Large Lesions Research Articles

"Honey pot"-like lesion formation: impact of catheter contact angle on lesion formation by novel temperature controlled ablation catheter in a porcine experimental model

Abstract Background The DiamondTemp(DT) catheter enables precise temperature-controlled ablation. However, the effects of the DT catheter's contact angle on lesion formation are poorly understood. Purpose This study evaluated lesion formation using the DT catheter at different angles in a porcine experimental model. Methods We used freshly sacrificed porcine hearts, and radiofrequency catheter ablation with DT was performed at 50 watts for 15 seconds at an upper-temperature setting of 60°C. The contact force (5, 10, and 30 grams) and catheter contact angles (30°, 45°, and 90°) were changed in each set (n = 13 each). The surface width (SW), maximum lesion width (MW), lesion depth (LD), surface area (SA), and distance from the distal edge to the widest area (DW) were evaluated. In addition, the generator impedance drop during radiofrequency application was analyzed. Results Figure 1 shows the summarized data in this study. SW and MW were longer at 30° than at 90° (SW 5 g: 6.34 ± 0.91 vs. 5.07 ± 0.87 mm; SW 10 g: 7.46 ± 0.55. vs. 5.60 ± 0.84 mm; SW 30 g: 7.42 ± 0.74. vs. 6.14 ± 0.77 mm; MW 10 g: 8.81 ± 0.55. vs. 7.89 ± 0.84 mm; MW 30 g: 9.24 ± 0.67. vs. 8.03 ± 1.04 mm, p <0.05, respectively). There were no significant differences in LD by catheter angle except at 30 g. SA was larger at 30° than at 90° (SA 5 g: 30.03 ± 0.91. vs. 23.61 ± 0.87; SA 10 g: 29.24 ± 0.55. vs. 21.27 ± 0.84; SA 30 g: 35.86 ± 0.74. vs. 31.74 ± 0.77, p <0.05, respectively). Besides, DW was longer at 30° than at 90° (DW 5 g: 4.28 ± 1.17. vs. 2.50 ± 0.32 mm; DW 10 g: 4.94 ± 0.52. vs. 2.47 ± 0.38 mm; DW 30 g: 5.34 ± 0.26. vs. 2.96 ± 0.40 mm, p <0.05, respectively). There were no significant differences in the impedance drop according to the catheter angle. Conclusion With the DT catheters, the lesion width increased at a shallower contact angle, whereas the LD did not. SA also increased at a shallower contact angle. The DT catheter created a large ablation lesion on the proximal side of the catheter, which looked like a "honey pot." (Figure 2)summarized dataImage of honey pot-like lesion formation

Association between silent cerebral embolism and cognitive alterations following transcatheter aortic valve replacement in bicuspid versus tricuspid aortic valve patients

Abstract Background Silent cerebral ischemic lesions (SCILs) is a common magnetic resonance imaging (MRI) finding in severe aortic stenosis patients post - transcatheter aortic valve replacement (TAVR). We evaluated the association between SCILs and cognitive alterations in patients with bicuspid aortic valve (BAV) versus tricuspid aortic valve (TAV) post-TAVR. Methods This study enrolled 100 consecutive TAVR (45 with BAV and 55 TAV). DW-MRI and neurocognitive evaluation (MoCA score) were performed at baseline, discharge, and 1- and 12-month post-discharge. Results Ninety-two out of the 100 patients (92%) exhibited cognitive dysfunction at baseline. Post-TAVR, overall cognitive function significantly improved, the average MOCA score increased from 18.69±6.74 to 22.18±6.30. During the 1-year follow-up, 54 patients demonstrated improved cognitive function, and the number of patients with moderate-to-severe cognitive dysfunction (MoCA score < 18) significantly decreased from 32 to 16. Prevalence of SCILs was 14% and 72% at baseline and discharge, respectively. New SCILs were observed in 60 patients at discharge, distributed across all vascular territories, averaging 4 lesions with a total volume of 215.4±195.4mm3. Although no significant correlation existed between total volume of new SCILs and cognitive changes post-TAVR (R=-0.133, p=0.206), patients with SCILs still displayed significant cognitive improvement (MoCA score from 18.4±6.6 to 22.0±7.1), whereas patients who developed large SCILs (lesion diameter >9) showed less improvement compared to those with small or median SCILs (number of patients who had cognitive improvement: 32 vs. 52, p<0.05). Cognitive function improvement post-TAVR did not significantly differ between BAV and TAV patients, MoCA scores were comparable (BAV group, n=45, from 18.63±6.68 to 21.88±6.80 vs. TAV group, n=55, from 18.73±6.81 to 22.42±5.80; p>0.05). DW-MRI revealed more new SCILs in BAV patients post-TAVR compare to TAV patients (235 lesions vs. 150 lesions, respectively). In BAV patients, SCILs primarily manifested in small and medium sizes (224 lesions), despite more severe calcification (valvular calcium volume 956.5±644.0 mm vs. 634.4±508.0 mm3; p=0.028). The number of large lesions was similar in the two groups (11 in BAV group and 10 in TAV group). Conclusion TAVR demonstrates positive effects on improving cognitive function in aortic stenosis patients, despite common occurrence of SCILs in both BAV and TAV patients. Cognitive function post-TAVR was comparable between BAV and TAV patients. The cognitive improvement from TAVR may be less impacted by small- and medium-sized SCILs, while severe SCILs might impede or diminish the cognitive benefits of TAVR.table

Analysis of long-term efficacy of CO2 laser partial excision of vocal folds for 599 cases in the treatment of vocal cord leukoplakia

Objective: To analyze long-term prognosis and influencing factors of recurrence in vocal fold leukoplakia treated by endoscopic cordectomy with CO2 laser. Methods: A retrospective review was conducted on 599 patients with vocal fold leukoplakia [566 males and 33 females, aged 17-84 years (median age 55 years)], undergoing endoscopic cordectomy by CO2 laser under general anesthesia at the Department of Otorhinolaryngology Head and Neck Surgery of Beijing Tongren Hospital, Capital Medical University, from January 2000 to December 2023. The study analyzed the clinical features, pathological grade, surgical methods, postoperative voice function, recurrence, malignant changes and analyzed the long-term efficacy and and its influencing factors. The patients were followed up for a duration of 6-249 months postoperatively, with a median follow-up time of 48 months. SPSS 20.0 software was used for statistical analysis. Results: Among the 599 patients, the histopathological grades included simple squamous cell hyperplasia in (n=264, 44.08%), mild dysplasia (n=96, 16.03%), moderate dysplasia (n=74, 12.35%), severe dysplasia(n=43, 7.81%), carcinoma in situ(n=35, 5.84%), and carcinoma in situ with microinvasion(n=87, 14.52%). The 3-year and 5-year overall recurrence rates were 12.91% and 16.00%, respectively. In patients with precancerous lesion, 3.91% of recurrences presented with an upgraded pathologic grade and 2.34% evolved into carcinoma. The risk of recurrence was higher in lesions involving the anterior commissure, larger lesions, significant reduction/absence of mucosal waves, neovascularization/suspected neovascularization, and pathology of dysplasia/carcinoma in situ/carcinoma in situ with microinvasion(F=44.76,21.54,11.55,8.78,23.20,respectively,P<0.05). Additionally, patients with recurrent disease exhibited higher reflux symptom index scores compared to those without recurrence. Exophytic lesion characteristics and the inability to cease smoking postoperatively were identified as independent risk factors for recurrence with an upgraded pathological grade, with odds ratios of 8.675 and 11.380 times greater than those with non-exophytic lesions and successful smoking cessation, respectively. At the 6-months postoperative assessment, patients who underwent subepithelial cordectomy (typeⅠ) demonstrated a statistically significant increase in fundamental frequency (t=-3.38, P<0.05), and while other voice acoustic parameters were not significantly different.Conversely, those who underwent transmuscular cordectomy (TypeⅢ) exhibited significant alterations in multiple voice acoustic parameters when compared to preoperative values (P<0.05). Furthermore, postoperative vocal fold adhesions developed in 84 patients with 13 of these individuals requiring surgical intervention for adhesion release. Conclusions: Lesions involving the anterior commissure, larger lesions, pathology of dysplasia/carcinoma in situ/carcinoma in situ with microinfiltration, significant reduction/absence of vocal fold mucosal waves, and neovascularization visible under NBI are indicative of an increased risk of recurrence, whereas exophytic lesions and the inability to cease smoking postoperatively significantly increase the risk of recurrence with elevated pathologic grade. Recovery of postoperative voice quality is procedure-dependent, underscoring the importance of surgical approach selection in the management of vocal fold leukoplakia.

Fusarium and Neocosmospora Species Associated with the Decline of Metasequoia glyptostroboides in China.

During surveys conducted in 2020, severe symptoms associated with death and decline were observed on >30-year-old Metasequoia glyptostroboides (Chinese redwood) trees in the shelter-forests along Yangtze River in Jingzhou city, Hubei province, China. A previous study showed that Phytophthora acerina was one of the causal agents of the decline of the Chinese redwood. In this study, a total of 147 fungal isolates were obtained from the diseased roots and xylem of trunks of declining M. glyptostroboides trees. Through morphology and multi-locus phylogenetic analysis, these isolates were identified as eight species belonging to the genera Fusarium and Neocosmospora including F. fujikuroi, F. irregulare, F. odoratissimum, F. reticulatum， N. falciformis, N. keratoplastica, N. solani, and N. tonkinensis. Single inoculation and co-inoculation with P. acerina assays of these Fusarium and Neocosmospora species were then performed to test pathogenicity on three-year-old seedlings of M. glyptostroboides. Lesions (i.e., on seedling stems) caused by species of the genera Neocosmopora and Fusarium were smaller than those caused by P. acerina. Co-inoculation of F. fujikuroi and P. acerina, as well as the co-inoculation of F. reticulatum and P. acerina caused larger lesions than inoculations with P. acerina alone. All these species of Fusarium and Neocosmospora were shown to have the potential to be pathogenic to M. glyptostroboides. This study provided evidence that the decline of M. glyptostroboides in Jingzhou is a disease complex.

Tratamento endodôntico em sessão única em dentes com lesão apical: relato de caso

Endodontics is a branch of dentistry responsible for treating the inside of the teeth through endodontic treatment. One of the main objectives of endodontic treatment is to guide the root canal system to a clean place, consequently eliminating microorganisms, providing the cure of the infection and later restoring the function of the tooth. Endodontic treatment performed correctly is successful in the long term regardless of the number of sessions, therefore, endodontic treatment in a single session is a great alternative due to the saving of operative time, lower risk of infiltrations, shorter time to resume function of the tooth in the stomatognathic system, reduced risk of cross-infection and reduced drug administration to patients who need antibiotic prophylaxis. The success of the root canal treatment will depend on the infection control through the correct cleaning and modeling of the canals, the filling of the same through the obturation and all the care to be executed and not the medication used between sessions. Thus, the objective of this work is to report the effectiveness of endodontic treatment in a single session through a clinical case report of a patient with a large periapical lesion in elements 21 and 22.

Case report: Microsurgical resection of a giant triple dumbbell shaped jugular foramen Schwannoma via retrosigmoid and transcervical approach

The surgical management of extensive jugular foramen schwannomas presents a formidable challenge, aiming for gross total resection while minimizing complications. Here, we present a case with giant triple dumbbell-shaped jugular Foramen Schwannoma. A 45-year-old male with a one-year history of a left neck mass underwent surgery. Initial misdiagnosis of submandibular gland inflammation led to persistent symptoms despite anti-inflammatory treatment. Imaging revealed a large lesion in the left cerebellar peduncle-neck-jugular foramen region (39.6 x 26.2 x 90 mm). The combination of retrosigmoid and transcervical approach was selected. Sufficient drilling of the infralabyrinthine, retrofacial area of the mastoid with facial nerve transposition is important for the safe gross total removal of the tumor. The patient underwent a gross total removal of the tumor. Facial nerve function was preserved. Although dysphagia and hoarseness complicated postoperatively, he became able to take foods orally after the surgery. In conclusion, this case underscores the successful surgical approach for a large jugular foramen Schwannoma, emphasizing the importance of precise techniques to achieve complete tumor resection while minimizing postoperative complications.

Near Complete Reversal Of Large Diffusion-Weighted Imaging Lesion After Thrombectomy: A Case Report And Literature Review.

Diffusion-Weighted Imaging (DWI) plays a crucial role in acute ischemic stroke (AIS), as it is used to evaluate the ischemic lesions that are irreversibly damaged. The reversibility of DWI ischemic lesions has been noted in patients with AIS who undergo revascularization therapy. In addition, the occurrence of this phenomenon in large ischemic regions remains rare, particularly the near-complete reversal of large DWI lesion cases. A 58-year-old male presented with a generalized tonic-clonic seizure. Emergent magnetic resonance imaging (MRI) revealed an extremely large infarction lesion in the right hemisphere with an Alberta Stroke Program Early Computed Tomographic Score (ASPECTS) value of 2 and occlusion of the terminal right internal carotid artery. The patient was immediately transferred to the Digital Subtraction Angiography (DSA) Unit for endovascular treatment with a stent retriever. After a rapid successful reperfusion with expanded treatment in cerebral infarction (eTICI) score of 3, the patient promptly recovered 24 hours after the procedure. A brain MRI was repeated after 8 days of admission, and interestingly, the DWI lesion showed significant reversal. The modified Rankin scale (mRS) at discharge was 2 and 1 at 90-day follow-up, respectively. Our case shows that the reversibility of DWI ischemic lesions can occur during the acute stroke phase, even in patients with extremely large regions, if rapid and successful reperfusion is achieved. The clinical implications of this phenomenon indicate that using DWI to evaluate the infarct core should be interpreted with caution.

Minimally invasive resection of a giant esophageal schwannoma

Benign tumors of the esophagus are uncommon, and primary esophageal schwannoma of the esophagus is even rarer, accounting for 2% of cases. Less than 30 cases have been reported in the literature. Here we report a case of a young man with a symptomatic giant esophageal schwannoma, which was completely removed by laparoscopic three-staged esophagectomy. This is the first case of such a large lesion being removed by a minimally invasive approach. Our patient was a 22-year-old male, presented with dysphagia and dyspnea for five years. An endoscopy and CT scan suggested a giant leiomyoma. Postoperative biopsy revealed a primary esophageal schwannoma. We present our case of benign esophageal tumor measuring about 10.5 cm in greatest dimension. This is the first schwannoma resection performed with the Mckeown technique among the limited case reports in the literature. Esophageal schwannoma must be kept as a possible diagnosis in patients presenting with benign esophageal tumors. Esophagectomy is the mainstay of treatment for giant esophageal schwannomas. Minimally invasive esophagectomy can be safely performed for giant benign esophageal tumors. doi: https://doi.org/10.12669/pjms.40.10.8824 How to cite this: Qureshi S, Khan S, Abbasi WA, Sohail M. Minimally invasive resection of a giant esophageal schwannoma. Pak J Med Sci. 2024;40(10):2447-2450. doi: https://doi.org/10.12669/pjms.40.10.8824 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Tumor Volume Doubling Time of Less Than One Year is Associated with a Higher Risk of Death from Medullary Thyroid Cancer.

Tumor volume doubling time (TVDT) is emerging as a useful tool in predicting oncologic outcomes. There is limited data on the prognostic role of TVDT in metastatic medullary thyroid cancer (MTC). The goal of this study was to assess the value of TVDT in predicting disease-specific survival (DSS) in patients with hereditary and sporadic MTC. This was an Institutional Review Board-approved cohort study including patients with metastatic MTC having at least 3 consecutive imaging studies. TVDT of up to the five largest lesions per organ was calculated using a standardized formula. The association between TVDT and DSS was analyzed using Kaplan-Meier survival curves. Cox proportional regression model was used to account for confounding factors. The study sample consisted of 51 patients presenting with 286 metastatic lesions measured with 457 scans during the follow-up of 51 (IQR 25-102) months. Median age was 19 years (IQR 15-41), 53% female patients. Cumulative volumes of all metastatic lesions and proportion of patients with TVDT of <1 year were higher in patients with sporadic as compared with hereditary MTC (p<0.01). Factors independently associated with shorter DSS were TVDT of <1 year based on 3 initial and 3 last scans as well as lung, brain and prostate as the organs with the fastest growing tumor. TVDT based on 2-dimentional and 3-dimentional measurements showed strong correlation (r=0.94, p<0.05). Three baseline and three most recent scans preceding follow-up visit enable calculation of TVDT and can be used as predictors of mortality from MTC.

Thoracoscopic minimally invasive surgical treatment with the same incisions in a patient with uremia complicated with large thymoma and right upper lobe lung cancer: a case report

A 41 year old female with stage 5 chronic kidney disease undergoing hemodialysis was admitted to the hospital. Chest CT scan revealed a large mass lesion of approximately 6.0 × 3.5x4.9 cm in size in the anterior superior mediastinum and a ground glass nodule in the upper lobe of the right lung, which increased in size from 9 × 7 mm 1 year and 9 months ago to 11mmx9mm before surgery. We designed a localization method to accurately locate the pulmonary nodule and successfully performed thoracoscopic minimally invasive resection of both thymoma and lung cancer through a subxiphoid approach with the same incision for this patient. With the support of perioperative hemodialysis, the patient's outcome is good. The pathological diagnosis of the anterior mediastinal mass is thymoma (b1 type), and the pathological diagnosis of the right upper lobe nodule is invasive lung adenocarcinoma (acinar type). This report describes the diagnosis and treatment process of the case.

Microsurgical Treatment of a Large Through-and-Through Periapical Lesion with Apicomarginal Defect using Guided Tissue Regeneration (GTR): A Case Report of a Two-Year Follow-Up

In case of a long-term periapical lesion, destruction of both vestibular and oral cortical plates is sometimes observed and even a through-and-through periapical lesion occurs. The success of the treatment decreases when an apicomarginal defect is added to the through-and-through periapical lesion. Large periapical lesions should be treated initially by orthograde root canal therapy. When the signs and symptoms of the infection don’t recede after the treatment, then surgical approaches should be considered. In this case report, a 22-year-old female with previously initiated therapy was referred for an endodontic microsurgery of tooth 22 (i.e., upper left lateral incisor). After the endodontic treatment the patient was referred to the oral surgeon for apicoectomy with augmentation of the bone defect. The sinus tract in the apex area of the tooth 22 remained active since the surgical intervention. Endodontic microsurgery and guided tissue regeneration were performed. The article presents diagnostic data, namely pre- and post-operative images of cone beam computed tomography (after 2 years), as well as pre-, intra- and post-operative clinical images. All pre- and intraoperative procedures and stages are detailed. In particular, separation of platelet-rich fibrin (PRF) from venous blood, retrograde preparation with an ultrasonic tip and a device using a dental operating microscope and the use of a collagen membrane. After two-year follow-up, radiographic examination revealed significant bone reconstruction and clinical signs and symptoms were absent. The patient hasn’t reported any symptoms since. The paper also analyzes scientific sources on the use of PRF and collagen membranes in bone defects of the jaws. Attention is also paid to the formation of a flap during operations of this type. The main six success factors in the treatment of such complex cases are highlighted. Rethinking the previously performed surgery (apicoectomy) in this patient, attention was paid to the main five factors that could contribute to the failure.

Clinical features and surgical treatments of neurofibromas associated with neurofibromatosis type 1

To explore the clinical features, surgical treatment, and effectiveness of neurofibromas associated with neurofibromatosis type 1 (NF1). A clinical data of 41 patients with NF1 admitted between December 2018 and April 2024 was retrospectively analyzed. There were 15 males and 26 females, with an average age of 27.5 years (range, 5-61 years). Only one type of neurofibroma existed in 3 patients and the rest of the patients had more than two types of neurofibromas. Fourteen patients had total resection of multiple cutaneous neurofibromas (CNF). Eighteen patients of diffuse neurofibromas underwent total, near-total, or subtotal resection. Among the 13 patients of localized nodular neurofibromas, 9 of benign tumors underwent total sub-capsular resection and 4 of malignant peripheral nerve sheath tumor (MPNST) underwent maginal resection, and only 1 underwent postoperative radiotherapy and chemotherapy. Among the 15 patients of plexiform neurofibromas (PNF), 5 patients underwent both superficial and deep PNF resection, 2 underwent the superficial PNF resection, and 8 underwent the large nodular lesions in the deep PNF resection. There were 8 MPNST, of which 7 cases underwent total sub-capsular resection and large tumor capsule resection under neurophysiological monitoring, and 1 case with the tumor located on the top of the head underwent wide resection and skin grafting. One patient underwent proton knife therapy after surgery, 2 patients did not receive radiotherapy, and the remaining patients received conventional radiotherapy. All patients were followed up after surgery, and the follow-up time was 3-66 months, with an average of 25.0 months. Patients with CNF recovered satisfactorily after surgery, and there was no recurrence during follow-up. Patients with diffuse neurofibromas relieved preoperative symptoms after surgery. Three patients with diffuse neurofibromas located in the head and face recurred during follow-up. The patients with benign localized nodular neurofibromas recovered well after surgery, and only 1 patient had transient regional neuralgia after surgery. Among the patients with MPNST, 2 patients died of recurrence and lung metastasis, while the remaining 2 patients had no recurrence and metastasis during follow-up. All preoperative symptoms disappeared in patients with benign PNF, and no tumor recurrence was observed during follow-up. Two patients with PNF located in the brachial plexus had difficulty in shoulder abduction after surgery, 1 patient with PNF located in vagus developed hoarseness after surgery. Among the 8 patients with MPNST in PNF, 1 died of lung metastases and 1 died of systemic failure. The remaining 6 patients were in stable condition during follow-up, and no tumor recurrence or metastasis was observed. According to the clinical features of neurofibromas in patients with NF1, choosing appropriate surgical approaches can obtain good effectiveness. Because of the difficulty of completely resection, diffuse neurofibromas, especially those located in the head and face, are prone to recurrence after surgery. MPNST has the worst prognosis, high incidence of recurrence/metastasis, and short survival period. Total resection combined with radiotherapy can decrease local recurrence.

Spinal anesthesia for endoscopic submucosal dissection of large recto-sigmoid lesions: a feasibility study

Background and study aims: Colorectal endoscopic submucosal dissection (ESD) is often challenging and time-consuming. Prolonged sedation and general anesthesia are associated with a relevant risk of anesthesia-related adverse events (ARAEs), especially in elderly and difficult airway patients. Spinal anesthesia (SA), a simple technique providing analgesia and motor block without systemic drug administration, has never been described in gastrointestinal endoscopy. We assessed the feasibility of SA in colorectal lesion ESD. Patients and methods: We retrospectively collected data on all consecutive patients who underwent ESD for colorectal laterally spreading tumors (LSTs) under SA in our Center during the last three years. We evaluated the rates of technical success, i.e. ESD completion under SA without need of conversion to deep sedation or general anesthesia, and ARAEs after SA. Results: ESD under SA was performed on 20 recto-sigmoid LSTs ≥35 mm. Technical success was achieved in 95.0% (19/20) of cases, while one patient (5.0%) required conversion to deep sedation. Two patients (10.0%) experienced acute urinary retention that was successfully treated with temporary catheterization. Conclusions: Our initial experience suggests that SA for ESD of large recto-sigmoid LSTs is feasible, and it may prove to be a valuable option especially for elderly and frail patients.

Versatility of patient specific implants in reconstruction of maxillofacial defect: a case report of central giant cell granuloma

Reconstructing maxillofacial defects is challenging due to its complex anatomy and cosmetic and functional effects on patients. From a functional and esthetic view, it is imperative for surgeons to accurately restore the defect in a way that will ensure patient satisfaction and well-being. Here, a case of large lytic lesion of anterior mandible, causing extensive bony resorption, in a young female patient is reported. Incisional biopsy was performed and the histopathological features were suggestive of Central giant cell granuloma (CGCG). Surgical treatment by en-bloc resection of the lesion was done. Several reconstruction options are available in the literature are available for the residual bony defect including iliac crest graft, costochondral graft, submental island flaps and more. However, the advent of additive manufacturing, 3–dimensional (3D) printing, and the recent advances in those technologies has positively influenced the biomedical field, leading to the utilization of patient-specific implants (PSIs) in the surgical repair of maxillofacial defects. This report highlights the advantages of using Patient Specific Implant and describes our experience with it.

Microbial diversity in primary endodontic infections: demographics and radiographic characteristics.

To analyze if the microbiome community composition in primary endodontic infections is associated with clinical or radiographic factors. Seventy-one patients with primary endodontic infections were evaluated for percussion tenderness, presence of a sinus tract, presence of caries, sex, probing depth > 4mm, and age. Samples from the root canals were obtained and the microbiome was subsequently characterized by 16S rRNA amplicon sequencing. For the radiographic analysis, a subset of 12 samples with a periapical index (PAI) ≤ 2 were compared with 19 samples with PAI of 5. The Shannon and Chao1 indices were used to measure alpha diversity. Differences in abundances of genera were evaluated using the Kruskal-Wallis test with Bonferroni's correction. Differences in community composition were evaluated using analysis of similarity (ANOSIM) with Bray-Curtis dissimilarity matrices. No significant differences in microbiome composition relative to clinical factors were found using ANOSIM. Teeth within the two categories of periapical index showed a similar number of species richness, and alpha diversity values P > 0.05. Community composition was significantly affected by the periapical index (ANOSIM P = 0.039, R = 0.10). Larger radiographic lesions demonstrated significant increase in Prevotellaceae, Olsenella, and the motile bacteria Oribacterium, Selenomonadaceae spp., and Treponema. Clinical factors associated with apical periodontitis have a limited impact on the root canal microbiome composition. Community composition appears to be affected in teeth with large apical lesions.

Current approaches to prenatal imaging of lung malformations: a review

INTRODUCTION: Congenital lung malformations are result of developmental disorders at any stage of organ formation. Manifestations of these changes vary significantly: from minimal in size to large space-occupying lesion of the lung, which can cause fetal death or severe postnatal respiratory disorders. In proper time and accurate prenatal diagnosis of lung development abnormalities is one of the fundamental factors determining management of pregnancy and prognosis.OBJECTIVE: To demonstrate the most typical features of a wide range of congenital lung anomalies by ultrasound and MRI.MATERIALS AND METHODS: The literature search was performed in open Russian and English databases Medline, PubMed, Web of Science, RSCI, eLIBRARY using keywords and phrases: «prenatal diagnosis», «fetal MRI», «ultrasound diagnostics», «сongenital lung malformations».RESULTS: Based on literature data and our own experience in the use of ultrasound and MRI in diagnosis of сongenital lung malformations, the main signs of normal development and the most specific types of lung anomalies are described. Algorithm for diagnostic search for congenital lung malformations is presented.CONCLUSION: Ultrasound is the main method for diagnosing congenital lung anomalies. Fetal MRI is used to clarify the nature and extent of changes, a more detailed assessment of adjacent organs, also to determine Multiple congenital anomalies. Understanding the characteristics of semiotics of lung malformations and the main signs of these anomalies is a fundamental criterion for prenatal counseling, as well as peri- and postnatal management of this category of patients.

Pixel to Pathology: A Prospective Cross-Sectional Study on the Role of Multidetector Computed Tomography in the Evaluation of Malignant Large Bowel Lesions With Histopathological Correlation

Pixel to Pathology: A Prospective Cross-Sectional Study on the Role of Multidetector Computed Tomography in the Evaluation of Malignant Large Bowel Lesions With Histopathological Correlation

Comparison of Endoscopic Ultrasound and CT Scan in the Diagnosis of Esophageal Duplication Cysts.

Esophageal duplication cysts (EDCs) are rare congenital malformations, often discovered incidentally during endoscopy or on computed tomography (CT) scans. The role of endoscopic ultrasound (EUS) and CT scan in the diagnosis of these lesions and indications for surgical treatment are underreported. The aim of this study was to investigate these topics in a cohort of patients. Between January 2001 and October 2020, 82 patients had a suspicion of esophageal duplication cyst on endoscopic ultrasound. Thirty four of these patients were referred for surgical enucleation of the lesion, but three patients were lost to follow-up. At the end, 31 patients, who underwent surgical treatment for their suspected EDC were included in this study. Clinical features, EUSfindings, CT images, surgical treatment, and outcome were collected from hospital health records. CT images were re-evaluated by a chest radiologist. Type of surgery, surgical complications, and final histological diagnosis were reported. The patients referred for surgery were younger (p = 0.0001) and had larger lesions (> 2cm; p = 0.005) than the patients who had non-operative follow-up. From thirty-one operated patients, eighteen (58%) had post-operative histological diagnosis of duplication cyst. On EUS the final histological diagnosis was correct in 58% (18/31) of all the operated cases and on CT scan 57% (17/30). CT scan misdiagnosed three of the EDCs but found two leiomyomas correctly. None of these patients developed malignancy. According to this study, neither EUS without fine-needle biopsy nor CT scan alone can differentiate EDCs from other mediastinal masses.

Complete stenosis after endoscopic submucosal dissection of a large circumferential rectal lesion

Complete stenosis after endoscopic submucosal dissection of a large circumferential rectal lesion

Case of a Newborn with a Neurocristic Hamartoma in a Congenital Melanocytic Naevi.

We present the case of a newborn female that was referred for review of a large melanocytic lesion on the lower back and multiple smaller lesions. Two biopsies were taken which showed features of congenital naevus and a small component of spindled dendritic cells that showed no positivity with melanocytic markers. As such, the histopathological findings of these biopsies were consistent with a diagnosis of a congenital naevus with areas resembling a neurocristic hamartoma. This case serves to highlight this rare condition and its clinical presentation, histopathological features and the importance of its early diagnosis and surveillance.