Lumbar Region Research Articles

Successful Management of Traumatic Cervical Spondyloptosis with Incomplete Neurological Deficit in a Child: A Case Report

Abstract Background: Spondyloptosis is a condition in which one vertebral body is completely displaced over the corpus of the adjacent one. It is more common in the lumbar region of the spine, but it very rarely occurs in the cervical spine. In this study, we report a case of post-traumatic cervical spine spondyloptosis in a child. Case Report: We describe a case of a 14-year-old male, who was admitted for cervicalgia with incomplete neurological deficit as a result of falling from a tree. Computed tomography (CT) of the neck revealed a posterior C5–C6 spondyloptosis with anterior spondylolisthesis of C7–T1. Surgical intervention was performed by the anterior approach only. The patient recovered completely after 2 months. Conclusion: Traumatic cervical spondyloptosis is an injury with rare occurrence with varied clinical presentations. Until now, there is no consensus concerning the most effective treatment for spondyloptosis. Satisfactory clinical and good outcomes can be obtained by anterior cervical corpectomy and fusion.

Biomechanical properties analysis of posterior lumbar interbody fusion with transpedicular oblique screw fixation

ObjectiveAn alternative to conventional posterior lumbar interbody fusion (PLIF) is a PLIF with transpedicular oblique screw fixation system. An assessment of new fixation system's viability and efficacy is conducted through a comparison of its biomechanical properties with those of conventional PLIF. MethodA comprehensive finite element model (FEM) of the lumbar regions L1-L5 was developed and the surgical segment L3-L4 was chosen to comprise the surgical models of both traditional PLIF and new PLIF. In new PLIF model, an analysis was conducted on segmental range of motion (RoM), cage stress, inferior endplates stress, vertebral stress, and internal fixation stress. Three-dimensional printers are utilized to fabricate and assemble the fusion cage and vertebrae, and compression test machines are employed to execute physiological load and extreme load experiments on new PLIF, so as to verify the accuracy of the FEM analysis and the mode of fatigue exhibited by new PLIF. ResultsIn new PLIF, the maximum stress on the inferior endplates under physiological loads was reduced in comparison to conventional PLIF. While the maximum stress on the cage, vertebral body, and screw increased, it remained within an acceptable range. The experimental data indicates that new fixation system can endure a vertical load exceeding 2800 N and an ultimate bending moment of 77 Nm. ConclusionThe new PLIF exhibits a comparable RoM to its predecessor, simultaneously mitigating inferior endplate stress and accommodating physiological loads, which reduce the amount of surgical incision and fusion fixation instruments. Consequently, it emerges as a sanguine surgical approach to fuse the degenerative lumbar spine.

Sarcopenic obesity in patients with head and neck cancer is predictive of critical weight loss during radiotherapy.

The impact of computed tomography-defined sarcopenia on outcomes in head and neck cancer has been well described. Sarcopenic obesity (SO) (depleted muscle mass combined with obesity) may pose a more serious risk than either condition alone. We investigated SO and its impact on survival and critical weight loss (≥ 5 %) in patients with head and neck cancer who received curative radiotherapy (± other modalities). Retrospective analysis of computed tomography cross-sectional muscle at cervical (C3), thoracic (T2) and lumbar (L3) regions was conducted. Patients were grouped by BMI and sarcopenia status based on established thresholds. A total of 413 patients were included for analysis, the majority having oropharyngeal carcinoma (52 %), and 56 % received primary concurrent chemoradiotherapy. The majority of the cohort (65 %) was overweight or obese (BMI ≥ 25 kg/m2). Sarcopenia was found in 43 %, with 65 % having SO (n 116), equating to 28 % of the whole cohort. Critical weight loss was experienced by 58 % (n 238). A significantly higher proportion of patients with SO experienced critical weight loss (n 70 v. 19, P < 0·001) and were four times more likely to do so during treatment (OR 4·1; 95 % CI 1·5, 7·1; P = 0·002). SO was not found to impact on overall or cancer-specific survival; however, in patients with sarcopenia, those with SO had better overall survival (median 9·1 v. 7·0 years; 95 % CI 5·2, 16·8; P = 0·021). SO at the time of presentation in patients with head and neck cancer is predictive of critical weight loss during treatment, and muscle evaluation can be useful in identifying patients at nutritional risk regardless of BMI and obvious signs of wasting.

Post-traumatic arachnoiditis ossificans of the thoracic spine. A case report with literature review

Background: Post-traumatic thoracic arachnoiditis ossificans (AO) is extremely rare in clinical practice. The lesion is a rare pathological entity usually confined to the thoracic and high lumbar regions that can cause progressive spinal cord myelopathy. The aim: To report a case of AO and to report briefly the literature. Case report: A case of posttraumatic AO secondary to lumbar fixation and decompression surgery for unstable thoracic fractures is reported. Conclusion: A thoracic computed tomography scan is the best investigation of the diagnosis of arachnoiditis ossificans. Magnetic resonance imaging of the spinal cord and potential coexisting pathology make both necessary.

Meningocele manqué. Case report of a rare disorder

A case of meningocele manqué with its management is presented and the literature of this rarely reported condition is reviewed. A one-year-old child was admitted with a small sac like lesion in the upper dorsal region with a soft swelling in the dorso lumbar region, was also associated with congenital bilateral talipes equinovarus which was being treated by a paediatric orthopedic surgeon. Methods. Craniospinal MRI was suggestive of dorso lumbar lipomyelomeningocele, and corresponding to the dorsal sinus/sac at DV3/DV4 level there was another tethering seen on the MRI due to a band and associated with syrinx of the dorsal cord below that, s/o meningocele manqué. Treatment. This patient underwent in 1st stage, DV2 to DV5 laminoplasty, excision of the sinus, durotomy, dissection of the multiple arachnoid cysts, and cutting of the dorsal band. In second stage will undergo surgery for Lipomyelomeningocele Conclusion: Meningocele Manque is rare, it can present in isolation or associated with other spinal dysraphism. With other spinal dysraphism they can be either at the same or at another location, as was seen in our case. Before operating all cases of spinal dysraphism it is of paramount importance to MRI screen the entire neuraxis and study images thoroughly. In our case along with the dorso lumbar lipomyelomeningocele, there was a Meningocele manqué at DV3/DV4 level. It is essential that the meningocele manqué be addressed first; if not the returning/recoiling cord after de-tethering at the lower level can get tugged/sheared at the tethered meningocele manqué causing deficits.

Immediate effects of thoracic mobilization versus soft tissue release on trunk motion, pain, and lumbar muscle activity in patients with chronic low back pain

IntroductionThoracic mobilization and tissue release are common manual techniques in clinical practice. However, the relative effects of these two treatments on chronic low back pain (CLBP) have not yet been explored. Thus, this study aimed to investigate and compare the immediate effects of thoracic mobilization with those of soft tissue release on trunk movement, pain sensation, and muscle activity in patients with CLBP. Methods28 participants were randomly assigned to two intervention groups. The mobilization group received mobilization treatment at the hypomobile joints of the trunk segment, while the soft tissue release group received thoracolumbar fascia release and massage in the lumbar region. The trunk range of motion (ROM), tissue hardness, pressure pain threshold (PPT), and erector spinae activity during light-weight lifting tasks were measured before and immediately after both interventions. FindingsAll measured outcomes in both groups improved after intervention (p < 0.05). The mobilization technique significantly improved side bending and rotation, PPT, and tissue hardness compared to soft tissue release. However, lumbar muscle activation reduced to a greater extent in the soft-tissue release group. ConclusionBoth techniques improved trunk ROM and PPT and reduced tissue hardness and muscle activation. Therefore, both these techniques are recommended for patients with CLBP. Trial registrationISRCTN75190733.

Lateral Sacral Artery Perforator Flap as a New Option in Myelomeningocele Reconstruction.

This study aims to present lateral sacral artery perforator (LSAP) flaps as a new option for myelomeningocele reconstruction and to discuss their advantages and disadvantages. Eleven patients were included in the study, and reconstruction was performed with 22 LSAP flaps. Patients were evaluated in age, gender, birth weight, kyphosis status, defect localization and size, flap size, operation time, amount of bleeding, and postoperative complications. Sixteen flaps were raised from the first and 6 from the second LSA. The average time for soft tissue reconstruction was 57 minutes. The mean blood loss was 11.1 mL/kg. No cerebrospinal fluid leakage was detected in any patient. In 1 of the 22 flaps, venous congestion did not completely resolved and resulted in partial necrosis secondary to venous insufficiency. In 2 patients, minimal wound dehiscence was detected in the distal part of the flap. No wound infections, hematomas, donor site complications, or seromas were observed in any patient. Considering that myelomeningoceles are often located in the lumbar region, we think that LSAP flaps will be a new option among other flaps. Additionally, if other flaps are used in the neonatal period, it may be a good alternative for pressure sore reconstruction in the kyphotic area.

Histomorphometric and developmental analysis of human fetal caecum and appendix with its embryological significance

PurposeThe variable positions of the appendix can mislead surgeons and physicians to a wrong diagnosis. When appendicitis happens in subhepatic caecum, it can be misdiagnosed and can lead to severe complications during surgical procedures. Therefore, this study aimed to understand the histomorphometric development of the appendix and caecum and to identify when lymphoid follicles appear in the appendix during fetal life.MethodsThe study was conducted on a total of 50 fetuses. The caecum and appendix were carefully dissected. Their position and various measurements were observed. Afterwards, the appendix was taken out for histological processing. All three layers, mucosa, submucosa, and muscularis externa were measured using Image Analyzer Software Image Pro Premiere 9.1, and the appearance of lymphoid follicles was also examined. Results were analyzed using SPSS statistical software.ResultsDuring the 1st, 2nd, and 3rd trimesters the most common caecum type was type 1: as a lengthy tube, type 3: The lateral wall expanded more, thus it has an asymmetric saccule, and type 4: adult-like caecum. The caecum was mostly situated in the right lumbar region in the 2nd and 3rd trimesters. In the 1st trimester, it was subhepatic in position. The most common position of the appendix was 11 o’clock in 1st and 3rd trimesters. 2nd trimester’s most common position of the appendix was 12 o’clock. The thickness of the mucosa, submucosa, and the muscularis externa increases as the trimester increases. The lymphoid follicles have appeared during the 2nd trimester.ConclusionThe knowledge from this study will be useful in the diagnosis and treatment of malformations, pathology, and anomalies of the caecum and appendix due to congenital causes.

Efficacy of Laser Therapy in Patient Self-Assessment for Cervical and Lumbar Spine Pain Syndromes – Original Study

Introduction: Laser therapy, or Light Amplification by Stimulated Emission of Radiation (LASER), is a relatively popular method used in rehabilitation for various patient conditions. Purpose: To evaluate the effectiveness of laser therapy in treating pain syndromes of the cervical and lumbar spine. Material: The study included 108 patients, consisting of 72 women (67%) and 36 men (33%) diagnosed with chronic pain syndromes in the cervical and lumbar spine regions. The average patient age was 64.4 years. Method: A proprietary questionnaire survey Results: According to 44.4% of respondents, the effects of laser therapy are moderate, while 28.7% reported significant improvement. The study showed that for 50% of patients, the pain relief was substantial, for 37% it was minimal, and for only 9.3% there was no noticeable improvement. Among the participants, 70.8% of women and 75% of men considered laser therapy to be an effective treatment. Notably, 100 respondents expressed a willingness to undergo laser therapy again in the future. Conclusions: The data indicates that laser therapy is an effective treatment for spinal pain syndromes, often resulting in significant symptom relief. However, the concern is the short duration of pain relief after therapy, with symptoms commonly recurring within a few months to a year. The willingness of 100 respondents to undergo future laser therapy underscores the positive perception of this rehabilitation method among patients.

The many faces of myxopapillary ependynomas.

Myxopapillary ependymomas (MPE), classified as grade 2 tumors by the WHO, are rare spinal neoplasms. Despite their slow growth and generally benign nature, MPE have a high recurrence rate and potential for cerebrospinal fluid dissemination. This study aims to identify the MRI characteristics and pathological patterns of MPE and investigate potential correlations between the MRI characteristics and specific histopathological patterns. We assessed 13 patients (7 men; mean age, 45.1 years) with pathologically proven MPE. MRI images were reviewed for tumor location, size, T1 and T2 signal characteristics, contrast enhancement, hemosiderin cap presence, vertebral scalloping, drop metastasis, and prominent intradural flow voids. Four histopathological patterns (microcystic, solid, hemorrhagic, and high hyalin content) were defined and segmented, with surface areas measured and percentages calculated relative to the total tissue surface. Most tumors were in the lumbar region (84.61%), with MRI revealing typical features such as T2 hyperintensity (100%) and contrast enhancement (92.3%). A rare non-enhancing MPE was noted. Large tumors exhibited a microcystic pathology pattern, with two cases with this pattern showing drop metastasis on MRI. Smaller tumors typically presented a solid pathology pattern with homogenous MRI signals. This study underscores the diverse MRI presentations of MPE and suggests a potential link between microcystic patterns in pathology and large MPE with drop metastasis.ABBREVIATIONS: MPE= myxopapillary ependymoma.

A calculator for musculoskeletal injuries prediction in surgeons: a machine learning approach

BackgroundSurgical specialists experience significant musculoskeletal strain as a consequence of their profession, a domain within the healthcare system often recognized for the pronounced impact of such issues. The aim of this study is to calculate the risk of presenting musculoskeletal injuries in surgeons after surgical practice.MethodsCross-sectional study carried out using an online form (12/2021–03/2022) aimed at members of the Spanish Association of Surgeons. Demographic variables on physical and professional activity were recorded, as well as musculoskeletal pain (MSP) associated with surgical activity. Univariate and multivariate analysis were conducted to identify risk factors associated with the development of MSP based on personalized surgical activity. To achieve this, a risk algorithm was computed and an online machine learning calculator was created to predict them. Physiotherapeutic recommendations were generated to address and alleviate each MSP.ResultsA total of 651 surgeons (112 trainees, 539 specialists). 90.6% reported MSP related to surgical practice, 60% needed any therapeutic measure and 11.7% required a medical leave. In the long term, MSP was most common in the cervical and lumbar regions (52.4, 58.5%, respectively). Statistically significant risk factors (OR CI 95%) were for trunk pain, long interventions without breaks (3.02, 1.65–5.54). Obesity, indicated by BMI, to lumbar pain (4.36, 1.84–12.1), while an inappropriate laparoscopic screen location was associated with cervical and trunk pain (1.95, 1.28–2.98 and 2.16, 1.37–3.44, respectively). A predictive model and an online calculator were developed to assess MSP risk. Furthermore, a need for enhanced ergonomics training was identified by 89.6% of surgeons.ConclusionsThe prevalence of MSP among surgeons is a prevalent but often overlooked health concern. Implementing a risk calculator could enable tailored prevention strategies, addressing modifiable factors like ergonomics.

Transforaminal Epidural Injection with Local Anesthesia and Steroid for Single-level Radiculopathy and Pain Score: A Prospective Study in the Tertiary Center of Western Nepal

Introduction: Radiculopathy resulting from prolapse of intervertebral disc commonly at L4-L5 and L5-S1, the prominent cause of low back pain affecting daily activities and has a significant socioeconomic burden. Hence, this needs to be addressed with a prominent solution, of which, the transforaminal epidural steroid injection has been one of the promising solutions these days. Aims: To assess the short term and long-term pain relief after transforaminal epidural steroid injection. Methods: 58 patients with radiculopathy at the single level of the lumbar or lumbosacral region were included for transforaminal epidural steroid injection with local anesthesia. Visual analog score, pain score was recorded before, in 15 minutes and four weeks after the steroid injection under C-arm guidance. Statistical analysis was done on the basis of Wilcoxon Signed Ranks Test, Spearman’s correlation test. A p-value &lt; 0.05 was considered to be statistically. Results: The change in Visual Analog Score from the time of presentation in relation to short and long term was significant, viz; VAS0 VAS15m p&lt;0.5 and VAS0/VAS4wks was p&lt;0.5. There was a positive correlation between immediate pain relief and long-term pain reduction however it was not significant (r=0.28, p=0.10) Conclusion: This study suggested the improvement of symptoms with transforaminal epidural steroid injection with local anesthesia and showed a positive correlation between immediate and long-term relief of pain, however it may not be significant.

Origin of median sacral artery with fourth pair of lumbar artery - an alert for spine surgeons and interventionalists: A case report and mini literature review.

The median sacral artery (MSA) is the single unpaired dorsal branch of the abdominal aorta. The present case describes the relatively unusual origin of the median sacral artery in common with the fourth pair of lumbar arteries via a common trunk in a 74-year-old males' cadaver. Unusual common trunk is prone for iatrogenic injury in surgeries of the lumbar and pelvic region. Owing to the deep seated nature of MSA close to the periosteum of lumbar vertebrae and sacrum, detection of accidental rupture of MSA and ligation thereof becomes a difficult task. MSA is also increasingly being utilized for intra-arterial embolization of pelvic tumours. The proximal portion of the common origin may at times undergo cone shaped dilatation which is referred to as infundibulum or infundibular dilatation and can also transform into aneurysm later. Knowledge of this variation is imperative for spine and pelvic surgeons to avoid unwanted complications.

Abstract A008: The effect of body mass index on Tumor Treating Fields (TTFields) intensity distribution in the abdomen: results of a simulation model study

Abstract Introduction: Tumor Treating Fields (TTFields) are electric fields that disrupt processes critical for cancer cell viability and tumor progression. They are generated by a portable medical device and delivered noninvasively to the tumor site via skin-placed arrays. TTFields therapy is approved for the treatment of recurrent and newly diagnosed glioblastoma as well as pleural mesothelioma. Recently, the randomized, pivotal (phase 3) LUNAR study (NCT02973789) demonstrated improved overall survival for TTFields therapy (150 kHz) delivered continuously until progression or intolerable toxicity together with an immune checkpoint inhibitor (ICI) or docetaxel (DTX) vs ICI/DTX alone in patients with metastatic non-small cell lung cancer following progression on or after platinum-based therapy. PANOVA-3 (NCT03377491) is an ongoing pivotal (phase 3), randomized, open-label study evaluating the safety and efficacy of TTFields therapy (150 kHz) together with nab-paclitaxel and gemcitabine for the treatment of patients with unresectable, locally advanced pancreatic adenocarcinoma. The effects of TTFields are dependent on several factors (i.e., intensity, frequency, and distribution) which may be affected by tissue composition/conductivity and array layout. Here, we evaluate guideline TTFields array layouts for TTFields delivery to the abdominal region at therapeutic intensities (∼1 V/cm [amplitude]) using simulation models with varying body mass index (BMI). Methods: Computerized phantom models (Ella, females with BMIs of 22, 26 and 30 kg/m2) were used to simulate the distribution of TTFields. Two different arrays sizes (small [13 disks] and large [20 disks]) were applied to the abdominal region of the models based on abdominal TTFields array layout guidelines. Region of interest (ROIs) included the left and right hypochondriac, left and right lumbar, epigastric, and umbilical regions. Simulations were performed using the Sim4Life platform v6.2.1.4910 (Zurich MedTech, Zurich, Switzerland). Electric field intensity distribution maps were generated for each model, and electric field intensity values across all ROIs in the abdomen were analyzed. Results: Electric field intensities were generally lower in the higher BMI model compared with the lower BMI models (field intensities across all ROIs were 1.60–2.57 V/cm for the 22 kg/m2 BMI model, 1.36–2.13 V/cm in the 26 kg/m2 BMI model and 1.35–1.97 V/cm in the 30 kg/m2 BMI model). However, all BMI models achieved TTFields intensities at therapeutic levels (∼1 V/cm) in all ROIs. Conclusions: Results from this simulation-based study demonstrate the feasibility of delivering TTFields at therapeutic intensities to patients with abdominal tumors regardless of their BMI when using abdominal guideline layouts. Citation Format: Ariel Naveh, Nadav Shapira. The effect of body mass index on Tumor Treating Fields (TTFields) intensity distribution in the abdomen: results of a simulation model study [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Advances in Pancreatic Cancer Research; 2024 Sep 15-18; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(17 Suppl_2):Abstract nr A008.

Possible effects of lumbar stabilization surgery on sagittal alignment, disability and quality of life

BackgroundIn order to restore the individual's health in lumbar stabilization surgeries, it is aimed to bring the sagittal alignment closer to normal values, to eliminate the findings, and thus to increase the quality of life of the individual by reducing the disability level. The aim of this study is to measure the effects of lumbar region stabilization surgeries performed in our clinic on some angular values in the spine, disability and quality of life. Preoperative (preop) and postoperative (postop) radiographs of 30 individuals over the age of 40 who applied to our clinic with various lumbar region complaints and underwent lumbar stabilization surgery between the years 2020–2022 were taken. Lumbar lordosis, pelvic tilt, sacral slope and pelvic inclination angles were measured from the images obtained. The Visual Analog Scale was used to measure the pain of individuals, the Oswestry Disability Index to measure the disability level, and the Nottingham Health Profile questionnaire to measure the quality of life. Preop and postop data were analyzed with the SPSS 23.0 program and p < 0.05 was considered significant.ResultsThe lumbar lordosis angles of individuals who underwent lumbar stabilization surgery approached normal values and the difference between preop–postop lumbar lordosis angle averages was significant (p < 0.05); It was observed that the harmony between the lumbar lordosis and pelvic inclination angles increased, the pain decreased and the difference between preop–postop pain values was significant (p < 0.05), disability levels decreased and quality of life increased.ConclusionsThe decrease in the level of disability and the increase in the quality of life seen in individuals who underwent lumbar stabilization surgery were associated with the decrease in pain; The changes in angular values are considered to be clinically significant.

Exploration of JI Laixi's academic thought of acupuncture and moxibustion in clinical practice

The paper summarizes Professor JI Laixi's academic thought on acupuncture and moxibustion. Professor JI Laixi inherits and carries forward the theory and technical system of Shanxi "new nine needles", deepens its academic connotation, and promotes clinical practice. He advocates the integration of Chinese and western medicine, and the inclusion of multiple disciplines, e.g. acupuncture and moxibustion of Chinese medicine and modern anatomy. He takes the lead in proposing a new approach to the treatment of meridian diseases of limbs, "treating the neck region for the diseases of head, treating the abdominal region for the diseases of the lumbar region, and treating the lumbar region for the disease of knees". He proposes the acupoint prescription being standardized and simplified, explores the system of acupoint prescription and establishes the prescriptions for gastric diseases, intestinal diseases and antihypertension.

Musculoskeletal Pain Patterns among Sudanese Surgeons: A Case-Control Study

Background: Musculoskeletal pain and discomfort are common causes that influence most surgeons' performance and lifestyle. The purpose of this study is to investigate where surgeons experience the most musculoskeletal discomfort and suffering compared to non-surgical specialty doctors. Methodology: This descriptive case-control study included 156 participants from El Obeid, a city in Sudan's Northern Kordofan state. We randomly selected the volunteers between May and June 2024, irrespective of their age or gender. Results: This study included 156 doctors from diverse disciplines aged 27 to 70, with a mean age of 37. Male-to-female ratio: 2:1. Of the 156 participants, 104 (67%) were males and 52 (33%) were females. The bulk of participants were 31–35 (33%), 36–40 (30%), and under 30 (13%). Neck pain was experienced by 38% of participants, including 44% of surgeons and 25% of non-surgical specialists. Surgeons had a greater neck pain rate (RR = 0.420, 95% CI = 0.201–0.879). About 20% of participants, including 24% of surgeons and 13% of non-surgical specialists, reported shoulder pain. The study found a relative risk (RR) of 0.492 and a 95% confidence interval (CI) of 0.197–1.227 between shoulder pain and surgery. Additionally, 57% of participants—66% surgeons and 38% other specialties—reported lower back pain. With an RR of 0.317 (95% CI 0.159–0.633), surgeons are more likely to experience lower back pain. Foot discomfort affected 7% of participants, 9% of cases, and 4% of controls. Cases increased foot pain risk by 0.422 (95% CI 0.088–2.029). Conclusion: Surgeons in various specializations in Sudan, as well as doctors in non-surgical specialties, have a significant prevalence of musculoskeletal discomfort. The most often reported areas of pain were the lumbar region, cervical region, shoulder, and lower extremities.

EP362 - Small Cell Ca of the Gall Bladder: A rare tumour of the gall bladder

Abstract Small cell carcinoma (SCC) of the gallbladder is an extremely rare tumour. Despite aggressive and varied treatments, its prognosis is poor. A 53/F presented with complaints of pain in abdomen and fever since 3 days. Patient was vitally stable and tenderness present over the epigastric, Right hypochondrium and Right lumbar region. Except leucocytosis, all labs were WNL. CECT Abdomen pelvis was suggestive of suspicious Gall bladder perforation with necrotic lymph nodes in the peri-pancreatic region. The patient was taken for exploratory laparotomy and a perforated gall bladder was seen intra op and cholecystectomy was performed. Histopathology findings were suggestive of small cell carcinoma - gall bladder and IHC markers (Synaptophysin, CD56, Ki67, EMA, CK19) sent for confirmatory findings were raised. Post op PET CT shows periportal, paracaval and aortocaval metastatic lymph nodes. Chemotherapy regimen (cisplatin + itoposide) was started post op and patient is under follow up. The incidence of SCC of the GB is approximately 0.5% of all GB cancers. Among NETs of the gastrointestinal tract, SCC of the GB compromises 0.2%. Less than 100 cases of this tumour have been documented in the English literature. Surgery is the mainstay of GB cancer treatment. Due to poor prognosis of SCC of the GB, even when curative surgery is possible, additional treatment methods such as chemoradiation should be considered.

The relationship of clinical and morphological parameters with the BRAF status of the tumor in patients with stage I skin melanoma

Aim: to study the relationship between clinical and morphological parameters of skin melanoma and the BRAF status of the tumor in patients with stage I of the disease. Materials and methods. The study was retrospective and included 200 patients with stage I skin melanoma (pT1-2aN0M0), of which BRAF status was assessed in 88 patients. All patients underwent clinical data analysis, an extended morphological study and a molecular genetic study to determine the BRAF V600E mutation in the primary tumor. Results. The median age of patients in the total sample was 61.5 years. Mutation in the BRAF V600E gene was detected in 25 patients (28.4%). Patient age, tumor location and Breslow thickness were recognized as independent predictors of BRAF status of stage I skin melanoma. With an increase in the patient's age by 1 year, the chance of having a BRAF V600E mutation decreased by 3.4% or 1.04 times (OR = 0.966; 95% CI = 0.935–0.999; p = 0.045). When melanoma was localized in the lumbar region, the chance of having a BRAF V600E mutation increased by 15.311 times (95% CI = 1.239–189.142; p = 0.033). With a tumor thickness according to Breslow of more than 0.7 mm, the chance of having a BRAF V600E mutation increased by 2.939 times (95% CI = 1.031-8.376; p = 0.044). With a threshold value of the logistic function of 50%, the sensitivity and specificity of the proposed model were 28.0% and 93.7%, respectively. When the threshold function value is reduced to 25.3%, the sensitivity of the model increases to 68% with a simultaneous drop in specificity to 61.9%. Conclusion. Younger age, greater tumor thickness according to Breslow, and tumor localization in the lumbar region in patients with stage I skin melanoma increase the chance of having a BRAF V600E mutation, while other morphological parameters of the tumor are not associated with BRAF status. However, moderate sensitivity does not allow for a sufficiently accurate determination of the presence of a mutation, thereby strengthening the belief in the need for molecular genetic testing.

Sustained acoustic medicine treatment of discogenic chronic low back pain: A randomized, multisite, double-blind, placebo-controlled trial.

Sustained acoustic medicine (SAM) is a noninvasive long-term treatment that provides essential mechanical and thermal stimulus to accelerate soft tissue healing, alleviate pain, and improve physical activity. SAM increases localized deep tissue temperature, blood flow, cellular proliferation, migration, and nutrition exchange, resulting in reduced inflammation and an increased rate of tissue regeneration. To assess the efficacy of SAM treatment of discogenic back pain in the lower spinal column to reduce pain, improve quality of life, and lower pharmacotherapy use. Sixty-five subjects with chronic low back pain were randomly assigned to SAM (N= 33) or placebo (N= 32) groups. Subjects self-applied SAM device bilaterality on the lower lumbar region for 4 hours daily for 8 weeks and completed daily pain diaries before, during, and after treatment. Subjects recorded pain reduction using a numeric rating scale (NRS), medication use, and physical activity using the Global Rating of Change (GROC) and Oswestry Disability Index (ODI). SAM treatment significantly reduced chronic lower back pain from baseline relative to placebo treatment (p< 0.0001). SAM treated subjects reported significantly lower back pain at 4 weeks, with the highest pain reduction (-2.58 points NRS, p< 0.0001) reported at 8 weeks. Similar trends were observed in improved physical activity (3.48 GROC, p< 0.0001, 69-88% ODI, p< 0.0001) and 22.5% (15.2 morphine milligram equivalent) reduction in the use of opioid medication from baseline to 8 weeks. Daily, home-use SAM treatment significantly improves the clinical symptoms of chronic lower back pain, improves physical mobility, and reduces daily medication use. SAM treatment is well-tolerated by patients and may be considered a safe, non-invasive treatment option for chronic discogenic, lower back pain.