EUS-guided transrectal drainage of pelvic abscesses: a retrospective analysis of 17 patients.

Background: Pelvic abscess is a common complication of abdominal surgery or intestinal or gynecological diseases. Over the last decades, endoscopic ultrasound (EUS)-guided drainage has emerged as a minimally invasive alternative to percutaneous or surgical treatment of pelvic abscesses. Aim: To evaluate safety and efficacy of EUS-guided transrectal pelvic abscess drainage in a single center. Methods: From February 2017 to April 2023, all data on patients who were treated for pelvic abscesses by EUS-guided drainage in a single center, were retrospectively analyzed. Results: A total of 17 patients were treated for pelvic abscesses by EUS-guided drainage. The procedure was technically successful and uneventful in all 17 patients (100%). Etiology of the abscess was postsurgical (n=5, 29%), secondary to medical illness (n=10, 59%) or gastrointestinal perforation (n=2, 12%). The abscess was multilocular in 5 patients (29%), the mean largest diameter was 76 mm (range 40-146 mm). Drainage was performed using 2 double pigtail stents, and in 1 patient an additional 10 Fr drainage catheter was deployed. Two patients (12%) required a second endoscopic intervention. Treatment success, defined by complete abscess resolution on follow-up CT scan along with symptom relief, was 100%. There was no need for surgical intervention. The median post-procedural hospital stay was 5 days. No recurrence was reported within a median time of follow-up of 39 months. Conclusion: EUS-guided transrectal drainage of pelvic abscesses using double pigtail stents is safe and highly effective. This case series contributes to the cumulative evidence that, in expert hands, EUS-guided drainage should be considered as first-line approach for treatment of pelvic abscesses.

Cytotoxic screening and antibacterial activity of Withaferin A.

Cancer and bacterial infections are among the leading causes of death worldwide. Plant-derived bioactive compounds constitute promising alternatives for development of new therapeutics. This study aimed at evaluating the biological activity of Withaferin A using 6 tumor cell lines: A549 (lung cancer), U87MG (glioblastoma), SH-SY5Y (neuroblastoma), B16-F10 (mouse melanoma), HeLa (uterine colon cancer) and K562 (chronic myeloid leukemia). In addition, 17 other standard bacterial strains and several multidrug resistant bacteria (MDR) clinical isolates were examined. Cell viability was assessed using the following assays: MTT, neutral red, and dsDNA PicoGreen®. Further, oxidative stress was measured by quantification of reactive oxygen species (ROS) production. The activity against bacteria was determined by the minimum inhibitory concentration (MIC), minimum bacterial concentration (CBM) and antibiofilm activity in the production of strains. Withaferin A was effective, as evidenced by its cytotoxic activity in tumor cell lines, enhanced ROS production in tumor cells and bactericidal and antibiofilm activity. Data demonstrated that Withaferin A may be therapeutically considered as an antitumor and antibacterial agent.

Do foodborne polyethylene microparticles affect the health of rainbow trout (Oncorhynchus mykiss)?

Due to the fact that plastic pollution is a global environmental problem of modern age, studies on the impact of these synthetic materials on aquatic, and especially fish organisms, are an important part of the ecosystem and human nutrition. In our study, the toxicity of pristine polyethylene (PE) microparticles (approx. 50 µm) on rainbow trout (Oncorhynchus mykiss) was tested in three different dietary concentrations - 0.5%, 2% and 5%. After six weeks of exposure, various health indices were evaluated. Electron microscopy of the intestine revealed the disintegration of PE particles to <5 µm in size, and thus we concluded that microplastics are able to reach tissues. The haematological profile revealed changes in total red blood cells count and haematocrit (5% PE) which could be associated with spleen congestion observed histologically. The marker of lipid peroxidation was increased in gills suggesting the disruption of balance in antioxidant enzymes capacity and histopathological imaging revealed inflammation in higher PE concentrations. In addition, ammonia was decreased and calcium elevated in biochemical profile, confirming the gill damage. Electron microscopy of the gills showed lesions of lamellae and visible rings around the mucinous cell opening indicating their higher activity. Another injured was the liver tissue, as confirmed by hepatodystrophies and increased expression of pro-inflammatory genes in 2% PE. Impaired innate immunity was confirmed by an increased presence of mucinous cells and a decrease in leukocytes. Kidney damage manifested itself by higher expression of pro-inflammatory cytokines and histopathology. The damage in gills, liver and kidney together correlated with the increased antioxidant capacity of plasma. In conclusion, PE microparticles are able to affect health indices of O. mykiss. The potential problem for aquatic ecosystems and even human consumption should be considered.

Improved method for tuberculocidal and mycobactericidal activity testing of disinfectants based on the European Standard EN 14348.

Safe measurements to prevent the transmission of (multidrug-resistant) mycobacteria such as disinfection are essential in healthcare settings. In Europe chemical disinfectants are tested for their tuberculocidal and mycobactericidal efficacy by the internationally accepted test procedure described in EN 14348. However, especially for amine-based disinfectants, invalid results may occur by this procedure due to insufficient neutralization. In this multi-laboratory study the procedure described in EN 14348 was optimized by a combination of chemical neutralization and membrane filtration in order to obtain a valid and secure method especially for amine-based disinfectants.

Dissecting leiomyoma of the uterus with unusual clinical and pathological features.

OBJECTIVE: Case description of dissecting uterine leiomyoma with extrauterine extension and infiltration of right parametrium, ureter and bladder wall. DESIGN: Case report. SETTING: Department of Pathology, Znojmo Hospital. METHODS: A 64-year-old woman with chronic pelvalgia and loss of renal function of the right kidney due to urinary tract obstruction is presented. Ultrasound examination, magnetic resonance imaging and computer tomography scan revealed a pelvic tumour affecting the right edge of the uterine wall, the right parametrium, distal part of the right ureter, the right and partially the cranial bladder wall. Due to this finding, hysterectomy, unilateral parametrectomy, partial resection of the bladder wall and resection of the distal part of the ureter was performed. Histology revealed morphologically bland spindle-cell smooth-muscle tumour corresponding to conventional uterine leiomyoma. Tumour necrosis, cellular atypia, vascular invasion or hydropic degeneration were not observed. A final diagnosis of dissecting leiomyoma of the uterus was made. CONCLUSION: The diagnosis of dissecting leiomyoma should be considered in all malignant tumours affecting the uterine corpus.

Primary synovial sarcoma of the ovary and Fallopian tube - case report and review of the literature.

OBJECTIVE: Case description of advanced biphasic synovial sarcoma in the tubo-ovarian area. DESIGN: Case report. SETTING: Department of Pathology, Znojmo Hospital. METHODS: Own observation, review of the literature. CONCLUSION: The diagnosis of synovial sarcoma must be considered in all spindle cell and undifferentiated tumours in various anatomical sites including female reproductive organs.

Estudio clínico radiológico de las fracturas esternales en edad pediátrica / Clinical and radiological study of sternal fractures in pediatrics

Las fracturas esternales se consideran infrecuentes en la edad pediátrica. Clásicamente se han descrito como fracturas secundarias a traumatismos de alta energía y con riesgo de lesiones asociadas. Objetivo: Describir los aspectos clínicos y de imagen de las fracturas esternales en niños menores de 18 años. Material y métodos: Se realiza una revisión retrospectiva de 79 pacientes pediátricos con diagnóstico de fractura esternal tras traumatismo. Resultado: Demostramos que en el 92,4% de los casos, las fracturas son causadas por mecanismos de baja energía y que únicamente en 3 (4%) pacientes se presentan lesiones asociadas. Conclusión: Nuestros resultados sugieren que las fracturas esternales en niños son frecuentemente causadas por traumatismo menor, con escasa incidencia de lesiones asociadas

Sternal fractures are considered uncommon in pediatric patients. Classically, they have been described as fractures secondary to high-energy trauma that have a risk of associated lesions. Objective: To describe the clinical and imaging features of sternal fractures in patients less than 18 years of age. Material and methods: We retrospectively reviewed 79 pediatric patients diagnosed with sternal fractures after trauma. Results: We found that 92.4% of the fractures were caused by low-energy trauma and that associated lesions were present in only 3 (4%) patients. Conclusion: Our results suggest that sternal fractures in children are often due to lesser trauma and that associated lesions are rare

Clinical and radiological study of sternal fractures in pediatrics. / Estudio clínico radiológico de las fracturas esternales en edad pediátrica.

Sternal fractures are considered uncommon in pediatric patients. Classically, they have been described as fractures secondary to high-energy trauma that have a risk of associated lesions. OBJECTIVE: To describe the clinical and imaging features of sternal fractures in patients less than 18 years of age. MATERIAL AND METHODS: We retrospectively reviewed 79 pediatric patients diagnosed with sternal fractures after trauma. RESULTS: We found that 92.4% of the fractures were caused by low-energy trauma and that associated lesions were present in only 3 (4%) patients. CONCLUSION: Our results suggest that sternal fractures in children are often due to lesser trauma and that associated lesions are rare.

[Minimally invasive robot-assisted gastric bypass after open Mason reduction gastroplasty]. / Minimal-invasive, roboterassistierte Magenbypassanlage nach offener Mason-Gastroreduktionsplastik.

BACKGROUND: The introduction of robot-assisted surgery in the treatment of morbidly obese patients has enlarged the armamentarium for surgeons involved in bariatric surgery. This article describes the experiences with a conversion surgery from a complicated open Mason gastroplasty to a Roux en Y gastric bypass using the da Vinci Xi robotic system. CASE: A 29-year-old female patient underwent a Mason reduction gastroplasty by laparotomy in 1995 (body mass index BMI 53.2 kg/m2). The course was complicated with a revision due to abscess formation and subsequent secondary healing. In 1996 an open revision of the gastroplasty due to persisting gastroesophageal reflux disease and outlet stenosis with dilatation of the outlet and an open cholecystectomy for cholecystolithiasis were performed . Abdominoplasty was performed for skin flaps in 2001 after the patient had lost 68 kg in weight. The patient presented at our hospital because of insufficient weight reduction even with weight gain since 2001 and treatment-refractive gastroesophageal reflux with adhesion problems. Clinical examination revealed normal scar tissue formation with no indications for an incisional hernia. The BMI was 48.2 kg/m2 with a body weight of 124 kg. The surgery was performed using a da Vinci Xi robotic system after access via a blunt dissection with the introduction of two trocars and adhesiolysis. The gastric pouch was created using Echelon 60 mm cartridges via an additional trocar. The gastroenterostomy was constructed with a 150 cm alimentary loop and a 60 cm biliodigestive loop resulting in a Roux en Y bypass. The operating time was 224 min. RESULTS: The postoperative course was uneventful. Enteral nutrition was resumed on day 2 and the patient was discharged from the hospital 4 days postoperation. CONCLUSION: This preliminary experience suggests that robotic revisional surgery can be performed safely even after complicated bariatric operations.

[Carcinoid of the appendix during pregnancy]. / Karcinoid apendixu v tehotenství.

OBJECTIVE: Early diagnosis of the appendiceal carcinoid during first trimester of pregnancy. DESIGN: Case report. SETTING: Department of Obstetrics and Gynaecology, Merciful Brothers Hospital, Brno. METHODS: Own observation, review of literature. CONCLUSION: In case of unclear clinical or intraoperative finding, the appendectomy may reveal a serious disease. Thorough examination of the appendix should be a part of every gynaecological operation.

Histiocytic sarcoma in 14 miniature schnauzers - a new breed predisposition?

OBJECTIVES: To describe a series of miniature schnauzers diagnosed with histiocytic sarcoma and assess for possible breed predisposition. MATERIALS AND METHODS: Medical records of miniature schnauzers with a diagnosis of histiocytic sarcoma between January 2008 and April 2015 were reviewed. Data collected included signalment, body weight, presenting complaint, date of diagnosis, clinicopathologic and diagnostic imaging findings, treatment, therapeutic response, date of death or last follow-up and necropsy findings. Breed predisposition was assessed with odds ratios, using breed-matched dogs without histiocytic sarcoma admitted during the study period as controls. Pedigree analysis was performed for dogs with available registration information. RESULTS: Fourteen miniature schnauzers were diagnosed with histiocytic sarcoma during the study period, making them over-represented among the hospital population (odds ratio=4·8, P=0·0009). Disease was considered localised in ten dogs and disseminated in four. Of the dogs with localised disease, nine were diagnosed with primary pulmonary histiocytic sarcoma based on the presence of a large pulmonary mass with (n=7) or without (n=2) evidence of intra-thoracic metastasis, and one had gastric histiocytic sarcoma with nodal metastasis. Treatments varied, but an aggressive clinical course was found in most patients. Pedigree analysis revealed a recent common ancestor for a subset of the dogs assessed. CLINICAL SIGNIFICANCE: Miniature schnauzers were over-represented among dogs with histiocytic sarcoma in this patient population. Pedigree analysis supports an inherited risk factor, which has not previously been suggested in the breed. Primary pulmonary involvement with or without intra-thoracic metastasis was common in this cohort.

Realistic kinetic loading of the jaw system during single chewing cycles: a finite element study.

Although knowledge of short-range kinetic interactions between antagonistic teeth during mastication is of essential importance for ensuring interference-free fixed dental reconstructions, little information is available. In this study, the forces on and displacements of the teeth during kinetic molar biting simulating the power stroke of a chewing cycle were investigated by use of a finite-element model that included all the essential components of the human masticatory system, including an elastic food bolus. We hypothesised that the model can approximate the loading characteristics of the dentition found in previous experimental studies. The simulation was a transient analysis, that is, it considered the dynamic behaviour of the jaw. In particular, the reaction forces on the teeth and joints arose from contact, rather than nodal forces or constraints. To compute displacements of the teeth, the periodontal ligament (PDL) was modelled by use of an Ogden material model calibrated on the basis of results obtained in previous experiments. During the initial holding phase of the power stroke, bite forces were aligned with the roots of the molars until substantial deformation of the bolus occurred. The forces tilted the molars in the bucco-lingual and mesio-distal directions, but as the intrusive force increased the teeth returned to their initial configuration. The Ogden material model used for the PDL enabled accurate prediction of the displacements observed in experimental tests. In conclusion, the comprehensive kinetic finite element model reproduced the kinematic and loading characteristics of previous experimental investigations.

Vinblastine as a second rescue for the treatment of canine multicentric lymphoma in 39 cases (2005 to 2014).

OBJECTIVES: The objective of this study was to retrospectively evaluate response and outcome of dogs with multicentric lymphoma treated with single-agent vinblastine as a second rescue. METHODS: Medical records from 39 client-owned dogs receiving vinblastine rescue treatment (having relapsed on or following completion of UW-Madison and CCNU/L-asparaginase protocols), between 2005 and 2014, were reviewed for information regarding clinical presentation, diagnostic testing, drug dosage, number of treatments, side effects, response and outcome. RESULTS: The median starting dose of vinblastine was 2·6 mg/m(2) (1·7 to 2·8 mg/m(2) ), administered weekly until disease progression. Of the 39 dogs treated, 3 dogs (7·7%) achieved a complete remission, 7 dogs (17·9%) achieved a partial response, 18 dogs (46·2%) maintained stable disease and 11 (28·2%) had progressive disease. Ten dogs (25·6%) developed a grade III or IV neutropenia, and 4 dogs (10·3%) developed grade III or IV thrombocytopenia (one dog in both categories). After starting vinblastine, the median progression-free survival was 29·5 days (0 to 77 days) and overall median survival time was 46 days (4 to 250 days). Duration of first remission was identified as a positive predictor of outcome. CLINICAL SIGNIFICANCE: Single-agent vinblastine is well tolerated in dogs with relapsed or refractory lymphoma. Responses were incomplete and short-lasting.

[Reality of treatment in psychotherapy: Results of a survey of German psychiatric hospitals]. / Versorgungsrealität in der Psychotherapie : Ergebnisse der Befragung deutscher psychiatrischer Versorgungskliniken.

OBJECTIVES: Since the introduction of the qualification as specialist for psychiatry and psychotherapy, in addition to psychopharmacotherapy psychotherapy is an integral component of the treatment of mentally ill people. A survey was carried out to evaluate the reality of clinical routine use of psychotherapy in German psychiatric hospitals. METHODS: Between October 2011 and March 2012 German hospitals of psychiatry and psychotherapy were contacted by the head organization, the conference of national directors (Bundesdirektorenkonferenz), to participate in a survey regarding the application of psychotherapy in the real clinical world of daily treatment. With an anonymous questionnaire, data were requested as either a printed form or online version. RESULTS: Data from 25 psychiatric hospitals in the year 2010 could be analysed (average number of beds 300 of which 53 were for psychosomatic/psychotherapeutic patients) and a total of 87,000 inpatients were treated whereby 34 % were diagnosed as F1 addictive disorders and 24 % as F3 affective disorders. More than 80 % of the hospitals applied group therapies of relaxation, cognitive behavior therapy, social competence training and specific techniques, such as dialectic-behavior therapy. As individual treatment methods, patients with depressive disorders were treated with cognitive behavior therapy, interpersonal psychotherapy or psychodynamic therapy in more than 50 % of the cases. Relaxation techniques were offered in most cases by the nursing staff, behavior therapy by psychologists and physicians and psychodynamic therapy mainly by psychiatrists.

Finite element analysis of the principles and loosening force of the conical telescopic crown: a computer-based study.

OBJECTIVES: The primary goal of the present finite element (FE) analysis of a special removable prosthesis, the conical telescopic crown (CTC), was to validate established results based on a rigid model of the CTC and to analyze its characteristic features as a function of the essential material and geometric parameters. Furthermore, the effectiveness of a new element, the composite stop (CS), was investigated. MATERIALS AND METHODS: The study used an axisymmetric FE model containing the inner and outer crown including resin or ceramic veneer, the CS, the cement layer between the interior crown and the tooth, and the upper part of the tooth itself. RESULTS: For a convergence angle (half-cone angle) α = 4 degrees and a moderate chewing force F = 150 N the loosening force decreased from - 50 N without to - 10 N with CS. Increasing α values yielded a decrease of the loosening force. Adherence between the inner (IC) and outer crown (OC) was achieved for all configurations (α = 2 degrees, 4 degrees, and 6 degrees), except for zirconium crowns with α = 6 degrees. In systems without CS, the maximum tensile stress in the veneer increased proportionally to F, but remained limited in those with CS. CONCLUSIONS: The angle a and the coefficient of static friction µ0 emerged as the decisive parameters of the CTC. The computed fitting/loosening behavior agreed well with results of a simple rigid-body model and experiments. The incorporation of a CS allows ceramic veneering of the outer crown. CLINICAL RELEVANCE: The optimal angle α of the CTC is ascribed to a number of customary material combinations for IC and OC. The CS limits the loosening forces of the CTC to values which guarantee non-traumatic removal of the prosthesis.

[Differential diagnosis of the chronic pancreatitis and the pancreatic ductal adenocarcinoma]. / Diferenciální diagnostika chronické pankreatitidy a duktálního adenokarcinomu pankreatu.

UNLABELLED: The histopathological distinction of pancreatic ductal adenocarcinoma (PDA) and chronic pancreatitis represents one of the most difficult differential diagnosis in surgical pathology, especially in small biopsy specimens and frozen sections. Practically usable morphological criteria, which allow an efficient differential diagnosis of these lesions have been determined by a number of authors. The perineural and vascular invasion represent findings, which are entirely diagnostic for PDA; however, they are rarely detectable in small biopsy specimens as well as in the presence of solitary naked ducts in fat without surrounding pancreatic elements or fibrous tissue, which also supports the diagnosis of PDA. The features that are suggestive of PDA include random haphazard distribution of ductal structures, irregular ductal contours, ruptured ducts, nuclear enlargement, pleomorphism, hyperchromatism, and mitoses. Uniterrupted proliferation of numerous ducts (>50), ducts lying adjacent to arterioles, intraluminal cellular debris, and hyperchromatic raisinoid nuclei represent less frequently displayed features that also support the diagnosis of PDA. On the contrary, the preserved lobular arrangement, clusters of uniform ductal units, smooth ductal contours, ducts related to the remaining acini and islets, and finding of intraluminnal mucoprotein plugs favor a benign process over PDA. The combination of presented criteria and features should enable a reliable differential diagnosis of invasive pancreatic cancer and chronic pancreatitis. KEYWORDS: chronic pancreatitis - pancreatic ductal adenocarcinoma - pseudotumor - differential diagnosis.

Selenium-72 formation via nat Br(p,x) induced by 100 MeV protons: steps towards a novel 72Se/72As generator system.

Selenium-72 production by the proton bombardment of a natural NaBr target has been successfully demonstrated at the Los Alamos National Laboratory Isotope Production Facility (LANL-IPF). Arsenic-72 (half life 26 h) is a medium-lived positron emitting radionuclide with the major advantage of being formed as the daughter of another "generator" radioisotope (Se-72, 8.5 d). A (72)Se/(72)As generator would be the preferred mechanism for clinical utilization of (72)As for positron emission tomography (PET). No portable (72)Se/(72)As generator system has been demonstrated for convenient, repeated (72)As elution ("milking"). In this work, we describe (72)Se production and recovery from irradiated NaBr targets using a 100 MeV proton beam. We also introduce an (72)As generator principle based on (72)Se chelation followed by liquid-liquid extraction, which will be transferred to a solid-phase sorption/elution system.

[Kidney failure in a patient with chronic B-lymphocytic leukaemia (B-CLL) with underlying cast nephropathy. The value of free immunoglobulin light chain identification for early diagnosis of this complication]. / Selhání ledvin u pacientky s chronickou B-lymfocytární leukemií (B-CLL) vzniklé na podklade tvorby odlitkových válcu v tubulech ledvin z monoklonálnich volných lehkých retezcu (cast nephropathy). Prínos stanovení volných lehkých retezcu imunoglobulinu pro casnou diagnostiku této komplikace.

We describe a case of an untreated female patient monitored over 8 years for chronic B-lymphocytic leukaemia (B-CLL). Over the 8 years, the patient has gradually developed severe kidney failure, even though the criteria for B-CLL treatment had not been fulfilled. Kidney biopsy revealed renal damage due to lamda free light chains cast nephropathy as well as an infiltration of renal parenchyma with B-CLL cells. It was not before this biopsy that the presence of monoclonal immunoglobulins has been investigated. Immunofixation identified free monoclonal lamda light chains in the serum and urine. Their serum concentration, quantified by densitometry, was 2.6 g/l and urine concentration was 0.5 g/l. A specific evaluation of free light chains in the serum revealed an extremely high concentration of free X light chains, over 4500 mg/l, and normal concentration of K free light chains, 10 mg/l. The aim of this report is to emphasise that monoclonal immunoglobulin may be present in B-CLL as well as other lymphoprolipherative diseases and that it may cause damage to organs, similar to multiple myeloma or monoclonal gammopathy of undetermined significance. The described case confirms poor prognostic value of monoclonal immunoglobulin free light chains in patients with B-CLL and usefulness of an evaluation of their presence in patients with B-CLL, particularly if the patients have increased creatinine level. The described case also highlights the need for evaluation of the presence of free light chains in the serum of all patients with unclear cause of renal failure.

An international trial of quantitative PCR for monitoring Legionella in artificial water systems.

AIMS: To perform an international trial to derive alert and action levels for the use of quantitative PCR (qPCR) in the monitoring of Legionella to determine the effectiveness of control measures against legionellae. METHODS AND RESULTS: Laboratories (7) participated from six countries. Legionellae were determined by culture and qPCR methods with comparable detection limits. Systems were monitored over ≥10 weeks. For cooling towers (232 samples), there was a significant difference between the log mean difference between qPCR (GU l(-1) ) and culture (CFU l(-1) ) for Legionella pneumophila (0·71) and for Legionella spp. (2·03). In hot and cold water (506 samples), the differences were less, 0·62 for Leg. pneumophila and 1·05 for Legionella spp. Results for individual systems depended on the nature of the system and its treatment. In cooling towers, Legionella spp. GU l(-1) always exceeded CFU l(-1) , and usually Legionella spp. were detected by qPCR when absent by culture. The pattern of results by qPCR for Leg. pneumophila followed the culture trend. In hot and cold water, culture and qPCR gave similar results, particularly for Leg. pneumophila. There were some marked exceptions with temperatures ≥50°C, or in the presence of supplementary biocides. Action and alert levels for qPCR were derived that gave results comparable to the application of the European Guidelines based on culture. Algorithms are proposed for the use of qPCR for routine monitoring. CONCLUSIONS: Action and alert levels for qPCR can be adjusted to ensure public health is protected with the benefit that remedial actions can be validated earlier with only a small increase in the frequency of action being required. SIGNIFICANCE AND IMPACT OF THE STUDY: This study confirms it is possible to derive guidelines on the use of qPCR for monitoring the control of legionellae with consequent improvement to response and public health protection.