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The article presents a case study of a 7-year-old pediatric patient with stercoral colitis and acute kidney injury resulting from chronic constipation. Topics discussed include the recognition of conditions like stercoral colitis in children, the widespread and often underdiagnosed nature of chronic constipation, and the potential long-term complications that can arise if this condition is not adequately managed.

Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare and aggressive mesenchymal tumor, with less than 400 reported cases to date. Complete resection of the tumor with clear margins is the only proven curative treatment, providing survival benefits. Nonetheless, leiomyosarcomas in the middle segment or those extending up to it within the inferior vena cava (IVC) frequently necessitate renal reimplantation or nephrectomy, with rates varying between 56% and 75%. In this case report, we present a 65-year-old female with lower segment IVC leiomyosarcoma with middle segment extension, successfully resected and reconstructed while avoiding associated renal reimplantation or nephrectomy morbidity. [ABSTRACT FROM AUTHOR]

Introduction: Haemoperitoneum due to spontaneous splenic rupture is a rare condition. Methods: We present a case of AL-type amyloidosis and chronic kidney disease (CKD) who is presented with diffuse abdominal pain. A contrast-enhanced CT scan of the abdomen revealed moderate to large amounts of free fluid in the peritoneum, indicating splenic rupture causing haemoperitoneum. Result: The patient underwent emergency exploratory laparotomy and splenectomy. After the operation, the patient was closely monitored in the ICU and was transferred to the ward on postoperative day 3. He was discharged home on day 6. Conclusion: This case report highlights a rare occurrence of haemoperitoneum secondary to spontaneous splenic rupture in a patient with AL amyloidosis. [ABSTRACT FROM AUTHOR]

Lumbar artery pseudoaneurysms are a rare complication of penetrating trauma that can result in devastating retroperitoneal hemorrhage or embolic complications if left untreated. Prompt recognition in the trauma setting can lead to timely definitive diagnosis via spinal angiography and treatment via endovascular embolization. We present a case of lumbar artery pseudoaneurysm secondary to a gunshot wound to the spine treated via coil embolization. [ABSTRACT FROM AUTHOR]

Solid pseudopapillary tumor is a mixed solid and cystic neoplasm of the pancreas which occurs most commonly in females in second or third decade of life with few reported pediatric cases. It has a low malignancy potential with good prognosis after surgical resection. We present a case of an 11-year-old male child with solid pseudopapillary tumor of pancreas who presented with clinical features of acute pancreatitis. He was initially evaluated with ultrasound, followed by computed tomography (CT) and magnetic resonance imaging (MRI). Solid pseudopapillary tumor of pancreas presenting as acute pancreatitis is rarely reported in literature. This case is a unique presentation of a pancreatic tumor and highlights the value of multiphase CT imaging and MRI in the diagnosis. [ABSTRACT FROM AUTHOR]

Background: Very-low-birth-weight (VLBW) infants often experience feeding intolerance owing to organ immaturity, and the most frequent sign is the presence of abdominal distention. Daikenchuto (DKT), a traditional Japanese herbal medicine, is used to improve gastrointestinal function, particularly in adults. The aim of this study was to investigate the effectiveness of DKT in reducing abdominal distention and intestinal gas in VLBW infants. Methods: This study involved a retrospective chart review of 24 VLBW infants treated with DKT at Hamamatsu University Hospital between April 2016 and March 2021. The effects of DKT treatment at a dose of 0.3 g/kg/day were evaluated through clinical parameters and abdominal radiography. Results: Before treatment, marked abdominal distention was observed in 46% of the infants, which reduced to 4% within a week of DKT administration. The gas volume score (GVS) decreased in 92% of the patients within the first week of treatment and markedly decreased by ≥20% in 46% of the patients. The effects of improving abdominal distention and decreasing the GVS on radiography persisted for 1–2 weeks after treatment initiation. No clinical parameters affecting a GVS reduction of ≥20% and no notable adverse effects were observed. Conclusions: While the preliminary findings suggest that DKT may help manage abdominal distention in VLBW infants, further studies with placebo-controlled trials, larger sample sizes, use of advanced image processing software, and consideration of additional influencing factors are required to substantiate these results and identify predictors of treatment response. [ABSTRACT FROM AUTHOR]

Introduction and objectives: Laparoscopic splenectomy and esophagogastric devascularization (LSED) are minimally invasive, effective, and safe in treating esophageal-fundic variceal bleeding with portal hypertension (PHT). The study aimed to assess the learning curve of LSED by cumulative summation (CUSUM) analysis. The 10-year follow-up data for LSED and open surgery were also examined. Patients and methods: Five hundred and ninety-four patients were retrospectively analyzed. Operation time, intraoperative blood loss, open operation conversion, and postoperative complications were selected as the evaluation indicators of surgical ability. The learning curve of LESD was assessed by the CUSUM approach. Patient features, perioperative indices, and 10-year follow-up data were examined. Results: Totally 236 patients underwent open surgery, and 358 underwent LSED. Patient characteristics were similar between groups. The LSED patients experienced less intraoperative blood loss, fewer complications, and faster recovery compared to the open surgery cohort. The learning curve of LESD was maximal for a case number of 50. Preoperative general characteristics were comparable for both stages. But the skilled stage had decreased operation time, reduced blood loss, less postoperative complications, and better recovery compared to the learning stage. The LSED group had higher recurrent hemorrhage-free survival rate and increased overall survival in comparison with cases administered open surgery in the 10-year follow-up. Free-liver cancer rates were similar between two groups. Conclusions: About 50 cases are needed to master the LSED procedure. Compared to open surgery, LSED is a safer, feasible, and safe procedure for PHT patients, correlating with decreased rebleeding rate and better overall survival. [ABSTRACT FROM AUTHOR]

Awareness of the vein dimensions facilitates the detection of both solid organ and vein pathologies. We aimed to provide reference values major intra-abdominal portal and systemic vein diameters in several pediatric age groups and reveal associations of vein diamaters with each other, age, and waist circumference using data from contrast-enhanced abdominal computed tomography. Abdominal computed tomography images of 800 pediatric patients (468 men, 332 women) aged 0–2, 3–5, 6–10, 11–14, and 15–17 years having normal abdominal radiological findings were examined. The means with standard deviations and the 10th, 25th, 50th, 75th, and 90th percentiles of the the major portal vein with right and left branches, superior mesenteric and splenic veins, right and left renal veins, and intrahepatic vena cava inferior diameters were calculated for all age groups. Differences in mean diameters were analyzed with the analysis of variance and Tukey's Honestly Significant Difference tests between age groups and with the t-test between gender groups. Pearson correlation analysis was performed to determine the associations of vein diameters with each other, age and waist circumference. There was no significant difference between gender groups in terms of age and vein diameters. Significant differences in mean diameters were identified in the consecutive age groups from group 1 to 4 (p = 0.001) for splanchnic venous system, renal veins, and vena cava inferior. Diameters were significantly greater in age group 5 compared to age group 4 (p = 0.049–0.001). Moderate positive correlations were found between diameters of the portal vein, superior mesenteric vein, and vena cava inferior with age and waist circumference (p = 0.001, r = 0.54–0.7). Moderate positive correlation was identified between age and estimated waist circumference (p = 0.001, r = 0.77). Age and waist circumference dependant regression equations and relative ratios for vein diamaters were depicted. We provide reference ranges as means and percentiles for the diameters of splanchnic venous system, renal veins, and vena cava inferior using computed tomography images of age stratified children. Vein diameters were correlated with each other, age, and waist circumference. [ABSTRACT FROM AUTHOR]

Atlases of normal genomics, transcriptomics, proteomics, and metabolomics have been published in an attempt to understand the biological phenotype in health and disease and to set the basis of comprehensive comparative omics studies. No such atlas exists for radiomics data. The purpose of this study was to systematically create a radiomics dataset of normal abdominal and pelvic radiomics that can be used for model development and validation. Young adults without any previously known disease, aged > 17 and ≤ 36 years old, were retrospectively included. All patients had undergone CT scanning for emergency indications. In case abnormal findings were identified, the relevant anatomical structures were excluded. Deep learning was used to automatically segment the majority of visible anatomical structures with the TotalSegmentator model as applied in 3DSlicer. Radiomics features including first order, texture, wavelet, and Laplacian of Gaussian transformed features were extracted with PyRadiomics. A Github repository was created to host the resulting dataset. Radiomics data were extracted from a total of 531 patients with a mean age of 26.8 ± 5.19 years, including 250 female and 281 male patients. A maximum of 53 anatomical structures were segmented and used for subsequent radiomics data extraction. Radiomics features were derived from a total of 526 non-contrast and 400 contrast-enhanced (portal venous) series. The dataset is publicly available for model development and validation purposes. [ABSTRACT FROM AUTHOR]

Acute cholecystitis is a leading cause of individuals seeking medical attention in the emergency department due to right upper quadrant pain. Common complications associated with this clinical condition, which is frequently encountered in daily practice, include gangrenous cholecystitis, pericholecystic abscess, cholangitis, and gallbladder perforation. It is important to also consider the rare but potentially severe complication of cystic artery pseudoaneurysm. This case report details the development of a cystic artery pseudoaneurysm secondary to acute cholecystitis and its subsequent endovascular treatment in a 59-year-old male patient with no known underlying medical conditions, in accordance with existing literature. [ABSTRACT FROM AUTHOR]

This manuscript seeks to describe diagnostic considerations in individuals with diabetes mellitus presenting to the ED with abdominal pain. It highlights the importance of early investigation with computerised tomography to differentiate aetiologies that compel early surgical intervention from those which may be treated conservatively. [ABSTRACT FROM AUTHOR]

The differential diagnosis of cystic echinococcosis should be considered in the suspected case of a pelvic mass presenting with vague symptoms. Primary pelvic hydatid cyst is rare, and the achievement of early diagnosis is important, as the involvement of bone in the pelvis is difficult to treat, and the probability of recurrences is greater. This case report presents a rare case of a primary pelvic hydatid cyst in a male in his 30s. The patient presented vague symptoms of difficulty in micturition and chronic pelvic pain. First-line radiological imaging techniques diagnosed it as a neoplastic mass and tuberculosis, while MRI revealed it as a cystic disease, probably a hydatid cyst. Surgical excision and histopathological examination confirmed the diagnosis of a primary pelvic hydatid cyst. Acquaintance with the varied presentation of cystic echinococcosis helps to obtain an accurate diagnosis and thus decreases the severe complication associated with the disease. This case report highlights the importance of considering parasitic infections in the differential diagnosis of cystic pelvic masses, even in regions with low endemicity. [ABSTRACT FROM AUTHOR]

Background: Intestinal necrosis in uremic patients has been reported but is rare. Case presentation: A 56-year-old male patient who underwent long-term regular haemodialysis was admitted to the hospital due to involuntary shaking of the limbs and nonsense speech. The patient's symptoms improved after continuous blood purification under heparin anticoagulation, rehydration, sedation, and correction of electrolyte disturbances. However, the patient experienced a sudden onset of abdominal pain and a rapid decrease in blood pressure; high-dose norepinephrine were required to maintain his blood pressure. A plain abdominal radiograph performed at bedside showed intestinal dilation. Colonoscopy revealed inflammation and oedema of the entire colon, with purulent secretions and multiple areas of patchy necrosis. The cause of intestinal ischaemia was not clear. Conclusions: Although rare, previous causes of uremic colitis have been reported. As the patient developed abdominal pain before the onset of shock and the necrosis was seen on colonoscopy, we suspect that this is a case of fulminant uremic colitis. [ABSTRACT FROM AUTHOR]

Background: Congenital adrenal hyperplasia (CAH) encompassed a bunch of autosomal recessive disorders characterized by impaired cortisol levels due to an enzymatic deficiency in steroid synthesis. In adult male patients with CAH, a frequent complication related to poor disease control is the development of ectopic adrenocortical tissue in the testes, named testicular adrenal rest tumors (TART). Conversely, ovarian adrenal rest tumors (OART) in females are extremely rare and adrenal rests in sites other than gonads are so uncommon to have been described only few times in literature. Case presentation: We report a case of a male patient with untreated CAH and oncologic history of pleomorphic sarcoma who presented with massive bilateral adrenal enlargement and adrenal rest tumors in peri-lumbar and peri-cecal sites, which mimicked metastasis from sarcoma. Conclusions: The development of massive adrenal enlargement and ectopic adrenal rest tumors in sites other than gonads, even if very uncommon, should be suspected in patients with CAH and prolonged periods of undertreatment. [ABSTRACT FROM AUTHOR]

The article focuses on a rare case of polyneuropathy associated with a solitary hepatic plasmacytoma, which is an unusual presentation in multiple myeloma spectrum disorders. Topics include the patient's symptoms and clinical findings, the diagnostic process involving various tests and imaging, and the management of the condition.

Coil migration during endovascular embolization is a complication that can result in thromboembolic occlusion leading to potentially large infarcts if not removed. Microsnares are commonly used to remove migrated coils. Current techniques, however, struggle in cases where the microsnare is unable to loop over and secure a free end of the coil. We present a case in which a microsnare combined with a microwire successfully removed a migrated coil in a patient with a bleeding hepatic pseudoaneurysm post-embolization. This technique proved beneficial when traditional methods were insufficient, especially in small vessels or coil packs that cannot be snared. The synergy of the microsnare and microwire technique presents a promising solution for challenging migrated coil retrievals. [ABSTRACT FROM AUTHOR]

The article focuses on considering liver abscess as a potential etiology for prolonged fever without an obvious cause in pediatric patients, especially those with acute changes in appetite, abdominal symptoms, or recent abdominal trauma. Topics include typical bacteria associated with liver abscesses, such as Staphylococcus aureus and Escherichia coli, as well as parasitic etiologies like Amebiasis and Human Echinococcosis, based on exposure history.

While drug trafficking is a major problem worldwide, body packing involving the storage of narcotic drugs in the human body represents an emergency because of the risk of deadly narcotic toxicity, intestinal obstruction and visceral perforation. We presented the evaluation of body packer cases, which have not been seen before in this region, in the emergency clinic. This study analyzes the medical records of body packers from January to July 2023. Hematological and biochemical tests, abdominal radiographs and tomographies, and removed packages were evaluated in all cases. Nine body packer cases carrying narcotic substances were observed in this study. The mean age was 33 ± 6.3, 2 (22%) were female and 7 (78%) were male. None of the patients required emergency surgery. One patient had acute narcotic intoxication. In this patient, whose packages were observed to be intact, drug intoxication was associated with substance use. Abdominal radiography diagnosed all cases and all were recovered and discharged. It is very important for public safety to diagnose body packing cases and prevent the transport of packages. In this issue, emergency physicians should have radiography and CT imaging features in asymptomatic body packing cases. [ABSTRACT FROM AUTHOR]

Background: Hyperspectral imaging (HSI), combined with machine learning, can help to identify characteristic tissue signatures enabling automatic tissue recognition during surgery. This study aims to develop the first HSI-based automatic abdominal tissue recognition with human data in a prospective bi-center setting. Methods: Data were collected from patients undergoing elective open abdominal surgery at two international tertiary referral hospitals from September 2020 to June 2021. HS images were captured at various time points throughout the surgical procedure. Resulting RGB images were annotated with 13 distinct organ labels. Convolutional Neural Networks (CNNs) were employed for the analysis, with both external and internal validation settings utilized. Results: A total of 169 patients were included, 73 (43.2%) from Strasbourg and 96 (56.8%) from Verona. The internal validation within centers combined patients from both centers into a single cohort, randomly allocated to the training (127 patients, 75.1%, 585 images) and test sets (42 patients, 24.9%, 181 images). This validation setting showed the best performance. The highest true positive rate was achieved for the skin (100%) and the liver (97%). Misclassifications included tissues with a similar embryological origin (omentum and mesentery: 32%) or with overlaying boundaries (liver and hepatic ligament: 22%). The median DICE score for ten tissue classes exceeded 80%. Conclusion: To improve automatic surgical scene segmentation and to drive clinical translation, multicenter accurate HSI datasets are essential, but further work is needed to quantify the clinical value of HSI. HSI might be included in a new omics science, namely surgical optomics, which uses light to extract quantifiable tissue features during surgery. [ABSTRACT FROM AUTHOR]

Convolutional Neural Networks have been widely applied in medical image segmentation. However, the existence of local inductive bias in convolutional operations restricts the modeling of long-term dependencies. The introduction of Transformer enables the modeling of long-term dependencies and partially eliminates the local inductive bias in convolutional operations, thereby improving the accuracy of tasks such as segmentation and classification. Researchers have proposed various hybrid structures combining Transformer and Convolutional Neural Networks. One strategy is to stack Transformer blocks and convolutional blocks to concentrate on eliminating the accumulated local bias of convolutional operations. Another strategy is to nest convolutional blocks and Transformer blocks to eliminate bias within each nested block. However, due to the granularity of bias elimination operations, these two strategies cannot fully exploit the potential of Transformer. In this paper, a parallel hybrid model is proposed for segmentation, which includes a Transformer branch and a Convolutional Neural Network branch in encoder. After parallel feature extraction, inter-layer information fusion and exchange of complementary information are performed between the two branches, simultaneously extracting local and global features while eliminating the local bias generated by convolutional operations within the current layer. A pure convolutional operation is used in decoder to obtain final segmentation results. To validate the impact of the granularity of bias elimination operations on the effectiveness of local bias elimination, the experiments in this paper were conducted on Flare21 dataset and Amos22 dataset. The average Dice coefficient reached 92.65% on Flare21 dataset, and 91.61% on Amos22 dataset, surpassing comparative methods. The experimental results demonstrate that smaller granularity of bias elimination operations leads to better performance. [ABSTRACT FROM AUTHOR]

Diagnostic reference levels (DRLs) and achievable doses (ADs) provide guidance to optimise radiation doses for patients undergoing medical imaging procedures. This multi-centre study aimed to compare institutional DRLs (IDRLs) across hospitals, propose ADs and multi-centric DRLs (MCDRLs) for four common x-ray examinations in Sri Lanka, and assess the potential for dose reduction. A prospective cross-sectional study of 894 adult patients referred for abdomen anteroposterior (AP), kidney-ureter-bladder (KUB) AP, lumbar spine AP, and lumbar spine lateral (LAT) x-ray examinations was conducted. Patient demographic information (age, sex, weight, BMI) and exposure parameters (tube voltage, tube current-exposure time product) were collected. Patient dose indicators were measured in terms of kerma-area product (PKA) using a PKA meter. IDRLs, ADs, and MCDRLs were calculated following the International Commission on Radiological Protection guidelines, with ADs and MCDRLs defined as the 50th and 75th percentiles of the median PKA distributions, respectively. IDRL ranges varied considerably across hospitals: 1.42–2.42 Gy cm2 for abdomen AP, 1.51–2.86 Gy cm2 for KUB AP, 0.83–1.65 Gy cm2 for lumbar spine AP, and 1.76–4.10 Gy cm2 for lumbar spine LAT. The proposed ADs were 1.82 Gy cm2 (abdomen AP), 2.03 Gy cm2 (KUB AP), 1.27 Gy cm2 (lumbar spine AP), and 2.21 Gy cm2 (lumbar spine LAT). MCDRLs were 2.24 Gy cm2 (abdomen AP), 2.40 Gy cm2 (KUB AP), 1.43 Gy cm2 (lumbar spine AP), and 2.38 Gy cm2 (lumbar spine LAT). Substantial intra- and inter-hospital variations in PKA were observed for all four examinations. Although ADs and MCDRLs in Sri Lanka were comparable to those in the existing literature, the identified intra- and inter-hospital variations underscore the need for dose reduction without compromising diagnostic information. Hospitals with high IDRLs are recommended to review and optimise their practices. These MCDRLs serve as preliminary national DRLs, guiding dose optimisation efforts by medical professionals and policymakers. [ABSTRACT FROM AUTHOR]

Copyright of Medical Journal of Bakirkoy is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: We aimed to assess risk factors of candida-related Vascular Graft Infections (VGIs). Methods: We did a case–control study (1:4) matched by age and year of infection, nested in a cohort of patient with a history of VGIs. Cases were defined by a positive culture for Candida spp. in biological samples and controls were defined by a positive culture for bacterial strains only in biological samples. Risk factors for Candida-related VGIs were investigated using multivariate logistic regression. Mortality were compared using survival analysis. Results: 16 Candida-related VGIs were matched to 64 bacterial-related VGIs. The two groups were comparable regarding medical history and clinical presentation. Candida-related VGIs were associated with bacterial strains in 88% (14/16). Gas/fluid-containing collection on abdominal CT scan and the presence of an aortic endoprosthesis were risk factors for Candidaspp.-related VGIs [RRa 10.43 [1.81–60.21] p = 0.009 RRa and 6.46 [1.17–35.73] p = 0.03, respectively]. Candida-related VGIs were associated with a higher mortality when compared to bacterial-related VGIs (p = 0.002). Conclusions: Candida-related VGIs are severe. Early markers of Candidaspp. infection are needed to improve their outcome. The suspicion of aortic endoprosthesis infection may necessitate probabilistic treatment with antifungal agents. [ABSTRACT FROM AUTHOR]

Introduction: The introduction of the functional lumen imaging probe (FLIP) has provided objective, real-time feedback on the geometric variations with each component of a hiatal hernia repair (HHR). The utility of this technology in altering intraoperative decision-making has been scarcely reported. Herein, we report a single-center series of intraoperative FLIP during HHR. Methods: A retrospective review of electronic medical records between 2020 and 2022 was conducted and all patients undergoing non-recurrent HHR with FLIP were queried. Patient and hernia characteristics, intraoperative FLIP values and changes in decision-making, as well as early post-operative outcomes were reported. Both diameter and distensibility index (DI) were measured at 40 ml and 50 ml balloon inflation after hiatal dissection, after hiatal closure, and after fundoplication when indicated. Results: Thirty-three patients met inclusion criteria. Mean age was 62 ± 14 years and mean BMI was 28 ± 6 kg/m2. The majority (53%) were type I hiatal hernias. The largest drop in DI occurred after hiatal closure, with minimal change seen after fundoplication (mean DI of 4.3 ± 2. after completion of HH dissection, vs 2.7 ± 1.2 after hiatal closure and 2.3 ± 1 after fundoplication when performed). In 13 (39%) of cases, FLIP values directly impacted intraoperative decision-making. Fundoplication was deferred in 4/13 (31%) patients, the wrap was loosened in 2/13 (15%); the type of fundoplication was altered to achieve adequate anti-reflux values in 2/13 (15%) patients, and in 1/13 (3%) the wrap was tightened. Conclusion: FLIP measurements can be used intraoperatively to guide decision-making and alter management plan based on objective values. Long-term outcomes and further prospective studies are required to better delineate the value of this technology. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is an extremely common disease with a variety of medical and surgical treatment approaches. A multidisciplinary expert panel was convened to develop evidence-based recommendations to support clinicians and patients in decisions regarding the diagnosis and treatment of appendicitis. Methods: A systematic review was conducted from 2010 to 2022 to answer 8 key questions relating to the diagnosis of appendicitis, operative or nonoperative management, and specific technical and post-operative issues for appendectomy. The results of this systematic review were then presented to a panel of adult and pediatric surgeons. Evidence-based recommendations were formulated using the GRADE methodology by subject experts. Results: Conditional recommendations were made in favor of uncomplicated and complicated appendicitis being managed operatively, either delayed (>12h) or immediate operation (<12h), either suction and lavage or suction alone, no routine drain placement, treatment with short-term antibiotics postoperatively for complicated appendicitis, and complicated appendicitis previously treated nonoperatively undergoing interval appendectomy. A conditional recommendation signals that the benefits of adhering to a recommendation probably outweigh the harms although it does also indicate uncertainty. Conclusions: These recommendations should provide guidance with regard to current controversies in appendicitis. The panel also highlighted future research opportunities where the evidence base can be strengthened. [ABSTRACT FROM AUTHOR]

Background and Aims: Lipomas are termed as universal tumours. They can potentially arise from any site having adipose tissue. Presence of lipomas in the intra-peritoneal region is rare, with mesentery being one of the rare locations. Methods: We present a rare case of a two-year-old child with a giant mesenteric lipoma. This child presented with malnutrition and was being treated for Koch's abdomen. Results: The child underwent uneventful resection of mass. Conclusion: Giant mesenteric lipomas due to their size can present with various unusual symptoms. However, these seldom infiltrate and are easily operable with an uneventful intra-operative course and follow-ups. [ABSTRACT FROM AUTHOR]

Bisphosphonates are widely used to treat several clinical conditions. Zoledronic acid is one of these classes, commonly used for the treatment and prevention of osteoporosis, hypercalcemia of malignancy, Paget's disease, and multiple myeloma. Side effects associated with zoledronic acid include fever, fatigue, arthralgia, myalgia, nausea, and bone pain. Liver damage caused by bisphosphonate is rare. No cases of acute pancreatitis have been described in the literature. We describe a 74-year-old woman who presented with features of acute pancreatitis 3 days following the first dose of intravenous zoledronic acid infusion administered to treat postmenopausal osteoporosis. Supportive treatment was given for 5 days. She was discharged without any problems. [ABSTRACT FROM AUTHOR]

Background. Duodenal atresia or stenosis are different degrees of the same abnormality. They usually occur at the level of the ampulla of Vater and are thought to be an embryologic defect during the development of the foregut, leading to abnormal recanalization. Complete duodenal atresia is usually symptomatic in the early neonatal period, while partial obstruction (web, stenosis) may have a late presentation and a more challenging diagnosis such as in our case. Case Presentation. The patient, a 16-year-old girl, presented with abdominal pain, recurrent vomiting, and growth failure. An upper GI study with barium showed an image compatible with gastroptosis. Further diagnostic procedures confirmed a rare finding such as congenital duodenal stenosis. She underwent surgical intervention, and the recovery period was uneventful. Conclusion. Gastroptosis is not diagnostic for a particular disease. This rare radiological finding in children may obscure uncommon diagnosis, such as congenital duodenal stenosis, which can present a diagnostic challenge beyond early childhood. [ABSTRACT FROM AUTHOR]

Although SARS-CoV-2 commonly affects the respiratory system, several other major organ systems can be involved, including the gastrointestinal. The main gastrointestinal manifestations are diarrhoea, nausea, and vomiting. Few cases of acute pancreatitis along with COVID-19 infection have been reported. Current evidence stresses that both clinical and radiographic studies can be suggestive of acute pancreatitis in COVID-19 patients, even without any respiratory symptoms. We report a case of a female patient who presented with severe epigastric pain and vomiting and was diagnosed with acute pancreatitis on a COVID-19 infection. The patient had an otherwise unremarkable medical history. Upper respiratory symptoms were developed on day 2 of her hospital stay. Acute pancreatitis was attributed to the COVID-19 infection, following the exclusion of other common causes of pancreatitis. Our case points out that acute pancreatitis can be developed in asymptomatic COVID-19-infected patients as well as those with a mild form of COVID-19 infection. [ABSTRACT FROM AUTHOR]

Rhodotorula mucilaginosa fungemia is rare and highly resistant to antifungal therapy. We herein report a case involving a 31-year-old male admitted after a high-velocity road traffic accident. He sustained a grade IV liver injury with right hepatic vein thrombosis, which necessitated an urgent laparotomy. Post-operatively, repeated imaging of the abdomen revealed the presence of a biloma. Percutaneous subdiaphragmatic drainage was carried out but appeared ineffective, prompting a second surgery for an urgent hemi-hepatectomy. The patient was then nursed in the intensive care unit (ICU); however, during his stay in the ICU, he became more sepsis, which was evident by worsening ventilatory support and a rise in septic parameters from the biochemistry parameters. Despite intravenous piperacillin–tazobactam and fluconazole, his septic parameters did not improve and a full septic workup was conducted and was found to be positive for Rhodotorula mucilaginosa from the blood cultures. After discussion with the infectious disease physicians and clinical microbiologists, it was decided to initiate a course of intravenous meropenem and amphotericin B based on minimum inhibitory concentration (MIC) values, considering the patient's extended ICU stay and catheter use. Eventually, after successfully weaning off mechanical ventilation, the patient was discharged from ICU care. This case underscores the necessity of individualized approaches, combining timely imaging, appropriate drainage techniques, and tailored treatments to optimize outcomes for such intricate post-traumatic complications. [ABSTRACT FROM AUTHOR]

Hepatocellular carcinoma (HCC) is the most common primary malignant tumor of the liver. Osteoclast-like giant cells (OGCs) are relatively more common in pancreatic cancer, but extremely rare in HCC. Currently, there have been only a few reported cases of OGCs in HCC, and their presence indicates an aggressive clinical course. Here, we present a case of primary undifferentiated carcinoma of the liver with OGCs in a 49-year-old male patient, and through a literature review, we summarize 20 similar cases to further understand the diagnosis, treatment, and clinical course of this disease entity. [ABSTRACT FROM AUTHOR]

Volvulus affecting the gastrointestinal (GI) tract is one of the common causes of recurrent pain in the abdomen, and often, patients present with non-specific abdominal pain associated with nausea and/or vomiting. A high degree of suspicion is required at the clinician's end to suspect this diagnosis, which is usually confirmed by imaging using radiographs, fluoroscopic evaluation, and computed tomography. Familiarity of the clinician and radiologist with the imaging appearances of these emergent conditions on various imaging modalities is quintessential to avoiding life-threatening complications like bowel ischemia or perforation, which are associated with delayed or missed diagnosis. Our article describes the clinical features and classical imaging of the various types of volvulus affecting different bowel segments in the entire GI tract. [ABSTRACT FROM AUTHOR]

To develop a fully automatic urinary stone detection system (kidney, ureter, and bladder) and to test it in a real clinical environment. The local institutional review board approved this retrospective single-center study that used non-enhanced abdominopelvic CT scans from patients admitted urology (uPatients) and emergency (ePatients). The uPatients were randomly divided into training and validation sets in a ratio of 3:1. We designed a cascade urinary stone map location-feature pyramid networks (USm-FPNs) and innovatively proposed a ureter distance heatmap method to estimate the ureter position on non-enhanced CT to further reduce the false positives. The performances of the system were compared using the free-response receiver operating characteristic curve and the precision-recall curve. This study included 811 uPatients and 356 ePatients. At stone level, the cascade detector USm-FPNs has the mean of false positives per scan (mFP) 1.88 with the sensitivity 0.977 in validation set, and mFP was further reduced to 1.18 with the sensitivity 0.977 after combining the ureter distance heatmap. At patient level, the sensitivity and precision were as high as 0.995 and 0.990 in validation set, respectively. In a real clinical set of ePatients (27.5% of patients contain stones), the mFP was 1.31 with as high as sensitivity 0.977, and the diagnostic time reduced by > 20% with the system help. A fully automatic detection system for entire urinary stones on non-enhanced CT scans was proposed and reduces obviously the burden on junior radiologists without compromising sensitivity in real emergency data. [ABSTRACT FROM AUTHOR]

Chromosome 17q12 deletion syndrome (OMIM #614527) is a rare genetic disorder associated with a heterozygous 1.4–1.5 Mb deletion at chromosome 17q12, leading to a spectrum of clinical manifestations, including kidney abnormalities, neurodevelopmental delay, maturity-onset diabetes of the young type 5 (MODY5), and Mayer–Rokitansky–Küster–Hauser (MRKH) syndrome. We present the case of a 14-year-old Korean female diagnosed with chromosome 17q12 deletion syndrome, confirmed by chromosomal microarray analysis. The patient exhibited MODY5 with pancreatic agenesis, MRKH syndrome, dysmorphic facial features, developmental delay, kidney rotation anomaly, portal vein thrombosis with liver hypoplasia, short stature, and scoliosis. Management involved the initiation of multiple daily insulin injections for diabetes control, gynecological evaluation for MRKH syndrome, and multidisciplinary care for associated complications. This case highlights the complexity and varied organ involvement in chromosome 17q12 deletion syndrome. A comprehensive and multidisciplinary approach is crucial for the management of affected individuals, including regular monitoring, tailored interventions across various medical specialties, and providing psychosocial support. [ABSTRACT FROM AUTHOR]

Copyright of Revista de la Facultad de Medicina Humana is the property of Instituto de Investigaciones en Ciencias Biomedicas de la Universidad Ricardo Palma and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Primary mesenteric and/or retroperitoneal amyloidosis is a rare entity with only few cases described in literature. Herein we describe an unusual such case in a 56-year-old man who presented with long-standing vague abdominal pain and lump. Abdominopelvic CT revealed numerous nodular variably calcifying deposits that were diffusely involving the mesenteric and retroperitoneal fat. Resected specimen pathology showed extracellular amyloid deposits replacing the adipocytes that were congophilic and exhibited apple green birefringence under polarized light. Kappa light chain restriction was noted in amyloid deposits on immunohistochemical studies. Myeloma studies did not reveal any significant abnormality. In view of the primary AL amyloidosis, the patient was started on cyclophosphamide, thalidomide, and dexona (CTD regimen). The patient responded well to the treatment with no further progression of the lesions. After 7 years of follow-up, the patient is alive with no systemic complications. [ABSTRACT FROM AUTHOR]

Background: Patients with non-specific symptoms or signs of cancer (NSSC) present a challenge as they are a heterogeneous population who are not candidates for fast-track work-up in an organ-specific cancer pre-planned pathway (CPP). Denmark has a cancer pre-planned pathway for this population (NSSC-CPP), but several issues remain unclarified, for example, distribution and significance of symptoms and findings, and choice of imaging. Aim: To investigate symptoms, cancer diagnoses, and diagnostic yield of computed tomography (CT) and fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in patients on NSSC-CPP to improve the overall diagnostic process. Design & setting: A retrospective medical chart review in a 1-year consecutive cohort (2020). Method: A total of 802 referrals were reviewed for diagnostic imaging in patients with NSSP from general practices, specialist practices, or the local hospital diagnostic centre responsible for NSSC-CPP. Results: The study included 248 patients; 21% had cancer, most frequently gastrointestinal cancer (27%). The most frequent symptom was weight loss (56%). CT had a sensitivity of 85%, specificity of 87%, positive predictive value (PPV) of 65%, and negative predictive value (NPV) of 96%. For 18F-FDG-PET/CT, the numbers were sensitivity 82%, specificity 62%, PPV 33%, and NPV 94%. Patients frequently underwent subsequent examinations following initial imaging. Conclusion: The findings were in accordance with the literature. Patients with NSSC had a cancer prevalence of 21%, most frequently gastrointestinal. The most frequent symptom was weight loss and, even as the only symptom, it is a potential marker for cancer. CT and 18F-FDG-PET/CT were sensitive with high NPV, whereas PPV was superior in CT. Better stratification by symptoms or findings is an obvious focus point for future studies to further optimise the NSSC-CPP work-up strategy. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to use deep learning techniques to discriminate different degrees of scoliosis on plain radiographs. Materials and Methods: The study was performed on 1006 standing plain abdominal and chest radiographs (age range 10-18 years) obtained from the archive of our institution. The radiographs were divided into three groups according to the degree of scoliosis: normal (0-9°), mild (10-29°), and moderate/advanced (30° and above). The data were randomly selected and 15% were used for testing, 15% for validation, and the remaining 70% for training. Due to the limited data, the transfer learning (TL) method was used. Pre-trained VGG-16, ResNet-101, and GoogLeNet networks were used for TL. The original classifier was replaced with a new one. Geometric transformations of the radiographs were used for data augmentation. Rotation (-30, 30 degrees), translation (-30, 30 pixels), and scaling (0.9, 1.1 pixels) were applied to the images. The performance of the networks was evaluated using the performance parameters of accuracy, sensitivity, specificity, precision, and F1 score. Results: Overall accuracy after testing the models was determined to be 90.1% for VGG-16, 86.1% for ResNet-101, and 85.5% for GoogLeNet. The accuracy, sensitivity, specificity, precision, and F1 score were 90.1%, 90.7%, 95.0%, 89.9%, and 90.1% for VGG-16, respectively. The VGG-16 values were determined to be higher than those of the ResNet-101 and GoogLeNet networks. Conclusion: The results showed favorable results for deep TL methods in the assessment of normal, mild, and moderate/advanced scoliosis. [ABSTRACT FROM AUTHOR]

Background: Lupus mesenteric vasculitis (LMV) is a serious complication of systemic lupus erythematosus (SLE) that can lead to a range of gastrointestinal issues, such as intestinal bleeding, necrosis, and perforation. The optimal surgical approach for cases of intestinal necrosis in LMV remains a topic of debate. Case presentation: We present the first documented instance of jejunal necrosis in a 56-year-old woman undergoing SLE treatment. The patient presented with symptoms including abdominal distension, pain, nausea, and vomiting. Physical examination revealed abdominal tenderness, rebound pain, and muscle tension. Following surgery and steroid therapy, the patient experienced successful recovery and was discharged from the hospital. Conclusions: Patients with jejunal necrosis due to SEL, during intraoperative exploration, surgical decisions should be made based on careful observation. In cases of extensive jejunal necrosis that cannot be preserved, it is advisable to resect the necrotic tissue as much as possible, with a recommended extended resection margin of 2–3 cm. [ABSTRACT FROM AUTHOR]

Simple Summary: Sarcopenia, conceived as low skeletal muscle mass and function, has been associated with worse outcomes in patients treated with Sorafenib for advanced HCC, with data coming mainly from the Oriental series. Skeletal muscle mass can be easily quantified from abdominal CT scans performed for advanced HCC staging. Sarcopenia and impaired liver function (MELD > 9) are strong predictors of unfavorable outcomes in patients affected by advanced HCC treated with Sorafenib. Their copresence can identify a subset of patients with particularly bad prognoses. Background and aims: Sarcopenia has been associated with poor outcomes in patients with cirrhosis and hepatocellular carcinoma. We investigated the impact of sarcopenia on survival in patients with advanced hepatocellular carcinoma treated with Sorafenib. Methods: A total of 328 patients were retrospectively analyzed. All patients had an abdominal CT scan within 8 weeks prior to the start of treatment. Two cohorts of patients were analyzed: the "Training Group" (215 patients) and the "Validation Group" (113 patients). Sarcopenia was defined by reduced skeletal muscle index, calculated from an L3 section CT image. Results: Sarcopenia was present in 48% of the training group and 50% of the validation group. At multivariate analysis, sarcopenia (HR: 1.47, p = 0.026 in training; HR 1.99, p = 0.033 in validation) and MELD > 9 (HR: 1.37, p = 0.037 in training; HR 1.78, p = 0.035 in validation) emerged as independent prognostic factors in both groups. We assembled a prognostic indicator named "SARCO-MELD" based on the two independent prognostic factors, creating three groups: group 1 (0 prognostic factors), group 2 (1 factor) and group 3 (2 factors), the latter with significantly worse survival and shorter time receiving treatment. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Previous systematic reviews have found insufficient and conflicting evidence for an association between the clinical and radiographic diagnosis of functional constipation. Abdominal X-ray is frequently used for the diagnosis of functional constipation in clinical practice. The objective of this study was to evaluate the diagnostic accuracy of abdominal X-ray for the evaluation of functional constipation in children. Results: Three studies were included in the final qualitative analysis. They were heterogeneous in their study design, definition of constipation, and radiologic parameters used to evaluate the abdominal X-rays. Sensitivities ranged from 73–92%, specificities ranged from 26–92%, and diagnostic accuracies ranged from 78–90%. Methods: This study involved a systematic review of English literature published between 2012 and 2022 covering children 2–18 years of age with a diagnosis of functional constipation in whom abdominal X-ray was performed. The databases searched include Medline, Embase, and Scopus. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) guidelines were followed. PROSPERO ID: CRD42022301833. Conclusions: There is insufficient evidence to support the use of abdominal X-ray as part of the diagnostic workup of functional constipation. More methodologically rigorous studies are needed to determine the utility of abdominal X-ray in the evaluation of functional constipation. The diagnosis of functional constipation should be based on history and clinical findings. [ABSTRACT FROM AUTHOR]

This case report presents a rare instance of a patient diagnosed with situs inversus totalis (SIT) and colon cancer. The report highlights the rarity of this combination and emphasizes the importance of recognizing the unique challenges in diagnosis and treatment associated with this congenital disorder. [ABSTRACT FROM AUTHOR]

Introduction: Hepatic portal venous gas is a rare and life-threatening condition characterised by the presence of gas in the portal vein. Hepatic portal venous gas is frequently associated with intestinal ischaemia and necrosis. We present the case of a paediatric patient with acute appendicitis with hepatic portal venous gas detected using ultrasonography. Case report: A 5-year-old boy was admitted to our hospital with a respiratory tract infection. The boy started vomiting on day 2 of hospitalisation. He did not complain of any symptoms due to developmental retardation. We performed bedside point-of-care ultrasound, which detected hepatic portal venous gas, although the appendix could not be detected due to an acoustic shadow associated with bowel gas. Contrast-enhanced computed tomography revealed perforated appendicitis and pneumatosis intestinalis associated with paralytic ileus. An emergency laparoscopic appendectomy was performed. He was discharged on day 25 of hospitalisation after antibiotic therapy. Discussion: The present case suggests that the mechanism of hepatic portal venous gas was paralytic ileus, which caused gas-forming bacterial proliferation. The gas produced by bacteria and/or the gas-forming bacteria entered the bowel wall, which caused pneumatosis intestinalis. The bubbles in the intestinal wall floated in the portal system and were detected as hepatic portal venous gas. Perforated appendicitis and paralytic ileus seemed to be caused by a delayed diagnosis of appendicitis. The point-of-care ultrasound examination was useful for detecting hepatic portal venous gas and for helping establish the diagnosis of appendicitis. Conclusion: Hepatic portal venous gas is a rare finding associated with appendicitis in children. In addition, point-of-care ultrasound is useful for detecting hepatic portal venous gas in paediatric patients. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: Differentiating granulomas from cancerous tissue poses a significant challenge in upper urinary tract surgery. We present the case of a 62-year-old male with a gelatin-based matrix (SurgifloTM) granuloma in the kidney following renal cyst decortication eight years earlier. Methods: Contrast-enhanced abdominal tomography revealed a Bosniak type-4 cyst at the previous operation site. The patient underwent laparoscopic partial nephrectomy with near-infrared imaging. Results: The lesion presented as hypofluorescent relative to normal kidney tissue. Histopathological examination revealed a foreign body granuloma due to unabsorbed Surgiflo. Conclusion: The fluorescence pattern could not distinguish a Surgiflo granuloma from a malignant lesion of the kidney. [ABSTRACT FROM AUTHOR]