Uncommon Metastasis of Laryngeal Cancer to Small Bowel Causing Intestinal Obstruction Treated by Laparoscopic Approach

Metastatic laryngeal cancer to the small bowel is extremely rare. Management of small bowel obstruction used to constitute a relative contraindication for the use of laparoscopic modality. We are reporting a case of an elderly man known to have laryngeal cancer who presented with small bowel obstruction due to metastatic deposit to the small bowel. The condition was successfully treated by laparoscopic assisted approach. A review of the natural history of advanced laryngeal cancer, common and uncommon sites of metastasis, and the rare presentation as small bowel obstruction is illustrated in this review

Resuscitative endovascular balloon occlusion of the aorta "REBOA": indications - advantages and challenges of implementation in traumatic non-compressible torso hemorrhage

Background: The indications and outcomes of resuscitative endovascular balloon occlusion of the aorta ‘REBOA’ in exsanguinating non-compressible torso hemorrhage remain controversial. We aim to evaluate the literature related to REBOA, report our first experience with the technique, and address the challenges faced during its implementation.Setting: University Hospital Center, Canada.Methods: To evaluate the literature, we used the five-stage framework of Arksey and O'Malley's scoping review methodology as a guide We performed a systematic search in the following databases: MEDLINE, EMBASE, BIOSIS, COCHRANE CENTRAL, PUBMED and SCOPUS from the earliest available publications. The aim was to identify diverse studies related to the topic of REBOA. For a comprehensive search, we explored organizational websites, key journals, and hand-search reference lists of key studies. Data was charted and sorted using a descriptive analytical approach. Evidence-based papers, as well as grey literature at large, were analyzed regardless of the quality of the manuscripts.In addition to the scoping review, relevant cases performed at our University Hospital Center are reported. In a first case report, we describe the first application of the second generation ER-REBOA in an unresponsive hypotensive polytrauma patient. A second case report describes the unique use of the technique in a penetrating gunshot injury to the lower extremity. Lastly, we established a clinical pathway to stratify the cases that will be eligible for the application of the novelty technique.Results: We identified 1176 articles related to the topic from all available database sources and 57 reviews from the grey literature search. The final review yielded 105 articles for detailed scrutiny revision. Quantitative and qualitative variables included patient demographics, study design, study objectives, methods of data collection, indications, REBOA protocol used, time to deployment, zone of deployment, occlusion time, complications, outcome, and the level of expertise at the concerned trauma center. So far, 7 cases underwent REBOA at our center. The results are still under detailed evaluation. The preliminary outcomes of the case reports are very encouraging.Conclusion: Growing levels of evidence are supporting the use of REBOA in selected indications. Our data analysis showed an advantage for its use in terms of morbidities and physiologic derangement in comparison to other resuscitation measures. Current challenges remain in the selective application, implementation, competency assessment and credentialing for the use of REBOA in trauma settings. The identification of the proper indication, terms of use and possible advantage of the pre-hospital and partial REBOA are topics for further researches.Contexte : Les indications et les résultats de l’utilisation du ballon occlusive de ressuscitation endovasculaire REBOA demeurent controversés. Nous envisageons à évaluer la littérature concernant le sujet de REBOA, rapporter notre expérience en utilisant cette technique, ainsi que l’études des défis rencontrées lors de la mise en œuvre du nouveau système au niveau de centres de trauma. Lieu : Centre Hospitalier Universitaire, Canada.Méthodes : Pour évaluer la littérature, nous avons utilisé le schéma à cinq étapes de la méthodologie de révision exploratrice d'Arksey et O'Malley. Nous avons effectué une recherche systématique dans les bases de données suivantes: MEDLINE, EMBASE, BIOSIS, COCHRANE CENTRAL, PUBMED et SCOPUS, depuis les plus anciennes publications disponibles. L'objectif est d'identifier diverses études liées au sujet du REBOA. Pour effectuer une recherche complète, nous avons exploré les sites d’organisations, les revues les plus connus et les listes de référence de publications clés. Les données ont été cartographiées et triées en utilisant une approche analytique descriptive. Les articles fondés sur des preuves, ainsi que la littérature public en général - ou ‘ littérature grise’- ont été analysés quelle que soit la qualité des publications.En supplément de révision exploratrice, nous rapporterons des cas pertinents effectués dans notre centre hospitalier universitaire. Dans un premier rapport de cas, nous décrivons la première application de nouvelle génération de ER-REBOA chez un patient hypotendu polytraumatisé. Un deuxième rapport de cas décrit l'unique utilisation de la technique dans une blessure par balle pénétrante du membre inférieur. Finalement, nous avons établi un une démarche clinique pratique pour l’application de la nouvelle technologie au sein de notre Centre Hospitalier Universitaire.Résultats : Nous avons identifié 1176 articles provenant de sources de base et 57 revues tirés de la recherche de littérature public ‘grise’. La revue finale a donné 105 articles pour une révision détaillée. Les variables quantitatives et qualitatives comprenaient la démographie des patients, la conception de l’étude, les objectifs de l’étude, les méthodes de collecte de données, les indications, le protocole REBOA utilisé, le délai de déploiement, la zone de déploiement, le temps d’occlusion, les complications, les résultats, et le niveau d’expertise du centre de traumatologie concerné. Jusque là, nous avons effectuée 7 cas. Les données sont toujours sous évaluations très détaillées. Cependant, les résultats primaires des cas rapportés sont très encourageants. Conclusion : Les preuves les plus récentes soutiennent l’utilisation du REBOA dans certaines indications bien spécifiques. Notre analyse a montré un avantage pour son utilisation en termes de morbidité et de dérangement physiologique par rapport à d'autres mesures de réanimation. Les défis actuels demeurent sur l’application sélective, la mise en œuvre, l’évaluation des compétences et l’accréditation de l’utilisation du REBOA dans le contexte de traumatologique. L'identification de l'indication appropriée, les conditions d'utilisation et les avantages possibles du REBOA préhospitalier ou partiel sont des sujets de potentiels futures recherches

Management of peri-anal giant condyloma acuminatum—A case report and literature review

Giant condyloma acuminatum (GCA), originally described by Buschke and Loewenstein in 1925 as a lesion of the penis, is more rarely seen in the anorectum and is characterized by clinical malignancy in the face of histologic benignity, however, malignant transformation to frankly invasive squamous-cell carcinoma has been described in about one-third of patients. In addition, malignant transformation has been reported in patients with "ordinary" condylomata acuminata. Human papillomavirus, known to cause condylomata acuminata, is also known to induce these tumors and was found in 96% of 63 cases reviewed in the last 10 years. These lesions have a propensity for recurrence and a likelihood of malignant transformation, and lead to significant mortality. Therefore, early and radical R0 excision, along with vigilant follow-up, provides the hope for cure. Conservative and/or multimodal therapy has been reported in a few cases, but its effect is not yet proved. The authors report one case of GCA, in addition, they reviewed the literature over the last 10 years and compared with previous reviews

Conservative Management of Acute Appendicitis In The Era Of COVID 19: A Multicenter prospective observational study at The United Arab Emirates

AbstractBackgroundSince its emergence in December 2019, the Novel Coronavirus (COVID-19) pandemic resulted in a profound impact on the health care system worldwide. We propose herein to evaluate the impact of implementing conservative management as an alternative approach to surgical appendectomy in the treatment of proven acute appendicitis during COVID19 pandemic.MethodsOur study is a prospective multicenter study that includes a cohort of 160 patients admitted to the surgical departments in both Tawam Hospital and Sheikh Shakhbout Medical City, Abu Dhabi, UAE, for the period from February 2020 till July 2020.ResultsOur results showed that 56 of our patients (35%) were treated conservatively, while the other 104 (65%) underwent operative management. There was a significant decrease in length of hospital stay (LOS) (2.32± 0.83 days) among the first group compared to the second (2.8± 1.47 days). Also, short term follow-up showed that 90% of those patients did not require further operative intervention or developed any serious complications. Out of the 110 patients that were swapped for COVID19, nine (8.18%) were confirmed to be positive. Our protocol was to avoid surgical management for COVID19 positive patients unless indicated. This resulted in (8/9) of COVID19 positive patients to be treated conservatively. Follow up was achieved by using telemedicine-based follow-up with the aim of empowering social distancing and reducing risk of viral exposure to patients as well as the health care providers. In conclusion, our results showed that the implementation of conservative management in treating patients with acute appendicitis who were COVID19 positive is a safe and feasible approach that maybe essential in reducing viral transmission risks as well as avoiding operative risks on COVID19 positive patients.</jats:sec

Leydig Cell Tumors of the Testis: An Update of the Imaging Characteristics of a Not So Rare Lesion

Pre-operative testicular tumor characterization is a challenge for radiologists and urologists. New data concerning imaging approaches or immunochemistry markers improve the management of patients presenting with a testicular tumor, sometimes avoiding radical orchiectomy. In the past 20 years, imaging modalities, especially ultrasound (US) and magnetic resonance imaging (MRI), improved, allowing for great progress in lesion characterization. Leydig cell tumors (LCT) are rare testicular tumors developing from the stromal tissue, with relatively scarce literature, as most of the studies focus on the much more frequent germ cell tumors. However, with the increase in testicular sonography numbers, the incidence of LCT appears much higher than expected, with some studies reporting up to 22% of small testicular nodules. Multimodal ultrasound using Doppler, Elastography, or injection of contrast media can provide crucial arguments to differentiate LCT from germ cell tumors. Multiparametric MRI is a second intention exam, but it allows for extraction of quantifiable data to assess the diagnosis of LCT. The aims of this article are to review the latest data regarding LCT imaging features, using multimodal ultrasound and multiparametric MRI, and to focus on the peculiar aspect of the testis of patients with Klinefelter’s syndrome. The possibility of an LCT should be raised in front of a small hypoechoic tumor with a marked corbelling hypervascularization in an otherwise normal testicular pulp. Ultrasonographic modules, such as ultrasensitive Doppler, contrast-enhanced ultrasonography, or elastography, can be used to reinforce the suspicion of LCT. MRI provides objective data regarding vascularization and enhancement kinetics

Management of peri-anal giant condyloma acuminatum—A case report and literature review

SummaryGiant condyloma acuminatum (GCA), originally described by Buschke and Loewenstein in 1925 as a lesion of the penis, is more rarely seen in the anorectum and is characterized by clinical malignancy in the face of histologic benignity; however, malignant transformation to frankly invasive squamous-cell carcinoma has been described in about one-third of patients. In addition, malignant transformation has been reported in patients with "ordinary" condylomata acuminata. Human papillomavirus, known to cause condylomata acuminata, is also known to induce these tumors and was found in 96% of 63 cases reviewed in the last 10 years. These lesions have a propensity for recurrence and a likelihood of malignant transformation, and lead to significant mortality. Therefore, early and radical R0 excision, along with vigilant follow-up, provides the hope for cure. Conservative and/or multimodal therapy has been reported in a few cases, but its effect is not yet proved. The authors report one case of GCA; in addition, they reviewed the literature over the last 10 years and compared with previous reviews

Update on Renal Cell Carcinoma Diagnosis with Novel Imaging Approaches

This review highlights recent advances in renal cell carcinoma (RCC) imaging. It begins with dual-energy computed tomography (DECT), which has demonstrated a high diagnostic accuracy in the evaluation of renal masses. Several studies have suggested the potential benefits of iodine quantification, particularly for distinguishing low-attenuation, true enhancing solid masses from hyperdense cysts. By determining whether or not a renal mass is present, DECT could avoid the need for additional imaging studies, thereby reducing healthcare costs. DECT can also provide virtual unenhanced images, helping to reduce radiation exposure. The review then provides an update focusing on the advantages of multiparametric magnetic resonance (MR) imaging performance in the histological subtyping of RCC and in the differentiation of benign from malignant renal masses. A proposed standardized stepwise reading of images helps to identify clear cell RCC and papillary RCC with a high accuracy. Contrast-enhanced ultrasound may represent a promising diagnostic tool for the characterization of solid and cystic renal masses. Several combined pharmaceutical imaging strategies using both sestamibi and PSMA offer new opportunities in the diagnosis and staging of RCC, but their role in risk stratification needs to be evaluated. Although radiomics and tumor texture analysis are hampered by poor reproducibility and need standardization, they show promise in identifying new biomarkers for predicting tumor histology, clinical outcomes, overall survival, and the response to therapy. They have a wide range of potential applications but are still in the research phase. Artificial intelligence (AI) has shown encouraging results in tumor classification, grade, and prognosis. It is expected to play an important role in assessing the treatment response and advancing personalized medicine. The review then focuses on recently updated algorithms and guidelines. The Bosniak classification version 2019 incorporates MRI, precisely defines previously vague imaging terms, and allows a greater proportion of masses to be placed in lower-risk classes. Recent studies have reported an improved specificity of the higher-risk categories and better inter-reader agreement. The clear cell likelihood score, which adds standardization to the characterization of solid renal masses on MRI, has been validated in recent studies with high interobserver agreement. Finally, the review discusses the key imaging implications of the 2017 AUA guidelines for renal masses and localized renal cancer