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The article focuses on a rare case of acute lymphoblastic leukemia (ALL) in a pediatric patient presenting with hypercalcemia and lytic lesions, which can be diagnostically challenging. Topics include the association of these symptoms with higher-risk leukemias and the need for further research to understand this relationship better.

Background: Striae distensae (SD) is a challenging cosmetic condition. Ablative fractional laser (AFL) is an effective method for treating SD. Recently, fractional radiofrequency (FRF) has been shown to be a promising treatment for SD; however, few studies have shown the differences between FRF and AFL in the treatment of SD. Aims: This study aimed to evaluate and compare the clinical efficacy and safety of bipolar FRF with 2940‐nm erbium yttrium aluminum garnet (Er:YAG) AFL in the treatment of SD. Patients/Methods: Twenty volunteers with abdominal SD were enrolled in this study. One half of the abdomen was treated with 2940‐nm Er:YAG AFL, whereas the other half was treated with bipolar FRF, with three sessions at 4‐week intervals. Photographic evaluations of clinical improvement were conducted by two independent investigators before and after treatment, and the patients provided self‐assessments. Two participants underwent three punch biopsies, one before treatment and two obtained from bilateral representative skin lesions on the abdomen 3 months following the final treatment. Results: Clinical improvements were observed in SD on both sides of the abdomen after the two treatments. Post‐treatment skin biopsies revealed increased thickness in the epidermis and dermis, and higher collagen and elastin density compared to those at the baseline. No statistically significant differences were observed in the clinical outcomes between the two treatment approaches. Conclusions: The efficacy and safety of bipolar FRF treatment are comparable to those of 2940‐nm Er:YAG AFL treatment, providing an alternative and effective treatment for SD. [ABSTRACT FROM AUTHOR]

• Vaginal foreign bodies represent a clinical and diagnostical challenge. • Most common symptoms are vaginal discharge and vaginal blood loss. Only 10% of patients presented with the complaint of a possible foreign object. Although a minority of patients develop complications, those with a battery as a foreign object are at a higher risk of mucosal injuries. • Ultrasonography is the most utilized diagnostic method, with a sensitivity of 79.9%. Radiography showed more false-negative than true-positive results, with a sensitivity of 33.3%. • Vaginoscopy is the gold standard for definitive diagnosis and therapy, as outpatient or under anesthesia. • A possible context of sexual violence should be considered, regardless the nature of the object. Vaginal foreign bodies represent a clinical and diagnostical challenge in pediatric gynecology. Several case reports, case series and retrospective studies have been published, highlighting rare or complex cases. A comprehensive systematic review is lacking. Published English-language articles on vaginal foreign objects in patients aged 16 years and younger, with full-text availability were included. Articles on adult patients and patients with an object migrating from the abdominal cavity into the vagina were excluded. Out of the 215 screened articles 75 were included, comprising a total of 522 patients. The age ranged from 6 months to 16 years, with an average of 6 years and 3 months. The presenting symptoms were documented in 340 patients, with the two most common being vaginal bleeding (n = 172) and vaginal discharge (n = 134). Toilet paper or tissue was the most common object, in 155 out of 447 patients. Ultrasonography was the most utilized diagnostic method, with a sensitivity of 79.9 %. Radiography showed more false-negative than true-positive results, with a sensitivity of 33.3 %. Complications were reported in 35 patients. Evidence of sexual abuse was found in a small group of 16 patients. Vaginoscopy under sedation was the most frequently used therapeutic approach. A swift and accurate diagnosis is crucial, with clinical examination and ultrasonography playing pivotal roles. Vaginoscopy is the gold standard for definitive diagnosis and therapy. Attention should be given to a potential context of sexual abuse. [ABSTRACT FROM AUTHOR]

Heterotopic ossification (HO) of the abdomen is a rare yet highly morbid complication following blunt and penetrating trauma requiring damage control laparotomy. We present the case of a 22-year-old man, 20 months after life-threatening motor vehicle crash with major vascular injury requiring multiple abdominal surgeries. The patient was initially treated at a community hospital and subsequently developed a chronic left lower quadrant enterocutaneous fistula, accompanied by a gradually worsening diffuse abdominal pain. He was referred to our tertiary care center with extensive skin breakdown and an inability to control the fistula despite numerous wound care consultations. He also had severe abdominal deformities due to HO in the abdominal wall, peritoneum, paraspinal muscles, and parapelvic regions. As HO is largely underreported, it is crucial to refer those patients, once medically stabilized, to tertiary care centers for surveillance and possible treatment when symptomatic. [ABSTRACT FROM AUTHOR]

The article presents the discussion on case study of 16-year-old male with no significant past medical history was referred to our pediatric nephrology clinic for high blood pressure detected by his primary care pediatrician. Topics include clinicians order this study for all children and adolescents with hypertension, particularly in the subspecialty setting; and diagnostic yield of kidney ultrasound in the evaluation of children and adolescents with hypertension.

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]

Intrauterine contraceptive devices (IUCD) are widely used as a reversible method of contraception. Although uterine perforation caused by an IUCD is rare, in some cases, the device may migrate to the pelvic/abdominal cavity or nearby structures. When the IUCD migrate to the bladder, it can lead to various symptoms. These include pain or discomfort in the lower abdomen, difficulties or pain during urination, frequent urinary tract infections, and the development of bladder stones. This article presents a case report of a 24-year-old woman with an intrauterine contraceptive device (IUCD) that had migrated completely into the bladder. She had an IUCD inserted by a midwife four years earlier and became pregnant a year later, unaware of the IUCD's presence. She later presented with lower abdominal pain, hematuria, and dysuria three months before being admitted to our hospital. Imaging confirmed the intravesical location of the IUCD. She underwent successful cystoscopy treatment to remove the migrated IUCD. Prompt diagnosis and appropriate management are crucial in preventing complications and improving patient outcomes. Clinicians should be aware of this potential complication and consider it when patients present with symptoms or complications after IUCD insertion. Regular monitoring and timely intervention can help detect and address IUCD migration effectively. [ABSTRACT FROM AUTHOR]

Over the years, the management of blunt trauma abdomen (BTA) has changed, especially in children. Operative management has evolved into a non-operative management (NOM) approach, with surgery reserved for those who present in extremis or become hemodynamically unstable despite resuscitation. This NOM approach has been associated with improved survival rates in severe liver injury and severe splenic injury. Patients that fail NOM and require emergency surgery are associated with increased morbidity and mortality. Therefore, management of even the severe American Association for the Surgery of Trauma (AAST) grade injuries of liver and spleen are managed based on the hemodynamics and general condition of the patient. [ABSTRACT FROM AUTHOR]

Background: Leakage of intestinal fluid is a challenging event when it appears in an open abdomen (OA) and surgical deviation does not seem possible. Intestinal contents in the abdominal cavity maintain inflammation and drainage is there for essential. We have developed a method, ChimneyVAC, to treat both deep and superficial enteroatmospheric fistulas (EAF) Aims: To describe this innovative surgical technique and our 10‐year experience. Material & Methods: This single‐center observational cohort study included all 16 consecutive patients treated with ChimneyVAC. Seven women and 9 men; median age: 47; (interquartile range [IQR]:39–63) years, 15 with a small bowel fistula and 1 with a large bowel fistula. All except of the colonic fistula were classified as a high output fistula; 14 were deep and 2 superficial. In this technique, a negative‐pressure source is applied directly above the fistula opening, in addition to negative pressure wound therapy for the OA. This controls the leakage of intestinal fluid by direct drainage into a vacuum system, thereby avoiding contamination of the abdomen. A controlled enterocutaneous fistula (ECF) then forms as the traction from the ChimneyVAC brings the fistula opening to skin level. Results: In 14 patients, an ECF formed after a median of 42 (IQR:28–55) days and 12 (IQR:7–16) dressing changes. The median length of hospitalization was 103 (IQR:58–143) days. Two patients died of multiorgan failure and 14 initially survived. Discussion: This study showed that 14 out of 16 patients survived the initial treatment for enteric leakage with the ChimneyVAC method. The outcome of ChimneyVAC treatment is a controlled ECF, which was then corrected after a median of six months. However, hospitalization is lengthy, the patients undergo several dressing changes and many needs additional parenteral nutrition until intestinal continuity is reestablished. Conclusion: ChimneyVAC is a feasible method for treatment of EAF in an OA, with favorable survival. [ABSTRACT FROM AUTHOR]

This study evaluated the performance of a vertebral fracture detection algorithm (HealthVCF) in a real-life setting and assessed the impact on treatment and diagnostic workflow. HealthVCF was used to identify moderate and severe vertebral compression fractures (VCF) at a Danish hospital. Around 10,000 CT scans were processed by the HealthVCF and CT scans positive for VCF formed both the baseline and 6-months follow-up cohort. To determine performance of the algorithm 1000 CT scans were evaluated by specialized radiographers to determine performance of the algorithm. Sensitivity was 0.68 (CI 0.581–0.776) and specificity 0.91 (CI 0.89–0.928). At 6-months follow-up, 18% of the 538 patients in the retrospective cohort were dead, 78 patients had been referred for a DXA scan, while 25 patients had been diagnosed with osteoporosis. A higher mortality rate was seen in patients not known with osteoporosis at baseline compared to patients known with osteoporosis at baseline, 12.8% versus 22.6% (p = 0.003). Patients receiving bisphosphonates had a lower mortality rate (9.6%) compared to the rest of the population (20.9%) (p = 0.003). HealthVCF demonstrated a poorer performance than expected, and the tested version is not generalizable to the Danish population. Based on its specificity, the HealthVCF can be used as a tool to prioritize resources in opportunistic identification of VCF's. Implementing such a tool on its own only resulted in a small number of new diagnoses of osteoporosis and referrals to DXA scans during a 6-month follow-up period. To increase efficiency, the HealthVCF should be integrated with Fracture Liaison Services (FLS). [ABSTRACT FROM AUTHOR]

Background: The gastric conduit is the most commonly used replacement organ for reconstruction after minimally invasive McKeown esophagectomy. Although the optimal route of gastric conduit remains controversial, the posterior mediastinal route is physiologically preferable but is not without disadvantages. Here, we report the safety and efficacy of a method of gastric conduit reconstruction via the anterior of the pulmonary hilum route. Methods: We have used the anterior of the pulmonary hilum route since 2021. This procedure involves pulling the gastric conduit up through a substernal tunnel between the right thoracic cavity and the abdominal cavity and passing it into the neck via the anterior of the pulmonary hilum route. In this retrospective study, we compared the clinical outcomes between 20 patients who underwent this procedure and 20 patients who underwent the posterior mediastinal route from 2021 to 2022. Results: No mortality was reported in either group. No significant differences were observed between the two groups in duration of surgery, blood loss, incidence of postoperative complications, and postoperative hospital stay. As a result of the anterior of the pulmonary hilum route, the primary tumor bed and lymph node drainage area were effectively bypassed, which facilitates postoperative adjuvant radiotherapy or chemoradiotherapy. The distance of the gastric conduit accompanying the airway was significantly shorter in the anterior of the pulmonary hilum route group. Conclusions: Our method is considered to be a safe and useful technique for the reconstruction of gastric conduit. [ABSTRACT FROM AUTHOR]

Background: Actigraphy is often used to measure sleep in pediatric populations, despite little confirmatory evidence of the accuracy of existing sleep/wake algorithms. The aim of this study was to determine the performance of 11 sleep algorithms in relation to overnight polysomnography in children and adolescents. Methods: One hundred thirty-seven participants aged 8–16 years wore two Actigraph wGT3X-BT (wrist, waist) and three Axivity AX3 (wrist, back, thigh) accelerometers over 24-h. Gold standard measures of sleep were obtained using polysomnography (PSG; Embletta MPRPG, ST + Proxy and TX Proxy) in the home environment, overnight. Epoch by epoch comparisons of the Sadeh (two algorithms), Cole-Kripke (three algorithms), Tudor-Locke (four algorithms), Count-Scaled (CS), and HDCZA algorithms were undertaken. Mean differences from PSG values were calculated for various sleep outcomes. Results: Overall, sensitivities were high (mean ± SD: 91.8%, ± 5.6%) and specificities moderate (63.8% ± 13.8%), with the HDCZA algorithm performing the best overall in terms of specificity (87.5% ± 1.3%) and accuracy (86.4% ± 0.9%). Sleep outcome measures were more accurately measured by devices worn at the wrist than the hip, thigh or lower back, with the exception of sleep efficiency where the reverse was true. The CS algorithm provided consistently accurate measures of sleep onset: the mean (95%CI) difference at the wrist with Axivity was 2 min (-6; -14,) and the offset was 10 min (5, -19). Several algorithms provided accurate measures of sleep quantity at the wrist, showing differences with PSG of just 1–18 min a night for sleep period time and 5–22 min for total sleep time. Accuracy was generally higher for sleep efficiency than for frequency of night wakings or wake after sleep onset. The CS algorithm was more accurate at assessing sleep period time, with narrower 95% limits of agreement compared to the HDCZA (CS:-165 to 172 min; HDCZA: -212 to 250 min). Conclusion: Although the performance of existing count-based sleep algorithms varies markedly, wrist-worn devices provide more accurate measures of most sleep measures compared to other sites. Overall, the HDZCA algorithm showed the greatest accuracy, although the most appropriate algorithm depends on the sleep measure of focus. [ABSTRACT FROM AUTHOR]

Objectives: The worldwide shortage of intravenous (IV) Omnipaque iodinated contrast (Iohexol, GE Healthcare; Milwaukee, WI, USA) forced institutions to adopt various policies regarding contrast allocation. We sought to evaluate the impact of our hospital's response to the shortage, which was to decrease the dose of IV contrast from 100 mL to 75 mL for patients weighing between 45.4 and 136 kg (100–300 lbs) undergoing abdominal computed tomography (CT) examinations. The main objective was to assess for any differences in liver attenuation and enhancement between contrast dosages. Secondary outcomes included assessing differences in aortic and portal vein attenuation, the variance in attenuation measurements, and whether radiology reports included the correct IV contrast dose. Material and Methods: Consecutive CT abdomen or CT abdomen and pelvis examinations without and with contrast were analyzed for the 3 months before the contrast shortage and for 3 months during the contrast shortage. Attenuation in Hounsfield units (HUs) was measured in the liver on pre-contrast and portal venous phase images. Vessel attenuation was measured in the aorta (arterial phase) and main portal vein (portal venous phase). Standard deviation of liver attenuation measurements was recorded as an indicator of signal-to-noise. Liver enhancement was calculated as the difference between liver portal venous phase attenuation and pre-contrast attenuations. Results: Thirty-nine fixed dose (100 mL) and 36 reduced dose (75 mL) consecutive CT studies were included in the study. There were no significant differences between the two groups with respect to baseline characteristics such as age, weight, body mass index, and gender. There was no significant difference in pre-contrast liver attenuation between groups, but there was statistically significant greater liver attenuation (99.6 vs. 91.2 HU, P = 0.04) and liver enhancement (51.5 vs. 39.1 HU, P < 0.0001) during the portal venous phase for the fixed-dose group compared to the reduced dose group. There was significantly greater main portal vein opacification during the portal venous phase for the fixed dose group (146.6 vs. 122.2 HU, P < 0.0001). No significant difference was found in aortic opacification during the arterial phase (245 vs. 254 HU, P = 0.52). There was no difference in the standard deviation of liver attenuation measurements on the portal venous phase between the groups. The dose was reported correctly in all the patients receiving the fixed dose and in 92% of patients receiving the reduced dose, which was not statistically significant (P = 0.11). Conclusion: Reducing the IV contrast dose from 100 mL to 75 mL Omnipaque 350 in patients weighing 45.4–136 kg (100–300 lbs) undergoing an abdominal CT examination resulted in significantly decreased portal vein opacification and liver enhancement. In particular, liver enhancement and calculated iodine concentrations fell below suggested thresholds for adequate conspicuity of liver lesions. The change in contrast administration protocol also led to more errors in contrast dose reporting in the radiologist's report. These findings are broadly applicable to many practice settings and can help inform strategies in response to any potential future-iodinated contrast shortage. [ABSTRACT FROM AUTHOR]

Gastric schwannomas (GS) are rare mesenchymal tumors from Schwann cells in the gastrointestinal (GI) tract, representing 2–6% of such tumors. We report a 52-year-old woman who experienced abdominal pain, hematemesis, and melena, initially suspected of having a GI stromal tumor through ultrasound and computed tomography abdomen. Despite no active bleeding found during an upper endoscopy, she underwent a successful open subtotal gastrectomy, with histopathology confirming GS. The diagnosis of GS, which may mimic other GI conditions, relies heavily on imaging and histopathological analysis due to its nonspecific symptomatology, including the potential for both upper and lower GI bleeding. This case underscores the diagnostic challenges of GS and highlights surgical resection as the preferred treatment, generally leading to a favorable prognosis. [ABSTRACT FROM AUTHOR]

Cryptorchidism is defined as the extra-scrotal position of the testes. It is a common disorder in male children, but rarely in adult patients. The association of cryptorchidism with hernia is a common finding in childhood, but is not frequent in adults or the elderly. Herein, we report a series of three cases (28-, 24-, and 34-year-old men) of adult inguinal hernia combined with cryptorchidism successfully managed by laparoscopic surgery under the same operative view. Laparoscopic transabdominal preperitoneal repair and orchiectomy were performed in all patients. No complications occurred in the postoperative period, and the patients were discharged on the first or second postoperative day. Pathological examination of the specimens revealed atrophic testes without malignancy. No hernia recurrence was observed during follow-up. The laparoscopic approach in the combined pathology of inguinal hernia and cryptorchidism is feasible in adult patients and has multiple advantages in terms of diagnosis and management. [ABSTRACT FROM AUTHOR]

Aim: Natural orifice specimen extraction (NOSE) in left‐sided colorectal surgery requires application of the circular stapler anvil to the proximal bowel without exteriorization through an additional abdominal incision. We describe an intracorporeal method to secure the stapler anvil, termed the intracorporeal antimesenteric ancillary trocar (IAAT) technique. Method: The ancillary trocar is attached to the stapler anvil before introduction into the abdominal cavity through the anal or vaginal orifice. The colon is incised before the trocar spike is brought out through the antimesenteric surface 3–4 cm within the cut edge. A linear stapler is used to seal the bowel end. The ancillary trocar is detached and retrieved via the NOSE conduit. Following the NOSE procedure, a side‐to‐end colorectal anastomosis is performed with the transanal circular stapler. Results: Ten consecutive patients underwent elective left‐sided colorectal resection with IAAT for NOSE (seven transanal, three transvaginal) from January to June 2023. Median age and body mass index were 66 (range 47–74) years and 24.3 (range 17.9–30.8) kg/m2 respectively. Two (20%) patients underwent sigmoid colectomy for sigmoid volvulus while eight (80%) underwent anterior resection for colorectal cancer. Median operating time, operative blood loss and postoperative length of hospital stay were 170 (range 140–240) min, 20 (range 10–40) mL and 1 (range 1–3) day respectively. There were no postoperative complications, readmissions or reoperations. Median follow‐up duration was 3 (range 1–6) months. Conclusion: The IAAT double‐stapling side‐to‐end anastomotic technique is safe and feasible for patients undergoing left‐sided colorectal resection with NOSE, resulting in good outcomes. [ABSTRACT FROM AUTHOR]

Abdominal trauma is a commonly encountered emergency which may be because of roadside accidents, assaults, or falls from height. Blunt injury to the abdomen is far more common than penetrating injury. Gastric perforation commonly occurs following penetrating abdominal trauma. However, gastric rupture is an uncommon entity following blunt trauma abdomen (BTA). Here, we are presenting three cases of isolated gastric perforation after BTA, two were due to a roadside accident, and one was a result of a fall from height. History suggests of a full stomach is usually found in traumatic gastric rupture. This condition usually presents with insignificant clinical or radiological signs. Isolated gastric rupture due to trauma is rare as it is usually associated with other injuries such as splenic and liver injuries. Early suspicion plays an important role in diagnosing this entity which carries higher morbidity and mortality if not managed timely. As isolated gastric perforation because of trauma leads to high morbidity and mortality, hence thorough lavage of the peritoneal cavity followed by double-layer closure after adequate debridement will reduce chances of intraperitoneal contamination thus improving outcome. Presentation after the last meal, the severity of gastric rupture, and other associated injuries play an important role in the prognosis of the patient. [ABSTRACT FROM AUTHOR]

Aim. To compare the clinical characteristics of survival and nonsurvival patients with severe acute pancreatitis (SAP) and explore the risk of mortality in SAP patients. Methods. This was a single-center retrospective study performed in a severe acute pancreatitis diagnosis and treatment center. According to the outcome, SAP patients were divided into survival group and nonsurvival group. One-way ANOVA or independent t -test was used to compare the clinical characteristics of two groups of patients. Multivariate retrospective analysis was used to identify risk factors for mortality in SAP patients. Results. A total of 486 SAP patients were included in the study, and the 90-day mortality for SAP patients was 13.58%. The common etiologies of SAP are biliary tract diseases (69.75%) and hyperlipidemia (17.28%). The most common complications caused by SAP were organ failure (55.14%), ARDS (50.62%), AKI (30.45%), sepsis (27.16%), and abdominal fluid collection (27.57%). There were differences in age, complications, and medical intervention between the nonsurvival group and the survival group. The main causes of death were infection (46.97%), abdominal bleeding (28.79%), and organ failure (9.09%). The binary logistic regression analysis showed that there were significant differences in age, AKI, sepsis, abdominal hemorrhage, organ failure, laparotomy, creatinine, and APTT between the nonsurvival group and the survival group. Conclusion. Age, AKI, sepsis, abdominal hemorrhage, and organ failure are risk factors for mortality in SAP patients. SAP patients with high creatinine and prolonged APTT upon admission require doctors to be vigilant. The main cause of death in SAP patients is pancreatitis-related organ failure and secondary infection. [ABSTRACT FROM AUTHOR]

Fogging and staining of a laparoscope lens negatively impact surgical visualization. We hypothesized that the disposable hot pack could not only warm but also clean laparoscopes. Hence, this study verified and developed the disposable hot pack with anti-fogging and cleaning function. The laparoscope was inserted into a swine abdominal cavity for five minutes. Then, the laparoscopic tip was heated with 65 °C saline or the folded disposable hot pack with nonwoven fabric coated surfactant for ten seconds (n = 15). Also, a laparoscopic tip with dirt was wiped with the prototype or conventional gauze for 10 s (n = 10). The dirt, fogging, and temperature of the laparoscopic tip were respectively evaluated after the laparoscope was inserted into the abdominal cavity. The laparoscopic tip temperature five minutes after insertion into the abdominal cavity was similar (31.1 °C vs 31.2 °C, p = 0.748) and there was no fogging in both methods. The conventional gauze had significantly less temperature of the laparoscopic tip after cleaning and higher fogging occurrence than the prototype (29.5 °C vs 34.0 °C, p < 0.001, 30% vs 0%, p = 0.030, respectively), although there was no dirt left after both methods. The disposable hot pack has a strong potential as an anti-fogging and cleaning device for use during laparoscopic surgery. [ABSTRACT FROM AUTHOR]

Background: Mature cystic teratoma (MCT) comprises 95% of ovarian germ cell tumors with 10-25% incidence in adults. The sequelae include torsion (15%), malignant transformation (1-2%), infection (1%), and rupture (0.3-2%). Spontaneous ruptures of MCT with spillage of sebaceous material into the abdominal cavity are rare due to its thick capsules. Ruptured ovarian teratoma can lead to chemical peritonitis, which is uncommon with diverse presentations. It presents with contralateral abdominal pain due to spillage of its contents into the opposite side of the abdominal cavity following tumor rupture. Case description: This is an unusual presentation of twisted and ruptured ovarian teratoma. A 26-year-old para 1 presented with persistent left lower abdominal pain that radiated to right and sought treatment from various clinics for a week duration. She was referred to a tertiary hospital for ruling out acute appendicitis for right-sided lower abdominal pain where the appendix is located. At first, she presented with sudden onset of moderate-to-severe left iliac fossa (LIF) pain during a bowel opening 5 days ago. Subsequently, the pain radiated to the right iliac fossa (RIF) and worsened on the day of admission. She also had multiple episodes of vomiting and vague suprapubic mass for 1 week. Abdominal examination revealed a palpable cystic suprapubic mass which is about 10 × 8 cm with persistent RIF pain. Ultrasonography showed a solid cystic mass at the LIF measured about 11 × 6 cm and the right ovary was visualized, with normal size uterus and thin endometrial lining. There was significant amount of free fluid, with normal kidneys seen. Ultrasound examination provided an inconclusive diagnosis and an emergency laparotomy was performed for suspicion of a ruptured ovarian cyst with a differential diagnosis of a perforated appendix. There was a twisted and ruptured left ovarian teratoma with a gangrenous base found intraoperatively which contains sebum, hair, and slough at the anterior part of the uterus and thicken omentum. Left-sided salpingo-oophorectomy and omentectomy were done. The peritoneal cavity was washed with copious amounts of warm saline. Conclusion: A ruptured dermoid cyst is one of the gynecological emergencies but is often an overlooked diagnosis. Mature ovarian teratoma consists of well-differentiated germ cell layers derivatives developing as hair, muscle, teeth, or bone. The size of dermoid cysts and torsion with infarction can contribute to their rupture. Correct diagnosis and timely surgical intervention are essential for preventing chemical peritonitis, long-term sequelae, and conserving the reproductive function. [ABSTRACT FROM AUTHOR]

Objective: To assess success and safety of CT-guided procedures with narrow window access for biopsy. Methods: Three hundred ninety-six consecutive patients undergoing abdominal or pelvic CT-guided biopsy or fiducial placement between 01/2015 and 12/2018 were included (183 women, mean age 63 ± 14 years). Procedures were classified into "wide window" (width of the needle path between structures > 15 mm) and "narrow window" (≤ 15 mm) based on intraprocedural images. Clinical information, complications, technical and clinical success, and outcomes were collected. The blunt needle approach is preferred by our interventional radiology team for narrow window access. Results: There were 323 (81.5%) wide window procedures and 73 (18.5%) narrow window procedures with blunt needle approach. The median depth for the narrow window group was greater (97 mm, interquartile range (IQR) 82–113 mm) compared to the wide window group (84 mm, IQR 60–106 mm); p = 0.0017. Technical success was reached in 100% (73/73) of the narrow window and 99.7% (322/323) of the wide window procedures. There was no difference in clinical success rate between the two groups (narrow: 86.4%, 57/66; wide: 89.5%, 265/296; p = 0.46). There was no difference in immediate complication rate (narrow: 1.3%, 1/73; wide: 1.2%, 4/323; p = 0.73) or delayed complication rate (narrow: 1.3%, 1/73; wide: 0.6%, 1/323; p = 0.50). Conclusion: Narrow window (< 15 mm) access biopsy and fiducial placement with blunt needle approach under CT guidance is safe and successful. Clinical relevance statement: CT-guided biopsy and fiducial placement can be performed through narrow window access of less than 15 mm utilizing the blunt-tip technique. Key Points: • A narrow window for CT-guided abdominal and pelvic biopsies and fiducial placements was considered when width of the needle path between vital structures was ≤ 15 mm. • Seventy-three biopsies and fiducial placements performed through a narrow window with blunt needle approach had a similar rate of technical and clinical success and complications compared to 323 procedures performed through a wide window approach, with traditional approach (> 15 mm). • This study confirmed the safety of the CT-guided percutaneous procedures through < 15 mm window with blunt-tip technique. [ABSTRACT FROM AUTHOR]

Objective: To characterize the use and impact of radiation dose reduction techniques in actual practice for routine abdomen CT. Methods: We retrospectively analyzed consecutive routine abdomen CT scans in adults from a large dose registry, contributed by 95 hospitals and imaging facilities. Grouping exams into deciles by, first, patient size, and second, size-adjusted dose length product (DLP), we summarized dose and technical parameters and estimated which parameters contributed most to between-protocols dose variation. Lastly, we modeled the total population dose if all protocols with mean size-adjusted DLP above 433 or 645 mGy-cm were reduced to these thresholds. Results: A total of 748,846 CTs were performed using 1033 unique protocols. When sorted by patient size, patients with larger abdominal diameters had increased dose and effective mAs (milliampere seconds), even after adjusting for patient size. When sorted by size-adjusted dose, patients in the highest versus the lowest decile in size-adjusted DLP received 6.4 times the average dose (1680 vs 265 mGy-cm) even though diameter was no different (312 vs 309 mm). Effective mAs was 2.1-fold higher, unadjusted CTDIvol 2.9-fold, and phase 2.5-fold for patients in the highest versus lowest size-adjusted DLP decile. There was virtually no change in kV (kilovolt). Automatic exposure control was widely used to modulate mAs, whereas kV modulation was rare. Phase was the strongest driver of between-protocols variation. Broad adoption of optimized protocols could result in total population dose reductions of 18.6–40%. Conclusion: There are large variations in radiation doses for routine abdomen CT unrelated to patient size. Modification of kV and single-phase scanning could result in substantial dose reduction. Clinical relevance: Radiation dose-optimization techniques for routine abdomen CT are routinely under-utilized leading to higher doses than needed. Greater modification of technical parameters and number of phases could result in substantial reduction in radiation exposure to patients. Key Points: • Based on an analysis of 748,846 routine abdomen CT scans in adults, radiation doses varied tremendously across patients of the same size and optimization techniques were routinely under-utilized. • The difference in observed dose was due to variation in technical parameters and phase count. Automatic exposure control was commonly used to modify effective mAs, whereas kV was rarely adjusted for patient size. Routine abdomen CT should be performed using a single phase, yet multi-phase was common. • kV modulation by patient size and restriction to a single phase for routine abdomen indications could result in substantial reduction in radiation doses using well-established dose optimization approaches. [ABSTRACT FROM AUTHOR]

Background. Ganglioneuroblastoma is a borderline tumor of sympathetic origin that is considered a childhood disease, with the majority of patients occurring in children less than five years old and few patients occurring in adults. There are no treatment guidelines for adult ganglioneuroblastoma. Here, we report a rare patient of adult gastric ganglioneuroblastoma that was completely resected by a laparoscopic approach. Case presentation. A 73-year-old man presented with dull pain in the upper abdomen along with abdominal distension for one month. Gastroscopy examination revealed chronic gastritis and submucosal tumors of the gastric antrum. Endoscopic ultrasonography showed a hypoechoic mass in the gastric antrum arising from the muscularis propria. An abdominal computed tomography scan revealed an irregular soft tissue mass in the gastric antrum with heterogeneous enhancement in the arterial phase. The mass was completely resected by laparoscopic surgery. Postoperative histopathology revealed that the mass contained differentiated neuroblasts, mature ganglion cells and ganglioneuroma components. The pathological diagnosis was ganglioneuroblastoma intermixed, and the patient was determined to be in stage I. The patient received no adjuvant chemotherapy or radiotherapy. At his two-year follow-up, the patient was doing well and showed no signs of recurrence. Conclusion. Despite the rarity of gastric ganglioneuroblastoma as a primary site of origin, it should be considered in the differential diagnosis of gastric masses in adults. Radical surgery is sufficient for the treatment of ganglioneuroblastoma intermixed, and long-term follow-up should be performed. [ABSTRACT FROM AUTHOR]

Polioencephalomalacia (PEM) is a nervous disease that affects ruminants, has a worldwide distribution and causes significant economic losses. PEM is abundantly described and studied in cattle and small ruminants, but there is little information about the disease in buffaloes, especially in Brazil. The objective of this work is to describe the clinical and pathological aspects of an outbreak of PEM in buffaloes in a feedlot in the state of Pará, Brazil. The outbreak occurred in a flock of 76 Murrah buffaloes, with an average age of five months, in a feedlot. Twenty-eight of these buffaloes became ill, and thirteen showed neurological signs and died. Two buffaloes underwent necropsy. The brain and fragments of various abdominal and thoracic cavity organs were fixed in 10% formalin and sent for histopathological examination. In the frontal, parietal, and occipital telencephalic lobes, the convolutions were flattened and yellowish, and when cut, there was a clear line of demarcation between the superficial and deep layers. Histologically, the intermediate layers of the cerebral cortex showed mild to moderate vacuolization of the neuropil, moderate enlargement of the perivascular, perineuronal, and periastrocyte spaces, moderate swelling and edema of astrocytes, and a large number of necrotic neurons. The work demonstrates that, despite being poorly documented in Brazil, PEM should be considered in the differential diagnosis of neurological syndromes in buffaloes. [ABSTRACT FROM AUTHOR]

Summary Point‐of‐care ultrasonography is a powerful tool for the practitioner in determining diagnosis and prognosis in unwell horses. Proper case selection and patient preparation are keys to successful ultrasonographic examinations of the equine thorax and abdomen. Practitioners can expand the use of their equipment to augment evaluations for multiple clinical complaints. The most common application for body cavity ultrasonography in the adult horse is acute abdominal pain. [ABSTRACT FROM AUTHOR]

Background: Photon-counting detector (PCD) computed tomography (CT) allows for the reconstruction of virtual monoenergetic images (VMI) at different thresholds. Objective: The aim of our study was to evaluate the optimal arterial contrast in portal venous (pv) scans regarding objective parameters and subjective image quality for different virtual keV levels. Methods: We identified 40 patients that underwent a CT scan with an arterial and pv phase on a PCD-CT (NAEOTOM alpha, Siemens Healthineers, Forchheim, Germany). The attenuation of abdominal arteries on pv phases was measured for different virtual keV levels in a monoenergetic+ application profile and for polychromatic (pc) arterial images. Two independent readers assessed subjective image quality, including vascular contrast in pv scans at different energy levels. Additionally, signal- and contrast-to-noise ratios (SNR and CNR) were measured. Results: Our results showed increasing arterial attenuation levels with decreasing energy levels in virtual monoenergetic imaging on pv scans with the highest attenuation at 40 keV, significantly higher than in the pc arterial phase (439 ± 97 HU vs. 360 ± 97, p < 0.001). Noise, SNR, and CNR were worse at this energy level (p < 0.001). Pv VMI showed less noise at energy levels above 70 keV (all p < 0.001). Subjective image quality was rated best at 70 keV, vascular contrast was best at 40 keV. Conclusions: Our research suggests that virtual monoenergetic images at 40 keV in Mono+ mode derived from a PCD-CT can be a feasible alternative to a true arterial phase for assessment of vessels with worse CNR and SNR. [ABSTRACT FROM AUTHOR]

Non-contrast computed tomography (CT) is commonly used for the evaluation of various pathologies including pulmonary infections or urolithiasis but, especially in low-dose protocols, image quality is reduced. To improve this, deep learning-based post-processing approaches are being developed. Therefore, we aimed to compare the objective and subjective image quality of different reconstruction techniques and a deep learning-based software on non-contrast chest and low-dose abdominal CTs. In this retrospective study, non-contrast chest CTs of patients suspected of COVID-19 pneumonia and low-dose abdominal CTs suspected of urolithiasis were analysed. All images were reconstructed using filtered back-projection (FBP) and were post-processed using an artificial intelligence (AI)-based commercial software (PixelShine (PS)). Additional iterative reconstruction (IR) was performed for abdominal CTs. Objective and subjective image quality were evaluated. AI-based post-processing led to an overall significant noise reduction independent of the protocol (chest or abdomen) while maintaining image information (max. difference in SNR 2.59 ± 2.9 and CNR 15.92 ± 8.9, p < 0.001). Post-processing of FBP-reconstructed abdominal images was even superior to IR alone (max. difference in SNR 0.76 ± 0.5, p ≤ 0.001). Subjective assessments verified these results, partly suggesting benefits, especially in soft-tissue imaging (p < 0.001). All in all, the deep learning-based denoising—which was non-inferior to IR—offers an opportunity for image quality improvement especially in institutions using older scanners without IR availability. Further studies are necessary to evaluate potential effects on dose reduction benefits. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is primarily treated by surgery; however, little is known about the changes in the intraperitoneal immune environment and the prognostic impact of surgery. Surgical stress and cancer-associated inflammation cause immune cells to mobilize into the abdominal cavity via numerous cytokines. One such cytokine, CX3CR1, has various immune-related functions that remain to be fully explained. We characterized the intraperitoneal immune environment by investigating CX3CR1+ cells in intraperitoneal lavage fluid during gastric cancer surgery. Methods: Lavage fluid samples were obtained from a total of 41 patients who underwent gastrectomy. The relative expression of various genes was analyzed using quantitative real-time PCR. The association of each gene expression with clinicopathological features and surgical outcomes was examined. The fraction of CX3CR1+ cells was analyzed by flow cytometry. Cytokine profiles in lavage fluid samples were investigated using a cytometric beads array. Results: CX3CR1high patients exhibited higher levels of perioperative inflammation in blood tests and more recurrences than CX3CR1low patients. CX3CR1high patients tended to exhibit higher pathological T and N stage than CX3CR1low patients. CX3CR1 was primarily expressed on myeloid-derived suppressor cells and tumor-associated macrophages. In particular, polymorphonuclear myeloid-derived suppressor cells were associated with perioperative inflammation, pathological N, and recurrences. These immunosuppressive cells were associated with a trend toward unfavorable prognosis. Moreover, CX3CR1 expression was correlated with programmed death–1 expression. Conclusions: Our results suggest that CX3CR1+ cells are associated with an acute inflammatory response, tumor-promotion, and recurrence. CX3CR1 expression could be taken advantage of as a beneficial therapeutic target for improving immunosuppressive state in the future. In addition, analysis of intra-abdominal CX3CR1+ cells could be useful for characterizing the immune environment after gastric cancer surgery. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is primarily treated by surgery; however, little is known about the changes in the intraperitoneal immune environment and the prognostic impact of surgery. Surgical stress and cancer-associated inflammation cause immune cells to mobilize into the abdominal cavity via numerous cytokines. One such cytokine, CX3CR1, has various immune-related functions that remain to be fully explained. We characterized the intraperitoneal immune environment by investigating CX3CR1+ cells in intraperitoneal lavage fluid during gastric cancer surgery. Methods: Lavage fluid samples were obtained from a total of 41 patients who underwent gastrectomy. The relative expression of various genes was analyzed using quantitative real-time PCR. The association of each gene expression with clinicopathological features and surgical outcomes was examined. The fraction of CX3CR1+ cells was analyzed by flow cytometry. Cytokine profiles in lavage fluid samples were investigated using a cytometric beads array. Results: CX3CR1high patients exhibited higher levels of perioperative inflammation in blood tests and more recurrences than CX3CR1low patients. CX3CR1high patients tended to exhibit higher pathological T and N stage than CX3CR1low patients. CX3CR1 was primarily expressed on myeloid-derived suppressor cells and tumor-associated macrophages. In particular, polymorphonuclear myeloid-derived suppressor cells were associated with perioperative inflammation, pathological N, and recurrences. These immunosuppressive cells were associated with a trend toward unfavorable prognosis. Moreover, CX3CR1 expression was correlated with programmed death–1 expression. Conclusions: Our results suggest that CX3CR1+ cells are associated with an acute inflammatory response, tumor-promotion, and recurrence. CX3CR1 expression could be taken advantage of as a beneficial therapeutic target for improving immunosuppressive state in the future. In addition, analysis of intra-abdominal CX3CR1+ cells could be useful for characterizing the immune environment after gastric cancer surgery. [ABSTRACT FROM AUTHOR]

This article presents a study on blunt abdominal injuries in a hospital in Kadapa. The study analyzed data from 100 patients over a 3-year period to evaluate the incidence, nature, and clinical presentations of these injuries. The study found that road traffic accidents were the most common cause of blunt trauma and examined the age and sex distribution of the patients. The article provides detailed information on procedures, complications, and mortality rates. The study suggests that conservative management can be effective for stable patients, but surgical intervention may be necessary in some cases. The importance of initial resuscitation, accurate diagnosis, and prompt management is emphasized. The study reports a mortality rate of 11%, with delayed presentation and poor general condition being major factors. [Extracted from the article]

Introduction: Aquafilling, a widely used soft-tissue filler since 2005, shows multiple adverse effects, necessitating the development of effective methods for its removal. We present a surgical method for removal of Aquafilling present in the breasts, breasts with migration to the chest and/or the abdomen, and the buttocks, and elaborate and discuss the advantages of this method. Aim: The aim of this study was to present a surgical method for removal of Aquafilling (soft-tissue filler) present in the breasts, breasts with migration to the chest and/or the abdomen, and the buttocks, and to elaborate the advantages of this proposed technique. Methods: The surgical Aquafilling removal method described here was used in 25 patients (age, 21-53 years). The technique was used to remove Aquafilling present in the breasts (14 patients), breasts with migration to the chest and/or the abdomen (7 patients), and the buttocks (3 patients). The detailed course of Aquafilling removal surgery and postoperative treatment for these three types of cases is described. Results: Surgical removal of Aquafilling with the described method did not cause any of the previously described ailments in each patient, excluding one patient who only showed significant pain reduction in both breasts preceding each menstruation cycle. Conclusions: The method described herein can be recommended for removal of Aquafilling present in the breasts, breasts with migration to the chest and/or the abdomen, and buttocks, since it allowed thorough Aquafilling removal and decreased the local inflammatory state and the risk of potential carcinogenesis. [ABSTRACT FROM AUTHOR]

Simple Summary: Given the important role played by the lymphatic system in tissue drainage, metabolism, water–salt metabolism, and its protective compensatory and immune functions, it is important to further study the role of the lymphatic system in the development of abdominal inflammation. The features of lymph transport through vessels and nodes, the state of formation and biochemical composition of the lymph, the state of innervation of lymph vessels and nodes, and the state of the cellular composition of lymph nodes in the experimental modeling of inflammation in the abdominal cavities of internal organs reveal new insights regarding the mechanisms of this disease. Since, in the literature, only isolated studies regarding the lymphatic system in violation of the abdominal cavity exist, it is clear that the roles and functional states of lymphatic vessels and nodes in inflammation in the abdominal cavity have not yet been studied in a complex and multi-faceted way. This paper provides data regarding the ratios of the functional structures of lymph nodes after inflammation in the abdominal organs. Lymph systems, including lymph nodes, function as filters of tissues and tissue fluids and are places of origin and lymphocyte production for normal physiological functions. They display specific morphological and functional responses in reaction to endogenous and exogenous substances. The morphological pattern of the mesenteric lymph node in experimental rat groups reflects a decrease in its immune function due to the processes of inflammation in the abdominal cavity. These processes work together with the associated organs and their involvement in the abdominal lymph nodes, in which there are discharges of the structure of the paracortical zone under conditions of reduced lymphogenic processes, according to the decrease in the size of the paracortex and the ratios of lymphoid nodes with and without germinal centers. Histological and morphometric analyses show changes in the mesenteric lymph node. These analyses are characterized by changes in the cortical and medullary substances, while the proportion of the cortical structure decreases. We also noted an increase in the number of macrophages in the lymphoid nodes and cerebral sinus, as well as a decrease in the number of mature plasmocytes, the paracortex, and the pulp strands. These changes indicate immunosuppressive effects on the lymph node. Under the conditions of inflammation, the formation of a mixed immune response occurs. [ABSTRACT FROM AUTHOR]

Bacteroides fragilis is the most anaerobic bacteria that infect humans, particularly in the abdominal cavity. Its pathogenesis is linked to numerous virulence factors. Understanding these factors and exploring alternative options for the use of antibiotics in the treatment of this bacterium, molecular techniques offer several advantages over traditional culture techniques because they are easier and more specific. The present study aimed to use specific primers for the 16sRNA and LuxR genes to identify B. fragilis. Genetic identification of the B. fragilis isolates was performed using the 16SrRNA gene, and the obtained sequences were submitted to National Centre for Biotechnology Information (NCBI) with accession numbers (OQ448827, OQ448828). Each strain was assigned a unique strain name, AS. AWB94 and AS. AWB79. From the total of all samples, it was found that the growth of various types of bacteria constituted (76%), and the samples that did not have growth formed (24%). It was noted that Bacteroidetes constituted only two isolates (2.7%), and these two isolates possessed the gene for quorum sensing (luxR gene), while the results confirmed that they do not possess the sialidase (nanH) enzyme gene. Both isolates possessed the quorum sensing gene (LuxR) out of one hundred samples. This suggests that the isolates have a quorum-sensing mechanism responsible for cell-to-cell communication, multidrug resistance, and biofilm formation. [ABSTRACT FROM AUTHOR]

We report a case of hemoperitoneum after percutaneous radiofrequency ablation in a patient with hepatocellular carcinoma. A 60-year-old female was hospitalized for the treatment of thrombasthenia and cirrhosis caused by chronic Hepatitis C, and computed tomography revealed hepatocellular carcinoma, which was treated by percutaneous radiofrequency ablation. After the ablation, hemoperitoneum was suspected because of the low hemoglobin level with abdominal pain. Approximately 6 h after the ablation treatment, the patient suddenly fell into a shock state and died. In this case, medical treatment-related death including malpractice was suspected, and forensic autopsy was performed. The abdominal cavity contained 910 mL of dark red fluid blood and 210 g of soft hemocoagula. Moreover, several puncture marks were observed on the liver surface and diaphragm, and there was no clear damage to the main arteries and veins. Considering the macroscopic and microscopic findings, the cause of death was assumed as hemorrhagic shock due to the hemoperitoneum caused by the damage to the liver by radiofrequency ablation. It is important to consider all the indications and adverse effects of radiofrequency ablation. [ABSTRACT FROM AUTHOR]

The testis develops in the abdominal cavity and descends into the scrotum. Although numerous theories have been proposed, the mechanism of descent and the reason for its inhibition remain unknown. Furthermore, none of the explanations account for the other occurrences related to the descent, such as failed obliteration of the processus vaginalis, or the reasons for the decrease in fertility and increase in the risk of malignancy associated with an undescended testis. The gubernaculum is a primitive mesenchymal tissue that was first described in 1786. However, the role of the gubernaculum in the descent process remains obscure. The testis descends through the processus vaginalis. Although the processus vaginalis (PV) is usually defined as a simple peritoneal protrusion, it actively develops into the gubernaculum. The gubernaculum gives rise to the smooth muscles that surround the processus vaginalis. The striated cremaster muscle (CM) is also derived from the gubernaculum. Because the testis descends through the processus vaginalis, the muscles develop to propel the testis. After propelling the testis, the smooth muscle (SM) undergoes programmed cell death. The initiation of programmed cell death through the intrinsic pathway requires activation of phospholipase C. A transient shift in the autonomic balance via a decrease in the sympathetic tonus and an increase in the parasympathetic tonus is essential for initiating this programmed cell death. Programmed cell death in the SM is the physiological pathway for the obliteration of the processus vaginalis. Differences in the timing, intensity, or duration of this physiological pathway result in pathological conditions. A shift before testicular descent diminishes the SM content that is required to propel the testis, and thus inhibits descent. The early shift persists throughout childhood and results in the decrease in fertility and increase in the risk of malignancy because of the differences in signal transduction. Despite a successful descent, persistence of the shift alters the contractility of the CM by increasing the cytosolic calcium levels. Contracted CMs retracts or even ascends the testis. Inadequate intensity or duration of the shift of autonomic tonus causes failure of the programmed cell death. Persistence of the SM hinders the obliteration of PV and gives rise to hydroceles or inguinal hernias depending on the amount of residual smooth muscles. Similar findings from different countries support these explanations. Thus, our proposed mechanism satisfactorily explains the process of descent while considering all the factors related to the process of testicular descent. [ABSTRACT FROM AUTHOR]

With advancements in cancer treatment, the survival rates for many malignancies have increased. However, both the primary tumors and the treatments themselves can give rise to various complications. Acute symptoms in oncology patients require prompt attention. Abdominopelvic oncologic emergencies can be classified into four distinct categories: vascular, bowel, hepatopancreatobiliary, and bone-related complications. Radiologists need to be familiar with these complications to ensure timely diagnosis, which ultimately enhances patient outcomes. [ABSTRACT FROM AUTHOR]

Objective: We aimed to analyze the clinical presentation, imaging, histopathology, and surgical management of pediatric intraabdominal cysts, which are relatively common but diverse lesions that pose diagnostic challenges. Materials and Methods: We conducted a retrospective analysis of pediatric intraabdominal cysts from 2010 to 2021 in a single tertiary center. We collected data on demographics, symptoms, radiological findings, surgical approaches, and histopathological diagnoses and compared them with the current literature. Results: A total of 36 cases were included. There were 30 females and 6 males, aged 1 to 16 years. Abdominal pain was the most common symptom, followed by tenderness and distention. Diarrhea and vomiting were also reported in some cases. The cysts varied in size, location, and origin and were diagnosed as lymphangioma, mucinous cystadenoma, paratubal cyst, lowgrade mucinous neoplasm, mature cystic teratoma, duplication cyst, mesothelial cyst, pseudocyst, serous cystadenoma, and simple hepatic cyst. The surgical management depended on the type and location of the cysts and involved excision, oophorectomy, appendectomy, or resection. Conclusion: Pediatric intraabdominal cysts are heterogeneous lesions that require timely diagnosis and surgical resection. They may present with various symptoms and complications, depending on their size and location. Radiological and histopathological evaluation is essential for accurate diagnosis and optimal treatment. [ABSTRACT FROM AUTHOR]

This study reports a case of uterine liposarcoma together with a literature review. At 52 years old, our patient was diagnosed with lipoleiomyoma by MRI. A mass (39 × 32 × 41 mm3) protruding from the anterior wall of the uterine body was observed. When the patient was 58, her previous doctor found that the tumor had grown, and she was referred to the gynecology department of our hospital. On MRI, the major diameter was 1.23-fold longer and the volume was 1.85-fold higher compared with the prior imaging findings. Diffusion-weighted images revealed no significant anomalous signals. Thus, malignant tumors were included in the differential diagnosis. The patient consented to total abdominal hysterectomy and bilateral salpingo-oophorectomy. The mass on the anterior wall remained completely in the myometrium. No implantation was found in the abdominal cavity, and ascites was not detected. No bleeding or necrosis was observed on the cut surface. Histopathologically, differences in the sizes of adipocytes and stromal cells were identified. There were irregularities in the nuclear findings. The immunohistochemical findings were as follows: CDK4 (+), desmin (+), S100p (−), and Ki − 67 = 1 %. Therefore, a diagnosis of well-differentiated liposarcoma was rendered. The lesion was localized in the uterus, and it was completely removed during surgery. Well-differentiated liposarcoma of uterine primary has no possibility of recurrence following complete resection, and thus, the patient underwent follow-up without additional treatment. No metastasis or recurrence has been observed for 10 months after surgery. [ABSTRACT FROM AUTHOR]

Background: Patent omphalomesenteric duct is one of the birth defects included in the spectrum of vitelline duct abnormalities. It is a rare anomaly with estimated prevalence of 0.13–0.2% in the general population. The most common presentation of patent vitelline duct is yellowish or mucoid type umbilical discharge which is usually noted in neonatal age or infancy. The main stay of diagnosis is clinical and outcome is favorable as long as timely surgical correction is offered. Here we present a 2 years old male child who presented with ileal prolapse through patent vitelline duct which is an exceptional mode of presentation of this pathology. Case presentation: 2 years old Ethiopian male child who was noticed to have umbilical discharge since early infancy presented with protrusion of pinkish mass per the umbilicus of 4 h duration. He had no signs and symptoms of bowel obstruction. Abdominal examination revealed a prolapsed bowel which was viable via the umbilicus which was about 6 cm long. Otherwise, he had no abdominal tenderness or rigidity. He was explored with a smiley incision just above the umbilicus. The prolapsed bowel was reduced gently to the abdominal cavity. The tract of the Patent vitelline duct was identified and completely resected along with a wedge of ileum at its base. Primary repair of the ileal end where the tract was inserted was done in two layers and abdomen was closed in layers. The child had smooth post op course and was discharged on the 4th post-operative day. Conclusion: Prolapse of a bowel through the umbilicus is unusual presentation of a rare anomaly namely patent vitelline duct. This presentation warrants early surgical intervention before bowel ischemia issues. Hence, all clinicians dealing with children should be aware of this rare pathology so that urgent surgical management can be offered. [ABSTRACT FROM AUTHOR]

Chyle leak is a rare but potentially morbid complication of abdominal surgery. There have been seven reported cases of chylous ascites following cholecystectomy, but no such occurrences are reported with percutaneous cholecystostomy tube (PCT) insertion. We report the case of a 67-year-old female with stage IVb recurrent uterine papillary serous carcinoma and extensive abdominal surgical history including a paraesophageal hernia repair, and a robotic hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, gastrocolic omentectomy, and hepatoduodenal lymphadenectomy. The patient presented with clinical findings suggestive of acute cholecystitis and decision was made to proceed with PCT placement. The PCT was dislodged and replaced during her course and several days after chylous output was noted from the PCT. The remainder of her hospital course was complicated by persistent distributive shock, adrenal insufficiency, and continued chyle leak. She ultimately was transitioned to inpatient hospice and died shortly after. [ABSTRACT FROM AUTHOR]

Burkitt Lymphoma, an aggressive form of non-Hodgkin's lymphoma, is a rare cause of ileocolic intussusception in adult patients. We present the case of a 17-year-old male patient, with a history of non-Hodgkin's lymphoma in childhood, presenting with acute abdominal pain, vomiting, and diarrhea. CT and colonoscopy findings revealed ileocolic intussusception with a large ileocecal mass, leading to a diagnosis of Burkitt Lymphoma after histopathological and immunohistochemical examination. This case highlights the rarity of Burkitt Lymphoma causing intussusception in adults, a condition more commonly seen in children. The case also underscores the importance of considering Burkitt Lymphoma in patients with a history of non-Hodgkin's lymphoma presenting with acute abdominal symptoms. He was successfully treated with surgery without any complications. On follow-ups, he is doing well. [ABSTRACT FROM AUTHOR]

A case study presents a 37-week 3-day gestation Small-for-Gestational-Age male admitted to the Neonatal intensive care unit due to respiratory distress and small size. Topics include the prenatal complexity of Noonan syndrome and the importance of recognizing milder phenotypes, alongside practical considerations for identifying and managing the disorder in neonates.

Key Clinical Message: Ingestion of foreign bodies is very common in clinical practice. However, gastrointestinal perforation caused by a foreign body is rare, as most foreign bodies can pass the alimentary tract spontaneously or be removed endoscopically. Ingesting a foreign body causes gastrointestinal tract perforation in less than 1% of cases that require surgery. In the past, the literature about gastrointestinal tract perforation caused by foreign bodies had been widely reported worldwide. However, the case of foreign bodies causing gastrointestinal perforation without significant abdominal infection was rarely documented. A 47‐year‐old woman presented with intermittent left lower abdominal pain associated with a mass for 1 month and had no other symptoms. Laparotomy was performed after clinical assessment. During the operation, a local inflammatory mass that adhered to the abdominal wall, part of the small intestine, and sigmoid colon was found in the left lower quarter of the abdominal cavity. The surrounding intestinal wall was edematous. There were two bony foreign bodies in it. Postoperative pathology suggested an inflammatory mass. A foreign body rarely migrates into the abdominal cavity without symptoms that may be related to the omentum's slow perforation process and good function. The best treatment is surgery and using appropriate antibiotics. [ABSTRACT FROM AUTHOR]

The application and removal of personal protective equipment (PPE) by health care workers (HCWs) is pivotal to their health and safety and the comprehensive efficacy of hospital infection control measures. This investigation was orchestrated to elucidate the challenges that HCWs may encounter during the donning and doffing of PPE. A total of 110 participants from a tertiary hospital in China were engaged. The study employed fluorescent markers to mimic the exposure of HCWs to tainted body fluids, quantified the contamination outcomes, and evaluated adherence to procedures for donning and doffing. Factors including gender, educational background, and the timing of the most recent instruction on PPE donning and doffing were found to influence the occurrence of contamination points (p < 0.05). No significant differences were identified in contamination frequency when assessing age, body mass index (BMI), occupation, educational background, positional title, working tenure, and experience in managing respiratory infectious diseases (p > 0.05). Predominant contamination sites for fluorescent marker residue included the shoulder (32.73%), neck (21.82%), forearm (16.36%), chest (12.73%), and abdomen (11.82%), with the shoulder being the most contaminated body part. A majority of HCWs exhibited susceptibility to errors during the removal of protective clothing, boot covers, and gloves. The contamination frequency was observed to be correlated with the timing of the last PPE training, educational background, and gender. In acknowledging the intricacy of PPE removal and the deficiencies in HCWs' removal techniques, there emerges a perpetual necessity to refine training methodologies and perpetuate regular PPE instruction. [ABSTRACT FROM AUTHOR]

Abdominal emergencies in cancer patients encompass a wide spectrum of oncologic conditions caused directly by malignancies, paraneoplastic syndromes, reactions to the chemotherapy or often represent the first clinical manifestation of an unknown malignancy. Not rarely, clinical symptoms are the tip of an iceberg. In this scenario, the radiologist is asked to exclude the cause responsible for the patient's symptoms, to suggest the best way to manage and to rule out the underlying malignancy. In this article, we discuss some of the most common abdominal oncological emergencies that may be encountered in an emergency department. [ABSTRACT FROM AUTHOR]

Background: We examined outcomes in Acute Mesenteric Ischemia (AMI) with the hypothesis that Open Abdomen (OA) is associated with decreased mortality. Methods: We performed a cohort study reviewing NSQIP emergency laparotomy patients, 2016–2020, with a postoperative diagnosis of mesenteric ischemia. OA was defined using flags for patients without fascial closure. Logistic regression was used with outcomes of 30‐day mortality and several secondary outcomes. Results: Out of 5514 cases, 4624 (83.9%) underwent resection and 387 (7.0%) underwent revascularization. The OA rate was 32.6%. 10.8% of patients who were closed required reoperation. After adjustment for demographics, transfer status, comorbidities, preoperative variables including creatinine, white blood cell count, and anemia, as well as operative time, OA was associated with OR 1.58 for mortality (95% CI [1.38, 1.81], p < 0.001). Among revascularizations, there was no such association (p = 0.528). OA was associated with ventilator support >48 h (OR 4.04, 95% CI [3.55, 4.62], and p < 0.001). Conclusion: OA in AMI was associated with increased mortality and prolonged ventilation. This is not so in revascularization patients, and 1 in 10 patients who underwent primary closure required reoperation. OA should be considered in specific cases of AMI. Level of Evidence: Retrospective cohort, Level III. [ABSTRACT FROM AUTHOR]

Introduction: The image quality of continuously acquired free-breathing Dynamic Contrast-Enhanced (DCE) golden-angle radial Magnetic Resonance Imaging (MRI) of abdomen suffers from motion artifacts and motion-related blurring. We propose a scheme by minimizing patients' motion status from breathing as well as optimizing the acquiring parameters to improve image quality and diagnostic performance of DCE-MRI with Golden-Angle Radial Sparse Parallel (GRASP) sequence of abdomen. Methods: The optimization scheme follows two principles: (1) reduce the impact on images from unpredictable and irregulate motions during examination and (2) adjust the sequence parameters to increase the number of radial views in each partition. For the assessment of image quality, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), the severity of radial artifact, the degree of image sharpness, and a visual scoring of image quality with a 5-point scale were assessed. Results: A total of 64 patients were included in this study before (16 men, 14 women, age: 54.9 ± 17.0) and after (18 men, 16 women, age: 58.6 ± 12.6) the optimization scheme was performed. The results showed that the SNR values of right and left lobe of liver in both plain phase and arterial phase were significantly increased (All P < 0.001) after the GRASP sequence been optimized. Significant improvements in CNR values were observed in the arterial phase (All P < 0.05). The significant differences in scores at each phase for visual scoring of image quality, noise of the right and left lobe of liver, radial artifact, and sharpness indicating that the image quality was significantly improved after the optimization (All P < 0.001). Conclusion: Our study demonstrated that the optimized scheme significantly improved the image quality of liver DCE-MRI with GRASP sequence both in plain and arterial phases. The optimized scheme of GRASP sequence could be a superior alternative to conventional approach for the assessment of liver. [ABSTRACT FROM AUTHOR]

For tumors wherein cancer cells remain in the tissue after colorectal cancer surgery, a hyperthermic anticancer agent is injected into the abdominal cavity to necrotize the remaining cancer cells with heat using a hyperthermic intraperitoneal chemotherapy system. However, during circulation, the processing temperature is out of range and the processing result is deteriorated. This paper proposes a look-up table (LUT) module design method that can stably maintain the processing temperature range during circulation via feedback. If the temperature decreases or increases, the LUT transmits a command signal to the heat exchanger to reduce or increase heat input, thereby maintaining the treatment temperature range. The command signal for increasing and decreasing heat input is Tp and Ta, respectively. The command signal for the treatment temperature range is Ts. If drug temperatures below 41 and above 43 °C are input to the LUT, it sends a Tp or Ta signal to the heat exchanger to increase or decrease the input heat, respectively. If the drug's temperature is 41–43 °C, the LUT generates a Ts signal and proceeds with the treatment. The proposed system can automatically control drug temperature using temperature feedback to ensure rapid, accurate, and safe treatment. [ABSTRACT FROM AUTHOR]

Simple Summary: This study, conducted within a large North American cohort from the Surveillance, Epidemiology and End Results (SEER) database (2004–2020), aimed to investigate whether more complex urinary diversion (UD) procedures, such as orthotopic neobladder and abdominal pouch, are associated with higher other-cause mortality (OCM) compared to the conventional ileal conduit in T1-T4aN0M0 bladder cancer patients. Among 3008 patients, 79% underwent ileal conduit, while 21% opted for continent UD. After rigorous analysis, including propensity score matching and multivariable adjustments, the study found that neither continent UD nor its subtypes (orthotopic neobladder and abdominal pouch) were associated with higher 10-year OCM rates relative to ileal conduit. The conclusion suggests that more intricate UD procedures do not seem to elevate OCM risk compared to the simpler ileal conduit. Background: It is unknown whether more complex UD, such as orthotopic neobladder and abdominal pouch, may be associated with higher OCM rates than ileal conduit. We addressed this knowledge gap within the SEER database 2004–2020. Methods: All T1-T4aN0M0 radical cystectomy (RC) patients were identified. After 1:1 propensity score matching (PSM), cumulative incidence plots, univariable and multivariable competing-risks regression (CRR) models were used to test differences in OCM rates according to UD type (orthotopic neobladder vs. abdominal pouch vs. ileal conduit). Results: Of all 3008 RC patients, 2380 (79%) underwent ileal conduit vs. 628 (21%) who underwent continent UD (268 orthotopic neobladder and 360 abdominal pouch). After PSM relative to ileal conduit, neither continent UD (13 vs. 15%; p = 0.1) nor orthotopic neobladder (13 vs. 16%; p = 0.4) nor abdominal pouch (13 vs. 15%; p = 0.2) were associated with higher 10-year OCM rates. After PSM and after adjustment for cancer-specific mortality (CSM), as well as after multivariable adjustments relative to ileal conduit, neither continent UD (Hazard Ratio [HR]:0.73; p = 0.1), nor orthotopic neobladder (HR:0.84; p = 0.5) nor abdominal pouch (HR:0.77; p = 0.2) were associated with higher OCM. Conclusions: It appears that more complex UD types, such as orthotopic neobladder and abdominal pouch are not associated with higher OCM relative to ileal conduit. [ABSTRACT FROM AUTHOR]