Lymphoepithelial cyst of the pancreas: can common imaging features help to avoid resection?

BACKGROUND: Differentiation of cystic pancreatic neoplasms remains a challenging task for radiologists regarding the main aim of identifying malignant and premalignant lesions. PURPOSE: The study aimed to compare the radiological features of lymphoepithelial cysts (LEC) with other cystic pancreatic lesions, which could help to differentiate them in order to avoid unnecessary resection. MATERIAL AND METHODS: We retrospectively reviewed 10 cases of resected and histopathologically confirmed LECs during a 12-year period with available imaging studies; 20 patients with mucinous cystic neoplasms (MCN), 20 patients with branch-duct intraductal papillary mucinous neoplasms (BD-IPMN), and 20 patients with serous cystic neoplasms (SCN) were selected to serve as control groups. Imaging findings as well as clinical data were analyzed. RESULTS: The following imaging morphology of LEC was identified: simple cystic appearance (20%) and mixed cystic-solid appearance (80%) with either a diffuse subsolid component (30%) or mural nodule(s) (50%). All lesions revealed exophytic location with a strong male predominance (9:1). MCNs occurred exclusively in middle-aged women, IPMN in both sexes showed slight male predominance (13:7), and SCN showed female predominance (5:15). Median patient age in LEC (48.5, IQR 47-54.5) was significantly younger compared to IPMN (p < 0.001) and SCN (p = 0.02). Unenhanced CT attenuation of LEC was higher than MCNs (p = 0.025) and IPMNs (p = 0.021), showing no significant difference to SCN (p = 0.343). CONCLUSION: The present study provides key radiological features of LEC for the differentiation from other cystic pancreatic lesions such as increased CT attenuation in the unenhanced phase, absence of a connection to the main pancreatic duct (MPD), and exophytic location. In addition to these imaging features, clinical data, such as male predominance in LEC, must be considered for the differentiation of cystic pancreatic lesions.

Abdominoplastia TULUA: modificaciones y aportes personales / TULUA abdominoplasty: personal approach and modifications

Introducción. La abdominoplastia ha evolucionado desde una simple resección en bloque de piel y tejido celular subcutáneo hasta un procedimiento multimodal que combina la corrección de todas las capas del abdomen asociado a una liposucción circunferencial para mejorar el contorno corporal. A pesar de que la combinación de liposucción y abdominoplastia ha demostrado ser segura, aún no hay un consenso en cuanto a la cantidad de volumen que se puede extraer en las diferentes áreas sin aumentar el riesgo. Con el fin de disminuir dichas complicaciones, Villegas desarrolló una modificación a la técnica clásica que denominó abdominoplastia TULUA. A partir de entonces, comenzamos a realizar la técnica con resultados satisfactorios, por lo que el objetivo de este trabajo es presentar dicha experiencia a través de una serie de casos con la técnica de TULUA y las modificaciones realizadas a lo largo de los años. Materiales y métodos. Se realizó un estudio observacional, retrospectivo y descriptivo de todos los pacientes intervenidos de abdominoplastia TULUA desde julio de 2017 hasta julio de 2020. Resultados. Fueron intervenidos 28 pacientes, todos del género femenino. La edad promedio fue de 45,6 años; 26 casos primarios y 2 secundarios; 24 de las cirugías fueron abdominoplastias TULUA convencionales y 4 fueron miniabominoplastias asociadas a mini-TULUA. El 67% de los casos fueron realizados con cirugías concomitantes. El promedio del volumen de liposucción fue de 3,3 litros. El promedio del tamaño de la plicatura fue de 7,5x22,9 cm. El tiempo promedio de cirugía fue de 3,01 horas. Seis pacientes evolucionaron con complicaciones. Conclusiones. La abdominoplastia TULUA es una alternativa a la abdominoplastia convencional que puede ser aplicada tanto en abdómenes primarios como secundarios, con resultados aceptables. Puede ser de gran utilidad en casos con cicatrices abdominales previas o pacientes con riesgo aumentado de complicaciones vasculares, como tabaquistas. La principal ventaja radica en su seguridad vascular al no generar un despegamiento epigástrico lo que permite una liposucción sin restricciones con preservación de perforantes y menor espacio muerto. Además, a través de la plicatura transversal, permite corregir la laxitud de la pared abdominal, disminuir la tensión sobre la cicatriz y ocluir el espacio muerto. El neoombligo, si bien es un desafío, logra resultados aceptables a largo plazo.

Introduction. Since its inception, abdominoplasty has evolved from a simple en-bloc resection of skin and fat to a multimodal approach that combines correction of all abdominal layers with simultaneous circular liposuction for silhouette contouring. Liposuction in combination with abdominoplasty has proven to be safe and effective, however, there is still debates on how much fat can be safely removed without increasing complication rates. To avoid vascular complications, Villegas addressed a set of modifications to abdominoplasty which he named TULUA. Since then, the authors had performed this technique with acceptable cosmetic outcomes. In this paper, we present a clinical series, marking some technical aspects and evaluating the results. Methods. A retrospective study was carried out involving 28 patients who underwent TULUA abdominoplasty between July of 2017 and July of 2020. Technical aspects, main outcomes and complications were reported. Results. Between this period, TULUA abominoplasty was performed in 28 patients by the senior author. Traditional abdominoplasty was performed in 24 patients and mini abdominoplasty in 4; 26 were primary cases. Mean amount of simultaneously aspired lipoaspirate was 3,3 liters, mean duration of surgery was 3,1 hours and mean size of plication was 7,5x22,9 cm. None of the patients had any skin necrosis or seroma; 6 patients presented complications. Conclusions. TULUA abdominoplasty is an alternative technique to classic abdominoplasty that can be perform in primary and secondary cases with acceptable cosmetic outcomes. Some population with increased risk of vascular complications such us smokers, patients with prior abdominal scars or secondary revisions may have an increased benefit from this approach. The main advantage of this technique is regarding vascular safety by limiting undermining and preserving vessels which allows a full liposuction with less risk. Also, by performing a transverse plication, abdominal wall laxity is addressed, tension at the suture line is reduced and limited dead space is obtained, thus reducing the chance of seroma.

TULUA Lipoabdominoplasty: Transversal Aponeurotic Plication, No Undermining, and Unrestricted Liposuction. A Multicenter Study of 845 Cases.

BACKGROUND: TULUA (transverse plication, no undermining, full liposuction, neoumbilicoplasty, and low transverse abdominal scar) is the acronym for a radically different lipoabdominoplasty, intended to add simplicity, improve vascular safety, and attain good results. Modifications are unrestricted liposuction, no flap detachment, massive transverse infraumbilical plication, umbilicus amputation, neoumbilicoplasty, diminished tension wound closure, and low transverse scar settlement. The objectives of this article are to describe the technique and analyze a multicenter experience. METHODS: Sixty-eight plastic surgeons from 10 countries provided data for a retrospective review of 845 patients. Aesthetic results were scored by each surgeon using the Salles scale and analyzed in combination with complications to identify associations between patient and surgery characteristics. RESULTS: Of the patients, 95.5 percent were female, 19.7 percent were obese, 35.6 percent had prior scars, 10.4 percent had undergone previous abdominoplasty, 6.5 percent were postbariatric, and 6.6 percent were smokers. One patient had a kidney transplant, and 16.5 percent had comorbidities. Surgery characteristics varied widely, being on average as follows: lipoaspirate, 2967 ml; resection, 1388 g; and surgical time, 3.9 hours; 46.5 percent were not hospitalized. Averaged results were 8.68 of 10 points, besides adequate positioning and proportion of scar and umbilicus, without epigastric compensatory bulging (4.97 of 6 points). Overall complications were 16.2 percent, mostly seroma (8.8 percent); vascular-related complications (i.e., necrosis, wound dehiscence, and infection) constituted 2.7 percent. There were no fatalities. The logistic regression model demonstrated that smoking and obesity duplicate the risk of complications; if age older than 60 years is added, the risk of complication increases seven to nine times. Reported indications were multiple; however, pathologic diastasis was excluded. CONCLUSION: TULUA lipoabdominoplasty is a new reproducible procedure with good quantified results and an acceptable complication rate. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Structured versus narrative reporting of pelvic MRI in perianal fistulizing disease: impact on clarity, completeness, and surgical planning.

OBJECTIVE: To evaluate clarity, completeness, and impact on surgical planning of MRI reporting of perianal fistulizing disease using a structured disease-specific template versus narrative reporting for planning of disease treatment by colorectal surgeons. MATERIALS AND METHODS: In this HIPAA-compliant, IRB-approved study with waiver of informed consent, a structured reporting template for perianal fistulizing disease MRIs was developed based on collaboration between colorectal surgeons and abdominal radiologists. The study population included 45 consecutive patients who underwent pelvic MRI for perianal fistulizing disease prior to implementation of structured reporting, and 60 consecutive patients who underwent pelvic MRI for perianal fistulizing disease after implementation of structured reporting. Objective evaluation of the reports for the presence of 12 key features was performed, as also subjective evaluation regarding the clarity and completeness of reports, and impact on surgical planning. RESULTS: Significantly more key features were absent in narrative reports [mean: 6.3 ± 1.8 (range 3-11)] than in structured reports [mean: 0.3 ± 0.9 (range 1-5)] (p ≤ 0.001). The use of structured reporting also increased the percentage of completeness (72.5-88.3% for surgeon 1, and 61.2-81.3% for surgeon 2; p = 0.05 and 0.03, respectively), helpfulness in surgical planning (7.1 ± 1.5-7.6 ± 1.5 for surgeon 1, and 5.8 ± 1.4-7.1 ± 1.1 for surgeon 2; p = 0.05 and p < 0.001, respectively), and clarity (7.6 ± 1.3-8.3 ± 1.1 for surgeon 1, and 5.2 ± 1.4-7.1 ± 1.3 for surgeon 2; p = 0.006 and p < 0.001, respectively) of the reports. CONCLUSION: Structured MRI reports in patients with perianal fistulizing disease miss fewer key features than narrative reports. Moreover, structured reports were described as more complete and clear, and more helpful for treatment planning.

Modificações anatômicas da fenda palpebral após blefaroplastia / Anatomic alterations of the palpebral fissure following blepharoplasty

O presente trabalho apresenta um estudo clínico prospectivo de 39 pacientes submetidos a blefaroplastia estética na 38ª Enfermaria da Santa Casa de Misericórdia do Rio de Janeiro, com o objetivo de determinar as modificações anatômicas da fenda palpebral e sua relação com o aparecimento dos sintomas de "olho seco" no pós-operatório. Para melhor compreensão destas alterações e de suas conseqüencias, os autores descrevem a anatomia da fenda palpebral, a fisiologia do sistema lacrimal e a síndrome de olho seco, ressaltando a importância da história clínica e da avaliação criteriosa da morfologia orbital e periorbital, na identificação de fatores predisponentes no pré-operatório.

Cirugía venosa ambulatoria: informe preliminar / Ambulatory major surgery of vein: preliminary results

El objetivo de este trabajo es presentar la experiencia inicial en safenectomía y ligadura de perforantes (Linton) ambulatorias. El programa implementado consiste en el ingreso al hospital a las 6,00, anestesia peridural a las 6,30, cirugía a las 7,00, fin de cirugía 8,45, con internación transitoria con vendaje elástico ajustado. Luego de control, alta alrededor de las 18,00. Se operaron, en un período de 6 meses, 10 mujeres y 5 hombres en su gran mayoría con dolor, pesadez, edema y prurito. Se realizó safenectomía y ligadura de perforantes según técnica clásica. Duración del período de internación: 12 hs. Complicaciones: 1 hematoma de la ingle. Número de consultas externas desde el diagnóstico hasta el alta en la 5* semana: 4. Todos los pacientes se reintegraron a sus tareas habituales en el 8* días postoperatorio. La cirugía venosa mayor puede realizarse en un programa ambulatorio con buena tolerancia por parte del paciente. El procedimiento resultó ser eficiente, sin complicaciones y expeditivo. Se continuará con el programa para informar sobre su resultado alejado en un número mayor de pacientes

Cirugía venosa ambulatoria: informe preliminar / Ambulatory major surgery of vein: preliminary results

El objetivo de este trabajo es presentar la experiencia inicial en safenectomía y ligadura de perforantes (Linton) ambulatorias. El programa implementado consiste en el ingreso al hospital a las 6,00, anestesia peridural a las 6,30, cirugía a las 7,00, fin de cirugía 8,45, con internación transitoria con vendaje elástico ajustado. Luego de control, alta alrededor de las 18,00. Se operaron, en un período de 6 meses, 10 mujeres y 5 hombres en su gran mayoría con dolor, pesadez, edema y prurito. Se realizó safenectomía y ligadura de perforantes según técnica clásica. Duración del período de internación: 12 hs. Complicaciones: 1 hematoma de la ingle. Número de consultas externas desde el diagnóstico hasta el alta en la 5* semana: 4. Todos los pacientes se reintegraron a sus tareas habituales en el 8* días postoperatorio. La cirugía venosa mayor puede realizarse en un programa ambulatorio con buena tolerancia por parte del paciente. El procedimiento resultó ser eficiente, sin complicaciones y expeditivo. Se continuará con el programa para informar sobre su resultado alejado en un número mayor de pacientes