The glymphatic system for neurosurgeons: a scoping review.

The discovery of the glymphatic system has revolutionized our understanding of cerebrospinal fluid (CSF) circulation and interstitial waste clearance in the brain. This scoping review aims to synthesize the current literature on the glymphatic system's role in neurosurgical conditions and its potential as a therapeutic target. We conducted a comprehensive search in PubMed and Scopus databases for studies published between January 1, 2012, and October 31, 2023. Studies were selected based on their relevance to neurosurgical conditions and glymphatic function, with both animal and human studies included. Data extraction focused on the methods for quantifying glymphatic function and the main results. A total of 67 articles were included, covering conditions such as idiopathic normal pressure hydrocephalus (iNPH), idiopathic intracranial hypertension (IIH), subarachnoid hemorrhage (SAH), stroke, intracranial tumors, and traumatic brain injury (TBI). Significant glymphatic dysregulation was noted in iNPH and IIH, with evidence of impaired CSF dynamics and delayed clearance. SAH studies indicated glymphatic dysfunction with the potential therapeutic effects of nimodipine and tissue plasminogen activator. In stroke, alterations in glymphatic activity correlated with the extent of edema and neurological recovery. TBI studies highlighted the role of the glymphatic system in post-injury cognitive outcomes. Results indicate that the regulation of aquaporin-4 (AQP4) channels is a critical target for therapeutic intervention. The glymphatic system plays a critical role in the pathophysiology of various neurosurgical conditions, influencing brain edema and CSF dynamics. Targeting the regulation of AQP4 channels presents as a significant therapeutic strategy. Although promising, the translation of these findings into clinical practice requires further human studies. Future research should focus on establishing non-invasive biomarkers for glymphatic function and exploring the long-term effects of glymphatic dysfunction.

An interesting twist: 90 year-old female with acute small bowel obstruction due to midgut volvulus.

We report an exceptionally rare presentation of midgut volvulus secondary to malrotation in a nonagenarian female. According to our extensive literature review, this 90-year-old female is the oldest reported case of midgut volvulus. This patient presented with acute recurrent emesis. Imaging showed midgut volvulus with associated small bowel obstruction. The patient underwent an exploratory laparotomy that revealed midgut volvulus because of congenital malrotation and Ladd's bands, necessitating a modified Ladd's procedure. The patient had an uneventful postoperative course. Congenital malrotation with Ladd's bands was likely asymptomatic throughout this patient's life. Our case adds to the scarce instances where midgut volvulus with malrotation is identified in elderly patients, underscoring the importance of considering this diagnosis irrespective of age. We recommend including midgut volvulus because of malrotation in a differential list of atypical small bowel obstruction in elderly patients.

Incidence, management, and outcome of incidental meningioma: what has happened in 10 years?

PURPOSE: The aim of this study was to study the use of brain scanning, and the subsequent findings of presumed incidental meningioma in two time periods, and to study differences in follow-up, treatment, and outcome. METHODS: Records of all performed CT and MRI of the brain during two time periods were retrospectively reviewed in search of patients with presumed incidental meningioma. These patients were further analyzed using medical health records, with the purpose to study clinical handling and outcome during a 3 year follow up. RESULTS: An identical number of unique patients underwent brain imaging during the two time periods (n = 22 259 vs. 22 013). In 2018-2019, 25% more incidental meningiomas were diagnosed compared to 2008-2009 (n = 161 vs. 129, p = 0.052). MRI was used more often in 2018-2019 (26.1 vs. 12.4%, p = 0.004), and the use of contrast enhancement, irrespective of modality, also increased (26.8 vs. 12.2%, p < 0.001). In the most recent cohort, patients were older (median 79 years vs. 73 years, p = 0.03). Indications showed a significant increase of cancer without known metastases among scanned patients. 29.5 and 35.4% of patients in the cohorts were deceased 3 years after diagnosis for causes unrelated to their meningioma. CONCLUSIONS: Despite the same number of unique patients undergoing brain scans in the time periods, there was a trend towards more patients diagnosed with an incidental asymptomatic meningioma in the more recent years. This difference may be attributed to more contrast enhanced scans and more scans among the elderly but needs to be further studied. Patients in the cohort from 2018 to 2019 more often had non-metastatic cancer, with their cause of scan screening for metastases. There was no significant difference in management decision at diagnosis, but within 3 years of follow up significantly more patients in the latter cohort had been re-scanned. Almost a third of all patients were deceased within 3 years after diagnosis, due to causes other than their meningioma.

Midgut Volvulus on an Octogenarian Male: A Case Report.

Midgut volvulus is a rare incidence in adults, especially in octogenarians. More unlikely is to find a midgut volvulus without necrosis or the need to do bowel resection when the volvulus is found within an internal hernia due to a mesenteric defect. No case has been reported with our unusual presentation, making it a rare and challenging discovery. We describe the case of an 83-year-old male who presented with nonspecific symptoms and was found to have a midgut volvulus with an internal hernia through a mesenteric defect, which had a successful recovery at the end.

Low-grade intestinal inflammation two decades after pelvic radiotherapy.

BACKGROUND: Radiotherapy is effective in the treatment of cancer but also causes damage to non-cancerous tissue. Pelvic radiotherapy may produce chronic and debilitating bowel symptoms, yet the underlying pathophysiology is still undefined. Most notably, although pelvic radiotherapy causes an acute intestinal inflammation there is no consensus on whether the late-phase pathophysiology contains an inflammatory component or not. To address this knowledge gap, we examined the potential presence of a chronic inflammation in mucosal biopsies from irradiated pelvic cancer survivors. METHODS: We biopsied 24 cancer survivors two to 20 years after pelvic radiotherapy, and four non-irradiated controls. Using tandem mass tag (TMT) mass spectrometry and mRNA sequencing (mRNA-seq), we charted proteomic and transcriptomic profiles of the mucosal tissue previously exposed to a high or a low/no dose of radiation. Changes in the immune cell populations were determined with flow cytometry. The integrity of the protective mucus layers were determined by permeability analysis and 16S rRNA bacterial detection. FINDINGS: 942 proteins were differentially expressed in mucosa previously exposed to a high radiation dose compared to a low radiation dose. The data suggested a chronic low-grade inflammation with neutrophil activity, which was confirmed by mRNA-seq and flow cytometry and further supported by findings of a weakened mucus barrier with bacterial infiltration. INTERPRETATION: Our results challenge the idea that pelvic radiotherapy causes an acute intestinal inflammation that either heals or turns fibrotic without progression to chronic inflammation. This provides a rationale for exploring novel strategies to mitigate chronic bowel symptoms in pelvic cancer survivors. FUNDING: This study was supported by the King Gustav V Jubilee Clinic Cancer Foundation (CB), The Adlerbertska Research Foundation (CB), The Swedish Cancer Society (GS), The Swedish State under the ALF agreement (GS and CB), Mary von Sydow's foundation (MA and VP).

The Integration of Artificial Intelligence Into Patient Care: A Case of Atrial Fibrillation Caught by a Smartwatch.

Artificial intelligence (AI) offers a wide range of applications in clinical practice, and new technologies are rapidly evolving the healthcare industry and enhancing outcomes. Smartwatches represent the most popular type of wearable AI device that can assist people in detecting cardiac arrhythmias via constant monitoring of heart activity. Numerous advantages result from integrating AI into healthcare systems, including improved patient care, lower rates of medical errors, better treatment recommendations, and more accurate diagnosis of diseases. However, doubts still remain regarding the adoption of AI into patient care due to the challenges it poses. In this paper, we report a case of atrial fibrillation (AF) in a young patient that was detected by his smartwatch. We also highlight some of the benefits and challenges of AI applications in healthcare.

Diagnostic nightmare: intra-intestinal bleed masks intra-abdominal bleed after colonoscopy.

Colonoscopy is a widely used method of screening, diagnosis and intervention. Complications are infrequent and generally present as colonic perforation or colonic hemorrhage. A rare and life-threatening complication of colonoscopy is splenic injury or rupture. We present a case report of an 81-year-old female who was admitted with hemodynamic instability and tachycardia due to gastrointestinal (GI) bleeding and developed hemoperitoneum within 24 hours following colonoscopy. The initial computed tomography (CT) scan was misdiagnosed due to the patient history of GI bleed, and the iatrogenic splenic injury was recognized only during a second CT after continued hemodynamic instability. The patient's initial diagnosis of a GI bleed masked the intraperitoneal bleed and led to a delayed diagnosis of splenic rupture and increased morbidity. This patient required an emergent laparotomy with a total splenectomy with lysis of adhesions.

Tinnitus Prevalence and Associated Factors among Dental Clinicians in the United Arab Emirates.

Dental clinicians are at increased risk for developing tinnitus due to exposure to high levels of occupational noise. This study aimed to determine tinnitus prevalence and associated factors among dental clinicians. Interviews were conducted with 150 randomly selected dental clinicians using a questionnaire. Noise levels were measured at three points of time at the operating area. Tinnitus was reported in 19.33% of the participants. The average noise level was significantly higher among participants with tinnitus compared to those without the condition. More participants complained of intermittent tinnitus and the rest had the constant type, with the latter being significantly more bothersome. The weekly average time of using high-speed handpieces, suction and electric handpieces, age and experience had a significant effect on the presence of tinnitus. Only 2.7% of the participants reported the use of a hearing protection device. Tinnitus is a common finding among dental clinicians especially those with higher levels of occupational noise and more frequent use of noise-generating equipment. Knowledge of tinnitus prevalence aids in realizing the extent of its impact and making informed decisions. These results call for improved awareness of the negative impact of clinically-generated noise and emphasize the importance of preventive measures and periodic audiometry exams.

Independent Risk Factors for Thromboembolic Events in High-Risk Patients With Takotsubo Cardiomyopathy.

Takotsubo cardiomyopathy (TCM) is characteristically associated with left ventricular apical ballooning and regional wall motion abnormalities that predispose to the formation of left ventricular (LV) thrombi and subsequent thromboembolic events (VTE). There is limited data about the risk factors of developing stroke in the absence of LV thrombi in patients with TCM. Identify risk factors that predispose patients with TCM to develop VTE and stroke. We retrospectively reviewed all patients admitted with a primary diagnosis of stress induced or Takotsubo cardiomyopathy at a large tertiary care center from 2005 to 2019. Patients who met the echocardiographic criteria of TCM, had resolution of WMA on repeat echocardiogram, did not have coronary artery disease if angiography was performed and survived for > 3 months after index presentation were included in the analysis. Patients were followed for up to a period of 1 year. Multivariate analysis was performed to identify predictors of thromboembolism. Among the 400 patients who presented with TCM, 146 patients were included in the analysis. A total of 13 patients (8.9%) had documented thromboembolic events. Patients with VTE more often had Atrial fibrillation (30.8% vs 6.8%, P = 0.018), higher LV mass (224.5g vs 184g, P = 0.04), lower EF on presentation (31.5% vs 40%, P = 0.011) and were less likely to have undergone coronary angiography following diagnosis (23.1% vs 54.9%, P = 0.04). On multivariate analysis, atrial fibrillation (OR 9.15, CI 1.15-72.70) and low ejection fraction on admission (OR 0.88, CI 0.81-0.97) were independent risk factors for the development of VTE. Atrial fibrillation and low ejection fraction on presentation were associated with higher risk of developing thromboembolic events in patients with TCM.

Simultaneous Sigmoid Volvulus and Small Bowel Obstruction: A Case Report.

Sigmoid volvulus and small bowel obstruction are typically thought to be separate clinical pathologies with distinct clinical features, diagnostic criteria, and treatment strategies. We present a rare case of simultaneous sigmoid volvulus and small bowel obstruction. To our knowledge, this is the first such case in literature and presented a unique set of challenges in regard to treatment and management. This case discusses a different approach to the surgical management of sigmoid volvulus and small bowel obstruction, which is markedly different from the expected and traditional surgical management of isolated sigmoid volvulus and small bowel obstruction.

Low fat diet versus low carbohydrate diet for management of non-alcohol fatty liver disease: A systematic review.

Although there is a consensus on beneficial effects of a low calorie diet in management of non-alcoholic fatty liver disease, the optimal composition of diet has not yet been elucidated. The aim of this review is to summarize the results of current randomized controlled trials evaluating the effects of low fat diet (LFD) vs. low carbohydrate diet (LCD) on NAFLD. This is a systematic review of all the available data reported in published clinical trials up to February 2022. The methodological quality of eligible studies was assessed, and data were presented aiming specific standard measurements. A total of 15 clinical trial studies were included in this systematic review. There is an overall lack of consensus on which dietary intervention is the most beneficial for NAFLD patients. There is also an overall lack of consensus on the definition of the different restrictive diets and the percentage of macronutrient restriction recommended. It seems that low calorie diets, regardless of their fat and carbohydrate composition, are efficient for liver enzyme reduction. Both LCD and LFD have similar effects on liver enzymes change; however, this improvement tends to be more marked in LFD. All calorie restrictive dietary interventions are beneficial for reducing weight, liver fat content and liver enzymes in individuals with NAFLD. Low fat diets seem to be markedly successful in reducing transaminase levels. Further research is needed to explore diet intensity, duration and long-term outcome.

Social impact and social performance of paddy rice production in Iran and Malaysia.

Purpose: Sustainable agri-food production is incredibly important for society. Despite Iran and Malaysia being one of the highest production countries for paddy rice, there is no study on the social life cycle assessment (S-LCA) for rice production for both countries in the literature. The lack of data and complexity of social issue are the challenges of conducting the S-LCA study. This study compared the social impacts from the related stakeholders in the life cycle of paddy rice production between Malaysia and Iran. Methods: This study applied S-LCA based on UNEP (UNEP/SETAC Life Cycle Initiative, 2020) as an evaluation technique to investigate social issues and social performance of paddy rice production in Malaysia and Iran. This research included workers, local communities, and farmers as the stakeholders. The inventory data were collected by using questionnaires. The subcategories for evaluation were adapted from UNEP 2020 guideline. The items in the questionnaire were separately validated by experts in Malaysia and Iran, and the reliability was done by conducting pilot studies in Malaysia and Iran. The questionnaires were distributed by multistage sampling method. The following four steps were conducted following the ISO14040 framework: (1) goal and scope definition, (2) social life cycle inventory analysis (S-LCI), (3) social life cycle impact assessment (S-LCIA), and (4) interpretation. Results and discussion: The result showed that the social performance of workers and farmers in Malaysia was better than Iran because of low cost with high yield for farmers, contributing to increased income. Rice cultivation in Iran for local community did not show good performance regarding health and safety because of burning of rice residue. Around 62% of local Iranian people reported air pollution from rice residue burning. However, the overall social performance for local community was not different in Iran and Malaysia, showing good performances with respect to job opportunity. Sexual harassment was identified as one of the negative social issues in Iran with the score of 60%, including unwanted sexual attention. Moreover, the farmers showed poor performance in Iran, resulting from low satisfactory from income, and low yield and high cost of paddy production in Iran. Conclusion: The key investigation from this research revealed that social performance of crop production in different geographical areas could show different results. The key finding from this study reported that modern agriculture could increase social and economic performance by reducing the production cost, and increasing productivity and social performance in terms of satisfactory from income for farmers. The result of this study can be used for policy makers to improve social performance by using modern agriculture.

The effect of androstenedione supplementation on testosterone, estradiol, body composition, and lipid profile: a systematic review and meta-analysis of randomized controlled trials.

OBJECTIVE: To date, no meta-analysis has been carried out to collect evidence from randomized placebo-controlled trials (RCTs) for the purpose of comprehensively summarizing the effect of androstenedione supplementation. Therefore, the aim of this research was to perform a systematic review and meta-analysis of all RCTs that explored the effect of androstenedione supplementation on individual hormonal, lipid, and anthropometric indices. METHODS: We searched five databases (Web of Science, SCOPUS, Embase, PubMed/MEDLINE, and Google Scholar) using a combination of medical subject headings (MeSH) and non-MeSH terms. Using the random-effects model, we summarized the outcomes as weighted mean difference (WMD) with 95% confidence interval (CI). RESULTS: Eight eligible articles were included in the meta-analysis. The pooled effect sizes suggested a significant effect of androstenedione supplementation on serum estradiol concentrations (WMD: 20.82 ng/ml, 95% CI: 7.25 to 34.38, p = 0.003), triglycerides (TG, WMD: -0.19 mg/dl, 95% CI: - 0.96, 0.57, p = 0.000), and high-density lipoprotein (HDL)-cholesterol (WMD: - 0.13 mg/dl, 95% CI: - 0.23 to - 0.03, p = 0.009); however, it had no effect on testosterone (WMD: 0.098 ng/ml, 95% CI: - 0.499 to 0.696, p = 0.748), body weight (WMD: 0.579 kg, 95% CI: - 4.02 to 5.17, p = 0.805), body mass index (BMI, WMD: - 0.73 kg/m2, 95% CI: - 2.98, 1.50, p = 0.519), low-density lipoprotein (LDL)-cholesterol (WMD: - 0.074 mg/dl, 95% CI: - 0.37 to 0.22, p = 0.622), and total cholesterol (TC, WMD: - 0.15 mg/dl, 95% CI: - 0.49, 0.17, p = 0.198). CONCLUSION: These findings indicate that androstenedione supplementation can lower TG and HDL-cholesterol and increase estradiol concentrations.

The effect of transdermal 17ß-estradiol combined with norethisterone acetate treatment on the lipid profile in postmenopausal women: A meta-analysis and systematic review of randomized controlled trials.

BACKGROUND AND AIM: The effect of transdermal 17ß-estradiol and norethisterone acetate co-administration on the lipid profile in postmenopausal women remains controversial as randomized controlled trials (RCTs) conducted to investigate this research question have produced conflicting results. Consequently, to clarify this issue, we conducted a systematic review and meta-analysis of RCTs that evaluated the impact of transdermal 17ß-estradiol combined with norethisterone acetate treatment on the concentrations of serum lipids in postmenopausal women. METHODS: Relevant articles published before February 1st, 2022 were identified by searching the PubMed/Medline, Scopus, and Embase, and Web of Science electronic databases. A random-effects model, employing the method of DerSimonian and Laird, was used to evaluate effect sizes, and results were expressed as weighted mean difference (WMD) and 95% confidence intervals (CIs). RESULTS: Pooled results from 7 RCTs with 9 intervention arms demonstrated that transdermal 17ß-estradiol combined with norethisterone acetate administration significantly decreased total cholesterol (TC) (WMD: -13.43 mg/dL, 95% CI: -18.11 to -8.75, P < 0.001) and low-density lipoprotein cholesterol (LDL-C) (WMD: -13.90 mg/dL, 95% CI: -20.40 to -7.41, P < 0.001). In the subgroup analyses, a notable reduction in TC was observed in subjects with baseline TC concentrations ≥ 130 mg/dL (WMD -14.49 mg/dL), when treatment duration was ≤ 6 months (WMD: -17.21 mg/dL), and in participants with a body mass index (BMI) ≥ 25 kg/m2 (WMD: -21.71 mg/dL). Moreover, in the subgroup analyses, transdermal 17ß-estradiol combined with norethisterone acetate decreased triglycerides (TG) levels when the treatment duration was ≤ 6 months (WMD: -21.37 mg/dL). However, the prescription of transdermal 17ß-estradiol combined with norethisterone acetate in postmenopausal women did not change high-density lipoprotein cholesterol (HDL-C) values. CONCLUSIONS: Based on our findings, the co-administration of transdermal 17ß-estradiol and norethisterone acetate in postmenopausal females can decrease TC and LDL-C levels, as well as TG values, but does not influence HDL-C concentrations.

Acquired Hemophilia A Post-COVID-19 Vaccination: A Case Report and Review.

Acquired hemophilia A (AHA) is an inhibitory coagulopathy that represents a rare variant of hemorrhagic syndromes. We present a case of idiopathic AHA in a 75-year-old male patient with a cutaneous hematoma that could be attributed to a recent COVID-19 vaccination. The aim of this report is to raise awareness of a possible association between AHA and COVID-19 vaccination and to review similar reported cases and management plans to prevent the development of possible morbidity and debilitating complications. This case illustrates an exceptionally rare side effect of the COVID-19 vaccination. The advantages of obtaining the COVID-19 vaccine outweigh the risks.

BRAF V600E mutation in papillary thyroid carcinoma: it's relation to clinical features and oncologic outcomes in a single cancer centre experience.

PURPOSE: This study focuses on the oncologic influence of BRAF V600E mutations in a cohort of Middle Eastern papillary thyroid carcinoma (PTC) patients treated at a single centre. We tested the association of BRAF V600E mutation with papillary thyroid carcinoma at King Hussein Cancer Center. METHODS: Patients with histologically confirmed PTC who underwent surgical treatment between 2006 and 2015 were included in this study. Oncological outcomes, both short- and long-termed, were collected. RESULTS: A total of 128 patients (68% females) were included in this study with a mean age of 38 years (±13.8). The median follow-up period was 50 months. The BRAF V600E mutation was found in 71% of patients. The tumour size for patients with a negative BRAF V600E mutation was significantly larger in comparison to patients who tested positive for the mutation (3.47 cm vs 2.31 cm, respectively, P = 0.009). The two groups showed similar disease-free survival (DFS) rates; positive = 75% (median 43 months (0-168)) compared to 78% for the negative BRAF V600E mutation (median 38 months (3-142)) (P = 0.162, HR = 0.731) Furthermore, both groups showed similar overall survival rates, positive = 94.5% (median 56 months (0-228)) compared to 94.6% for the negative BRAF V600E mutation (median 43 months (3-157)) (P = 0.941, HR = 0.940). CONCLUSION: BRAF V600E mutation had no effect on loco-regional recurrence, distant metastasis, overall survival, or DFS. These findings may be attributed to geographic variations or reflect that BRAF V600E may only serve as an indicator of poor prognosis in high-risk group as such.

Unusual Chemotherapeutic Resistant Testicular Embryonal Germ Cell Tumor with Widespread Metastasis in a Case of Klinefelter Syndrome: A Case Report.

Cryptorchidism is an undeniable risk factor for testicular germ cell tumors (TGCTs) and is also commonly associated with Klinefelter syndrome (KS) patients. Embryonal cell carcinoma usually shows strong expression of CD30 and OCT3/4, with patchy staining of PLAP1. Most patients with nonseminomatous GCTs (NSGCTs) can achieve total remission with proactive chemotherapy, and most can be cured. We present an extremely rare case of a testicular embryonal germ cell tumor that is atypical in its gene expression and response to chemotherapy treatment. A 71-year-old male patient presented in July 2019 with abdominal pain of unknown duration, weight loss for one year, and recent history of altered bowel habits. His past medical history is significant for KS and congenital unilateral cryptorchidism. Physical examination yielded mild abdominal distention and bilateral inguinal lymphadenopathy. Imaging revealed a posterior mediastinal mass and large retroperitoneal masses. The above features, in addition to the history of KS and unilateral cryptorchidism, were highly suggestive of a testicular retroperitoneal germ cell tumor. Serologic studies revealed elevated lactate dehydrogenase (LDH) while other tumor markers were normal. Excisional biopsy of inguinal lymph nodes revealed poorly differentiated embryonal cell carcinoma with strong expression of SALL4, a rare expression of OCT 3/4, and the absence of expression of CD30 and placental alkaline phosphatase (PLAP). The patient was given four cycles of bleomycin, etoposide and platinum (BEP) chemotherapy, as is the standard chemotherapy regimen for these tumors, without any significant change in the size of the masses or lymph nodes. Unfortunately, there are no specific guidelines when it comes to the management of KS patients with testicular GCTs (embryonal cell carcinoma) with aberrant histological markers and normal serum tumor markers. These findings in combination with chemotherapeutic resistance indicate a need for more specific treatment modalities and follow-up for unusual testicular embryonal GCTs in KS patients.

Relationship between intra-operative hypotension and post-operative complications in traumatic hip surgery.

BACKGROUND AND AIMS: The relationship between intra-operative hypotension and post-operative complications has been recently studied in non-cardiac surgery. Little is known about this relationship in traumatic hip surgery. Our study aimed to investigate this relationship. METHODS: A retrospective study was conducted on patients who underwent surgical correction of traumatic hip fracture between 2010 and 2015. We reviewed the perioperative blood pressure readings and the episodes of intra-operative hypotension. Hypotension was defined as ≥30% decrease in the pre-induction systolic blood pressure sustained for ≥10 min. The relationship between intra-operative hypotension and post-operative complications was evaluated. Post-operative complications were defined as new events or diseases that required post-operative treatment for 48 h. Factors studied included type of anaesthesia, blood transfusion rate, pre-operative comorbidities and delay in surgery. We used the Statistical Package for Social Sciences (SPSS, IBM 25) to perform descriptive and non-parametric statistics. RESULTS: A total of 502 patients underwent various types of traumatic hip surgery during the study period. Intra-operative hypotension developed in 91 patients (18.1%) and 42 patients (8.4%) developed post-operative complications. Significantly more patients with hypotension developed post-operative complications compared to patients with stable vitals (18.7% vs. 6.1; P < 0.001). There was no statistically significant difference in the incidence of post-operative complication in patients receiving general or spinal anaesthesia. Pre-operative comorbidities had no significant relationship with post-operative complications. Intra-operative blood transfusion was related to both intra-operative hypotension and post-operative complications. CONCLUSION: There was an association between intra-operative hypotension and post-operative complications in patients undergoing traumatic hip surgery.

Failure of 3 different methods and biopsy sites to diagnose a patient with invasive colorectal cancer: A case report.

RATIONALE: Colorectal cancer is one of the most commonly diagnosed cancers worldwide, and the majority arise from neoplastic adenomatous polyps. Bladder involvement in colorectal cancer is uncommon and found in approximately 3% of the cases, most commonly in sigmoid and rectal tumors and the diagnosis is classically based on biopsies of affected tissues. PATIENT CONCERNS: A 68-year-old male with no significant past medical history underwent diagnostic colonoscopy for abdominal distension and constipation with positive fecal occult blood test ordered by the primary care physician. DIAGNOSIS: Colonoscopy showed a sigmoid mass with biopsy finding of tubulovillous adenoma. Laparoscopy was performed for sigmoid colonic resection, but as the mass was large, a diverting loop colostomy and multiple biopsies were performed revealing tubulovillous adenoma again. Postoperative workup revealed right hydronephrosis, and cystoscopy was performed confirming bladder wall invasion with biopsies showing benign bladder wall tissue with no evidence of dysplasia or malignancy. Furthermore, computed tomography (CT)-guided core-needle biopsies of the colonic mass were performed but revealed adenomatous colonic mucosa without evidence of carcinoma. INTERVENTION: Definitive surgical en bloc excision of the tumor and anterior bladder wall was performed with urology team until grossly free margins were attained. Final pathology revealed well-differentiated mucinous adenocarcinoma arising from a preexisting tubulovillous adenoma with direct invasion of the bladder wall. OUTCOMES: The patient's postoperative recovery was uneventful, and he was discharged 2 weeks postoperatively with planned adjuvant chemotherapy. LESSONS: This case represents a classical presentation of invasive colorectal cancer. Perioperative workup, however, was confounded by failure of open, cystoscopic, and CT-guided biopsies to establish a tissue diagnosis for directed therapy. Upon literature review, evidence exists to support our approach to this unique dilemma.

An innovative procedure for NORM scales treatment and radionuclides separation.

The present study focuses on the development of a new chemical treatment method for naturally occurring radioactive materials (NORM) scale wastes from the oil industry. The method consists of three-stages, including the separation of oil using the Fenton oxidation process at room temperature, the complete dissolution of soluble and slightly soluble salts and separation of Ra and Pb isotopes. The proposed method can be considered as an innovative procedure for NORM scales treatment and radionuclides separation, which in turn support the radioactive waste management with economic benefits.