Mucinous adenocarcinoma, a rare subtype of primary bladder adenocarcinoma, accounts for approximately 20% of primary bladder adenocarcinomas and should be distinguished carefully from secondary adenocarcinomas of gastrointestinal origin. Herein, we report an unusual case of primary mucinous adenocarcinoma arising from a villous adenoma in a 52-year-old male presenting with urinary difficulties and recurrent bladder tumours. The patient had a significant medical history including right nephrectomy and left ureterolithotomy. Radiological and pathological evaluations revealed invasive mucinous adenocarcinoma. Surgical management included radical cystectomy, left nephroureterectomy, right ureterectomy, segmental rectal resection, and bilateral pelvic lymphadenectomy. This case emphasizes the complexity of diagnosis and management, highlighting the importance of distinguishing primary bladder mucinous adenocarcinoma from secondary gastrointestinal malignancies.
Colorectal carcinoma (CRC) ranks among the most prevalent cancers worldwide, contributing significantly to cancer-related mortality. Despite advancements in understanding CRC’s pathophysiology, traditional staging systems like tumour, node, and metastasis (TNM) lack comprehensive prognostic indicators, particularly regarding tumour microenvironment and host-related factors. The Glasgow Microenvironment Score (GMS) integrates inflammatory cell infiltration and stromal percentage, offering a potentially more comprehensive prognostic tool. This study aims to evaluate GMS in CRC and its correlation with established clinicopathological prognostic markers and pathological tumour, node, and metastasis (pTNM) staging. A retrospective study involving 68 CRC patients who underwent curative surgery between January 2022 and March 2024. Haematoxylin and eosin-stained sections were assessed for inflammatory infiltration (Klintrup-Mäkinen score) and tumour stromal percentage, forming the GMS. Statistical analyses evaluated associations between GMS and clinicopathological markers, including lymphovascular invasion (LVI), perineural invasion (PNI), nodal status, and histological grading. The study found significant correlations between GMS and poor prognostic markers. High GMS was associated with increased LVI, PNI, and nodal involvement. GMS showed significant associations with LVI (p<0.0003), PNI (p<0.026), and nodal involvement (p<0.002). GMS serves as a robust prognostic indicator in CRC, correlating with key pathological features that influence patient outcomes. This scoring system could enhance traditional prognostic models, aiding in better stratification of CRC patients for therapeutic interventions.
Jejunal diverticulitis is a rare and often underdiagnosed condition characterized by inflammation of jejunal diverticula, more commonly seen in elderly patients with comorbidities. While most cases remain asymptomatic and are incidentally discovered during imaging studies, some patients may present with nonspecific symptoms such as abdominal pain and discomfort. The diagnosis is challenging due to its low prevalence and non-specific clinical presentation, often mimicking other causes of acute abdomen like appendicitis or colonic diverticulitis. Computed tomography with intravenous contrast is considered the gold standard for identifying diverticula, associated inflammatory changes, and potential complications. Ultrasound can also aid in diagnosis in certain cases. Management depends on the clinical severity. Uncomplicated cases generally respond well to conservative treatment with antibiotics and supportive care, while complicated cases may require surgical intervention. Early recognition and appropriate management are essential to prevent severe complications, such as perforation, bleeding, or obstruction, and to improve patient outcomes.
The objective was to evaluate the influence of two tongue cleaning methods (copper tongue scraper and toothbrush) on morning halitosis in dental students. Thirteen dental students were included. After training, the first participant took the halimeter home and used it for 6 days. On the first three days, halitosis was measured immediately after the participant woke up in the morning. The night before each of these first three days, before going to sleep, the participant cleaned their mouth with dental floss and a soft-bristled toothbrush. The individual’s same soft-bristled toothbrush was also used to brush his tongue. Only one halitosis measurement was taken per day and the value was recorded each day (toothbrush group). On the fourth, fifth and sixth day, the same process was carried out, but the night before measuring halitosis, a copper tongue scraper was used to clean the participants’ tongue. Only one halitosis measurement was taken per day and the value was recorded each day (tongue scraper group). Subsequently, for each participant, the highest halitosis value of the first three days (toothbrush group) was chosen, as well as the highest halitosis value of the last three days (tongue scraper group). The Wilcoxon test was used to compare the two groups (P<0.05). The halitosis value (median) in the toothbrush group was significantly higher than that in the tongue scraper group. Only the tongue scraper group showed a clinically acceptable halitosis value (imperceptible odour). Therefore, the copper tongue scraper is more recommended for cleaning the tongue.
Lumbar plexus blockade can be performed using both the classical landmark technique and ultrasound guidance. Reports suggest that ultrasound-guided blockade may enhance the safety of the procedure. Various approaches can be utilized for ultrasound-guided lumbar plexus blockade, including the paravertebral paramedian transverse scan, the Shamrock approach, and Trident imaging. In these imaging methods, needle guidance can be accomplished using either an in-plane or out-of-plane technique. Each of these application methods has limitations concerning needle imaging and guidance. In this case report, we present the outcomes of five patients who underwent lumbar plexus blockade for hip fracture surgery using an out-of-plane approach with Shamrock imaging, which could serve as a viable alternative to other methods.
