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Assessment of difficulty in laparoscopic distal pancreatectomy: a modification of the Japanese difficulty scoring system - A single-center high-volume experience.

J Hepatobiliary Pancreat Sci 2021 Jun 11. Epub 2021 Jun 11.

Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, Verona, Italy.

Background: The Japanese difficulty scoring system (DSS) was developed to assess the difficulty of laparoscopic distal pancreatectomy (LDP). The study aimed to validate a modified DSS (mDSS) in a European high-volume center.

Methods: Patients' clinical data underwent LDP for benign and malignant pancreatic lesion between September 2013 and February 2020 were reviewed. Read More

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A 64-year-old woman with rapid neurologic decline diagnosed with encephalitis after presumed metastatic cancer.

SAGE Open Med Case Rep 2021 24;9:2050313X211019784. Epub 2021 May 24.

University of California, Irvine School of Medicine, Irvine, CA, USA.

In an era of fragmented medical care, concurrent clinical features that ultimately lead to a unified diagnosis may not be prioritized appropriately. We present a case of a 64-year-old woman referred to hematology clinic for anemia, with recent memory loss and gait disturbance. Two months later, she developed pneumonia; imaging workup showed a left renal mass. Read More

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Recreational cannabis use causing non-ischaemic cardiomyopathy and cardioembolism in a young adult.

BMJ Case Rep 2021 Jun 1;14(6). Epub 2021 Jun 1.

Cardiology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

Cannabis is one of the most common illicit drugs and has been implicated with various complications which include stroke, acute myocardial infarction, arrhythmia and limb arteritis. We are reporting a case of a young man, who is a recreational cannabis smoker along with tobacco, who developed exertional progressive breathlessness for the last 4 months, mild cough for 2 months and acute left-sided hemiparesis along with ipsilateral facial palsy for 1 day that was attributed to an acute right middle cerebral artery territory infarct. There was also gangrene in his left forearm as a result of left radial artery thrombosis. Read More

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Arrhythmogenic Left Ventricular Cardiomyopathy: Genotype-Phenotype Correlations and New Diagnostic Criteria.

J Clin Med 2021 May 20;10(10). Epub 2021 May 20.

Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy.

Arrhythmogenic cardiomyopathy (ACM) is an inherited heart muscle disease characterized by loss of ventricular myocardium and fibrofatty replacement, which predisposes to scar-related ventricular arrhythmias and sudden cardiac death, particularly in the young and athletes. Although in its original description the disease was characterized by an exclusive or at least predominant right ventricle (RV) involvement, it has been demonstrated that the fibrofatty scar can also localize in the left ventricle (LV), with the LV lesion that can equalize or even overcome that of the RV. While the right-dominant form is typically associated with mutations in genes encoding for desmosomal proteins, other (non-desmosomal) mutations have been showed to cause the biventricular and left-dominant variants. Read More

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Postoperative pain due to an occult spinal infection: A case report.

World J Clin Cases 2021 May;9(15):3637-3643

Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.

Background: A high degree of vigilance is warranted for a spinal infection, particularly in a patient who has undergone an invasive procedure such as a spinal injection. The average delay in diagnosing a spinal infection is 2-4 mo. In our patient, the diagnosis of a spinal infection was delayed by 1. Read More

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Ocular ischaemic syndrome following coil embolisation for direct carotid cavernous fistula.

BMJ Case Rep 2021 May 27;14(5). Epub 2021 May 27.

Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India.

A 36-year-old man presented with proptosis and external ophthalmoplegia of the left globe following road traffic injury. Cerebral angiogram revealed moderate flow direct carotid cavernous fistula on left side for which coil embolisation was done repeatedly. Subsequently, the patient developed decreased vision in left eye and developed features of left-sided ocular ischaemic syndrome. Read More

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5-year results of accelerated partial breast irradiation (APBI) with SBRT (stereotactic body radiation therapy) and exactrac adaptive gating (Novalis) for very early breast cancer patients: was it all worth it?

Clin Transl Oncol 2021 May 27. Epub 2021 May 27.

Department of Radiation Oncology, U.H. Sanchinarro. HM Hospitales, Calle Oña, 10, 28050, Madrid, Spain.

Purpose: To explore the feasibility of image-guided and respiratory-gated Stereotactic Body Radiation Therapy (SBRT) for Accelerated Partial Breast Irradiation (APBI) in patients with very early breast cancer.

Material And Methods: Selected patients with early breast carcinoma after breast-conserving surgery were enrolled in this phase II trial. A fiducial marker was percutaneously placed close to surgical bed and five external fiducials were set on the skin. Read More

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Association between Laterality and Location of Deep Vein Thrombosis of Lower Extremity and Pulmonary Embolism.

Vasc Specialist Int 2021 May 25;37:12. Epub 2021 May 25.

Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Purpose: The aim of this study was to investigate the relationship between the anatomical location of thrombi in the lower extremities and the development of pulmonary embolism (PE).

Materials And Methods: We collected and analyzed the data of patients diagnosed with deep vein thrombosis (DVT) of the lower extremities between 2006 and 2015, and included those whose computed tomography (CT) data were available for PE identification. We evaluated the relationship between the laterality and the proximal/distal location of the thrombi in lower extremites and the location of PE. Read More

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Cost-Effectiveness of Anti-Epidermal Growth Factor Receptor Therapy Bevacizumab in KRAS Wild-Type (WT), Pan-RAS WT, and Pan-RAS WT Left-Sided Metastatic Colorectal Cancer.

Front Oncol 2021 3;11:651299. Epub 2021 May 3.

Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hong Kong, Hong Kong.

Objectives: We aimed to compare the economic value of chemotherapy plus anti-epidermal growth factor receptor (anti-EGFR) monoclonal antibody (mAb) against chemotherapy with bevacizumab (Bev, an anti-vascular endothelial growth factor mAb) as first-line treatment in KRAS wild-type (WT), pan-RAS WT and pan-RAS WT left-sided metastatic colorectal cancer (mCRC) patients from the Hong Kong societal perspective.

Materials And Methods: We developed Markov models and 10-year horizon to estimate costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratio (ICER) of chemotherapy plus anti-EGFR therapy against chemotherapy plus Bev in KRAS WT, pan-RAS WT, and pan-RAS WT left-sided mCRC. We considered two times of the local gross domestic product per capita (GDPpc) as the willingness-to-pay (WTP) threshold (2× GDPpc; US$97,832). Read More

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Incidence and prognostic significance of pleural effusions in pulmonary arterial hypertension.

Pulm Circ 2021 Apr-Jun;11(2):20458940211012366. Epub 2021 Apr 28.

Advanced Lung Disease and Transplant Center, Inova Fairfax Hospital, Falls Church, VA, USA.

It has been suggested pleural effusions may develop in right heart failure in the absence of left heart disease. The incidence and prognostic significance of pleural effusions in pulmonary arterial hypertension is uncertain. Patients with pulmonary arterial hypertension followed at our tertiary care center were reviewed. Read More

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A case of endobronchial actinomycosis as a challenging cause of lung atelectasis.

BMC Infect Dis 2021 May 8;21(1):433. Epub 2021 May 8.

Pulmonology and RICU, S Donato Hospital, Arezzo, Italy.

Background: Primary endobronchial actinomycosis is exceptionally uncommon and can be misdiagnosed as unresolving pneumonia, endobronchial lipoma, bronchogenic carcinoma or foreign body. Predisposing factors are immunosuppressive conditions, chronic lung diseases, poor oral hygiene or foreign body aspiration.

Case Presentation: We reported a case of 88-year old woman with a 4 days history of mild exertional dyspnea, productive cough with purulent sputum and fever up to 37. Read More

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Failure to Cure Patients with Colorectal Liver Metastases: The Impact of the Liver Surgeon.

Ann Surg Oncol 2021 Apr 30. Epub 2021 Apr 30.

Department of Surgery, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA.

Background: Lack of a liver surgeon (LS) may lead to failure to cure in patients with possibly resectable colorectal liver metastases (CRLM). This study aims to quantify the failure-to-cure rate due to noninclusion of an LS.

Patients And Methods: All patients who underwent chemotherapy with palliative intent for CRLM at a community oncology network between 2010 and 2018 were identified from a prospectively maintained cancer registry. Read More

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Fatal cerebral haemorrhage after COVID-19 vaccine.

Tidsskr Nor Laegeforen 2021 04 29;141. Epub 2021 Apr 29.

Background: New vaccines against COVID-19 are being rolled out globally. AstraZeneca's vaccine ChAdOx1 nCoV-19 was not known to cause vaccine-induced immune thrombotic thrombocytopenia (VITT) at the time of this case.

Case Presentation: The patient was a previously healthy woman in her thirties with headaches that developed one week after vaccination with ChAdOx1 nCoV-19. Read More

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Targeted therapy in Xp11 translocation renal cell carcinoma.

Klin Onkol 2021 ;34(2):137-140

Background: Translocation renal cell carcinoma (TRCC) is a rare form of RCC affecting mostly children and young adults with the occurrence of only 1-5% of all renal cell carcinomas. These carcinomas are associated with different translocations on a short arm of chromosome X in the region 11.2, which results in genetic modification of the p arm containing the transcription factor E3 gene. Read More

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January 2021

Aorto-left atrial fistula secondary to infective aortic endocarditis and endarteritis in a cat with valvular aortic stenosis.

J Vet Cardiol 2021 Mar 29;35:101-107. Epub 2021 Mar 29.

Department of Medicine and Epidemiology, School of Veterinary Medicine, University of California - Davis, One Garrod Drive, Davis, CA 95616, USA.

A cat previously diagnosed with valvular aortic stenosis developed acute respiratory distress. A new continuous heart murmur was noted on physical exam. Echocardiographic examination revealed vegetative lesions on the aortic valve and continuously shunting blood flow from the aorta into the left atrium. Read More

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Colorectal cancer surveillance with chromoendoscopy in inflammatory bowel disease: results from a real-life experience.

Scand J Gastroenterol 2021 Apr 27:1-6. Epub 2021 Apr 27.

Gastroenterology Unit. Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Universidad Autónoma de Madrid (UAM), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain.

Background: Patients with inflammatory bowel disease are at increased risk for colorectal cancer. The aim of this study was to know the prevalence of dysplasia and colorectal cancer with chromoendoscopy, to describe the characteristics and the management of the detected lesions and to identify possible risk factors of dysplasia in clinical practice.

Methods: Observational, retrospective study of all chromoendoscopies performed between January 2016 and May 2019 in patients with left-sided/extensive ulcerative colitis or Crohn's disease involving more than one-third of the colon. Read More

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Malignant middle cerebral artery infarction following subacute subdural hematoma: A case report and literature review.

Surg Neurol Int 2021 17;12:105. Epub 2021 Mar 17.

Neurosciences Research Centre, Molecular and Clinical Sciences Research Institute, Atkinson Morley Neurosurgery Centre, St George's, University of London, Tooting, London, United Kingdom.

Background: Subacute subdural hematomas (ASDH) are only treated surgically when they cause mass effect significant enough to give symptoms. Rarely, sub-ASDH may cause enough pressure to result in a malignant middle cerebral artery (MCA) territory infarction. Decompressive craniectomy (DC) is the last resort to reduce intracranial pressure following malignant MCA infarction. Read More

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Thoracoscopic repair of congenital diaphragmatic hernia in neonates: findings of a multicenter study in Japan.

Surg Today 2021 Apr 20. Epub 2021 Apr 20.

Department of Pediatric Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.

Purpose: We compared the efficacy of thoracoscopic repair (TR) with that of open repair (OR) for neonatal congenital diaphragmatic hernia (CDH).

Methods: The subjects of this multicenter retrospective cohort study were 524 infants with left-sided isolated CDH, diagnosed prenatally, and treated at one of 15 participating hospitals in Japan between 2006 and 2018. The outcomes of infants who underwent TR and those who underwent OR were compared, applying propensity score matching. Read More

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First-in-Human Clinical Experience Using High-Definition Exoscope with Intraoperative Indocyanine Green for Clip Reconstruction of Unruptured Large Pediatric Aneurysm.

World Neurosurg 2021 Apr 17;151:52. Epub 2021 Apr 17.

Department of Neurosurgery, University of California-San Diego, La Jolla, USA; Department of Neurosurgery, Rady Children's Hospital, San Diego, California, USA.

The operative exoscope is a novel tool that combines the benefits of surgical microscopes and endoscopes to yield excellent magnification and illumination while maintaining a comparatively small footprint and superior ergonomic features. Until recently, current exoscopes have been limited by 2-dimensional viewing; however, recently a 3-dimensional (3D), high-definition (4K-HD) exoscope has been developed (Sony-Olympus, Tokyo, Japan). Our group had previously described the first in-human experiences with this novel tool including microsurgical clipping of intracranial aneurysms. Read More

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Oncogene targeted therapy for metastatic primary scrotal melanoma.

Can J Urol 2021 Apr;28(2):10643-10647

Scott Department of Urology, Baylor College of Medicine, Houston, Texas, USA.

Primary scrotal melanoma represents the rarest genitourinary malignancy. We describe the 25th reported case. The 79-year-old patient presented with a rapidly enlarging right cutaneous scrotal mass which after local excision demonstrated pT4b nodular malignant melanoma (BRAF V600E mutation positive). Read More

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Hypoplastic Left Heart: Stage-I Will be Performed Interventionally, Soon.

Pediatr Cardiol 2021 Apr 19;42(4):727-735. Epub 2021 Apr 19.

Pediatric Heart Center, Justus-Liebig University, Feulgenstrasse 12, 35385, Giessen, Germany.

The hypoplasia of left-sided heart structures shows great variability and complexity. What the many variants have in common is that their heart structures are neither fully developed before nor after birth. Fetuses and newborns require an individual therapy depending on anatomy and function of the heart. Read More

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Twice Negative PCR in a Patient With Herpes Simplex Virus Type 1 (HSV-1) Encephalitis.

Neurohospitalist 2021 Jan 22;11(1):66-70. Epub 2020 Jul 22.

Division of Neurology, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.

Untreated herpes simplex virus type 1 (HSV-1) encephalitis is associated with high mortality. Missed cases can have devastating consequences. Detection of HSV-1 in cerebrospinal fluid (CSF) with polymerase chain reaction (PCR) is reported to have high sensitivity and specificity and is considered the diagnostic gold standard for HSV-1 encephalitis. Read More

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January 2021

A rare cause of stroke: fail-implanted venous port catheter system - a case report.

BMC Neurol 2021 Apr 14;21(1):158. Epub 2021 Apr 14.

Department of Neurology, University Hospital Giessen and Marburg, Klinikstrasse 33, 35392, Giessen, Germany.

Background: We present the case of a 75-year-old female with acute embolic cerebral infarction caused by a fail-implanted venous port catheter system in the left subclavian artery.

Case Presentation: A 75-year-old woman presented to our emergency room after acute onset of a right-sided hemiparesis and dysarthria. Within 2 days after admission, she developed a left-sided hemiparesis, ataxia with concordant gait disturbance and incoordination of the left upper limb. Read More

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A case of Spigelian hernia after laparoscopic incisional hernia repair.

Asian J Endosc Surg 2021 Apr 13. Epub 2021 Apr 13.

Department of Surgery, Hyogo Prefectural Kakogawa Medical Center, Kakogawa, Japan.

Laparoscopic ventral hernia repair with intraperitoneal onlay mesh reinforcement is often performed in clinical practice. We herein describe a patient who developed a Spigelian hernia at the edge of the mesh due to rupture of the muscular layer in the abdominal wall. A 69-year-old woman developed a left-sided abdominal bulge 15 months after laparoscopic ventral hernia repair. Read More

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Epilepsy surgery in COVID times-a unique conundrum.

Childs Nerv Syst 2021 Apr 10. Epub 2021 Apr 10.

Department of Neurosurgery, Neurosciences Centre, All India Institute of Medical Sciences, Room No. 607, New Delhi, 110029, India.

The COVID-19 pandemic has forced hospitals to prioritize admissions. Epilepsy surgeries have been postponed at most centers. As the pandemic continues with no definite end in sight in the near future, the question arises until when such patients should be denied appropriate treatment. Read More

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Moyamoya disease with refractory hypertension associated with peripheral arterial stenosis in the renal parenchyma.

CEN Case Rep 2021 Apr 7. Epub 2021 Apr 7.

Department of Nephrology, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan.

Moyamoya disease (MMD) has long been known to be associated with hypertension. While renal artery stenosis (RAS) is considered one of the causes of hypertension with MMD, most hypertension causes remain unexplained. A boy with MMD was diagnosed with renovascular hypertension (RVH) due to left-sided RAS by angiography. Read More

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Early diagnosis of chyle fistula with SD LipidoCare after neck dissection.

J Laryngol Otol 2021 Apr 31;135(4):355-358. Epub 2021 Mar 31.

Department of Otolaryngology - Head and Neck Surgery, Chonnam National University Medical School and Hwasun Hospital, Hwasun, South Korea.

Objective: This study aimed to analyse the results of chyle fistula testing using the SD LipidoCare system in patients who had undergone neck dissections performed in our hospital in 2019.

Method: Sixty patients who underwent neck dissections from March 2019 to November 2019 were identified based on their medical records.

Results: Post-operative chyle fistulas were observed in 3 of 60 patients (5 per cent). Read More

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Utility of cerebral embolic protection in non-TAVR transcatheter procedures.

Cardiovasc Revasc Med 2021 Mar 20. Epub 2021 Mar 20.

Division of Cardiology, Henry Ford Health System, Detroit, MI, United States of America. Electronic address:

Background: Cerebrovascular events that occur during structural and interventional procedures are a well known risk which is associated with increased mortality. The FDA has approved the use of the Sentinel device in TAVR. Hereby we report on our experience on the safety and efficacy of using Sentinel in a patient population undergoing non-TAVR transcatheter procedures. Read More

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Further to the Left: Stress-Induced Increase of Spatial Pseudoneglect During the COVID-19 Lockdown.

Front Psychol 2021 24;12:573846. Epub 2021 Feb 24.

Natural and Artificial Cognition Laboratory, Department of Humanities, University of Naples Federico II, Naples, Italy.

Background: The measures taken to contain the coronavirus disease 2019 (COVID-19) pandemic, such as the lockdown in Italy, do impact psychological health; yet, less is known about their effect on cognitive functioning. The transactional theory of stress predicts reciprocal influences between perceived stress and cognitive performance. However, the effects of a period of stress due to social isolation on spatial cognition and exploration have been little examined. Read More

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February 2021

Minimally invasive repair of a left diaphragm hernia after debulking surgery for advanced ovarian cancer.

Gynecol Oncol Rep 2021 May 11;36:100713. Epub 2021 Feb 11.

Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

Eighty percent of women with ovarian cancer have advanced disease (FIGO stage III or IV) at the time of diagnoses and require extensive upper abdominal surgery to obtain complete gross resection (Minig et al., 2015, Eisenhauer et al., 2006). Read More

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