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   Table of Contents - Current issue
September-October 2021
Volume 54 | Issue 5
Page Nos. 165-203

Online since Tuesday, October 12, 2021

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The application of image-guided video-assisted thoracoscopic surgery to bilateral pulmonary nodules resection p. 165
Ya-Fu Cheng, Chu-Chun Liang, Heng-Chung Chen, Pei-Cing Ke, Wei-Heng Hung, Ching-Yuan Cheng, Bing-Yen Wang
Background: In tradition, bilateral small pulmonary nodules are localized in a computed tomography room and operation twice for fear of complications. In contrast, image-guided video-assisted thoracoscopic surgery (iVATS) is applied to localize small pulmonary nodules and resect these nodules in a single stage. The application of iVATS for bilateral pulmonary nodule localization and resection has not been explored. This study describes the methods and outcomes of bilateral small pulmonary nodule localization and resection in a single-staged method. Materials and Methods: This study is a retrospective analysis in our institute (Changhua Christian Hospital, Changhua, Taiwan). Patients with bilateral small pulmonary nodules who received single-staged iVATS from July 2018 to May 2020 were included in the study. The outcome measurements include operative time, localization time of one side, nodule pathologies, operative method, presence of complications, chest tube duration, and length of hospital stay (LOS). Results: Twenty-one patients with bilateral pulmonary nodules were included in this study, and a total of 50 pulmonary nodules were resected. The average operative time for a procedure was 203 min (95% confidence interval [CI]: 160–246 min), which included 18 min (95% CI: 13–23 min) of localization time for each side. Eight of 21 patients (38.10%) showed different pathologies among their bilateral nodules. There was only one complication noted; it was due to prolonged air leakage at the left side. Conclusion: There were about 40% different pathologies for synchronous bilateral lung nodules. Single-staged iVATS is feasible and efficient for bilateral small lung nodules resection.
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Significance of telomerase reverse-transcriptase promoter mutations in differentiated thyroid cancer p. 171
Hung-Fei Lai, Chi-Yu Kuo, Shih-Ping Cheng
Background: Telomerase reverse-transcriptase (TERT) encodes the reverse transcriptase of telomerase, and TERT promoter mutations are enriched in advanced thyroid cancer. In this study, we aimed to characterize the clinicopathologic biology of differentiated thyroid cancer harboring TERT promoter mutations in Taiwan. Materials and Methods: Consecutive adult patients treated with differentiated thyroid cancer between 2017 and 2019 were included in this study. Mutational testing for the TERT promoter was performed by DNA-based polymerase chain reaction. Results: Among 389 patients included in the analysis, 22 (5.7%) had papillary or follicular thyroid cancer harboring TERT promoter mutations, including C228T (n = 18), C250T (n = 3), and CC242TT (n = 1). The frequency of BRAF V600E mutation was 73%. TERT promoter mutations were significantly associated with older age, tall cell variant of papillary thyroid cancer, extrathyroidal extension, positive surgical margins, lymphovascular invasion, perineural invasion, and distant metastasis. The generalized additive model showed that patient age was positively and almost linearly correlated with the likelihood of the presence of TERT promoter mutations. Conclusion: The frequency of TERT promoter mutations is relatively low in patients with differentiated thyroid cancer in Taiwan. These tumors carry unfavorable clinicopathologic features, present in a more advanced stage, and probably predict worse prognosis.
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Comparison of intralesional bleomycin with/without doxycycline in the primary management of pediatric lymphangiomas p. 177
Naresh M Pawar, Aditya Pratap Singh, Arun Kumar Gupta, Vinita Chaturvedi, Dinesh Kumar Barolia
Background: Although surgical excision is the treatment of choice for lymphangiomas, recently many centers are practicing intralesional sclerotherapy as the primary modality. The purpose of this study was to review the efficacy of intralesional Bleomycin, to study the efficacy of a combination of intralesional bleomycin and doxycycline and compare the results. Materials and Methods: In this clinical observational study, all patients were evaluated clinically and color Doppler ultrasonography. Patients were grouped into Group A, in which intralesional Bleomycin alone and Group B, in which a combination of intralesional Bleomycin and Doxycycline was instilled into the cysts. The clinical response was assessed and compared between the groups. Results: Out of 52 patients in the study, the most common site of lymphangioma was cervical 28 (53%) and the most common type was macrocystic lesion 44 (84.5%). In Group A, out of 26 patients, the response was excellent in 15 (58%), satisfactory in 8 (30%), and poor in 3 (12%). In Group B, out of 26 patients, the response was excellent in 22 (85%), satisfactory in 2 (7.5%), and poor in 2 (7.5%). The postprocedure complications were observed more in Group A than Group B, of which the most common was pain/tenderness in five patients followed by redness and fever. Conclusion: Intralesional bleomycin alone and a combination of intralesional bleomycin and Doxycycline injection both can be safe and effective sclerosant formulas for primary nonsurgical management. The use of combination of Bleomycin and Doxycycline required fewer treatment sessions to obtain clinical success compared to Bleomycin alone.
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Geriatric nutritional risk index in screening malnutrition among young adult and elderly trauma patients p. 183
Yueh-Wei Liu, Ching-Hua Tsai, Sheng-En Chou, Wei-Ti Su, Chi Li, Shiun-Yuan Hsu, Ching-Hua Hsieh
Background: The geriatric nutritional risk index (GNRI) calculated as 1.489 × albumin (g/dL) +41.7× (current body weight/ideal body weight) is useful in identifying high-risk for malnutrition in elderly patients with subacute or chronic diseases. Given that trauma patients have sustained injuries in an acute condition, this study is designed to explore the association between GNRI on admission and outcomes in elderly and young adult patients with trauma. Materials and Methods: From January 01, 2009, to December 31, 2019, a total of 1772 elderly and 2194 young adult trauma patients were categorized into four nutritional risk groups according to GNRI: high-risk group (GNRI <82), moderate-risk group (GNRI 82 to <92), low-risk group (GNRI 92–98), and no-risk group (GNRI >98). Propensity score-matched patient cohorts were created in different nutritional risk groups against the no-risk group to minimize the confounding effects of sex, age, pre-existing comorbidities, Glasgow Coma Scale score, and Injury Severity Score on outcome measurements. Primary outcome was in-hospital mortality, and secondary outcome was the length of hospital stay. Results: Young adult patients with trauma were comparable in pattern of mortality outcomes and hospital stays to that in elderly patients. Analysis of the selected propensity score-matched patient cohorts revealed that both elderly and young adult patients in the high-risk group had significantly higher odds of mortality (elderly, odds ratio [OR], 6.5; 95% confidence interval [CI], 3.00-14.03; P < 0.009; young adult, OR, 2.7; 95% CI, 1.45-5.11; P = 0.001) and longer hospital stay (elderly, 21.5 days vs. 12.4 days, respectively, P < 0.001; young adults, 22.5 days vs. 14.1 days, respectively, P < 0.001) than those of the no-risk group. Conclusion: This study demonstrated that the GNRI could serve as a useful screening method to identify high-risk malnutrition in acutely injured trauma patients, including not only the elderly trauma patients but also the young adult trauma patients.
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Primary osteosarcoma of the breast p. 191
Hung-An Huang, Sheng-Lan Wang
A 58-year-old female with a primary osteosarcoma of the breast (POB) is presented here. The diagnosis was based on the characteristic histological picture and on the immunohistochemical results. The possibility of the secondary lesion from a primary skeletal osteosarcoma or direct extension of an osteogenic sarcoma arising from nearby ribs or the sternum was excluded. Approximately, 150 cases of POB had been reported in the literature with tumor size affecting survival. The diagnosis needs to be made as early as possible to improve the survival of this disease.
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Primary pleomorphic leiomyosarcoma of descending mesocolon p. 196
Suhaildeen Kajamohideen, Balasubramanian Venkitaraman, Sathyanarayanan M Shivkumaran, Prithviraj Premkumar
Mesenteric tumors range from benign cysts to aggressive malignancies and pose both diagnostic and therapeutic challenge. Leiomyosarcomas are rare tumors of the digestive tract comprising <0.1% of colorectal tumors. Similarities between mesenchymal tumors of the digestive tract make histological diagnosis difficult. We report a case of 53-year-old female diagnosed with leiomyosarcoma of descending mesocolon, who has undergone surgery following neoadjuvant chemotherapy and has been on regular follow-up for 2 years. This case signifies the diagnostic difficulties encountered in these rare tumors with a review of the literature.
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Spontaneous spinal epidural hemorrhage due to polycythemia vera p. 200
Tzu-Yao Lin, Shih-Chao Chien, Chan-Lin Chu, Jie-Yang Jhuang, Cheng-Chia Tsai, Hsin-Yao Lin
Spontaneous spinal epidural hematoma (SSEH) as an initial presentation of polycythemia vera (PV) is rare. It can present with the features ranging from simple back pain to complete paraplegia depending on the site of the spinal compression. Herein, we describe a case of undiagnosed PV presented as back pain with radiation to the chest wall in a 46-year-old male patient and subsequently diagnosed with spontaneous spinal epidural hemorrhage. To the best of our knowledge, only one case of spinal epidural hematoma-related PV has been reported so far. Emergent decompressive laminectomy was done within 10 h of initial presentation with excellent clinical outcome. Therefore, this condition must be promptly diagnosed and treated with decompression surgery to minimize the risk of neurological complication.
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Factors influencing the outcome of necrotizing fasciitis p. 203
Fachreza Aryo Damara, Dedy Pratama
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