treatment is supportive, consisting of analgesia and the prevention of secondary complications such as a bacterial superinfection, urinary retention due to dysuria or scarring. In severe cases with extensive lesions and/or insufficient pain control by other means, a treatment with corticosteroids may be considered, preferably topically.

Restoration of a Vital Tooth With Extensive Crown Destruction Using Glass Fiber and Polyethylene Fiber-reinforced Composite Resin: A Clinical Case.

Conservative restorative dentistry has been evolving in the last 25 years, focusing mainly on the development of direct restorative materials. Resin-based composites remain an excellent conservative alternative for restoration of teeth with extensive caries lesions. Over time, several strategies have been proposed to improve the mechanical properties of these composites so that they can adequately withstand masticatory forces. Glass fiber-reinforced resin-based composites and their use in situations where there is great loss of tooth structure have gained popularity due to their favorable mechanical properties. Combined techniques with polyethylene fibers can further enhance their clinical performance. This study presents a brief review of their most important qualities and potential use in direct restorative procedures. In addition, a clinical case is described where a vital tooth with extensive coronal destruction was restored using polyethylene fibers embedded in glass fiber-reinforced flowable resin under resin-based composite. The reinforcement of both the remaining tooth structure and the restoration with fibers is a valid treatment option since the network structure formed by the fiber reinforcement can increase the longevity of the direct composite restorations. There are few reports in the literature describing the use of a combined technique using polyethylene fibers embedded in glass fiber-reinforced flowable resin under resin-based composite. Thus, clinical follow-up of this case is required.

Multiple Sclerosis Presenting as Intracranial Hypertension in the Setting of COVID-19 Infection

Background: Multiple sclerosis (MS) and idiopathic intracranial hypertension (IIH) occur more commonly in women of childbearing age. There are altered cerebrospinal fluid dynamics in both diseases, causing them to have similar presentations at times. Coronavirus disease 19 (COVID-19) has also been reported to affect the central nervous system (CNS) of any age. Case Presentation: We report a19 year old male who initially presented with headaches and fever, and was diagnosed with COVID-19 infection. A few days later, he developed acute severe left eye pain, blurred vision, diplopia, and left ear tinnitus. The patient was found to have reduced visual acuity, left sixth nerve palsy, esotropia and asymmetric bilateral papilledema. Later, he developed left facial nerve palsy. MRI of the brain showed extensive demyelinating lesions. Lumbar puncture revealed significantly increased intracranial pressure (ICP) and positive oligoclonal bands. Conclusion: This is a unique case of MS presenting with intracranial hypertension (IH) in the setting of COVID-19 infection that could have been the trigger for the MS clinical attack.

Oral Manifestation of Viral-Induced Erythema Multiforme Major: A Rare Presentation.

Erythema multiforme is an acute inflammatory mucocutaneous disease manifested as macules, vesicles, bullae, erosion, and papular lesions. In the present case, a 55-year-old female patient reported painful growth in the oral cavity and difficulty in mastication. The patient gave a history of prodromal symptoms before the onset of lesions On intra-oral examination, elevated plaque-like lesions were present bilaterally on lateral borders of the tongue and buccal mucosa near the retromolar region. Extraoral examination revealed concentric erythematous target (or) bull's eye lesions in palms, forearm, and foot. Based on history, clinical examination, and laboratory investigations, recurrent herpes-associated erythema multiforme was diagnosed. We report a rare clinical presentation of recurrent herpes-associated erythema multiforme manifesting as an extensive plaque-like lesion intra-orally.

MR imaging differences between Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders: A single institutional study in a tertiary referral centre in Sri Lanka.

Background and objectives- Multiple Sclerosis (MS) and Neuromyelitis Optica Spectrum Disorders (NMOSD) are the commonest demyelinating diseases of the central nervous system with overlapping clinical and radiological features, leading to frequent misinterpretation. This study aimed to describe neuroimaging features for differentiating MS and NMOSD and also comparing NMOSD subcategories.Methods- A cross sectional study was conducted at a single tertiary referral center in Sri Lanka. The magnetic resonance imaging (MRI) characteristics of 82 MS and 36 NMOSD patients were prospectively evaluated by a fourth-year resident under the supervision of consultant radiologists and were analyzed using standard descriptive statistical tests. Results- Statistical analyses indicated significance (p&lt;0.05) in distinguishing both entities (MS and 36 NMOSD) across lesions in periventricular, subcortical, intracortical, inferior temporal, corpus callosum, and infratentorial locations by MRI. Dawson finger lesions, U fibers, calloso-septal interface involvement and T1 black holes indicated MS, whereas linear ependymal lesions suggested NMOSD. In the spinal cord, peripherally located short-segment lesions were significant for MS (p=0.000) and longitudinally extensive lesions involving central grey matter (p=0.000) pointed towards NMOSD. There was only a slight variation in lesion distribution between cervical and thoracic cord. MS showed more brain parenchymal volume loss while spinal cord atrophy was higher in NMOSD. Symmetry and location of the optic pathway lesions reinforced the differentiation.Conclusion- Comprehensive analyses support the use of neuroimaging in distinguishing between NMOSD and MS. However, further multicentric longitudinal studies are required to differentiate NMOSD phenotypes.

Extensive lesions and a positive cone margin are strong predictors of residual disease in subsequent hysterectomy following conization for squamous intraepithelial lesion grade 2 or 3 study design

BackgroundThis study aimed to determine the predictive factors for post-conization of residual disease in subsequent hysterectomy for cervical intraepithelial neoplasia grade 2 or 3.MethodsThis retrospective study included 267 patients with histologically confirmed cervical intraepithelial neoplasia grade 2 or 3 who underwent hysterectomy within 7 months after conization. Clinical data (e.g., age, menopausal status, gravidity, parity, type of transformation zone, conization method) as well as pathological data pertaining to conization and hysterectomy were collected from medical records. A logistic regression model was used to analyze the relationship between the variables and risk of residual lesions in hysterectomy samples.ResultsOverall, 70 (26.2%) patients had residual lesions in their hysterectomy specimens. Univariate analyses revealed that age ≥ 50 years (p=0.019), endocervical gland involvement(p=0.013), positive margin(p < 0.001), and involvement of 3–4 quadrants(p < 0.001) were risk factors for residual lesions. Conversely, postmenopausal status, gravidity ≥ 3, parity ≥ 2, loop electrosurgical excision procedure, and type III transformation zone were not risk factors for residual lesions. A positive margin(p < 0.001) and multiple-quadrant involvement(p < 0.001) were identified as independent risk factors for residual lesions on multivariate analysis.ConclusionsMultiple-quadrant involvement and a positive cone margin were reliable predictive factors for residual disease. Total hysterectomy or repeated cervical conization should be considered for patients with these two risk factors. The identification of high-risk patients with extensive lesions by colposcopic examination before conization is indispensable, as it will enable surgeons to perform conization with consideration of risk factors and possibly improve the approach used for the excisional procedure. For high-risk patients, colposcope-guided cold-knife conization is preferred when resources permit.

P23 Stabilization of aggressive disease in NRAS kaposiform lymphangiomatosis with sirolimus

Abstract Kaposiform lymphangiomatosis (KLA) is a rare disorder of lymphatic vasculature characterized by infiltrative and multifocal lymphatic abnormalities. The disease course is often complicated by a severe coagulopathy and frequently involves the central conducting lymphatic vessels leading to large-volume chylous pleural/pericardial effusions and ascites. There is a significant morbidity and mortality with 5-year survival from time of diagnosis estimated to be 50%. The genetic basis of KLA has recently been described as somatic activating mutations of the RAS–MAPK pathway. A 14-month-old girl, previously well, presented with a massive pericardial effusion leading to cardiac tamponade and cardiac arrest, requiring emergency pericardial drainage and extracorporeal membrane oxygenation. The patient had a profound thrombocytopenia not responding to repeat transfusion. MRI of the thorax revealed extensive cystic lesions consistent with diffuse lymphatic disease. Clinical suspicion of KLA was confirmed by mediastinal biopsy revealing characteristic kaposiform spindle-shaped lymphatic endothelial cells. Targeted next-generation sequencing revealed a mutation in NRAS (p.Q61R) in 2% of sequenced reads. Treatment with mTOR inhibitor sirolimus plus vincristine rapidly stabilized her refractory thrombocytopenia and led to a rapid clinical improvement enabling extubation within 72 h. Repeat MRI 2 months later confirmed reduced lymphatic disease. Lymphatic disease remains stable after 18 months of sirolimus monotherapy with no significant adverse effects. KLA is an aggressive mosaic disease of the lymphatic vasculature with high morbidity and mortality. Early diagnosis is key to enabling targeted medical therapies in this cohort. Clinicians should be aware of this differential when presented with high-volume effusions and refractory thrombocytopenia.

P30 Blisters in a newborn: all that glitters is not gold

Abstract Mastocytosis is a rare and clinically heterogeneous disease characterized by abnormal accumulation of mast cells in various tissues. There are three major types of cutaneous mastocytosis (CM): diffuse cutaneous mastocytosis (DCM), urticaria pigmentosa and solitary mastocytoma, which is the most common form before the age of 3 months: 90% of CM cases present before 2 years of age, and congenital mastocytosis has been described in 23% of those. Solitary mastocytoma has been associated with a mutation of the KIT gene. A male infant was born at 39 weeks, with a large, indurated, blistering, ulcerated plaque containing yellow serous fluid affecting half his right calf. His nails and oral mucosa were normal. Our centre was contacted on suspected diagnosis of inherited epidermolysis bullosa (EB). There was no family history of EB, and the parents were not related. Initial testing showed a PCR positive for HSV type 1 and treatment with aciclovir and cefotaxime was initiated. There was no improvement after 2 weeks of treatment. Viral and bacterial skin swab were negative. A skin biopsy and ultrasound were performed showing extensive superficial hypoechoic lesion and reactive popliteal lymph nodes and the biopsy confirmed the diagnosis of mastocytoma. Bloods including tryptase level and abdominal ultrasound were normal. The lesion healed within 4 weeks with dressings and topical steroids. This case of a single isolated congenital mastocytoma shows the broad differential diagnoses that must be considered in the evaluation of bullous lesions in a newborn. It is key to biopsy early and always exclude ­infection.

Comprehensive analysis of ureter injuries: A systematic review of the medical literature

This article presents an exhaustive systematic review of the medical literature focused on the detailed analysis of ureter injuries. Injuries to this anatomical conduit, which connects the kidneys to the bladder, can arise as a consequence of various causes, such as abdominal surgeries, trauma, gynecological and urological procedures, among others. The aim of this study is to provide a comprehensive and updated view of the etiology, epidemiology, classification, clinical manifestations, diagnosis and treatment options for ureteral injuries. During the investigation, numerous scientific articles, case reports, and retrospective studies were extensively reviewed, with particular focus on identifying the risk factors associated with these lesions. Also highlighted were the various diagnostic approaches and imaging tools, including computed tomography (CT), retrograde urography, cystoscopy, and magnetic resonance imaging (MRI), which are critical for the accurate diagnosis and extensive evaluation of ureter injuries. Significant differences in treatment options were observed, depending on the severity and location of the lesions, with endourological and laparoscopic techniques being the preferred options for milder cases, while complex reconstructive surgeries are reserved for more extensive and complex lesions. Innovative surgical techniques, including ureteral anastomosis, tissue grafting and the use of ureteral stents, are addressed with the goal of optimally restoring ureteral function and structure. This systematic review highlights the importance of a multidisciplinary approach in the management of ureteral injuries, involving urologists, general surgeons, gynecologists and radiologists, to ensure timely diagnosis and effective treatment. Furthermore, the relevance of prevention and early identification of ureteral injuries is emphasized, with the purpose of minimizing complications and improving long-term clinical outcomes. In conclusion, this research provides a valuable source of information for the medical and surgical community, promoting a better understanding and comprehensive management of ureteral injuries.

Pemfigus Vulgaris

Pemphigus vulgaris (PV) is a chronic intraepidermal bullous disease that causes extensive skin lesions. Pemphigus vulgaris initially appears in the form of vesicles and loose-walled bullae that break easily on normal skin, which then develop into bullae with an erythematous base, then rupture, causing erosion, excoriation, which is usually accompanied by crusting and pain. Bullae occur due to damage or damage to intercellular adhesion due to IgG autoantibodies to desmoglein 3, causing epithelial cells called acantholysis (epidermal cell separation reaction). The hallmark of pemphigus is erosion that extends into normal skin by pulling on remnants of the blister wall or rubbing on the periphery of an active lesion. Erosion can be induced on normal-appearing skin away from the active lesion by mechanical stress or shear, a phenomenon known as the Nikolsky sign. Prognosis before corticosteroids are used, death occurs in 50% of patients within the first year. Treatment with corticosteroids makes the prognosis better. Pemphigus vulgaris in the early stages will be easier to control than those with widespread manifestations, the mortality rate will increase if there is a delay in therapy.

Comprehensive analysis of ureter injuries: A systematic review of the medical literature

This article presents an exhaustive systematic review of the medical literature focused on the detailed analysis of ureter injuries. Injuries to this anatomical conduit, which connects the kidneys to the bladder, can arise as a consequence of various causes, such as abdominal surgeries, trauma, gynecological and urological procedures, among others. The aim of this study is to provide a comprehensive and updated view of the etiology, epidemiology, classification, clinical manifestations, diagnosis and treatment options for ureteral injuries. During the investigation, numerous scientific articles, case reports, and retrospective studies were extensively reviewed, with particular focus on identifying the risk factors associated with these lesions. Also highlighted were the various diagnostic approaches and imaging tools, including computed tomography (CT), retrograde urography, cystoscopy, and magnetic resonance imaging (MRI), which are critical for the accurate diagnosis and extensive evaluation of ureter injuries. Significant differences in treatment options were observed, depending on the severity and location of the lesions, with endourological and laparoscopic techniques being the preferred options for milder cases, while complex reconstructive surgeries are reserved for more extensive and complex lesions. Innovative surgical techniques, including ureteral anastomosis, tissue grafting and the use of ureteral stents, are addressed with the goal of optimally restoring ureteral function and structure. This systematic review highlights the importance of a multidisciplinary approach in the management of ureteral injuries, involving urologists, general surgeons, gynecologists and radiologists, to ensure timely diagnosis and effective treatment. Furthermore, the relevance of prevention and early identification of ureteral injuries is emphasized, with the purpose of minimizing complications and improving long-term clinical outcomes. In conclusion, this research provides a valuable source of information for the medical and surgical community, promoting a better understanding and comprehensive management of ureteral injuries.

Particular Aspects Related to CD4+ Level in a Group of HIV-Infected Patients and Associated Acute Coronary Syndrome.

People living with HIV infection are at high risk for cardiovascular events due to inflammation and atherosclerosis. Also, some antiretroviral therapies may contribute to the risk of cardiovascular complications. Immune status is highly dependent on the level of lymphocyte T helper CD4+. There are data suggesting that immune status and CD4+ cell count may be involved in the development of cardiovascular complications in these patients. Our study is longitudinal and retrospective and included a total number of 50 patients with HIV infection associated with acute coronary syndrome, divided into two subgroups based on the nadir of CD4+ cells. This study analyzes the relationship between the immune status of HIV patients, assessed by the nadir of the CD4+ T-cell count, and the outcome of these patients. Also, secondary endpoints were the assessment of the magnitude of coronary lesions and of thrombotic and bleeding risk assessed by specific scores. Clinical and biological parameters and also the extension and complexity of coronary lesions were assessed. Although patients with poor immune status had more complex coronary lesions and increased operative risk and bleeding risk at one year, this was not associated with significant differences in major adverse cardiac and cerebrovascular events at the 30-day and 1-year outcomes.

The Comparison of Coronary Angiographic Profile between Diabetic and Non-Diabetic Patients with Coronary Artery Disease in a Nepalese Population

Background: Diabetes mellitus is associated with an increase in cardiovascular morbidity and mortality. As the prevalence of diabetes mellitus is increasing globally the burden of death related to cardiovascular disease including myocardial infarction will be a great burden to countries like Nepal. The aim is to compare the extent and severity of coronary artery disease between diabetic and non-diabetic patients referred for coronary angiography.&#x0D; Materials and methods: It was a Hospital-based, cross-sectional study conducted in the Department of Internal medicine, BPKIHS Dharan, Nepal. All consecutive patients undergoing coronary angiography with a clinical indication for the procedure during the study period of one year were included in the study. 61 subjects with diabetes were compared with 147 subjects without diabetes for assessing the severity and extent of coronary artery disease. The coronary atherosclerosis score was used to grade the severity of lesions visualized by coronary angiography.&#x0D; Results: The mean coronary atherosclerosis score was 6.64±4.18 among diabetes and 4.97±4.07 among the non-diabetic group with p-value of 0.008 which was statistically significant. The left anterior descending coronary artery was significantly more frequently involved in diabetics than nondiabetic patients 88.52% vs. 66.67% (p&lt;0.002).&#x0D; Conclusion: Diabetic patients had more severe and extensive atherosclerotic lesions in coronary arteries than the non-diabetic patients on coronary angiography suggesting atherosclerotic burden in the diabetes population is higher in our population.