Anatomical variations of the axillary artery and its branches are clinically relevant as they may complicate surgeries in the axilla and shoulder. Accessory heads of the biceps brachii can compress key neurovascular structures. The present report describes these variations observed on the left upper limb of a 79 years old male cadaver during cadaveric dissection. We observed that the usual branches of the 3rd part of the axillary artery as well as the profunda brachii artery originated from the 2nd part of the axillary artery via a common trunk in the left axilla. In addition to that, a small accessory head of the biceps brachii was observed on the left arm originating from the shaft of the humerus. Knowledge about variant branches of the axillary artery is surgically important for establishment of collateral circulation around the scapula following shoulder surgeries. The accessory head of biceps brachii may cause nerve entrapment neuropathy leading to mysterious pain syndrome in the upper limb.
Dural arteriovenous fistulas are pathological vascular malformations within the dura mater, characterized by abnormal connections between pial arteries and veins. These are rare lesions that can present with a variety of neurological symptoms, and, when ruptured, can result in a fatal hemorrhage. This disease can be managed by endovascular embolization, surgical resection, and stereotactic radiosurgery. Particularly with the advancement of endovascular techniques, surgery is less frequently used to treat these lesions. However, it remains a viable treatment option in certain cases. In this article, we present a series of 17 patients with dural arteriovenous fistulas treated at a single tertiary neurosurgical center. This study was conducted at São João University Hospital in Porto, Portugal. We retrospectively collected data from all patients who underwent microsurgical or endovascular treatment for dural arteriovenous fistulas between 2014 and 2023. We collected information regarding the patients’ sex, age, and radiological classification of the dAVF, also, the treatment modality chosen, dAVF obliteration rate and information about any complications that have resulted from the treatment. Endovascular treatment had been attempted in 5 patients (29.4%), resulting in partial embolization of the dural arteriovenous fistulas in 3 patients (17.6%). In 2 patients (11.8%), embolization was attempted but deemed technically unfeasible. The remaining cohort, comprising 12 patients (70.6%), underwent surgical intervention as the primary treatment modality. Overall, all of the patients presented in this cohort underwent surgical resection. The factors why patients underwent surgical resection as the primary treatment modality were: endovascular embolization was deemed technically unfeasible due to the location in the anterior cranial fossa, or due to the multidisciplinary decision to operate on these lesions. Lesions were also operated on in the presence of a hematoma that required an evacuation. Immediate postoperative angiography showed that 94.1% (n = 16) of the patients achieved complete exclusion of the lesion. At the time of the latest follow-up, a second DSA was performed, and 88.23% (n = 15) of the patients showed complete obliteration of the lesion. 41.17 % of the patients (n = 7) had resolution of their pre-operative symptoms. 58.8 % (n = 10) remained symptomatic after the surgical procedure. The cumulative surgical complication rate in this cohort was 23.6% (n = 4). In this article, we also provide a comprehensive review of the literature regarding the treatment modalities that are available to treat this complex condition. In conclusion, surgical treatment is nowadays less frequently used, but it still remains a viable option for the treatment of dural arteriovenous fistulas. Our patient cohort demonstrated that selective treatment of these rare and complex lesions surgically is associated with high obliteration rates and relatively low rates of complications. Surgical treatment can be considered a primary treatment option when dealing with ethmoidal-type dural arteriovenous fistulas or others located within the anterior cranial fossa, and the presence of a hematoma requiring urgent evacuation.
Background: Staphylococcus aureus is a major opportunistic pathogen in hospitals, where sustained exposure to antimicrobial agents and disinfectants promotes the emergence and persistence of resistant strains. In addition, tolerance to heavy metals may facilitate co-selection and long-term survival of resistant S. aureus in clinical settings. Purpose: This study investigated the occurrence of methicillin-resistant S. aureus (MRSA), vancomycin-intermediate S. aureus (VISA), and vancomycin-resistant S. aureus (VRSA), and evaluated antibiotic and heavy metal resistance profiles among S. aureus isolates recovered from hospitals. Materials and Methods: Seventy-nine bacterial isolates were collected from three hospitals. Identification using Gram staining and biochemical tests identified 71 S. aureus isolates. Resistance to antibiotics was determined by disk diffusion, and was quantified using the multiple antibiotic resistance (MAR) index. Resistance to heavy metals was assessed at increasing concentrations, and the multiple heavy metal resistance (MHMR) index was calculated. MRSA, VISA, and VRSA were screened using selective agar containing oxacillin and vancomycin. Cluster analysis was performed based on combined antibiotic and heavy metal resistance profiles. Results: High resistance rates were observed for penicillin and ampicillin (95.8% each), whereas most isolates showed low levels of resistance to chloramphenicol, bacitracin, streptomycin, kanamycin, and methicillin. MAR index values ranged from 0 to 0.88, with most isolates exceeding 0.2. All isolates exhibited resistance to multiple heavy metals, with MHMR values between 0.57 and 0.71, and marked tolerance to chromium and lead. Screening identified 9 MRSA, 3 VISA, and 1 VRSA isolate, including one strain classified as both MRSA and VRSA. Cluster analysis resolved nine major resistance-associated groups. Conclusion: Hospital-associated S. aureus isolates showed extensive antibiotic and heavy metal resistance, supporting the likelihood of co-selection of resistance traits. These findings underscore the importance of integrated antimicrobial stewardship and environmental control strategies in hospitals.
Background. Acute pancreatitis (AP) is a leading cause of gastrointestinal hospitalization and remains associated with measurable in-hospital mortality despite advances in supportive care. While earlier decades were characterized by declining mortality, contemporary temporal patterns within mature tertiary-care systems remain uncertain. We aimed to evaluate longitudinal trends in admission volume, demographic characteristics, intensive care unit (ICU) utilization, and crude, age-standardized, and adjusted in-hospital mortality in a tertiary academic center. Materials and Methods. We conducted a retrospective cohort study of consecutive adult hospitalizations with a primary diagnosis of acute pancreatitis at a tertiary referral center between 2016 and 2024. Temporal trends were assessed using linear and logistic regression models. Age-standardized mortality rates were calculated using direct standardization to a fixed reference population. Multivariable logistic regression evaluated the independent association between year of admission and in-hospital mortality, adjusting for age and sex. A prespecified sensitivity analysis excluded ICU admissions. Analyses were limited by the lack of reliably recorded etiologic and standardized severity data within the administrative dataset. Results. A total of 1,981 hospitalizations were included. Overall, in-hospital mortality was 5.0%. Annual admission volume, median age, sex distribution, and ICU utilization showed no significant temporal trends. Crude mortality ranged from 1.8% to 6.5% annually and demonstrated no significant temporal association. Age-standardized mortality likewise showed no significant trend. In multivariable analysis, year of admission was not independently associated with mortality, whereas advancing age was the strongest measured independent predictor, with a 34% increase in odds of death per 10-year increment. Exclusion of ICU admissions yielded consistent findings. Conclusions. In this nine-year tertiary-center cohort, in-hospital mortality for acute pancreatitis was approximately 5% and did not demonstrate a statistically significant temporal change. After adjustment, mortality risk was more strongly associated with age than with calendar year of admission. These findings suggest relative stability within this cohort; however, given the limitations of the study, further research using larger and more detailed datasets is needed to better characterize temporal trends and determinants of mortality.
Background: Gordon Holmes syndrome (GHS) is a rare genetic disorder, usually manifesting as a broad spectrum of neurological symptoms and hypogonadotropic hypogonadism. Only a limited number of cases presenting this congenital disorder have been reported in the literature. Since the genetic and phenotypic heterogeneity of GHS, it is crucial to report novel cases. Case presentation: Here we report a novel homozygous missense variant in RNF216 gene c.1055T>G (p.(Phe352Cys)) in three siblings. Primary concerns were absence of secondary sexual characteristics, and amenorrhea occurred among female patients. Based on laboratory test results and clinical features, hypogonadotropic hypogonadism was diagnosed. Neurological examination revealed no signs of ataxia in siblings. However, brain magnetic resonance imaging revealed pronounced changes in the cerebral white matter for female patients. Due to primary amenorrhea and the absence of secondary sexual characteristics, treatment was initiated. Treatment might be adjusted in the presence of fertility considerations. Conclusions: This case contributes to the limited knowledge of GHS and highlights the importance of hypogonadotropic hypogonadism treatment and close observation of neurological symptoms that may develop over time.
Introduction: Additional risk factors have been identified, and the outcomes of surgical treatment in patients with hypertriglyceridemia-induced acute necrotizing pancreatitis treated with plasmapheresis have been analyzed.Aim: To evaluate the effectiveness of plasmapheresis in the treatment of patients with hypertriglyceridemia-induced acute necrotizing pancreatitis, with an emphasis on the early use of minimally invasive techniques and delayed open surgical interventions, and to identify additional risk factors associated with adverse disease outcomes.Materials and methods: The treatment outcomes of 82 patients have been analyzed: 53 patients (65%) were included in the main group, and 29 patients (35%) were included in the comparison group.Results: The use of plasmapheresis resulted in a significant reduction in blood triglyceride levels (p=0.002), total cholesterol (p=0.001), low-density lipoproteins (p=0.012), and the atherogenic index (p=0.001). In the comparison group, the decrease in these parameters was not significant. In the main group, a favorable disease course and the effectiveness of minimally invasive interventions were achieved in 60% of the patients (29/48), compared with 46% (12/26) in the comparison group (p=0.238).Discussion: According to the ROC analysis, adverse prognostic factors for a complicated disease course included arterial hypertension (p=0.042), overweight with a body mass index greater than 27.6 kg/m² (p=0.030), diabetes mellitus (p=0.021), and hypertriglyceridemia (p=0.001). This study will allow us to evaluate the results of the treatment of patients with hypertriglyceride-induced acute necrotic pancreatitis and the effectiveness of plasmapheresis, as well as to identify additional prognostic risk factors leading to laparotomy.Conclusions: Plasmapheresis in the early stages of hypertriglyceride-induced acute necrotic pancreatitis had a positive effect on the course of the disease and ensured the final effectiveness of mini-invasive surgical interventions in 60% of the patients in the main group. Additional prognostic factors for complicated hypertriglyceride-induced acute necrotic pancreatitis, accompanied by purulent-septic complications and requiring laparotomy, are arterial hypertension, a body mass index greater than 27.6 (kg/m2), diabetes mellitus, and hypertriglyceridemia.
Aim: Uncontrolled external bleeding remains a leading cause of preventable death in military and civilian tactical environments, necessitating continuous improvement in the means and algorithms for haemorrhage control. The aim of this study was to determine the comparative effectiveness and optimal sequence of application of modern methods for controlling external bleeding in tactical medicine, in order to maximise survival of the wounded until evacuation to hospital. Materials and methods: The study was conducted as a systematic review with a semi-quantitative comparison of efficacy and safety based on registries, clinical cohorts, and severe animal models of coagulopathic haemorrhage. Result: The results demonstrated that new-generation chitosan dressings provide 100% survival for up to 180-240 minutes with minimal blood loss (112-300 ml) in models of severe coagulopathy, outperforming kaolin-based standards (86% survival, blood loss 260-1021 ml). The use of any modern topical haemostatic agent in real combat conditions increases survival by 7%, while the systematic introduction of tourniquets and haemostatic agents reduces preventable mortality from extremity bleeding by 67-87%, saving 1,000-2,000 lives in the conflicts in Iraq and Afghanistan alone. Injectable sponges achieve 100% stable haemostasis for up to 72 hours and are applied three times faster than traditional tamponade, which is critically important for deep, narrow wound channels. Early administration of tranexamic acid (within the first three hours) further reduces the risk of death from bleeding by 10-20%. Under the most challenging conditions, the greatest benefit is achieved through the combined use of tourniquets, new-generation chitosan agents, and specialised devices. Conclusions: The proposed differentiated algorithm enables rapid and reliable haemostasis even in cases of deep traumatic coagulopathy and prolonged evacuation, making it a practical tool for updating tactical medicine protocols and significantly improving survival prior to hospital evacuation.
Background: Sacrococcygeal teratoma (SCT) is the most common congenital neoplasm in fetuses and newborns. Altman Type III lesions may be difficult to diagnose and manage prenatally because of their marked intrapelvic extension. Materials and Methods: A 24-year-old primigravida woman was referred at 20 weeks of gestation after routine ultrasonography revealed a sacrococcygeal mass extending into the abdomen. Prenatal evaluation included ultrasonography, fetal magnetic resonance imaging, and chromosomal microarray analysis. The pregnancy was managed by a multidisciplinary team with serial fetal surveillance. Results: Imaging demonstrated a predominantly cystic lesion consistent with Altman Type III SCT. During follow-up, bilateral fetal hydronephrosis, gestational diabetes mellitus, and mild polyhydramnios developed. At 38 weeks, an elective cesarean section was performed. On postnatal day 4, total tumor resection with coccygectomy was successfully completed. Histopathology confirmed a mature teratoma. At 6 months, persistent hydronephrosis remained under follow-up, with no documented recurrence. Conclusions: Accurate prenatal imaging, close surveillance, multidisciplinary planning, and timely postnatal surgery are essential for favorable outcomes in Type III fetal SCT.
Background: The aim of the study - based on the latest literature, this narrative literature review aims to provide a comprehensive evaluation of deep gluteal syndrome (DGS) and to assess the significance of anatomical variations of the sciatic nerve (SN) in relation to the syndrome. Materials and methods: A review of the scientific literature was conducted using the PubMed, ClinicalKey, and ScienceDirect databases. Publications were selected from 2015 to 2026. All publications were written in English. The following keywords and their combinations were used during the search: “deep gluteal syndrome,” “sciatic nerve variations,” “sciatic nerve entrapment,” and “piriformis syndrome.” Results: The sciatic nerve, characterized by significant anatomical variability in the deep gluteal space, may result in altered biomechanics and predispose the nerve to compression. Anatomical variations of the sciatic nerve, depending on their relationship with the piriformis muscle, are categorized according to the Beaton and Anson classification (types A–F). In recent decades, the term “deep gluteal syndrome” has come into use, encompassing extrapelvic non-discogenic sciatic nerve compressions. The syndrome most commonly manifests as persistent, “shooting” pain that worsens after prolonged sitting and radiates toward the back of the knee, hip, and/or gluteal region, as well as dysesthesia and nocturnal pain. There is currently no gold standard for the diagnosis of DGS. Diagnostic criteria may include compression of the SN in the deep gluteal region, sciatica-like pain, and a non-discogenic origin of symptoms. First-line treatment options include physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), muscle relaxants, and rest. In addition, intramuscular injections of a local anaesthetic may be administered to alleviate symptoms. If conservative treatment proves ineffective, surgical nerve decompression should be considered. Conclusions: The most common abnormal sciatic nerve variation worldwide is the type B variant. Although anatomical variations of the sciatic nerve alter its biomechanics, they have no direct, statistically significant association with the development of deep gluteal syndrome, according to the latest literature. Anatomical variations of the sciatic nerve may be considered a predisposing factor that increases the risk of DGS when additional primary etiological factors are present. However, more comprehensive scientific studies are needed to assess this.
Background: Noninvasive ventilation (NIV) is a cornerstone treatment for hypercapnic respiratory failure in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to evaluate the impact of selected comorbidities on the effectiveness of NIV in these patients, and to compare clinical characteristics and outcomes between continuous positive airway pressure (CPAP) and bilevel positive airway pressure (BiPAP) modalities.Materials and methods: This prospective, randomized, single-center study included 80 patients with hypercapnic respiratory failure due to COPD, randomized 1:1 to CPAP or BiPAP. Demographic and clinical data, comorbidities, vital signs, and arterial blood gas parameters were recorded at admission and during NIV. The primary outcome was pCO₂ reduction at the end of treatment compared with baseline.Results: Arterial hypertension significantly enhanced pCO₂ reduction with CPAP, but not with BiPAP. Systolic and mean arterial pressure independently predicted the magnitude of pCO₂ reduction, regardless of NIV modality. Patients treated with BiPAP more frequently had decompensated cor pulmonale and severe pulmonary hypertension, while pneumonia was more common in the CPAP group. NIV modality itself was not an independent predictor of pCO₂ reduction.Conclusion: Systemic hemodynamic status and arterial hypertension influence NIV effectiveness in hypercapnic COPD. The cardiovascular status should be considered alongside respiratory parameters when selecting the NIV strategy.
Aim: The aim of this study was to investigate the impact of genetic factors on the development of type 2 diabetes in the population of Kazakhstan. Materials and methods: The methodology included the collection of demographic data, the analysis of biochemical parameters, and the application of polymerase chain reaction genotyping for single-nucleotide polymorphisms in genes associated with type 2 diabetes. Result: The main results of the study demonstrated that patients with type 2 diabetes had a 20% higher body mass index (29.5±4.2 kg/m2 versus 24.3±3.1 kg/m2) and 29% lower physical activity (3.2±1.5 hours per week versus 4.5±2.0 hours per week) compared with the control group. Biochemical parameters showed a 50% higher glucose level (7.8±2.1 mmol/L versus 5.2 ± 0.8 mmol/L), insulin levels by 76% (15.3±5.2 microunits per millilitre versus 8.7±2.5 microunits per millilitre), and glycated haemoglobin by 42% (7.5±1.2% versus 5.3±0.5%) in patients with type 2 diabetes. The genetic analysis revealed substantial associations between type 2 diabetes and risk alleles in the TCF7L2 (rs7903146), KCNJ11 (rs5219), FTO (rs9939609), PPARG (rs1801282), and ADIPOQ (rs1501299) genes, which were linked to compromised insulin secretion and metabolic anomalies in the study population. Conclusions: The practical significance of the study lies in the potential application of these findings to develop personalised approaches for the prevention and treatment of type 2 diabetes, including lifestyle modification, the use of modern pharmaceuticals, and anti-inflammatory drugs to improve glucose control in patients.
Background: Despite the difficulties of diagnosing intracranial hypotension (IH), the literature focusing on specific IH misdiagnoses remains scarce. We report on the case of a pediatric patient with spontaneous intracranial hypotension (SIH) caused by thecal sac dilatation due to Marfan syndrome, who was initially misdiagnosed. Additionally, a systematic literature review was conducted, focusing specifically on misdiagnoses of IH. Materials and Methods: The material search for the literature review was performed across PubMed, Scopus, and Web of Science databases. The inclusion criteria were: published within the last ten years, involved human participants, written in English, and included case reports or series with a clear diagnostic pathway, in which a specified initial misdiagnosis was followed by IH as the final diagnosis. Publications were excluded if they did not meet these criteria. Due to the nature of the case reports, reporting bias and certainty assessment were not formally evaluated. Additionally, a single-patient case report was retrospectively analyzed. Results: A 13-year-old woman presented to the emergency department complaining of a severe postural headache, nausea, sleepiness, generalized weakness, dizziness, and loss of appetite. An asymptomatic venous thrombosis and functional headaches were suspected. The patient was transferred to a third-level hospital, where a magnetic resonance imaging scan of the whole spine revealed thecal sac dilatation. SIH was diagnosed, and, after 3 weeks of conservative treatment, the patient was discharged from the hospital with full recovery. In the systematic review, 24 studies containing 28 patients were included in the final report. The most frequent initial misdiagnoses were Chiari I malformation (39.29%) and migraine (21.43%). 75% of studies identified SIH as a cause of IH, 16.67% determined it was iatrogenic, 4.17% - traumatic, and 1 case report did not include the cause of IH. Conclusions: While the case report illustrates the difficulties in diagnosing IH, the systematic review distinguishes initial misdiagnoses of this condition, of which the most common are migraine and Chiari I malformation.
Background:Limb salvage is the mainstay of surgical treatment for primary sarcomas as well as metastatic lesions of the proximal humerus. This involves wide excision of the involved humeral segment followed by a reconstruction of the defect. The purpose of this review was to determine which reconstruction modality offers a better overall functional outcome. Methods:After registering a review with the PROSPERO database (ID No. CRD 42025642215), PubMed and Cochrane Library databases were systematically screened for relevant studies meeting our inclusion criteria. The Methodological Index for Non-randomized studies (MINORs) questionnaire was the primary Risk Of Bias (ROB) assessment tool. The included articles were compared with respect to their intra-operative parameters, functional outcome scores, postoperative shoulder Range Of Motion (ROM), as well as complication rates. Results:A total of eight studies, involving 348 subjects in total, were included in this review, out of which, only four articles were found eligible for meta-analysis. Primary malignancy of the bone was the most common diagnosis (Osteogenic sarcoma followed by Ewing sarcoma). A higher frequency of axillary nerve sacrifice was seen in patients undergoing spacer implantation. Musculoskeletal Tumour Society Scores (MSTS) were used as the chief functional outcome determinant and were significantly better in patients undergoing arthroplasty (73.7 ± 7.9 versus 68.9 ± 8.5). A similar trend was observed with regards to shoulder flexion, extension and abduction. The most common complication noted with a cement spacer was proximal implant migration followed by implant failure. On the other hand, dislocation or subluxation of the prosthesis was the most frequently reported issue with arthroplasty. Overall, the local recurrence rate was 9.5%. Conclusion:Cement spacers are ideally suited for patients with a poor socio-economic background, aggressive lesions and a shorter life expectancy, while joint replacement is the reconstructive modality of choice in low-grade, well differentiated, isolated malignancies with negligible chances of sacrificing the shoulder abductor mechanism.
Introduction:Undifferentiated uterine sarcoma (UUS) is a rare, aggressive uterine mesenchymal malignancy with poor prognosis, for which, evidence supporting metastasis-directed treatment strategies is limited. Case presentation:A 59-year-old woman underwent total hysterectomy with bilateral salpingo-oophorectomy (R0) for stage IB UUS in 2016, followed by adjuvant doxorubicin-ifosfamide. Three years later, surveillance CT identified bilateral pulmonary metastases. Video-assisted thoracoscopic resection confirmed metastatic UUS, and stereotactic body radiotherapy (SBRT) was delivered to residual and subsequent lung lesions, achieving sustained local control without systemic therapy. The patient remained progression-free for almost three years. In 2024, follow-up imaging showed no active sarcoma but incidentally detected a left breast lesion; biopsy revealed invasive ductal carcinoma with mucinous features. She underwent breast-conserving surgery with sentinel lymph node biopsy (pT1N0(sn)), followed by adjuvant whole-breast radiotherapy and endocrine therapy with tamoxifen. Outcomes:At 8.5 years from UUS diagnosis and one year after breast cancer treatment, the patient remains alive with no evidence of recurrent or metastatic disease and with excellent performance status (ECOG 0). Conclusions:This case demonstrates prolonged, chemotherapy-free control of metastatic UUS using a metastasis-directed strategy combining surgery and SBRT, and highlights the importance of continued surveillance for secondary primary malignancies. It supports considering an oligometastatic treatment paradigm and multidisciplinary management in selected UUS patients despite the absence of prospective data.
Background:Atherosclerotic cardiovascular disease (ASCVD) is a chronic inflammatory disease of the arteries. The primary driver of atherosclerosis is the progressive accumulation of low-density lipoprotein cholesterol (LDL-C) and other apolipoprotein (Apo) B containing lipoproteins within the arterial wall. Despite the intensive LDL-C lowering therapy, a substantial residual risk of ASCVD persists and is significantly associated with elevated triglyceride concentrations. Objective:To review the pathogenesis of triglycerides (TG), triglyceride-rich lipoproteins (TRL) and their remnants as well as their role in the development of atherosclerosis and clinical relevance for assessing residual ASCVD risk. Materials and methods:A literature search was conducted using keywords relevant to the topic and their combinations. A targeted PubMed search prioritized English-language guidelines, consensus statements, randomized clinical trials, cohort studies, and meta-analyses published between 2019 and 2025, with older landmark publications included where necessary. Reference lists of key articles were also manually screened to identify additional relevant studies. Results:The literature shows that elevated TG concentrations are associated with a higher risk of ASCVD, regardless of LDL-C. Given that no clear signal indicates which features of TRL give rise to risk of ASCVD, plasma TG levels remain a reasonable surrogate marker for risk assessment. Evidence suggests that the atherogenicity of TRL is driven primarily by the cholesterol carried within TRL and their remnants rather than TG themselves. TRL remnants may be at least as atherogenic as, and potentially more atherogenic than, low-density lipoproteins (LDL) because they can be taken up by intimal macrophages without prior oxidative or structural modification, persist longer within the intima, are larger in size, and carry more cholesterol per particle. They also more effectively promote foam-cell formation and contribute to low-grade inflammation. Given the conflicting results of large-scale randomized clinical trials, it is not yet possible to conclude that lowering TG concentrations alone reduces the ASCVD risk. Conclusions:Elevated plasma TG concentrations are associated with an increased risk of ASCVD, independent of LDL-C levels. Given the ongoing need to identify the most reliable metric for risk stratification, TG remain a rational surrogate marker for estimating residual ASCVD risk related to TRL and their remnants.
Introduction:: Multiple sclerosis (MS) may present as a tumor-like, or tumefactive demyelinating lesion, that is indistinguishable clinically and radiologically from a brain tumor. This poses a diagnostic challenge. Case presentation:We present a case report of a 23-year-old woman who was hospitalized in the Neurosurgery Department for biopsy of a brain mass. She had been diagnosed with Hodgkin's lymphoma at the age of 12, underwent surgery and chemotherapy, and had been in remission ever since. During her annual follow-up a magnetic resonance imaging (MRI) of the brain was performed that revealed a lesion in the right temporal lobe. It was interpreted as central nervous system (CNS) lymphoma. Before arranged neurosurgical intervention, a follow-up MRI scan revealed multiple new small lesions in both hemispheres. Biopsy was not performed, and the patient was referred to the Neurology Department for clarification of the diagnosis. No abnormalities were detected in the tests performed. Cerebrospinal fluid (CSF) was not tested due to the patient's refusal to repeat the unsuccessful procedure. The patient was discharged from the hospital. Three months later, she arrived at the Emergency Department abroad with impaired coordination and hypoesthesia on the right side of the body. Two MRI scans revealed a new lesion in the left posterior periventricular area. CNS lymphoma was suspected again. The patient received treatment with levetiracetam and dexamethasone. Upon her return, an MRI scan was repeated, which revealed an enlargement of the lesion. CSF testing showed indistinct oligoclonal bands. As CNS lymphoma could not be excluded, a lesion biopsy was performed after discontinuation of the steroids therapy. Histological examination excluded malignancy. Later, an MRI scan was repeated; it showed two new contrast-enhancing lesions. Relapsing-remitting multiple sclerosis (RRMS) diagnosis was confirmed, and treatment with disease-modifying therapies (DMTs) was planned. Conclusions:Open-ring enhancement with little or no mass effect on MRI suggests a tumefactive demyelinating lesion (TDL). Moreover, TDLs tend to have a lower relative cerebral blood volume, and higher minimum and average apparent diffusion coefficient values compared to CNS lymphomas. Flow cytometry shows a monotypic B lymphoid population in cases of CNS lymphoma, not in MS.
Background:Differentiating benign from malignant peripheral pulmonary lesions (PPLs) remains a clinical challenge, especially in resource-limited settings. While computed tomography is the standard imaging modality, it involves radiation exposure and often lacks specificity. Shear Wave Elastography (SWE) is a non-invasive ultrasound technique that quantifies tissue stiffness and may aid in the evaluation of PPLs. Methods:In this prospective observational study, 42 patients with peripheral pulmonary lesions underwent transthoracic SWE prior to histopathological evaluation. Elastography values were compared between benign and malignant lesions. Statistical analysis included ROC curve assessment, logistic regression, and correlation with histopathological and microbiological outcomes. Results:Of the 42 patients, 64.3% had malignant and 35.7% had benign lesions. The mean SWE value for malignant lesions was significantly higher (6.82 ± 2.27 kPa) than for benign lesions (3.72 ± 2.23 kPa; p <0.001). The AUROC for mean SWE values in predicting malignancy was 0.849 (95% CI: 0.713-0.986), demonstrating good diagnostic performance with statistically significant difference (p = <0.001), with a cutoff of ≥4.8 kPa yielding 85% sensitivity and 80% specificity. Squamous cell carcinoma exhibited the highest stiffness among malignancies. Certain benign lesions, particularly tuberculosis, showed elevated stiffness, resulting in false positives. Logistic regression identified mean SWE as an independent predictor of malignancy (OR = 2.11, p = 0.030). Conclusion:Transthoracic SWE is a non-invasive, radiation free and promising tool for evaluating PPLs, offering good diagnostic accuracy in distinguishing malignant from benign lesions. It holds particular promise in settings where access to advanced imaging or biopsy is limited, and may assist in triaging patients for early tissue diagnosis.
The caecum normally descends to the right iliac fossa during embryogenesis. Disruptions in midgut development may result in its atypical positioning. In a male cadaver, the small, conical caecum and paracaecal appendix were in the right lumbar region. The ileocaecal orifice was on the anterior caecal wall, and the appendicular orifice opened on the medial caecal wall inferior to it. The ascending colon was short, and the hepatic flexure was inferior to hepatic quadrate lobe. The right colic artery was absent. The ascending branch of the ileocolic artery supplied the caecum, and the appendix. The disposition of the rest of the intestinal tract and peritoneum were observed, and measurements were taken. Midgut development involves multiple regulatory genes, signalling pathways, transcription factors and mesenchyme-endoderm cross-talk. Mutations in several candidate genes were identified as contributing to midgut malrotation. Awareness of such a rare anatomical variation is essential to avoid misdiagnosis of atypical appendicitis or intestinal obstruction.
Background: We present the case of a 15-year-old adolescent with swelling in the left vulva that was found to have a tumor measuring approximately 20x15 cm in her vulva. Ewing’s sarcoma/primitive neuroectodermal tumors (ES/PNET) are rare and malignant. Materials and Methods: Preoperative magnetic resonance imaging and computed tomography performed to screen for metastasis were negative. The mass was surgically excised in total. Results: Immunohistochemistry showed the mass to be ES/PNET. The patient underwent positron emission tomography-computed tomography which revealed metastasis to inguinal lymph nodes and bone. While under chemotherapy for stage-4 ES/PNET, the patient was found to have lung metastasis. She died due to recurrent chemotherapy complications during treatment. Conclusions: This rare case highlights that significant of early diagnosis and multidisciplinary approach to treatment of ES/PNET cases.
Aim:The study aimed to determine the efficacy of antibodies to the NR2ab subunits of the N-methyl-D-aspartate (NMDA) receptor (NR2ab) as a biomarker for the differential diagnosis of acute and chronic cerebral ischaemia (CCI) among patients in Kazakhstan. Materials and methods:The study involved 52 patients with CCI classified as second-degree according to the Fazekas scale and 47 patients with acute ischaemic stroke (AIS), rated at 16-20 on the National Institutes of Health Stroke Scale (NIHSS), who were hospitalised in stroke centres within 24 hours of the first symptoms of stroke and confirmed by magnetic resonance imaging. Serum samples were collected to determine NR2ab antibody levels. Results:The results of the study showed that the mean level of NR2ab in patients with CCI was 1.42 ng/ml (95% CI: 1.2-1.6), while in patients with AIS it was 1.99 ng/ml (95% CI: 1.7-2.3). Statistical analysis revealed a significant difference between the groups (p=0.003), and logistic regression determined the prognostic significance of NR2ab with a coefficient of 1.885. The Receiver Operating Characteristic (ROC) curve analysis showed a diagnostic accuracy of 0.675, which indicates the prospects of using this biomarker to detect acute cerebral ischaemia. Conclusions:The results confirm that determining the level of NR2ab can be a useful tool for a timely diagnosis and selection of adequate treatment, especially in conditions of limited access to neuroimaging. Incorporation of this method into the standard diagnostic process can improve the efficiency of detecting ischaemic disorders and optimise patient care.
