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In community health practice, home rounds are essential. In Nigeria, a home round is a regular visit to outpatients/clients in their homes by a team of community health specialists to make decisions concerning patient/client’s care, review, and follow-up on the progress of their health condition. The team visits within the treatment period to make sure the patient is adhering to prescriptions, address any barriers to care, and make referrals if necessary. Home rounds start with examining patient records, putting together a team, assessing patients in their homes, and recording the findings and actions. A competent community health practitioner (CHP) should be compassionate, informed, and skillful at conducting house rounds, identifying family health problems, and taking the necessary action. In primary health care, home rounds can detect less common but serious individual and family conditions; and enhance community health. However, challenges like shortage of manpower, insecurity, lack of logistics, and unskillful health workers have made home rounds impossible in some primary healthcare facilities. To facilitate home rounds, it is recommended that governmental and nongovernmental organizations train community health practitioners in home rounding, provide logistics at primary healthcare facilities, and staff each health center with a sufficient number of community health practitioners by primary healthcare standards. Community health practitioners should be adaptable, sensitive, and skilled, and families and communities should work together to provide security.
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Renal primitive neuroectodermal tumor is a highly malignant neoplasm that commonly affects young adults and infrequently presented in children and adolescents. We report a case of a 14-year-old female child who presented with abdominal mass. PET-CT showed an FDG avid cystic lesion in the inter and lower polar regions of the right kidney, extending into the right renal fat and renal vein, with multiple FDG avid lesions in the axial and appendicular skeleton, suggesting renal mass with bony metastases. Biopsy confirmed the diagnosis of primitive neuroectodermal tumor of the kidney. The patient completed six cycles of chemotherapy with partial response and subsequently the patient defaulted and lost to follow-up. To emphasize the critical significance of renal PNET in the differential diagnosis of renal tumors in children.
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Primary hyperparathyroidism is a disease with a large potential population. Some cases of primary hyperparathyroidism are non-primary, preventable and curable at early stage, requiring long-term follow-up after surgery. Therefore, all-round and full-cycle management are necessary for primary hyperparathyroidism, which involves an enhancing focus on etiological prevention, early detection, prompt diagnosis, timely intervention, multi-disciplinary standardized diagnosis and treatment, and postoperative scientific management. Meanwhile, implementing a "12+5+1" multidisciplinary joint diagnosis and treatment model, along with a two-way referral model, to achieve the transition from a disease-oriented diagnostic and treatment model to a patient-oriented, all-round and full-cycle interdisciplinary management model. This management can reduce the incidence and recurrence rate of primary hyperparathyroidism, and related osteoporosis or osteopenia, fractures, nephrolithiasis, metastatic vascular calcification, and systemic abnormal migratory calcium deposits, improve the overall quality of life and prognosis of patients.
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Objective To investigate the CT and MRI findings of different types of small round cell tumor(SRCT)in the nasal cavity and sinuses.Methods A retrospective analysis was conducted on the imaging data and clinical data of 35 SRCT patients confirmed by pathology.Thirty-one SRCT patients underwent CT examination,and 19 SRCT patients underwent MRI examination.Results There were 20 cases of tumors that invaded the nasal cavity and 19 cases involved the sinuses,including 11 cases of the maxillary sinus,7 cases of the ethmoid sinus,2 cases of the sphenoid sinus,and 1 case of the frontal sinus.CT findings of SRCT were all soft tissue masses.Lymphoma was relatively homogeneous with mild bone destruction,and usually involved nasal vestibular skin.Rhabdomyosarcoma(embryonic type)happened at an early age and easily caused bone destruction and metastasis.Melanoma generally occurred in the nasal septum and nasal cavity,which was prone to bleeding.Small cell neuroendocrine carcinoma was heterogeneous,with moderate to significant enhancement,bone absorption and destruction were often noticed.The MRI manifestations of SRCT were equal or long signal on T1WI,high signal on T2WI,and significant diffusion limitation on diffusion weighted imaging(DWI)and apparent diffusion coefficient(ADC)except for melanoma.On contrast-enhanced images,lymphoma showed mild to moderate enhancement,rhabdomyosarcoma showed typical"grape sign",and small cell neuroendocrine carcinoma showed"sieve"and"map-like"obvious enhancement.Typical melanoma showed a high signal on T1WI and a low signal on T2WI and usually caused bleeding.The MRI findings were related to the presence of melanoma and hemorrhage within the lesion.Conclusion SRCT of the nasal cavity and sinuses have a high degree of malignancy and poor prognosis,CT and MRI have many similar manifestations.Combining clinical data,bone destruction,MRI enhancement,and DWI sequence can effectively distinguish different types of SRCT,as well as squamous cell carcinoma of the nasal cavity and sinuses and adenoid cystic carcinoma.
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Objective:Based on the construction of intelligent intensive care unit(ICU)in hospital,to analyze the effectiveness of intelligent ICU life support equipment in clinical decision-making assistance.Methods:The functional modules of the ICU ward interaction system,equipment management system,risk response system and intelligent ward round system were designed to collect information and data of life support equipment in diagnosis and treatment,nursing,operation and technical support in real time to provide medical auxiliary decision-making basis for the improvement of diagnosis,treatment and nursing measures for critically ill patients.115 life-support equipment in clinical use in 3 hospitals including Zhujiajiao People's Hospital of Qingpu District,Shanghai from July 1,2018 to December 31,2022 were selected,the traditional assisted decision-making management mode(referred to as traditional mode,83 sets)and intelligent assisted decision-making management mode(referred to as intelligent mode,89 sets,including 57 units of the traditional mode and 32 newly added units)were adopted respectively.The management level and management effect of life support equipment of the two management modes were compared.Results:The data collection time of the equipment of intelligent mode was(5.67±2.80)min,which was less than that of the traditional mode,the accuracy and completeness of data acquisition,as well as the effective resolution rate of equipment deployment and use,monitoring and alarm,equipment failure and emergency response were(99.02±1.14)%,(94.35±3.46)%,(98.78±0.90)%,(98.99±0.91)%,(88.26±5.31)% and(90.23±5.54)%,respectively,which were higher than those of the traditional mode,the difference between was statistically significant(t=6.504,6.474,3.574,7.620,6.784,4.522,3.719,P<0.05).The effective utilization rates of diagnostic decisions for treatment,care and rehabilitation of intelligent mode equipment were(93.83±3.12)%,(94.99±2.47)% and(91.44±4.62)%,respectively,the comprehensive scores of respiratory function support equipment,circulatory function support equipment,blood purification support equipment and emergency monitoring support equipment were(92.97±4.35)points,(94.34±2.95)points,(93.01±2.44)points and(94.11±1.89)points,respectively,which were higher than those of the traditional mode,the difference was statistically significant(t=4.169,4.875,5.159,4.069,3.033,2.757,6.893,P<0.05).Conclusion:Based on the construction of intelligent ICU,it can improve the quality of life support equipment operation data collection,solve the equipment operation problems in a timely manner,provide an effective basis for the decision-making of diagnosis and treatment,nursing and rehabilitation of critically ill patients,and improve the clinical service level of equipment.
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Abstract Introduction Cochlear implantation has been considered as the best treatment in patients with severe to profound hearing loss unaidable with hearing aids. The main value of endoscope-assisted cochlear implantation is improved visibility of the RW Objective to assess the value of endoscopic assisted CI surgery via facial recess approach without elevating tympanic anulus. Methods This Prospective case series study non-randomized sample was performed on 50 patients with severe to profound hearing loss unaidable with hearing aids undergoing unilateral endoscopic assisted cochlear implant surgery with round window electrode insertion Results There were 23 male and 27 female patients. Most of the cases were children (41 cases). Of those 50 patients, 39 were prelingually hearing impaired. Fourcases had various inner ear abnormalities. The standard mastoidectomy and Posterior Tympanotomy approach were used for all cases. Endoscopic identification of the RW through the PT enabled us to perform regular surgery in all cases. The current study concludes the difference between microscopic exposure and endoscopic exposure represented by Saint Tomas classification found that endoscopic exposure of round window classification is better represented by downgrading in the classification of round window exposure as type I 29(58%), type IIa 18(36%) type IIb 3 (6%) Non were type III by endoscopic exposure compared to microscopic exposure of round window is a type I 7 (14%), type II 14(28%), type IIb 22(44%) and type III 7 (14%). Conclusion Endoscopy proved a great value in exposure and identification of RW in CI surgery through posterior tympanotomy approach,
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Resumen El tumor desmoplásico de células pequeñas y redon das es una neoplasia poco frecuente y muy agresiva que forma parte de la familia de los "tumores de célu las pequeñas, redondas y azules". Presenta una mayor incidencia en el sexo masculino en la segunda década de la vida. Se debe a la translocación t(11;22) (p13;q12). Se puede localizar tanto en el abdomen como en el re troperitoneo caracterizándose por presentar síntomas inespecíficos. El tratamiento es muy variado y no se ha detectado todavía aquel que garantice la cura total del paciente. El objetivo del presente estudio es exponer un caso clínico de tumor desmoplásico como enfermedad abdo minal infrecuente y su expresión imagenológica.
Abstract Desmoplastic small round cell tumor is a rare and very aggressive neoplasm that belongs to the family of "small round blue cell tumors". It has a higher incidence in males in the second decade of life. It is due to trans location t(11;22) (p13;q12). It can be located both in the abdomen and in the retroperitoneum and is character ized by nonspecific symptoms. The treatment is very varied and the one that guarantees the total cure of the patient has not yet been detected. The objective of this study is to expose a clinical case of desmoplastic tumor as an rare abdominal disease and its imaging expression.
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Objective:To investigate the application of scenario simulation teaching rounds in the residency training of teachers.Methods:A total of 56 faculty members in the surgical system were divided into the traditional method group and the scenario simulation group. The traditional method group adopted the training including multimedia centralized training, live rounds demonstration and observation, discussion and summary, while the scenario simulation group adopted the training including multimedia centralized training, scenario simulation demonstration and observation followed by step-by-step discussion and demonstration, review and summary. After the training, the training satisfaction questionnaires of the participants were collected. The participants were evaluated for teaching rounds before and after the training. The data were analyzed using Graphpad prism 7.Results:There were no significant differences between the two groups in terms of professional title, teaching years and gender ( P > 0.05). The average scores of teaching rounds before and after training in the scenario simulation group were (80.17±0.99) and (87.38±0.52). The average scores of teaching rounds before and after training in the traditional method group were (78.27±0.82) and (83.24±0.53). The teaching ability had improved after the teacher training in both groups, while the scenario simulation group performed significantly better than the traditional method group ( P < 0.05). The questionnaire survey showed that the satisfaction and training effect of the scenario simulation group were much higher than those of the traditional method group, and the difference was statistically significant ( P < 0.05). Conclusion:The scenario simulation teaching rounds training significantly improves the competency of teaching rounds of residential training teachers, as well as the scenario simulation capabilities of demonstration teachers and volunteers, which makes it worthy of further promotion in order to have a better performance on standardized residency training.
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Objective:To investigate the clinical efficacy of modified vaginal hysterectomy in the treatment of uterine prolapse.Methods:A total of 60 patients with uterine prolapse who received treatment in Fengtai County People's Hospital from July 2017 to October 2021 were included in this study. They were divided into control and observation groups ( n = 30/group) according to different treatment methods. The patients in the control group were treated with traditional vaginal hysterectomy (vaginal hysterectomy + vaginal anterior and posterior wall repair). The patients in the observation group were treated with modified vaginal hysterectomy (vaginal hysterectomy + vaginal anterior and posterior wall repair + autologous ligament suspension). The changes in surgical indicators and treatment effectiveness were evaluated between the two groups. All patients were followed up at 3, 6, and 12 months. Vaginal fornix prolapse and quality of life score were compared between the two groups. Results:The average drainage volume, average anal exhaust time, the average time to get out of bed, and the average length of hospital stay in the observation group were (520.13 ± 52.14) mL, (36.47 ± 5.72) hours, (32.48 ± 7.12) hours, and (16.48 ± 2.67) hours, respectively, which were significantly less or shorter than those in the control group ( t = 19.35, 18.25, 17.56, 17.35, all P < 0.05). The total response rate in the observation group was 93.3% (28/30), which was significantly higher than 80.0% (24/30) in the control group ( χ2 = 6.32, P = 0.005). At 3, 6, and 12 months after surgery, vaginal fornix prolapse did not occur in any patient in the observation group, but it occurred in two, three, and seven patients in the control group at the corresponding time points. Treatment efficiency was superior in the observation group to that in the control group ( χ2 = 4.21, P = 0.001). At 3, 6, and 12 months after surgery, quality of life score in the observation group was significantly higher than that in the control group [3 months: (60.71 ± 7.58) points vs. (50.69 ± 2.89) points; 6 months: (76.42 ± 3.50) points vs. (63.31 ± 8.67) points; 12 months: (81.30 ± 2.64) points vs. (70.72 ± 6.51) points], and the differences were statistically significant ( t = 7.21, 7.10, 6.31, all P < 0.05). Conclusion:The modified vaginal hysterectomy for the treatment of uterine prolapse has an ideal effect. It can effectively reduce the amount of drainage, shorten the exhaust time and the length of hospital stay, improve quality of life, and thereby is worthy of clinical promotion.
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Objective:To investigate the short-term efficacy of rotational femoral neck osteotomy with preservation of the round ligament in the treatment of subchondral insufficiency fracture of the femoral head (SIFFH) in young and middle-aged people.Methods:A retrospective case series study was used to analyze the clinical data of 13 patients with SIFFH, who were admitted to 920th Hospital of Joint Logistics Support Force from January 2017 to January 2022. The patients included 10 males and 3 females, aged 22-49 years [(33.5±8.3)years]. There were 6 patients with fracture on the left hip and 7 on the right hip. All the patients were treated by rotational femoral neck osteotomy with preservation of the round ligament. Postoperatively, standardized joint functional training was given. The operative time and intraoperative bleeding were recorded. The modified Harris hip score and visual analogue score (VAS) were compared preoperatively, at 3, 6 months postoperatively and at the final follow-up. Radiological examinations were used to observe the occurrence of any collapse of the femoral head, non-union at osteotomy site or other complications.Results:The patients were followed up for 13-24 months [(17.9±3.1)months]. The operative time was (127.3±9.8)minutes, with the intraoperative bleeding of (393.9±21.9)ml. The values of modified Harris hip score were (61.6±3.3)points, (80.2±4.4)points, and (91.9±4.1)points at 3, 6 months postoperatively and at the final follow-up, respectively, being significantly higher than the preoperative (51.4±3.5)points (all P<0.05), and there were significant differences between different postoperative timepoints (all P<0.05). The values of VAS were (4.9±1.1)points, (3.0±0.9)points, and (1.4±0.5)points at 3, 6 months postoperatively and at the final follow-up, respectively, being significantly lower than preoperative (6.7±0.9)points (all P<0.05), and there were significant differences between different postoperative timepoints (all P<0.05). Imaging examination showed no femoral head collapse, with all the bones healed at the osteotomy site. There were no serious complications such as bone non-union, incision infection or peripheral nerve injury. Conclusion:Rotational femoral neck osteotomy with preservation of the round ligament in treating SIFFH in the young and middle-aged population has the advantages of shortened operative time, less intraoperative bleeding, promoted hip function recovery, attenuated pain and decreased complications, showing a satisfactory early effect.
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Objective:To explore the clinical effect of daily target list of ICU patients with mechanical ventilation (hereinafter referred to as target list) for patients with mechanical ventilation in ICU based on multidisciplinary ward round design.Methods:A non contemporaneous controlled study with a quasi experimental design was conducted. One thousand and seventy-one patients with mechanical ventilation admitted to the comprehensive care unit of the First Affiliated Hospital of Medical College of Zhejiang University from January to December 2019 were selected as the experimental group. The target list was used to standardize the communication of multidisciplinary ward rounds and guide the clinical nursing process. Nine hundred and fifty patients with mechanical ventilation admitted from January to December 2018 were selected as the control group. Routine medical communication, ward rounds and nursing shift handover were used. The duration of mechanical ventilation and the length of stay in ICU, the utilization rate of catheter and related infection rate, the implementation rate of daily nursing measures, the incidence of nursing adverse events and the satisfaction of medical staff with multidisciplinary cooperation were compared.Results:Before the intervention, there was no significant difference in the basic data between the two groups ( P>0.05). After the intervention, the duration of mechanical ventilation and the length of stay in ICU were 4 (2, 9) h and 3 (3, 7) d in the experimental group, which were lower than those in the control group 6 (5, 35) h and 4 (3, 8) d, the differences were statistically significant ( Z=-13.76, -3.62, both P<0.01). The standard rate of sedation, the implementation rate of early activities and the implementation rate of venous thromboembolism preventive measures in the experimental group were 83.10% (4 435/5 337), 80.16% (3 155/3 936) and 93.97% (5 530/5 885) respectively, which were higher than the 81.42% (4 190/5 146), 68.83% (2 197/3 192) and 87.86% (5 839/6 646) in the control group, the differences were statistically significant( χ2=5.05, 120.93, 138.50, all P<0.05). The use rate of physical restraint, the incidence of incontinence-associated dermatitis, medical adhesive related skin injury, deep vein thrombosis and delirium in the experimental group were 39.75% (2 936/7 387), 3.64% (39/1 071), 4.11% (44/1 071), 5.23% (56/1 071), 6.54% (70/1 071), which were lower than the 43.50% (3 180/7 312), 5.90% (56/950), 8.53% (81/950), 9.26% (88/950), 12.42% (118 / 950) in the control group, the differences were statistically significant( χ2 values were 5.71-20.67, all P<0.05). The level of multidisciplinary cooperation was greatly improved, 3.83 ± 0.38 vs. 3.61 ± 0.51 ( t=-3.33, P<0.01). Conclusions:The use of target list can improve the implementation rate of treatment and nursing measures for critical patients, improve the level of multidisciplinary cooperation and team satisfaction, reduce the ICU hospitalization time, mechanical ventilation time, the incidence of nursing adverse events, and improve patient safety.
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Objective:To investigate the magnetic resonance imaging (MRI) features of desmoplastic small round cell tumor (DSRCT) of the abdomen and pelvis.Method:The retrospec-tive and descriptive study was conducted. The clinicopathological data of 8 patients with DSRCT of the abdomen and pelvis, including 3 cases admitted in Yueqing People's Hospital and 5 cases admitted in Wenzhou People's Hospital, from January 2008 to June 2022 were collected. There were 5 males and 3 females, aged (43±5)years. All patients underwent MRI plain and enhanced scanning. Observa-tion indicators: (1) imaging features of DSRCT of the abdomen and pelvis; (2) treatment and pathological examination characteristics of DSRCT of the abdomen and pelvis; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distri-bution were represented as M(range). Count data were described as absolute numbers. Results:(1) Imaging features of DSRCT of the abdomen and pelvis. ① Tumor location. Of the 8 patients, there were 6 cases with tumors located respectively at the lower edge of the liver in the right quarter costal region, the medial side of the ileocecal region in the right iliac region, the medial side of the caecum in the right iliac region, the gastro-pancreatic space in the left quarter costal region, the mesenteric space in the left iliac region and the right side of pelvic bladder, and 2 cases with tumors located at retroperitoneal space of left quarter rib region. ② Tumor size. There were 13 lesions in the 8 patients, and the maximum diameter of tumor was 9.1 (range, 3.5?20.0)cm. Of the 8 patients, there were 5 cases with single tumor and 3 cases with multiple tumors. ③ Tumor shape and boundary. Of the 8 patients, there were 4 cases with tumor in expansive growth and 4 cases with tumor in invasive growth. There were 5 cases with tumor of intratumoral necrosis and cystic degene-ration, 4 cases with tumor of intratumoral hemorrhage, 4 cases with tumor of intratumoral spot calcification, 3 cases with tumor of peritumoral tissue exudation. One patient may combined with multiple imaging manifestations. ④ Imaging characteristics of MRI plain scanning. Of the 8 patients, there were 4 cases with tumor of homogeneous hypointensity signal and 4 cases with tumor of hypointensity mixed with speckled hyperintensity (with hemorrhage) in T1 weighted imaging of MRI plain scanning. There were 3 cases with tumor of homogeneous hyperintensity and 5 cases with tumor of high signal at the edge, patchy and spot-shaped in the center in T2 weighted imaging of MRI plain scanning. There were 5 cases with tumor of high, equal and low confounding signals and 3 cases with tumor of high and low signals in T2 weighted imaging fat suppression sequence of MRI plain scanning. There were 3 cases with tumor of uniform high signals and 5 cases with tumor of high, equal and low mixed signals in diffusion weighted imaging of MRI plain scanning. ⑤ Imaging characteristics of MRI enhanced scanning. All 8 patients had tumor of heterogeneous enhancement in MRI enhanced scanning, including 2 cases with significant enhancement in arterial phase, continuous enhancement in portal phase, slightly reduced enhancement in delayed phase, 4 cases with moderate enhancement in arterial phase, continuous enhancement in portal phase, slowly exited enhancement in delayed phase, 2 cases with mild enhancement in arterial phase, continuous enhancement in portal phase, slowly exited enhancement in delayed phase. Of the 8 patients, there were 3 cases with tumor of annular enhancement with intratumoral strip or grid signals and 3 cases with tumor of peritumoral blood vessels increased and thickened signals. ⑥ Tumor invasion and metastasis. Of the 8 patients, there were 4 cases with tumor invaded bowel, 2 cases with tumor invaded surrounding tissues, 1 case with tumor invaded left kidney, spleen and pancreatic tail, 1 case with tumor invaded distal of left ureter. There were 5 cases with abdominal, retroperitoneal and inguinal lymph nodes enlargement, 4 cases with multiple nodular thickening of peritoneum and ascites, 2 cases with tumor liver and lung metastasis and 1 case with tumor rib, femur and sacrum metastasis. One patient may combined with multiple tumor metastasis. (2) Treatment and patholo-gical examination characteristics of DSRCT of the abdomen and pelvis. Of the 8 patients, 3 patients underwent complete resection as clear tumor boundary, 3 patients underwent tumor partial resection as tight adhesion between tumor and surrounding blood vessels, 2 cases underwent tumor tissue pathological examination as extensive metastasis of peritoneum, omentum, mesentery and surrounding intestine. All 8 patients were diagnosed as DSRCT by microscopic examination, electron microscopic examination, immunohistochemical staining and cytogenetic examination. (3) Follow-up. All 8 patients underwent postoperative follow-up and died during the follow-up.Conclusion:MRI features of abdominal and pelvic DSRCT include single or multiple lobulated masses with unclear boundaries, invading the omentum, mesentery, peritoneum and adjacent tissues in most cases, mixed signals and heterogeneous mild to moderate enhancement in enhanced scanning.
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Resumen ANTECEDENTES: El teratoma es un tumor casi siempre benigno, con una amplia variabilidad en su localización, extremadamente rara, en el ligamento redondo. CASO CLÍNICO: Paciente de 30 años, con antecedente de un embarazo a término. En la revisión ecográfica se reportó una lesión quística paraovárica izquierda de 46 x 35 mm, sin componente sólido, graso ni calcificaciones. En el examen ginecológico se palpó una masa por encima del útero, orientada hacia el lado izquierdo, no dolorosa. El resto del examen físico trascurrió sin otras alteraciones. La impresión diagnóstica inicial fue de teratoma abdominopélvico sustentada en la ecografía transvaginal en la que los ovarios se observaron normales, con una masa de ecogenicidad mixta de 50 x 40 x 46 mm, con áreas ecolúcidas y ecogénicas de intensidad variable hacia la fosa iliaca izquierda superior, sin contacto con el ovario. El ligamento redondo se seccionó a ambos lados de la masa y se extrajo sin complicaciones; el reporte histopatológico fue de: teratoma quístico maduro. CONCLUSIONES: El ligamento redondo es una localización infrecuente de los quistes dermoides que debe considerarse en los diagnósticos diferenciales de las masas pélvicas; es susceptible de tratamiento quirúrgico por vía laparoscópica.
Abstract BACKGROUND: Teratoma is an almost always benign tumor, with a wide variability in its location; its location in the round ligament is extremely rare. CLINICAL CASE: 30-year-old patient, with a history of a full-term pregnancy. On routine ultrasound examination, a 46 x 35 mm left paraovarian cystic lesion was reported, with no solid, fatty component or calcifications. In the gynecological examination a mass was palpated above the uterus, oriented to the left side, non-painful. The rest of the physical examination passed without other alterations. The initial diagnostic impression was of abdomino-pelvic teratoma supported by transvaginal ultrasound in which the ovaries were normal, with a mass of mixed echogenicity of 50 x 40 x 46 mm, with echolucent and echogenic areas of variable intensity towards the left superior iliac fossa, without contact with the ovary. The round ligament was sectioned on both sides of the mass and removed without complications; the histopathologic report was: mature cystic teratoma. CONCLUSIONS: The round ligament is an infrequent location of dermoid cysts that should be considered in the differential diagnoses of pelvic masses; it is amenable to surgical treatment laparoscopically.
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Ewing抯 sarcomas are rare, aggressive tumors with a tendency toward recurrence following resection, and early metastasis. Although patients of younger or older age account for almost 30% of instances, peak incidences occur between the ages of 10 and 20. We, hereby, report the case of a 10-year-old girl who presented with a 3-month history of pain in her right hip that was unable to be relieved by non-steroidal anti-inflammatory medicine and physical therapy. On examination, bone mar
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Tumors of the pituitary gland and sellar region represent about 15% of all brain tumors, with pituitary adenoma being the commonest and pituitary carcinoma being very rare. Pituitary tumors in children are even rarer. Pituitary blastoma, a pediatric adenohypophysial tumor, is a new entity described in the 2017 WHO classification of pituitary tumors. This is a very rare tumor with only 21 cases reported so far. Hence, we are reporting this unusual case seen in a 7-month-old infant who presented with a large sellar/suprasellar mass with pressure symptoms of short duration. Typically, they present between 7–24 months of age. On histopathology, a cellular tumor was seen with primitive-looking round cells with scanty cytoplasm with few well-defined gland or rosette-like structures. The immunohistochemical stains showed diffuse strong staining for synaptophysin with a very high MIB-1 index. Other markers for common round cell tumors in this age group and hormonal markers of pituitary tumors were negative with INI-1 being intact. The initial cases described by Scheithauer presented with Cushing's disease and at least focally expressed adrenocorticotrophic hormone on immunohistochemistry. However, nonfunctioning tumors are also seen, albeit rarely. These are known to be associated with DICER 1 mutations and have a poor prognosis. Hence, morphologic recognition in the right clinical context and excluding other differential diagnoses in infants help make the correct diagnosis.
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Background: Neuroblastoma (NB) is the fourth most common tumor of childhood. There is a paucity of literature on its subtyping of cytology and prognostic utility. Aims: We aimed to study the cytopathological features of NB on the aspirated material, subtype it, and assess the role of International Neuroblastoma Pathology Classification (INPC) classification on cytology smears in the preoperative prognosis of NB. Materials and Methods: Fifteen cases of NB reported on fine-needle aspiration cytology (FNAC) in the past 3 years were included. Detailed clinical, radiological, and cytological features were noted. Smears were assessed for characteristics such as cellularity, neuroblasts (cytoplasmic, nuclear details), rosettes, neuropil, Schwann cells, fibroblasts, calcification, and necrosis. Afterward, cases were categorized as undifferentiated (UD), poorly differentiated (PD), and differentiating (D) subtypes. Mitotic-karyorrhectic index (MKI) was calculated and correlated with histopathology. Follow-up was done to date. Results: The age ranged from 19 days to 10 years with an M: F ratio of 3:1. Twelve cases were retroperitoneal, two cervical, and one mediastinal. Metastatic disease was seen in six cases, one to the cervical, four to the bone marrow, and two to the scalp. The International Neuroblastoma Risk Group (INRG) staging system was available in all cases, out of which three were in stage L1, six in stage L2, four in stage M, and two in stage Ms. On cytology, four cases were differentiating NB, five PD NB, and six UD NB. The MKI was high (>4%) in 80% of UD, intermediate (2–4%) in 100% of PD, and low (<2%) in 75% of D cases. MKI corroborated in both histology and cytology, except in one case. Conclusion: NB can be subtyped on cytology on the basis of characteristics of neuroblasts, presence of neutrophils, rosettes, and necrosis. UD NB has a high MKI and is associated with a poor prognosis. A preoperative comprehensive reporting of NB on cytology can be very useful in guiding appropriate chemotherapy with some increment in survival. However, larger studies are needed to validate the calculation of MKI on FNA smears.
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Desmoplastic small round cell tumor (DSRCT) is a very rare diagnosis with about 200 cases reported in literature. DSRCT is a recently described histopathological entity by Gerald and Rosai in 1989. Abdominopelvic cavity especially peritoneum is the most common site. We report a case of a huge omental DSRCT with lymph node metastasis which was initially misdiagnosed as gastrointestinal stromal tumor on radiology. A 26-year-old male presented with complaints of upper abdominal swelling associated with constant dull pain. On examination there was a large 15 × 12 cm intraabdominal mass in the epigastric and umbilical region. Imaging studies were suggestive of neoplastic mesenchymal etiology. Image-guided fine-needle aspiration cytology (FNAC) was suggestive of mesenchymal neoplastic etiology. On laparotomy, there was a huge 20 × 15 cm mass arising from omentum with multiple omental and mesenteric seedlings and mesenteric, peripancreatic and perigastric lymphadenopathy. The patient underwent debulking surgery with uneventful post-operative recovery. Histopathological examination with immunohistochemistry revealed a diagnosis of DSRCT of omentum and small bowel mesentery with lymph node metastasis. Patient then received adjuvant chemotherapy with multiple chemotherapeutic drugs as per P6 protocol and has stable disease at 1 year follow up.
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Objective:To explore the application and effect of peri-operative recovery-quality-directed teaching reform for clinical internship training of anesthesiology.Methods:A total of 60 interns of five-year program anesthesiology from the Department of Anesthesiology of Chongqing Medical University were recruited for this teaching reform and randomly allocated to teaching reform group ( n=30) and control group ( n=30). Students in control group received conventional training for internship of clinical anesthesiology and follow-up, while students in teaching reform group received additional recovery-quality-directed clinical rounds per teaching week and patients discussed in those rounds were followed up until 30 days after operation. At the end of internship, teaching satisfaction, graduation test scores and patients' satisfaction were compared. SPSS 21.0 was used for t test. Results:Compared with those students in control group, interns in teaching reform group had significantly higher scores on teaching satisfaction [(9.1±1.3) vs. (6.7±1.9), P<0.05], graduation test scores [(80.0±5.0) vs. (67.0±6.0), P<0.05] and patients' satisfaction [(92.0±6.0) vs. (83.0±11.0), P<0.05]. Conclusion:Recovery-quality-directed peri-operative teaching reform can enhance the professional identity and sense of responsibility of anesthesiology students, improve their teaching satisfaction and theoretical knowledge level, and improve the satisfaction of related patients with anesthesia services.
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Objective:To explore the application effect of the teaching ward-round workshop on the teaching ability training for clinical teachers.Methods:From July to October 2019, 83 clinical teachers from The Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University included in the study were divided into 8 groups for the training of teaching ward-round workshop. After the training, the evaluation results of clinical teaching ward-round, the satisfaction of clinical teaching ward-round, and the satisfaction of the workshop teaching model were compared. Chi-square test and t test were performed by SPSS 22.0. Results:The trainees were highly satisfied with the training mode of the teaching ward-round workshop. After the training, the clinical teaching ward-round assessment scores [(96.83±1.77) points] were higher than the average scores of the same period from April to June in 2019 [(91.25±2.86) points], with statistical significance ( P<0.05). In terms of satisfaction with clinical teaching ward rounds, the scores of 7 dimensions including preparation before ward rounds, highlighting the key and difficulties, and standard physical examination after the training were all higher than those before the training, with significant differences ( P<0.05). Conclusion:The training model of the teaching ward-round workshop helps to enhance the training effect, promote the teaching ability of clinical teachers, and improve the clinical teaching ward-round assessment results and satisfaction, which provides new ideas and references for the training of clinical medical professionals.
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The 2022 Fudan university doctorate academic public health forum hosted by the graduate school of Fudan university， the graduate work department of the party committee of Fudan university， and the school of public health of Fudan university was successfully held on December 10， 2022 in the school of public health of Fudan university. In the early stage， a total of 53 manuscripts from nationwide universities and research institutes were received， and 10 were selected as excellent papers to participate in the forum report. More than 100 teachers and students attended the forum. Focusing on the theme of " Adhering to the original ambition of scientific research to serve the country and practicing the mission of public health youth"， the major contents of the forums included excellent paper reports in the morning and round-table discussion in the afternoon. Experts and students conducted discussions and communications on prevention， control and management of public health emergencies. It is of great benefit for students to uphold the original intention，practice the mission and further improve public health research.