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[This retracts the article DOI: 10.7759/cureus.19306.].
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In the treatment of various patients, the presence of lymphovascular invasion is a prognostic determinant, often taken into account by surgeons and oncologists. The exact frequency and prognostic impacts of this microscopic event in adenoid cystic carcinoma (ACC) patients are, however, not clear. This systematic review and meta-analysis aimed to investigate the lymph node involvement and the clinical stage of cancer as predictors of ACC prognosis. A systematic search was conducted covering a number of databases, including PubMed, Science Direct, Google Scholar, Web of Science, and EBSCO. A total of three studies were included in this analysis, with 591 participants, 247 of whom were males. Lymph node involvement and clinical stage were demonstrated as significant bad prognosis factors among ACC patients (HR = 1.48, 95% CI, 1.00, 1.96; P<0.0001). We found that lymph node involvement and clinical stage of the cancer are both significant predictors of bad prognosis of ACC.
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We performed a systematic review and meta-analysis of patients with suspected recurrent cholesteatoma who underwent non-echo planar imaging (non-EPI) using diffusion-weighted magnetic resonance imaging (MRI), with surgery as the reference standard. We searched Medline, Google Scholar, and the Cochrane database for diagnostic test accuracy studies. The following prespecified subgroup analyses were performed: patient age, number of radiologists interpreting MRI, study design, and risk of bias. We used a bivariate model using a generalized linear mixed model to pool accuracies. Of the 460 records identified, 32 studies were included, of which 50% (16/32) were low risk of bias. The overall pooled sensitivity was 92.2% (95% CI 87.3-95.3%), and specificity was 91.7% (85.2-95.5%). The positive likelihood ratio was 11.1 (4.5-17.8), and the negative likelihood ratio was 0.09 (0.04-0.13). The pooled diagnostic odds ratio was 130.3 (20.5-240). Heterogeneity was moderate on visual inspection of the hierarchical summary receiver operating characteristic curve. Subgroup analyses showed prospective studies reporting higher accuracies (p=0.027), which were driven by higher specificity (prospective 93.1% (88.4-96.0%) versus retrospective 81.2% (81.0-81.4%)). There was no difference in subgroups comparing patient age (p=0.693), number of radiologists interpreting MRI (p=0.503), or risk of bias (p=0.074). No publication bias was detected (p=0.98). In conclusion, non-EPI is a highly sensitive and specific diagnostic test able to identify recurrent cholesteatomas of moderate to large sizes. This test can be considered a non-invasive alternative to second-look surgery.
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Coronavirus disease 2019 (COVID-19) is primarily a respiratory illness and pulmonary manifestations are the typical presentations of the disease. However, it became evident that the COVID-19 is not limited to the respiratory system. Specifically, gastrointestinal involvement in patients with COVID-19 is very common, particularly in patients with a critical illness. We present a case of a 52-year-old man who was diagnosed as having severe COVID-19 pneumonia and underwent endotracheal intubation and mechanical ventilation. The patient remained in the intensive care unit for seven days. Following his recovery, he started to experience generalized abdominal pain. The pain did not resolve with conservative measures. A computed tomography scan of the abdomen demonstrated small bowel loops clustered with a surrounding thin membrane. Such findings conferred the diagnosis of sclerosing encapsulating peritonitis. The patient was prepared for laparoscopic surgery. Resection of the membrane was performed without any injury to the encapsulated bowel. Analysis of peritoneal fluid by reverse transcription-polymerase chain reaction (RT-PCR) was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The patient had an uneventful recovery. Sclerosing encapsulating peritonitis is a very rare condition associated with COVID-19 pneumonia. The present case is the first reported case to document the presence of the SARS-CoV-2 virus in the peritoneal fluid in a patient with sclerosing encapsulating peritonitis.
