Surgical Findings Research Articles

HPV-Related Multiphenotypic Sinonasal Carcinoma: A Clinicoradiological Series of 3 Cases With Full Endoscopic Surgical Outcome.

Context: Human papillomavirus (HPV)-related multiphenotypic sinonasal carcinoma (HMSC), formerly known as HPV-related carcinoma with adenoid cystic like features, is a rare tumor subtype with unusual correlation between radiological, histopathological, and surgical findings. The shared histological characteristics with other sinonasal tumors make the diagnosis challenging. Optimal surgical and oncological treatments for this rare condition remains to be clearly defined. Methods: The objective of the study was to describe the unique characteristics and endoscopic surgical treatment of this rare tumor. In this retrospective case series, all patients with an HMSC diagnosis treated in our tertiary center were selected. Results: Three HMSC cases were identified, including 2 male and 1 female patients. All cases originated from the posterior nasal cavity. One case presented with a tumor of 8.9 cm × 6.4 cm × 8.7 cm, which is the largest tumor volume described to date. All patients received exclusively endoscopic surgical treatment, followed by adjuvant radiation therapy. No patient showed clinical or radiological sign of disease recurrence, or regional or distant metastasis, with a follow-up ranging from 9 months to 4 years. In 2 cases, initial diagnoses incorrectly suggested adenoid cystic or basaloid squamous cell carcinoma. HPV-DNA testing confirmed the presence of HPV in all cases, with identification of strains 16 and 18. Conclusion and Relevance: HMSC represents a newly identified diagnosis that constitutes a significant challenge for both clinicians and pathologists. It is crucial to acknowledge its indolent clinical course and the apparent contradiction between aggressive radiological features and the noninvasive nature of surgical findings. Skull base surgeons should be aware that, despite these complexities, endoscopic treatment is achievable in the majority of cases. This understanding is essential for the effective management of HMSC.

Non-contrast MRI and post-mastectomy silicone breast implant rupture: preventing false positive diagnoses.

Breast implants are not lifelong, with implant rupture being the third leading cause of revisional surgery in augmented women. Noncontrast MRI is a reliable tool to assess implant integrity; however, false positive and false negative diagnoses have been reported due to an incorrect interpretation of MRI signs. This study aims to investigate the incidence of these misleading results, comparing MRI findings with intraoperative surgical observations and exploring signs of nonunivocal interpretation. Between March 2019 and October 2022, our hospital, a referral center for breast cancer care, conducted 139 breast MRI examinations to evaluate implant integrity. Surgical intervention was deemed necessary for patients diagnosed with suspected or confirmed implant rupture at MRI. Those patients who did not undergo any surgical procedure (63 cases) or had surgery at different institutes (11 cases) were excluded. Among the 65 patients who underwent preoperative MRI and subsequent surgery at our institute, surgical findings confirmed the preoperative MRI diagnosis in 48 women. Notably, 17 women exhibited a discordance between MRI and surgical findings: three false negatives, 11 false positives and three possible ruptures not confirmed. Signs of nonunivocal or misleading interpretation were assessed on a patient-by-patient basis. The importance of obtaining detailed information about a patient's breast implant, including fill materials, number of lumens, manufacturer and shape, proved immensely beneficial for interpreting MRI signs accurately. Pre-MRI knowledge of implant details and a meticulous evaluation of non-univocal signs can aid radiologists in accurately assessing implant integrity, reducing the risk of unnecessary revisional surgeries, and potentially averting allegations of medical malpractice.

Clinical outcomes after hip arthroscopy in acetabular dysplastic patients, previously treated with periacetabular osteotomy: a minimum of two-year follow-up data from the Danish Hip Arthroscopy Registry

ABSTRACT Periacetabular osteotomy (PAO) is the treatment of choice in dysplastic acetabulum. Due to continued symptoms, 2–11% of these patients require an additional hip arthroscopy. The purpose of this study was to report clinical outcome after a minimum of 2-year follow-up of additional hip arthroscopy after PAO with data from Danish Hip Arthroscopy Registry. Inclusion criteria in the study cohort were PAO surgery resulting in an additional hip arthroscopy procedure. The cohort was evaluated according to the surgical findings and patient-related outcome measures (PROMs) pre-operatively and at 2-year follow-up. A total of 287 patients were included in the study cohort. PROMs improved significantly in all subscales from pre-operatively to 2-year follow-up in the study cohort. According to PROM subscales, 47.8–57.6% and 25.2–38.2% achieved Minimal Clinical Important Difference and Patient Acceptable Symptom State, respectively. This study demonstrates, in PAO-treated patients, significant PROM improvements after additional hip arthroscopy. Unfortunately, only ∼50% and 30% achieved Minimal Clinical Important Difference and Patient Acceptable Symptom State, respectively.

Chiasm gliomas in pediatric patients. Part 1. Сlinical manifestations

Chiasm gliomas are very important heterogeneous group of tumors manifesting in the first and second decades of life and is the second leading cause of blindness in children with neurosurgical pathology. It is a benign, slow-growing piloid astrocytoma, accounting for 1–5% of intracranial gliomas in children. The incidence of neurofibromatosis type 1 among patients with chiasm glioma ranges from 7 to 60%. The location of the tumor is determined based on ophthalmological symptoms, neuroimaging data (MRI), and surgical findings. The initial growth of the tumor occurs in the anterior visual pathway structures (optic nerves, chiasm, optic tracts) and leads to ophthalmological symptoms, which are dominant in the clinical manifestations of the disease. Chiasm damage may occur in one or both optic nerves, in one or both optic tracts. Damage to the chiasm manifests as bitemporal heteronymous hemianopsia. Moreover, the spread of the tumor to the optic nerves is accompanied by decreased visual acuity. Damage to the optic tract is manifested by homonymous hemianopia and normal visual acuity. However, isolated damage to the optic tract is uncommon and usually occurs with chiasm and optic nerve lesions; hence, visual disturbances are more complex. Lesions in the optic nerve fibers in the chiasm and optic nerves/tracts lead to primary descending atrophy of the optic nerves. Papilledema with optic nerve atrophy indicates occlusive hydrocephalus. Delayed diagnosis of the disease affects treatment results.

Long-term outcome of microvascular decompression for typical trigeminal neuralgia with autologous muscle: an analysis of 1025 patients from a developing country.

The objective was to evaluate the long-term outcome of microvascular decompression (MVD) utilizing autologous muscle for trigeminal neuralgia (TGN). A retrospective review was performed of all first-time MVD patients for typical classic TGN without prior surgical intervention who were treated between 2000 and 2019 at a tertiary supraregional neurosurgery practice. Demographic characteristics, surgical findings, operative results, complications, and recurrence rates at 1 year, 5 years, and last follow-up were collected. Pain outcome was assessed using the Barrow Neurological Institute (BNI) pain score. The chi-square test with continuity correction was used to compare categorical variables, and Kaplan-Meier curves and Cox regression were used to identify factors associated with recurrence. In total, 1025 patients were studied with a median (interquartile range [IQR]) (range) follow-up of 8 (5-13) (3-20) years. In the immediate postoperative period, 889 patients (86.7%) had complete pain relief and 106 (10.3%) had partial pain relief; neither group required medication, and 30 patients (2.9%) had no relief. One hundred forty-one recurrences (13.8%) occurred over a median (IQR) of 3 (2-6) years after surgery. The proportion of patients without recurrence was 97% at 1 year, 90% at 5 years, 85% at 10 years, 82% at 15 years, and 81% at 20 years. There was no significant difference in the probability of recurrence between patients with complete (114/907 [12.6%] recurrences) or partial (19/106 [17.9%] recurrences) postoperative pain relief (p = 0.124, log-rank test). Patients with venous compression (n = 322) had a significantly higher rate of MVD failure (n = 16 [5%]) compared to those with arterial compression (14/703 [2%]) (p = 0.015, chi-square test). In the Cox proportional hazards model, venous compression and lack of immediate postoperative pain relief had hazard ratios of 1.62 (95% CI 1.16-2.27) and 2.65 (95% CI 1.45-4.82) for recurrence, respectively. One hundred twenty-four (12.1%) complications were documented, including facial numbness (44 [4.3%]), facial nerve palsy (37 [3.6%]), CSF leak (13 [1.3%]), and diplopia (5 [0.5%]), which resolved in all patients. MVD with autologous muscle provides long-lasting pain relief in TGN patients with vascular compression with minimum morbidity and is a viable alternative to synthetic materials.

Correlación clínico-patológica para el diagnóstico de mastitis crónica tratada con cirugía

ObjectivesChronic mastitis (CM) frequently relapse without an identified etiology, although they have been treated with a spectrum of treatments that includes different antibiotics, anti-inflammatories and surgery, more or less aggressive depending on their extension. The objective is to investigate if clinicopathological correlation is useful in the diagnosis of CM. Material and methodsA descriptive, observational and retrospective study of a series of 100 patients (n = 100) diagnosed during ten years with CM is presented. Anamnesis, clinical debut, physical examination, imaging techniques, type of surgery, number of recurrences, histological inflammatory pattern data, complementary tests including microbiological study and serology, number of biopsies, number of consultation visits and time until final diagnosis are evaluated. Finally, the average of cases diagnosed by clinicopathological correlation is determined. ResultsResults of surgical interventions, clinical and histopathological findings, microbiology and serology are included in tables. Clinicopathological correlation achieved etiopathogenic diagnosis in 99% of the cases including chronic suppurative galactophoritis (91%); vasculitis (3%), two of them compatible with granulomatosis with polyangiitis; idiopathic granulomatous mastitis (2%) and non-diabetic lymphocytic lobulillitis (3%). Thirty-eight percent of the cases presented recurrences. The mean time to definitive diagnosis was 20.02 (standard deviation = 49.87) weeks. The average number of visits to outpatient clinics was 15.35 (standard deviation = 14.97). ConclusionsClinicopathological correlation improves the diagnosis of CM, specially relapsed and without an identified etiology, although it may take a long time.

Abstract 5065: Integrating blood based liquid biopsies with TNM stage improves survival prediction model for non-small cell lung cancer

Abstract Introduction:Stage is the most important prognostic factor for survival in non-small cell lung cancer (NSCLC). The current TNM (Tumor, Node, Metastasis) staging system for NSCLC uses physical exam, histology, imaging, and surgical findings to define the extent and spread of a patient’s cancer. Despite advances in molecular testing which can impact treatment and prognosis for NSCLC patients, the current system does not incorporate molecular data into staging. We proposed a novel predictive model for survival analysis which integrates molecular analysis of liquid biopsies (B) into the TNM staging system (1). In this study, we tested this new staging system and our predictive model shows TNM + B (TNMB) provides a better predictive model for survival compared to TNM alone. Methods:176 patients were identified at Atrium Health Wake Forest Baptist with Guardant 360 liquid biopsies sent at diagnosis for NSCLC. Clinical data was obtained through retrospective chart review. Molecular analysis was performed on 81 genes across all Guardant 360 liquid biopsies. Using Cox proportional hazards model, we identified significant gene mutations or genes with significant magnitude of variant allele frequency (VAF) that improved survival prediction. We then designed a novel staging system incorporating whether a patient had a positive liquid biopsy test (B1), defined by the presence of these impact gene variables, to TNM stage. Results: Three impact genes STK11 (p=0.0253), NFE2L2 (p = 0.0025), TP53 (p=0.0129) and one gene with a magnitude of VAF, ARID1A (p=0.0082) was identified which significantly improved the predictive model for survival. Patients with negative liquid biopsy test, B0, had improved survival compared to patients with a positive liquid biopsy test, B1 (p<0.005). In our cohort, TNM staging alone did not show a significant survival difference between stage II and III (p = 0.19). Whereas TNMB staging showed a significant survival difference between stage II, III and IV. Conclusions: While TNM stage remains a major prognostic factor for NSCLC patients, it fails to incorporate molecular data which has a critical impact on management and prognosis. We designed a novel method to analyze molecular data obtained by liquid biopsy to identify significant gene mutations and gene magnitude of VAF that impacts survival prediction. In our cohort, we showed 4 impact genes which we used to create a new TNMB staging system which led to improved survival prediction compared to TNM alone. Acknowledgments: Research partly supported by NIH T32 Grant (T32CA247819) and Cancer Center Support Grant (P30CA012197) Reference: (1) Yang M, Forbes ME, Bitting RL, O'Neill SS, Chou PC, Topaloglu U, Miller LD, Hawkins GA, Grant SC, DeYoung BR, Petty WJ, Chen K, Pasche BC, Zhang W. Incorporating Blood-based Liquid Biopsy Information into Cancer Staging: Time for a TNMB System? Ann Oncol. 2018 Feb 1;29(2):311-323. Citation Format: Lauren Schmalz, Cetin Urtis, Liang Liu, Elizabeth Forbes, Fang-Chi Hsu, Nury Steuerwald, Alberto de Hoyos, Thomas Lycan, Jimmy Ruiz, William Petty, Wei Zhang. Integrating blood based liquid biopsies with TNM stage improves survival prediction model for non-small cell lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 5065.

Probabilistic Prediction of Bowel Ischemia after Cardiothoracic Surgery.

Gastro intestinal ischemia (GIisch) is challenging to diagnose in patients after cardiothoracic surgery. Computed tomography angiography (CTA) carries substantial false-negative and false-positive rates. The aim of the study was to evaluate if a combination of readily available variables improves the diagnosis of GIisch after cardiothoracic surgery. This retrospective study included patients receiving intensive care after cardiothoracic surgery. GIisch was confirmed by surgical and/or endoscopic findings. A GIisch prediction score was developed using the Spiegelhalter-Knill-Jones system in a training cohort then tested in a validation cohort (patients without obvious signs of GIisch on CTA). The training cohort comprised 125 consecutive patients with suspected GIisch in 2008-2019, including 85 with confirmed GIisch. CTA, performed in 92 patients, had a high false-negative rate of 17/60 (28%) and a lower false-positive rate of 7/32 (22%). The score included cardiopulmonary bypass, negatively associated with GIisch, and six variables positively associated with GIisch: intraoperative mean arterial pressure <50 mmHg, aspartate aminotransferase >15N, lactate increase in 24 h >20%, and 3 CTA findings, namely, bowel dilation, bowel-wall thickening, and mesenteric vasoconstriction. The AUROC was 0.82 (95%CI, 0.51-0.93) in the training cohort and 0.82 (95%CI, 0.68-0.96) in the validation cohort (n=34 patients). Reliability of the predicted probabilities was greatest for probabilities ≤30% or ≥70 %. In patients receiving intensive care after cardiothoracic surgery, GIisch cannot be ruled out based solely on CTA findings. A scoring system combining CTA findings with other variables may improve the diagnosis of GIisch in this population.

Diagnostic performance of contrast enhanced computed tomography in intestinal obstruction

Intestinal obstruction (IO) is a frequent cause of admission to the surgery and emergency departments. For the prevention of complications, such as ischemia and perforation, early recognition of IO is crucial. Computed tomography (CT) provides excellent details regarding cause, site &amp; complications of IO and also helps in treatment planning.To evaluate the efficacy and accuracy of CECT imaging in diagnosing IO and detecting complications. To correlate CECT findings with surgical or histopathological findings. A prospective study was conducted in the Department of Radiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India for a period of 2 years from September 2020 to September 2022. Fifty patients with suspected intestinal obstruction were evaluated, after obtaining informed consent. Data was analysed using SPSS 22 version software. Male predominance was seen in this study, males constituted 58% and females 42%. The commonest age group affected was 41-50 years. Small bowel obstruction (SBO) was much more prevalent than large bowel obstruction (LBO). The most common site of BO was ileum. The leading cause of SBO was adhesions and in LBO was bowel malignancy. IO is a fairly common presentation in clinical and radiological practice. There are various causes as well as mimickers of IO, which makes it a challenging task to accurately diagnose. CECT helps in treatment planning by providing information about bowel viability. We found it is extremely useful to include CECT study as a standard protocol in evaluation of patients presenting with bowel obstruction.

Clinical course of five patients definitively diagnosed with idiopathic perilymphatic fistula treated with transcanal endoscopic ear surgery.

An idiopathic perilymphatic fistula (PLF) can be difficult to diagnose because patients present with sudden sensorineural hearing loss (SSHL) and/or vestibular symptoms without any preceding events. In such cases, we currently test for cochlin-tomoprotein (CTP) to confirm the diagnosis of idiopathic PLF because CTP is only detected in the perilymph. In this study, we report the clinical course of five patients definitively diagnosed with idiopathic PLF who underwent PLF repair surgery using transcanal endoscopic ear surgery (TEES). Five patients were initially treated with intratympanic dexamethasone for SSHL, at which time a CTP test was also performed (preoperative CTP test). Due to refractory hearing loss and/or fluctuating disequilibrium, PLF repair surgery using TEES was performed to seal the oval and round windows using connective tissue and fibrin glue. These patients were diagnosed with definite idiopathic PLF based on pre- or intra-operative CTP test results (negative, < 0.4 ng/mL; intermediate, 0.4-< 0.8 ng/mL; and positive, > 0.8 ng/mL). We evaluated pre- and intra-operative CTP values, intraoperative surgical findings via a magnified endoscopic view, and pre- and post-operative changes in averaged hearing level and vestibular symptoms. Pre- and intra-operative CTP values were positive and intermediate in three patients, positive and negative in one patient, and negative and positive in one patient. None of the patients had intraoperative findings consistent with a fistula between the inner and middle ears or leakage of perilymph. Only two patients showed a slight postoperative recovery in hearing. Four patients complained of disequilibrium preoperatively, of whom two had resolution of disequilibrium postoperatively. A positive CTP test confirms PLF in patients without obvious intraoperative findings. The CTP test is considered more sensitive than endoscopic fistula confirmation. We consider that CTP test results are important indicators to decide the surgical indication for idiopathic PLF repair surgery. In our experience with the five cases, two of them showed improvements in both hearing and vestibular symptoms.

Reinjury Following Return to Play.

Radiologists are frequently called on for guidance regarding return to play (RTP) for athletes and active individuals after sustaining a musculoskeletal injury. Avoidance of reinjury is of particular importance throughout the rehabilitative process and following resumption of competitive activity. Understanding reinjury risk estimation, imaging patterns, and correlation of clinical and surgical findings will help prepare the radiologist to identify reinjuries correctly on diagnostic imaging studies and optimize management for a safe RTP.

Respiratory epithelial adenomatoid hamartoma in a child with nasal polyposis. Case report

Benign and malignant formations of the nose and paranasal sinuses in the early stages of development are asymptomatic or manifest minor nonspecific signs, and therefore often remain unrecognized. Hamartoma is a tumor-like formation of a dysembriological nature, consisting of excessive tissues peculiar to the affected organ. Due to the rarity of the occurrence of hamartomas of the sinonasal region, especially in pediatric practice, their diagnosis may present certain difficulties, since they can mimic other formations, such as nasal polyps or inverted papilloma, may occur as an isolated formation in the nasal cavity, or in combination with chronic rhinosinusitis, nasal polyposis, allergic rhinosinusitis. Aim – to report a rare clinical case in pediatric practice of respiratory epithelial adenomatoid hamartoma associated with allergic rhinosinusitis and polyposis, display the relationship between the occurrence of respiratory epithelial adenomatoid hamartoma and chronic inflammation of the nasal cavity and paranasal sinuses, to carry out differential diagnosis with other exophytic aggressive lesions of the nasal cavity, combine and summarize available data on sinonasal hamartomas. The article describes a clinical case of respiratory epithelial adenomatoid hamartoma in a 17-year-old child with a previous 4-year follow-up with nasal cavity polyposis and a history of repeated polypotomy. The results of endoscopy and computed tomography of the nasal cavity and paranasal sinuses, the results of surgical intervention, as well as the conclusions of a histological examination of the tumor removed from the patient are presented. The authors analyzed the domestic and foreign literature, on the basis of which they presented a differential series of sinonasal hamartomas. Respiratory epithelial adenomatoid hamartoma is a rare pathological formation of the sinonasal region, which manifests itself as an isolated polypoid mass in the nasal cavity or as an accidental surgical finding in patients with chronic sinusitis. The association with nasal polyps supports the hypothesis that inflammation may be one of the inducing factors. Respiratory epithelial adenomatoid hamartoma, although rare, should be considered in the differential diagnosis of exophytic lesions of the nasal cavity. The tactics of treatment involves endoscopic removal of the formation within healthy tissues, which provides good long-term results, relapses are extremely rare.

Dynamic Magnetic Resonance Imaging (MRI) in Inguinal-Related Chronic Groin Pain (CGP): Comparison With Systematic Surgical Assessment.

Objective This study aimed to assess the performance of dynamic MRI in Chronic Groin Pain (CGP) related to the inguinal region, comparing it with surgery as the gold standard. Materials and methods A cohort of 25 consecutive patients exhibiting persistent clinical inguinal-related CGP underwent a pre-surgical pelvis MRI. Imaging encompassed strictly axial Fast Spin Echo (FSE) T1 sequences, both without (static sequence) and with Valsalva Maneuver (VM, dynamic sequence), alongside axial-oblique Proton Density weighted with Fat Saturation (PDFS). Evaluation of these sequences focused on identifying Abdominal Wall (AW) injuries. A consistent surgical approach was employed by the same surgeon across all patients (34 AW injuries in 25 patients). Specificity (Sp), Sensitivity (Se), Negative Predictive Value (NPV), Positive Predictive Value (PPV), and overall accuracy of MRI sequences and their combinations for detecting AW injuries were computed by comparing them to surgical findings. Results Ninety sequences were obtained, revealing that the axial PDFS oblique sequence emerged as the most singularly reliable (Accuracy: 58.82%). The optimal sequence combination was found to be axial T1 combined with axial T1 VM, exhibiting an accuracy of 75.00% (Se: 85.71%, Sp: 70.59%, PPV: 54.55%, NPV: 92.31%, with an average duration of 4 minutes and 31 seconds). Conclusion Based on our findings, we advocate for the adoption of the axial FSE T1 combined with Valsalva Maneuver as a dependable protocol for inguinal-related CGP, characterized by a highly reasonable examination duration.

Anatomical review of internal jugular vein cannulation.

The internal jugular veins (IJV) are the primary venous outflow channels of the head and neck. The IJV is of clinical interest since it is often used for central venous access. This literature aims at presenting an overview of the anatomical variations, morphometrics based on various imaging modalities, cadaveric and surgical findings, and the clinical anatomy of IJV cannulation. Additionally, the anatomical basis of complications, techniques to avoid complications, and cannulation in special instances are also included in the review. The review was performed by a detailed literature search and review of relevant articles. A total of 141 articles were included and organized into anatomical variations, morphometrics, and clinical anatomy of IJV cannulation. The IJV is next to important structures such as the arteries, nerve plexus, and pleura, which puts them at risk of injury during cannulation. Anatomical variations such as duplications, fenestrations, agenesis, tributaries, and valves, may lead to an increased failure rate and complications during the procedure, if unnoticed. The morphometrics of IJV, such as the cross-sectional area, diameter, and distance from the skin-to-cavo-atrial junction may assist in choosing the appropriate cannulation techniques and hence reduce the incidence of complications. Age, gender, and side-related differences explained variations in the IJV-common carotid artery relationship, cross-sectional area, and diameter. Accurate knowledge of anatomical variations in special considerations such as paediatrics and obesity may help prevent complications and facilitate successful cannulation.

Effects of hydronephrosis on the surgical outcomes of fluoroscopically guided supine percutaneous nephrolithotomy.

To evaluate the effect of hydronephrosis on operation success and the development of complications in supine percutaneous nephrolithotomy (PCNL). A total 259 patients were included in the study who underwent supine PCNL in our clinic between September 2019 and November 2023. The patients were divided into four groups: normal, mild, moderate and severe, according to their preoperative hydronephrosis degrees. Demographic data, kidney stone characteristics, clinical aspects, surgical findings, and postoperative complications were compared across groups. In terms of American Society of Anesthesiologists score, stone-free rate, operation time, fluoroscopy time, and Clavien-Dindo classification grades, a statistically significant difference was found between the hydronephrosis groups. The stone-free rate in the normal, mild, moderate, and severe groups was 86.6, 82.5, 76.0, and 61.5, respectively. The severe hydronephrosis group varied statistically substantially from the other hydronephrosis groups in terms of stone-free rate, according to the post-hoc analysis. In terms of Clavien-Dindo classification grades, the severe hydronephrosis group varied statistically significantly from the normal and mild hydronephrosis groups (p values 0.04, 0.02, respectively). In terms of Clavien-Dindo classification grades, no statistically significant difference was seen between the severe and moderate hydronephrosis groups (p = 0.085). The findings of this study demonstrated that the existence of hydronephrosis was a predictive factor for the occurrence of complications and decreased the success rate of supine PCNL. Furthermore, univariate and multivariate analyses showed that the presence of hydronephrosis was a predictive factor for PCNL success and the development of complications.

Comparison of diagnostic performance of X‑ray, CT and MRI in patients with surgically confirmed subtle Lisfranc injuries.

The present study aimed to compare the diagnostic performance of three imaging tests: X-ray, computed tomography (CT) and magnetic resonance imaging (MRI), for subtle Lisfranc injuries and three anatomical subtype injuries. The non-weight-bearing X-ray, CT and MRI imaging results of patients with subtle Lisfranc injuries from September 2013 to March 2022 were retrospectively reviewed. Subtle Lisfranc injuries and three anatomical subtypes (first, second and cuneiform rays) were diagnosed based on the surgical reports. The diagnostic performance of X-ray, CT and MRI was compared. The sensitivity (Sn), specificity (Sp), positive predictive value, negative predictive value, area under the receiver operating characteristic curve (AUC) and κ coefficient were reported. A total of 31 patients were included in the study. The correct diagnosis was made in 48.4% (15/31), 87.1% (27/31) and 96.8% (30/31) of patients by X-ray, CT and MRI, respectively. A total of 54 different anatomical injuries were found intraoperatively in all patients, with MRI and CT having high agreement (Sn, 72.2 and 87.0%; κ, 0.69 and 0.78, respectively) and X-ray having a low agreement (Sn, 29.6%; κ, 0.26) with the surgical findings. Regarding the first-ray injuries, CT had the highest Sn (76.9%), Sp (100%) and AUC (0.885) in diagnosing subtle Lisfranc injuries. MRI showed the best Sn (88.5 and 93.3%, respectively) and AUC (0.942 and 0.904, respectively) in both second and cuneiform rays. In conclusion, non-weight-bearing X-rays had poor diagnostic accuracy for subtle Lisfranc injuries and their subtypes. CT was superior to X-rays and MRI in diagnosing first-ray injuries. Although not significantly different from CT in terms of overall diagnosis, MRI was superior to X-ray and CT in diagnosing second and cuneiform-ray injuries.

Diagnostic value of basic laboratory parameters in the diagnosis of complicated appendicitis

In this investigation, we sought to examine the efficacy of laboratory parameters in predicting complicated appendicitis in patients who had surgery for acute appendicitis. 153 patients who underwent appendectomy were included and whose pathological results showed acute appendicitis. The patients were divided into two groups based on pathology findings and surgical findings: simple and complicated appendicitis groups. The patients’ age, gender, preoperative leukocyte count, neutrophil count, neutrophil percentage, neutrophil–lymphocyte ratio, erythrocyte distribution width, mean platelet volume, and C-reactive protein levels were recorded. The simple and complicated appendicitis groups comprised 97 and 56 patients, respectively. Patients with complicated appendicitis were older on average than those with simple appendicitis (p=0.007). In the complicated appendicitis group, leukocyte count (p

Painful eccrine spiradenoma containing nerve fibers in the forearm: a case report

Eccrine spiradenomas are rare benign adnexal tumors that originate from the eccrine glands. They mainly arise in the head, neck, and upper trunk of young adults and are sometimes accompanied by pain and tenderness. Although spontaneous pain is a typical symptom of eccrine spiradenoma, the underlying mechanism remains unclear. We report the case of a patient who had a spiradenoma in the subcutaneous tissue of the left forearm that was accompanied by agonizing pain triggered by pressure. A 42-year-old man who had undergone surgical excision of a left forearm mass 5 years ago presented for relapsed pain and a palpable mass at the previous excision site. The agonizing pain had been triggered a few days ago, in response to even a slight touch. The mass measured approximately 0.8×0.8 mm, and ther e were no changes visible around the scar. Irregularly shaped masses, each measuring approximately 5 mm, were removed with a 2-mm safety margin from the subcutaneous fat. A histopathologic examination revealed the resected nodules were surrounded by delicate fibrous capsules, some parts of which contained blood vessels and prominent thickened nerve fibers. By the time of the 6-month follow-up, the masses had not recurred, and the biopsy site was well maintained without pain. We describe the surgical and histopathologic findings of an isolated eccrine spiradenoma accompanied by recurrent agonizing pain. The peculiar microscopic arrangement of the thickened nerve fibers encasing the nodule of eccrine spiradenoma may correlate with its pain mechanism.

Temporal CT Evaluation of the Relationships between Basic Anatomical Structures and the Round Window: Importance for the Cochlear Implant Surgery

Abstract Objectives In the present study, we investigated the round window (RW) and neighboring anatomical structures using temporal computed tomography (CT) which are important for cochlear implant (CI) electrodes. Methods In this retrospective study, the temporal CT images of 112 adult patients (45 males and 67 females) were evaluated. We classified mastoid pneumatization, and measured RW diameter, RW–carotid canal (CC) distance, RW–facial nerve mastoid segment (FNMS) distance, RW–pyramidal eminence distance, RW–jugular bulb (JB) distance, and RW–internal acoustic canal (IAC) distance. Additionally, RW–cochlea angle and RW–facial nerve angle were also measured. Results RW diameters in males were significantly higher than those in females bilaterally (p &lt; 0.05). RW–CC distance and RW–JB distance were both smaller than 10 mm. RW–IAC distance was 2.54 to 2.68 mm, and RW–FNMS distance was 4.20 to 4.40 mm. RW–cochlea angle ranged from 39.62 to 41.91 degrees and RW–FN angle ranged from 17.28 to 18.40 degrees. Males showed better mastoid pneumatization values (p &lt; 0.05). In higher RW diameters, RW–JB distance decreased, and in pneumatized mastoids, RW–JB distance increased. RW–JB distance and RW–CC distance were detected to increase together (p &lt; 0.05). Conclusion RW is crucial anatomic structure for CI surgeries. RW diameters are between 1.21 and 1.35 mm and lower in the females. Males exhibited better mastoid pneumatization values than the females, and CC and JB distances from RW were farther in well-pneumatized mastoids. Future studies should include comprehensive clinical and surgical findings.

Evaluation of bone marrow invasion on the machine learning of 18 F-FDG PET texture analysis in lower gingival squamous cell carcinoma.

Lower gingival squamous cell carcinoma (LGSCC) has the potential to invade the alveolar bone. Traditionally, the diagnosis of LGSCC relied on morphological imaging, but inconsistencies between these assessments and surgical findings have been observed. This study aimed to assess the correlation between LGSCC bone marrow invasion and PET texture features and to enhance diagnostic accuracy by using machine learning. A retrospective analysis of 159 LGSCC patients with pretreatment 18 F-fluorodeoxyglucose (FDG) PET/computed tomography (CT) examination from 2009 to 2017 was performed. We extracted radiomic features from the PET images, focusing on pathologic bone marrow invasion detection. Extracted features underwent the least absolute shrinkage and selection operator algorithm-based selection and were then used for machine learning via the XGBoost package to distinguish bone marrow invasion presence. Receiver operating characteristic curve analysis was performed. From the 159 patients, 88 qualified for further analysis (59 men; average age, 69.2 years), and pathologic bone marrow invasion was identified in 69 (78%) of these patients. Three significant radiological features were identified: Gray level co-occurrence matrix_Correlation, INTENSITY-BASED_IntensityInterquartileRange, and MORPHOLOGICAL_SurfaceToVolumeRatio. An XGBoost machine-learning model, using PET radiomic features to detect bone marrow invasion, yielded an area under the curve value of 0.83. Our findings highlighted the potential of 18 F-FDG PET radiomic features, combined with machine learning, as a promising avenue for improving LGSCC diagnosis and treatment. Using 18 F-FDG PET texture features may provide a robust and accurate method for determining the presence or absence of bone marrow invasion in LGSCC patients.