Inflammatory Myofibroblastic Tumor of the Retroperitoneum Including Chronic Granulomatous Inflammation Suggesting Tuberculosis: A Case Report

An inflammatory myofibroblastic tumor (IMT) is a solid tumor of unknown etiology frequently affecting children and young adults and commonly affecting the lung or orbital region. We present a case involving a 41-year-old man who had an IMT combined with Mycobacterium tuberculosis infection in the retroperitoneum. He presented with only pain in the right lower abdomen without accompanying symptoms; a retroperitoneal mass was found on computed tomography. The tumor had invaded the end of the ileum and was attached to the omentum, so mass excision could not be performed. The tumor was completely excised surgically and had histological features diagnostic of an IMT. Histologic findings of the omentum were positive for Ziehl-Nielsen staining for acid-fast bacilli and for a positive polymerase chain reaction for M. tuberculosis. The patient had no apparent immune disorder. These findings made this case exceptional because IMTs, which are mostly due to atypical mycobacteria, have been found mainly in immunocompromised patients.

Inhibitory effect of sustained perivascular delivery of paclitaxel on neointimal hyperplasia in the jugular vein after open cutdown central venous catheter placement in rats

PURPOSE: Inhibitory effect of paclitaxel on neointimal hyperplasia after open cutdown has not been elucidated. METHODS: For the control group (n = 16), silicone 2.7-Fr catheters were placed via the right external jugular vein with the cutdown method. For the treatment group (n = 16), a mixture of 0.65 mg of paclitaxel and 1 mL of fibrin glue was infiltrated around the exposed vein after cutdown. After scheduled intervals (1, 2, 4, and 8 weeks), the vein segment was harvested and morphometric analysis was performed on cross-sections. RESULTS: Proliferation of smooth muscle cell (SMC) was strongly suppressed in the treatment group, and the ratio of neointima to vein wall was significantly reduced in the treatment group (8 weeks; 0.63 ± 0.08 vs. 0.2 ± 0.08, P < 0.05). Luminal patency was significantly more preserved in the treatment group, and the luminal area was significantly wider in the paclitaxel-treated group compared to the control group (8 weeks; 1.91 ± 0.43 mm² vs. 5.1 ± 0.43 mm², P < 0.05). Mean SMC counts measured at 1 and 2 weeks after cutdown were significantly lower in the treatment group (2 weeks; 115 ± 22 vs. 62 ± 22). Paclitaxel was undetectable in systemic circulation (<10 ng/mL). CONCLUSION: Sustained perivascular delivery of paclitaxel with fibrin glue was effective in inhibiting neointimal hyperplasia in rat jugular vein after open cutdown.

Increasing utilization of abdominal CT in the Emergency Department of a secondary care center: does it produce better outcomes in caring for pediatric surgical patients?

PURPOSE: The use of abdominal computed tomography (ACT) utilization is increasing to a remarkable extent in the pediatric Emergency Department (ED), but the clinical benefit of increased use of ACT for pediatric surgical patients remains uncertain. METHODS: A retrospective review was conducted to investigate if, for patients who had visited pediatric ED during the last 5 years, increasing utilization of ACT would increase the detection rate of acute appendicitis, increase the detection rate of surgical conditions other than appendicitis, and decrease the hospital admission rate for surgical conditions. RESULTS: During the study period, there were 37,918 ED visits; of these, 3,274 (8.6%) were for abdominal pain, 844 (2.2%) had ACT performed. The annual proportional increase of the ACT was statistically significant (1.56% to 2.46%, P = 0.00), but the detection rate of acute appendicitis (3.3% to 5.1%) or other surgical conditions (1.7% to 2.8%) showed no statistically significant changes. Hospital admission rates (5.6% to 6.8%) also showed no significant changes during the study period. CONCLUSION: Increasing utilization of ACT does not lead to the improved outcomes in caring for pediatric surgical patients visiting the pediatric ED. Careful evaluation for the indication for ACT is needed in the pediatric ED.