Residual Cavity Research Articles

Liver resections for the treatment of hydatid cyst

Introduction: Liver resections for the treatment of hydatid cyst, have been discussed over the years. Trying to retain the maximum amount of functional hepatic parenchyma is considered essential. Nevertheless, in some specific cases such as multiples hydatid cysts (QH), gall destruction, residual cavities and fibrosis, liver resections have its formal indication. Objective: Analyze morbidity and liver resection Materials and methods: Observational, descriptive and retrospective study. 13 cases. Results: Patients were 9 men and 4 women, from 17 to 75 years old. 70% presented simple cholangitis and the 5% had abdominal pain. 60% was located in the left lobe and the 40% in the right lobe. Right hepatectomy 31% of the cases, 8% left hepatectomy, bisegmentectomy II–III 39% of the cases, atypical resections 15% o and segmentectomy III 8%. The morbidity was 31%. No mortality. Discussion and conclusions: The cystoresection is the most atypical resection used and the most common typical resections are right hepatectomy, segmentectomy V–VI, segmentectomy IV, or II–III bisegmentectomy. In hepatic hydatid surgery, the vascular aspect is important in order to avoid leaving no functional parenchyma. The biliary tract was importantly commitment that forced to performed cystobiliary disconnection, adding complexity to the procedure. These radical procedures are not exempt of complications.. We conclude that in general, liver resections must be solved using a tactical and technical resource, trying to achieve good results, avoiding complications and consequences of morbidity and mortality which are non-negligible for a endemic benign disease in our environment.

Pneumonostomy in the Surgical Management of Hydatid Cyst of the Lung.

Background Pneumonostomy in the surgical treatment of bilateral hydatid cyst of the lung(HCL) was described by Anand et al. This study presents the comparative long-term results of pneumonostomy for simple and complicated HCL. Methods and Patients The pneumonostomy technique was applied to both open and minimally invasive operations. The cyst was opened, endocyst removed, and any bronchial openings closed. The pericyst was closed over a 20-French Malecot tube, which was exteriorized and connected to an underwater seal. The tube was removed after 3 weeks by which time a well-established tract had formed. Hospital records of 26 children with 30 HCL who underwent pneumonostomy between 2001 and 2014 were reviewed and followed up. Patients were analyzed in two groups:group1 comprised uncomplicated and group2 complicated HCL. There was a statistically significant difference in the age at presentation in the two groups. The groups were comparable with respect to presenting symptoms, sex ratio, and side or size of cyst. Results Six(20%) children with surgical complications were graded by Clavien-Dindo classification. Three(10%) children qualified as grade 1 and did not require pharmacologic or surgical therapy. Three(10%) children had grade 3 complications; two developed empyema and one pneumothorax. There were no prolonged air leaks. Children with complicated cysts did not require longer hospitalization. Follow-up was possible in 80.76% of the children. The mean duration of follow-up was 21.3 months (interquartile range, 5-63 months). There were no postoperative recurrences or disease-related mortality. Conclusion Pneumonostomy is a safe and effective technique for dealing with the residual cavity in large complicated cysts and bilateral HCL.

Localisations cervico-faciales du kyste hydatique : série de 17 cas

Head and neck localizations of hydatid cyst are very rare (1% of human cases) even in countries where echinococcosis is endemic (human sites). Our objective was to report the epidemiological, and clinical characteristics and the management of head and neck localizations of hydatid cyst. A retrospective descriptive study of 17 cases of head and neck hydatid cysts taken in charge in our department between 2000 and 2014 was conducted. The mean age was 35 years. Male were slightly predominant (sex ratio: 1.12). Eighty-eight percent of the patients had regular contact with dogs and 53% were of rural origin. The soft tissues of the head and neck were involved in six patients, the parotid gland in 6 patients, the thyroid in 4 patients and the submaxillary gland in one patient. Complete surgical resection of the lesions was systematically done. Hydatid disease was confirmed in all the cases by histology. The outcome was uneventful in all the patients with a mean follow-up of 2 years. Given the lack of recommendations for the surgical treatment of head and neck hydatid cysts, we advocate a total resection of the affected organ if there is no functional risk. Otherwise, an excision of the cyst and of the surrounding tissues combined with an abundant washing-out of the residual cavity must be done, especially in case of intraoperative breaking of the cyst.

Опыт лечения пациентов с дивертикулами Ценкера

The average time of the traditional surgery – 47±16 min (re‑covery in 100 % of the cases). The average time of stapled ezofagodi‑verculostomy – 70±22 min. Regurgitation and dysphagia have been preserved in one case, relapses were found in four cases, diverticulitis – in two patients. One patient 3 years after the surgery was diagnosed malignancy residual cavity diverticulum. The average time of endo‑scopic ezofagodiverculostomy – 62±21 min. Regurgitation and dys‑phagia persisted in two cases, recurrences are found in two patients.

Mechanics of an Asymmetric Hard-Soft Lamellar Nanomaterial.

Nanolayered lamellae are common structures in nanoscience and nanotechnology, but most are nearly symmetric in layer thickness. Here, we report on the structure and mechanics of highly asymmetric and thermodynamically stable soft-hard lamellar structures self-assembled from optimally designed PS1-(PI-b-PS2)3 miktoarm star block copolymers. The remarkable mechanical properties of these strong and ductile PS (polystyrene)-based nanomaterials can be tuned over a broad range by varying the hard layer thickness while maintaining the soft layer thickness constant at 13 nm. Upon deformation, thin PS lamellae (<100 nm) exhibited kinks and predamaged/damaged grains, as well as cavitation in the soft layers. In contrast, deformation of thick lamellae (>100 nm) manifests cavitation in both soft and hard nanolayers. In situ tensile-SAXS experiments revealed the evolution of cavities during deformation and confirmed that the damage in such systems reflects both plastic deformation by shear and residual cavities. The aspects of the mechanics should point to universal deformation behavior in broader classes of asymmetric hard-soft lamellar materials, whose properties are just being revealed for versatile applications.

Astrocyte migration in injectable gelatin-hydroxyphenyl propionic acid matrices for neuronal guidance in spinal cord injury

Event Abstract Back to Event Astrocyte migration in injectable gelatin-hydroxyphenyl propionic acid matrices for neuronal guidance in spinal cord injury Josna Joseph1*, Kazuhide Hayakawa2*, Motoichi Kurisawa3*, Li Shan Wang3*, Wanting Niu1 and Myron Spector1 1 VA Boston Healthcare System, Brigham&Women's Hospital, Harvard Medical School, Tissue Engineering, United States 2 Massachusetts General Hospital, Neuroprotection Research laboratory, Department of Neurology& Radiology, United States 3 Institute for Bioengineering and Nanotechnology, Singapore Introduction: The glial scar that is formed around residual cavities after certain spinal cord injuries is a physical and physiological impediment to neuronal regeneration. Gelatin–hydroxyphenyl propionic acid (Gtn-HPA), a novel injectable matrix with tuneable cross-linking properties[1], could provide the missing stroma in such defects, enabling migration of astrocytes from the glial scar into the matrix-filled defect and their guidance of neurons into the lesion[2]. The principal objective of this study was to evaluate astrocyte migration and activation in an in vitro ‘tissue simulant’ model using Gtn-HPA incorporating select growth factors. Materials and Methods: Cortical astrocytes were isolated from postnatal rats, and grown in DMEM high glucose medium. Astrocyte proliferation in Gtn-HPA gels at days 2, 4 and 7 was analysed by counting live cells stained by Calcein-AM under fluorescence microscopy. A three-dimensional migration assay model was set up in 3% agarose-coated 24-well culture plates by surrounding Gtn-HPA cores (1cm diameter) containing EGF (50 or 200 ng/ul) or TGF-β1 (50 or 200 ng/ul) with an annular tissue simulant of 2 wt. % Gtn-HPA gel (cross-linked with 0.1 U/ml horseradish peroxidase and 1.2 mM H202) containing 3*105 cells/ml. Cellular migration into the growth factor-laden inner core was analysed quantitatively by counting cells and measuring the migration distance (n=5 fields) from the gel interface to the farthest cell body (n=4 gels) under phase contrast microscopy. Immunostaining of 30-mm thick cryo sections of gel construct was carried out to detect the presence of GFAP-positive astrocytes. GFAP expression by migrated cells was quantified by Western blot by lysing the gel with collagenase 1 (500U/ml). The results were tested for statistical significance by ANOVA and post-hoc tests. Results and Discussion: Astrocytes migrated in response to chemotactic gradients in Gtn-HPA gels in contrast to the blank gels which displayed virtually no migration. The migration distance was significantly higher (p<0.001) in TGF-50 ng (TGFL) group when compared to EGF and blank Gtn-HPA control group (Fig.1). The number of cells infiltrating the inner core and GFAP expression was significantly higher in the EGF-50 ng (EGFL) group (Fig.2). This indicates that astrocytes migrate well in response to TGF-β1 and are activated by EGF at low concentration, whereas higher conc. of EGF has no specific effect on GFAP expression. Conclusion: This study shows that growth factor-laden Gtn-HPA hydrogels provide a supportive environment for astrocyte migration, proliferation and activation. Gtn-HPA hydrogels laden with optimum combination of EGF and TFG-β1 could effectively guide astrocyte infiltration and subsequent neurite outgrowth in a spinal cord injury defect with diminished glial scarring. J. Joseph acknowledges Fulbright Fellowship from United States India Educational Foundation. Gtn-HPA was provided by the Institute of Bioengineering and Nanotechnology, Singapore.

Surgery of a Hydatid Cyst of the Left Ventricle

A fifteen-year-old patient, with no past medical history, was admitted to the cardiology department for dyspnea occurring at the effort. Physical examination of the patient showed no signs of cardiac failure, with a normal cardiac and pulmonary auscultation. Electrocardiogram revealed a sinus rhythm with tachycardia. Chest radiography showed no cardiomegaly and no mediastinal or pulmonary opacity. So, a trans-thoracic echocardiography was performed. It confirmed a huge cystic formation measuring 9 cm of diameter, located into the posterior wall of the left ventricle. Diagnosis of hydatidosis was suspected, and thoraco-abdominal magnetic resonance imaging was performed. It revealed a huge cyst occupying the posterior and the inferior wall of the left ventricle (Figure 1), without hepatic involvement. So, our patient was operated under cardiopulmonary bypass between the ascending aorta and the two venacava. Cysto-pericystectomy of the sous-epicardic mass was done after exposure of the inferior wall of the heart (Figure 2). Then, the residual cavity was repaired by direct suture. The postoperative period was uneventful with resolution of the dyspnea.

Наложение двойного спирального непрерывного гемостатического шва при резекции печени

The new method of applying a suture during hepatic resection was developed. It consists in applying a double spiral uninterrupted hemostatic suture after resection. The method approved in the 24 dogs experiment revealed good results. The application of the technique developed accelerates suturing, provides a reliable hemostasis, ensures uniform compression on the vascular and bile formations of liver parenchyma at the manipulation area, and significantly reduces the ischemic area of the liver stump, which lies distal to sutures. It minimizes the chance of postoperative necrosis of this area and reduces the number of possible residual cavities between the wound surface of the liver and epiploon portion. It contributes to far more successful surgical results with minimum postoperative complications.

Surgical treatment of complicated liver echinococcosis - Our experience with 184 cases in 10 Years

Background: The aim of this study was to analyze the treatment of patients with complicated liver hydatid cysts. Methods: The records of 184 patients who had undergone surgery for complicated liver hydatid cyst in our institution during 2005 and 2014 were reviewed retrospectively. Results: Among all complications, the most common were intrabiliary rupture (140 patients) and suppuration of the cysts (27 patients). Eleven cases had a combination of two complications. Other complications were rupture in the thorax (4 cases), rupture in the peritoneum (7 patients) and vascular erosions (6 patients). Surgery was based on the nature of complications, number and sizes of hydatid cysts and patients general condition. The surgical treatment of choice was partial (peri) cystectomies and drainage of the residual cavity with suture of the biliary fistula. In cases with complications such as suppuration, remaining bile fistulas, large cyst cavities or extrahepatic location, external drainage of the common bile duct (CBD)was mandatory. Post-operative complications occurred in 45 patients (24.4 %). Postoperative mortality was 1 % (two patients). Conclusion: Appropriate investigation and well planned surgical techniques may improve the outcome of complicated liver echinococcosis. These data suggest that cyst diameter is an independent factor that is associated with a high risk of biliary-cyst communication in clinically asymptomatic patients. Preoperative endoscopic retrograde cholangiopancreatography (ERCP) should be performed in these asymptomatic patients to reduce the incidence of postoperative complications.

Mesenchymal stem cells in post-surgical cavities of large maxillary bone lesions.

Recent studies have highlighted that MSCs are capable of regenerating large bone defects when used in combination with bone substitutes and increasing allo-graft osteointegration. We investigated the hypothesis that autologous MSCs may lead to increased bone regeneration and reduced healing time in post-surgical cavities of large maxillary bone lesions. This study involved 10 patients (TEST GROUP) (6 males and 4 females). All patients had expansive mandibular lesions larger than 3 cm. From the surgical point of view, the 10 patients were treated with MSCs (withdrawal of the iliac crest bone marrow BMMSs) directly into the post-surgical cavity, without the addition of filler. and radiological data, in the postoperative, were compared to those of patients who did not receive any grafting of MSCs. The 7 patients with mandibular lesions showed a rapid and very good healing with an 85-90% ossification of the major defect at 12 months. Through the use of stem cells a greater ossification of the residual cavity (85-90%) was observed at 12 months after surgical enucleation in contenitive defects.

Adjunctive role of dental restorations in personal identification of burnt victims

Background:Fire remains one of the major causes of morbidity and mortality throughout the world and identification of a body from the fatal fire remains a daunting task. Several forensic cases involve interpretation of burnt human bodies from airline and automobile accidents, bombings and unlawful cremation. Fire is also involved in homicides, suicides, accidental death, arson and in attempts to destroy forensic evidence in criminal cases. Soft tissue destruction from fire can be so extensive that conventional methods of identification may be impossible. However, teeth survive even high temperatures due to their resistant composition and so, obviously, the restorative material housed in the teeth are even more secure and can yield valuable information in personal identification.Aim:To assess the usefulness of most common restorations in personal identification in burnt cases.Materials and Methods:The study was conducted on 40 extracted teeth which were divided into four groups (Group 1 - Unrestored teeth, Group 2 - Amalgam restored, Group 3 - Glass ionomer restored and Group 4 - Composite resin restored teeth. The effect of incineration at 200°C, 400°C, 600°C, 800°C, 1000°C for 15 min at each target temperature followed by subsequent cooling was studied.Results:Amalgam restoration was resistant and intact even at 1000°C, whereas GIC and composite restoration are identifiable till 600°C, the residual cavity preparation leaves a clue for narrowing down the spectrum of identification.

The choice of treatment of patients with liver echinococcosis in children

For the Article by Salimov Sh. T. as co-author on the topic: “The choice of treatment in patients with hepatic echinococcosis in children”. The article analyzes the results of treatment of 96 patients aged 3 to 18, who underwent laparoscopic echinococcectomy between 2007 and 2015. Solitary echinococcosis was detected in the liver of 66 (68.8 %) patients, multiple (two or more cysts) — in 30 patients (31.2 %). A total of 147 echinococcus cysts were removed. Of the 96 taken laparoscopic liver echinococcectomy in 7 (7.3 %) cases due to intrahepatic localization of the cyst and due to technical difficulties, conversion was required. Residual cavities located in the anterior segments of the liver — were laparoscopically sutured inside. Rigid RC (residual cavities) of IV–V liver segments in the vicinity of the gate of the liver and gall bladder were dabbed with greater omentum. Fibrous capsule of residual cavity of visceral surface of the liver was excised circularly within the liver tissue and external drainage was performed. Medium and large size of the residual cavity of VI–VII and VIII segments of the liver, after excision of the fibrous capsule was drained as well. In fine and small residual cavity of echinococcus cyst was performed laparoscopic coagulation of the inner wall of the fibrous capsule with abdominization without drainage.In 89 (92.7 %) patients after laparoscopic liver echinococcectomy postoperative period was much more favorable than after traditional echinococcectomy. Patients intensified by the end of 1–2 days. 5 (5.2 %) patients had bile leakage on drainage, which independently docked at 8–11 day, suppuration of the residual cavity was observed in — 3 (3.1 %), non-parasitic cyst formation in the late period was observed in 7 (8.3 %) patients. The average hospital stay in the postoperative period was 6.5 ± 0.5 bed days. Laparoscopic elimination of residual cavity at echinococcectomy liver with kapitonnage, external drainage, abdominization, omentoplasty methods is accompanied by a significant attenuation of the cavity and extends the subsequent elimination of the residual cavity.

Metastatic nodular pneumonia due to septic embolism: a Staphylococcal infection

Ill-defined lung nodules mimicking secondary metastasis caused by Staphylococcus aureus though defined, is uncommon. We report a 58 years male with chest pain, dry cough, fever and abscess over the nape of neck. Bilateral nodules in the chest x-ray resembled metastasis. Workup for malignancy was negative. Induced sputum grew Staphylococcus aureus resistant to penicillin group. The lesions cavitated and produced air-fluid levels. Computed tomography confirmed the peripheral location, right sided hydropneumothorax and loculated fissural collection. Recovery was favourable but delayed with injectable ceftriaxone and levofloxacin initially followed by oral levofloxacin. Review chest radiograph showed residual cavities with small pneumothorax. Follow-up after three months showed resolution of all cavities and pneumothorax. Literature review revealed both Methicillin sensitive and resistant staphylococcus aureus can cause metastatic nodular pneumonia. Rapidly necrosis occurs if the organisms are capable of producing the toxin: Panton-Valentine Leukocidin. But this tendency is more common with community-acquired methicillin resistant strains.Journal of Advances in Internal Medicine 2014;3(2):68-71

Efficacy of Equine Demineralized Bone Matrix in treating Oral Cyst following Enucleation: A Histologic and Clinical study in Humans

Objectives: The aim of this study is to report the effect of equine demineralized bone matrix (DBM) on the healing of oral cystic cavities following enucleation using clinical parameters. Study design: Twelve patients aged from 20 to 40 years and suffering from cystic lesion in the jaw were included in this study. Cystic cavity augmentation with DBM was performed on 6 patients. After an average of 6 months’ healing period, a core bone was obtained and stained for histologic analysis simultaneously with implant placement. Results: Uneventful healing and spontaneous filling of the residual cavities was obtained in all cases. All implants showed favorable Osseointegration, and final restorations were completed without failure in all cases. Histologically, new bone formation was active around grafted bone, and grafted bone was well integrated to the newly formed bone matrix. In histomorphometric analysis, vital bone volume was 25.2 ±11.9%. Conclusion: The equine DBM is clinically useful for the increase of bone volume in cystic cavities after enucleation, because of its favorable effect of new bone formation and it is considered to be a safe, simple, reliable, acceptable, and easy handling bone grafting material.

Left Atrial Appendage Remodeling After Lariat Left Atrial Appendage Ligation.

Left atrial appendage (LAA) ligation with the Lariat device is being used for stroke prevention in atrial fibrillation. Residual leaks into the LAA are commonly reported after the procedure. Little is known about the anatomic LAA remodeling after Lariat ligation. In an exploratory study, we evaluated LAA 3-dimensional geometry via computed tomographic scan in 31 consecutive patients before Lariat closure and after a minimum of 30 days post procedure. Thirteen patients were classified as unfavorable cases based on anatomic criteria. Our population had an average age of 70±12 years, a mean CHADS2 (congestive heart failure, hypertension, age>75, diabetes mellitus, history of stroke) score of 3.2±1.2, a mean CHADS2VASC (CHADS2 in addition to female sex, ages 65-75, as well as double impact of age >75, vascular disease) of 4.2±1.5, and a mean HASBLED (hypertension, abnormal renal/liver function, stroke, bleeding predisposition/history, labile international normalized ratio, elderly, drugs/alcohol) bleeding score of 4.0±1.1. Successful suture deployment was achieved in all cases, but 3 patients had intraprocedural residual flow into the LAA (leak). On follow-up, 10 patients (32%) had recanalized residual LAA cavities, which were morphologically similar to the original LAA, albeit significantly smaller in volume (22.5±13.3% of the original volume). Recanalization was not associated with age, sex, comorbid conditions, stroke or bleeding risk scores, follow-up interval, baseline LAA volume, or morphology. Unfavorable cases had anatomic outcomes comparable with those of the anatomically favorable population. No patients have exhibited thromboembolism after 842±338 days post ligation. Incomplete LAA ligation after Lariat is common. However, the remodeled LAA cavity is dramatically reduced. Diminished cavity size and tightening of the LAA orifice may play a role in the reduction of thrombus formation.

Imaging features and diagnosis of hepatic cystic echinococcosis

Objective To summarize the features of computed tomography (CT) and magnetic resonance imaging (MRI) of hepatic cystic echinococcosis, and investigate the key points of identification and diagnosis. Methods The clinical data of 58 patients with hepatic cystic echinococcosis who were admitted to the Affiliated Hospital of Inner Mongolia Medical University from August 2011 to August 2014 were retrospectively analyzed. Patients received plain and enhanced scan of CT and MRI. Hepatic cystic echinococcosis was divided into the 5 types according to the literatures, including unilocular echinococcasis in type Ⅰ, multivesicular hydatid cysts in type Ⅱ, anechoic content with detachment of laminated membrane from the cyst wall in type Ⅲ, calcification of lesions in type Ⅳ and mixed echinococcosis in type Ⅴ. Patients who were diagnosed as with definite or suspected hepatic cystic echinococcosis underwent surgery. The follow-up including observing the recurrence of hepatic cystic echinococcosis was performed by outpatient examination and telephone interview at postoperative month 3, 6, 12 for 1 year and then once every year up to August 2015, and was ended if there was no recurrence for more than 5 years. Results (1) The results of CT and MRI examinations: of the 58 patients, 54 received scan of CT and 21 received scan of MRI. Seventeen patients were detected in type I with clear-boundary and low-density cystic lesions by CT examination; MRI examinations showed there were single or multiple, round or oval abnormal signal including low T1WI signal, high T2WI signal and low T1WI and T2WI signal of cyst wall. Thirteen patients were detected in type Ⅱ, CT examination showed the daughter cysts of multiple sizes were found in the mother cyst, arranged in honeycomb or wheel shape; MRI examination showed there were lower T1WI signal in the daughter cyst and higher T2WI signal in the daughter cyst compared with signal in the mother cyst, and low signal in the cyst wall of the daughter cyst and mother cyst. Six patients were detected in type III with in sign and water snake sign by CT examination and ribbon sign by MRI examination. Thirteen patients were detected in type Ⅳ, CT examination showed there were irregular high-density calcified shadow with the performances for return or sample volume skins changes. Nine patients in type Ⅴ had more than 2 kinds of lesions. (2) Diagnosis: 4 patients were misdiagnosed by CT examination including 3 with preoperative diagnosis of hepatic cyst and 1 with preoperative diagnosis of metastatic carcinoma of liver, with an accurate rate of diagnosis of 92.6%(50/54). Two patients with preoperative diagnosis of hepatic cystic adenocarcinoma were misdiagnosed by MRI examination, with an accurate rate of diagnosis of 90.5%(19/21). (3) Treatment and follow-up: 58 patients underwent surgery, including 40 undergoing internal capsule removal with external capsule suturing (31 with open operation and 9 with laparoscopic operation), 10 undergoing partial hepatectomy and 8 undergoing external capsule enucleation. Of 58 patients, 3 were complicated with effusion of residual cavity, 2 with unclosed external capsule, 1 with bile leakage and then was cured after 4-8 week drainage. Fifty patients were followed up for 12.0-48.0 months with a median time of 27.1 months and a follow-up rate of 86.2%(50/58). During the follow-up, 1 patient undergoing internal capsule removal had recurrence at postoperative month 8 and was cured by CT-guided interventional therapy using absolute alcohol, and other patients had no recurrence. Conclusions There was a higher accuracy in CT and MRI examinations for hepatic cystic echinococcosis. Honeycomb and wheel shapes are characteristic findings of hepatic cystic echinococcosis in type II. The characteristic performances of CT examination for hepatic cystic echinococcosis in type III are in capsule and water snake signs, and characteristic performances of MRI examination is ribbon sign. The ring-like enhancement of edge by MRI examination is an essential of identification and diagnosis between hepatic cystic echinococcosis and hepatic cyst, and irregular calcification is a differential point between hepatic echinococcosis and hepatic tumor. Key words: Echinococcosis, hepatic; Tomography, X-ray computed; Magnetic resonance imaging; Diagnosis

The chondromyxoid fibroma toe: About a case and review of the literature

The chondromyxoid fibroma is a rare benign bone tumor that represents less than 1% of all bone tumors and may raise diagnosis problems to the pathologist. We report the case of a 46 years old woman with no particular history, admitted for management of painful swelling of the 2nd left toe without alteration of her general condition. Clinical examination found a mass at the dorsum of the third phalanx of the second left toe, painful, hard and fixed at the deep plan. Foot X-ray showed an osteolytic lesion of the phalanx with dented outlines. The patient underwent a resection of the mass with the establishment of a small cortico-cancellous graft taken from the ipsilateral iliac crest and maintained by racking. Pathological examination of the piece of surgical resection showed a chondromyxoid fibroma. The outcome was favorable with no clinical or radiological abnormalities after 10 months of decline. Bone tumors are rarely located in the foot; this low incidence exposed to delays and errors in diagnosis and in treatment decisions. The chondromyxoid fibroma is a rare benign tumor of the bone (2% of benign tumors). Pain is the most common symptom. If it affects long bones most of the time, its location in short or flat bones is rare. Imaging makes the positive diagnosis, and its treatment is the surgical resection of tumor tissue with filling the residual cavity by cortico-cancellous tissue to prevent recurrence. The chondromyxoid fibroma is a rare benign tumor and radiology allows the diagnosis of lytic lesion, its treatment being surgery.

Comparison of endoscopic endonasal and bifrontal craniotomy approaches for olfactory groove meningiomas: A matched pair analysis of outcomes and frontal lobe changes on MRI

We compare the outcomes and postoperative MRI changes of endoscopic endonasal (EEA) and bifrontal craniotomy (BFC) approaches for olfactory groove meningiomas (OGM). All patients who underwent either BFC or EEA for OGM were eligible. Matched pairs were created by matching tumor volumes of an EEA patient with a BFC patient, and matching the timing of the postoperative scans. The tumor dimensions, peritumoral edema, resectability issues, and frontal lobe changes were recorded based on preoperative and postoperative MRI. Postoperative fluid-attenuated inversion recovery (FLAIR) hyperintensity and residual cystic cavity (porencephalic cave) volume were compared using univariable and multivariable analyses. From a total of 70 patients (46 EEA, 24 BFC), 10 matched pairs (20 patients) were created. Three patients (30%) in the EEA group and two (20%) in the BFC had postoperative cerebrospinal fluid leaks (p=0.61). Gross total resections were achieved in seven (70%) of the EEA group and nine (90%) of the BFC group (p=0.26), and one patient from each group developed a recurrence. On postoperative MRI, there was no significant difference in FLAIR signal volumes between EEA and BFC approaches (6.9 versus 13.3cm3; p=0.17) or in porencephalic cave volumes (1.7 versus 5.0cm3; p=0.11) in univariable analysis. However, in a multivariable analysis, EEA was associated with less postoperative FLAIR change (p=0.02) after adjusting for the volume of preoperative edema. This study provides preliminary evidence that EEA is associated with quantifiable improvements in postoperative frontal lobe imaging.

Chronic airway obstruction after successful treatment of tuberculosis and its impact on quality of life.

Tuberculosis (TB) clinic in Tijuana, México. Chronic airway obstruction (CAO) can be a sequella of pulmonary tuberculosis (PTB), independently of smoking history. To determine the prevalence of CAO in subjects recently recorded as cured after treatment of PTB, and its impact on quality of life. Cross-sectional study. Overall, 34.3% of patients with a history of PTB had non-reversible CAO, defined as FEV1 <70% post-bronchodilator. Subjects with CAO had significantly more radiographic fibrocavitary sequellae on chest X-rays, more extensive changes (1.8 ± 0.8 affected quadrants vs. 1.3 ± 0.6, P = 0.04), more residual lung cavities (1.4 ± 0.8 vs. 0.5 ± 0.7, P = 0.002), and greater mediastinal retraction (42.4% vs. 16.7%, P = 0.026). The mean COPD Assessment Test score for subjects with CAO was 15.1 ± 10.4. The prevalence of irreversible CAO using the lower limit of normal criteria was higher (40%) than that calculated with fixed ratio criteria (34.3%). Functional abnormalities are frequently already present at the end of treatment for PTB; patients with CAO are often symptomatic and experience a significant impact on quality of life.

Drainage of a Pancreatic Pseudocyst via a Spontaneous Cyst Duodenostomy

51-year-old woman presented with 5 days of Aacute-onset severe epigastric and right upperquadrant pain associated with nausea and vomiting. Laboratory test results showed obstructive jaundice and acute pancreatitis. An abdominal ultrasound showed multiple stones within the gallbladder and a dilated common bile duct (CBD). A computed tomography (CT) scan showed evidence of severe necrotizing pancreatitis and the patient was started on intravenous fluids and antibiotics. Three days later, as a result of progressive obstructive jaundice and possible cholangitis, an endoscopic retrograde cholangiopancreatography was performed that showed a distal CBD stricture. Complete ductal clearance of stones could not be achieved and a plastic stent was placed. Symptoms improved and she was discharged home for elective cholecystectomy. Ten weeks later she returned with fevers, chills, and severe abdominal pain. The gallbladder and biliary stent were in place and liver function test results were normal. A CT scan of the abdomen now showed a 15 12.5 cm pancreatic pseudocyst (Figure A). Endoscopic cyst-gastrostomy was attempted 1 day after the CT scan. An esophagogastroduodenoscopy showed a large opening within the duodenal bulb leading into the pseudocyst cavity (Figure B). Minimal fluid was seen within the pseudocyst cavity along with trace amounts of adherent debris along the walls (Figure B). Endoscopic ultrasound confirmed a partially drained cystic collection. She returned 11 weeks later for endoscopic retrograde cholangiopancreatography, stent removal, and clearing of the CBD stones. The cyst-duodenostomy appeared well healed without evidence of a residual cyst cavity (Figure C); this was confirmed on CT scan (Figure D).