Retroperitoneal fibrosis is a rare fibroinflammatory disorder that can lead to progressive encasement of retroperitoneal structures, including the aorta, inferior vena cava, ureters, and iliac vessels, most commonly resulting in ureteral obstruction. It may be idiopathic or secondary to medications, malignancy, radiotherapy, or other causes. Its radiological appearance often mimics malignant disease, which may complicate the diagnostic approach, particularly in patients with a previous oncologic history. We report the case of a 70-year-old man with a past medical history significant for chronic lymphocytic leukemia under surveillance and intermediate-risk prostate adenocarcinoma previously treated with hormone therapy and currently without evidence of active disease, who presented to the emergency department with persistent left-sided flank pain. Contrast-enhanced abdominal computed tomography revealed an irregular left retroperitoneal soft-tissue density, measuring approximately 8 cm in longitudinal extent, located anteroinferior to the aortic bifurcation, encasing the left ureter and causing mild to moderate ipsilateral hydronephrosis. Given concern for malignancy, a biopsy of the retroperitoneal lesion and an adjacent lymph node was performed, demonstrating fibro-adipose tissue with a mononuclear inflammatory infiltrate and no evidence of neoplasia. Serum immunoglobulin G4 levels were within normal limits. After exclusion of alternative diagnoses, corticosteroid therapy was initiated, resulting in rapid clinical improvement and complete radiological resolution on follow-up imaging. Retroperitoneal fibrosis should be considered in patients presenting with unexplained obstructive uropathy, and an etiological workup is essential to exclude secondary causes and guide appropriate management.
Hansen’s disease is a chronic infectious disease caused commonly by Mycobacterium leprae. Although it is rare in Europe, sporadic cases occur due to migration from endemic areas. In Portugal there are 4 cases reported in 2023 and 4 cases reported in 2024. Lepromatous leprosy represents the anergic pole of the disease spectrum, characterized by diffuse bacillary proliferation and multisystem involvement, often mimicking autoimmune conditions. A 36-year-old Brazilian male from Rio de Janeiro living in Portugal presented with recurrent painless leg ulcers and violaceous halos for one year, accompanied by non-tender granulomatous lesions on the ears, eyelids, and nasal alas. He developed inflammatory polyarthralgias involving small and medium joints. Subsequent serologic and autoimmune studies revealed mild inflammatory activity, positive antinuclear antibodies and rheumatoid factor, elevated angiotensin-converting enzyme, and polyclonal hypergammaglobulinemia. Imaging demonstrated hepatomegaly and mild axillary and inguinal lymphadenopathy. Sarcoidosis was considered as the main differential diagnosis. Skin biopsy of an ulcer revealed foamy histiocytes and numerous acid-fast bacilli on Fite-Faraco staining, consistent with M. leprae. He was treated with multidrug therapy (rifampicin, clofazimine, and dapsone), leading to rapid resolution of lesions and arthralgias. In an increasingly globalised world, even in non-endemic regions, leprosy should be considered in the differential diagnosis of chronic ulcers and inflammatory arthropathy, especially when patients come from endemic areas. An enhanced awareness among clinicians is needed. Early recognition, histopathologic confirmation, and multidrug therapy are essential to prevent irreversible complications and reduce transmission.
Endoscopic Retrograde Cholangiopancreatography (ERCP) is a key procedure in the diagnosis and treatment of biliary and pancreatic diseases. Artificial intelligence has been pointed as one solution to automatize diagnosis. However, public ERCP datasets are scarce, which limits the use of such approach. To help address these limitations, this study aims to help fill this gap by providing a large and curated dataset. The collection is composed of 19.018 raw images and 19.317 processed sections from 1.602 patients. 5.519 images are labeled, which provides a ready-to-use dataset. All images were manually inspected and annotated by two gastroenterologists with more than 5 years of experience and reviewed by another gastroenterologist with more than 20 years of experience, all with more than 400 ERCP procedures annually. The utility and validity of the dataset is proven by a classification experiment. This collection aims to provide or contribute for a benchmark in automatic ERCP analysis and diagnosis of biliary and pancreatic diseases.
PRCIS:The Susanna Glaucoma Drainage Device achieved sustained 5-year IOP and medication reduction, with a 80.9% success rate and a favorable safety profile, supporting its effectiveness for long-term management of refractory glaucoma. PURPOSE:To evaluate the 5-year outcomes of the Susanna Glaucoma Drainage Device for the treatment of glaucoma. PATIENTS AND METHODS:Medical records from consecutive patients aged 18 years or older with glaucoma who underwent implant surgery with the Susanna Glaucoma Drainage Device from January 2017 to January 2020 were included. The primary outcome was success, defined as IOP ≥6 and <18 mm Hg and the absence of loss of light perception or additional glaucoma surgery. Secondary outcomes included IOP, hypotensive therapy, adverse events, and surgical interventions. RESULTS:A total of 104 patients were included; the mean patient age was 60.8±17.6 years. The mean preoperative IOP was 29.9±11.6 mm Hg, with 2.8±0.9 glaucoma medications. At 5 years, the cumulative success rate was 80.9%. IOP and medication use were significantly reduced at all postoperative visits. At 5 years, mean IOP was 13.4±3.6 mm Hg (55.2% reduction, P <0.001), and mean medication use was 1.9±1.4 (32.1% reduction, P <0.001). The primary reason for failure was elevated IOP (38.9%). Five patients underwent glaucoma reoperation to lower IOP; 2 cases were treated with cyclophotocoagulation, while 3 underwent a second SGDD inferiorly. Hypotony-related failure was observed in 1 case. Among the failures, 5 patients developed significant vision loss. CONCLUSIONS:The Susanna implant effectively reduced IOP and medication dependence over 5 years. It demonstrated a high success rate (80.9%) and sustained pressure control. These findings support the long-term efficacy of the Susanna implant in managing refractory glaucoma.
BackgroundThe Hoffmann (H-) reflex is a monosynaptic electrophysiological response that reflects S1-root integrity. Although widely used in experimental and in clinical outpatient neurophysiological testing, its intra-operative application during endoscopic lumbar surgery is rarely reported. We present the first real-time documentation of H-reflex normalization immediately after endoscopic decompression of an acute L5-S1 disc herniation.Case descriptionA 49-year-old woman presented with acute right-sided S1 radiculopathy (ankle dorsiflexion/plantar-flexion MRC grade III; hallux extension grade I). MRI showed a large, right sub-articular L5-S1 disc extrusion compressing the S1 nerve root. Unilateral biportal endoscopic discectomy was performed under general anesthesia with multimodal intra-operative neuromonitoring (MEPs, free-run EMG, and continuous tibial-nerve H-reflex). Baseline recordings revealed marked side-to-side asymmetry: right-leg MEP amplitudes were depressed, and the right H-reflex was low and unstable. During foraminoplasty and fragment removal, a sudden, sustained 100% surge in right H-reflex amplitude occurred, coincidence with root decompression, while MEPs remained unchanged. Free-run EMG discharges abated after the H-reflex improved. Post-operative recovery was uneventful. At 2 months the patient demonstrated near-complete motor recovery (MRC IV-V) and full pain relief.ConclusionContinuous H-reflex monitoring provided an immediate, sensitive marker of S1-root decompression when conventional MEPs failed to reflect functional recovery. This single-case experience supports the feasibility and potential prognostic value of adding H-reflex surveillance to the neuromonitoring toolkit for endoscopic lumbar surgery. Prospective studies in larger cohorts are warranted to validate threshold criteria, refine stimulation parameters, and determine cost-effectiveness.
