Recurrent retroperitoneal abscess after biliary tract surgery in an elderly patient: a minimally invasive nonsurgical approach and its consequences: a case report

Hepatic abscess can be defined as an encapsulated collection of suppurative material within the liver parenchyma. Hepatic abscess can be distinguished as pyogenic, amebic, or fungal. Biliary tract disease rema...

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Rapid Onset of Effect of Benralizumab on Morning Peak Expiratory Flow in Severe, Uncontrolled Asthma

Publication date: Available online 23 February 2019

Source: Annals of Allergy, Asthma & Immunology

Author(s): Geoffrey Chupp, Njira L. Lugogo, Joel N. Kline, Gary T. Ferguson, Ian Hirsch, Mitchell Goldman, James G. Zangrilli, Frank Trudo

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Epidemiology of otorhinolaryngologic emergencies in a secondary hospital: analysis of 64,054 cases

Abstract

Purpose

To determine the incidence and distribution of care in relation to urgent otorhinolaryngologic pathologies by the different medical specialist units.

Methods

A descriptive, observational and retrospective study was conducted of patients seen by the Emergency Service at a secondary hospital over the course of 7 years (2011–2017).

Results

A total of 546,701 patients were seen during the period in question, of which 64,054 presented with otorhinolaryngologic symptoms. The attendance rate was 450/1000 inhabitants/year. The most frequent diagnoses were upper respiratory tract infection, with 13,639 cases (21.3%), tonsillopharyngitis, with 10,150 cases (15.8%) and vertigo/dizziness with 8761 cases (13.7%). Patients seen by the Hospital Emergency Service physicians and those referred to the Otorhinolaryngology or Paediatric Units were analysed both together and separately. The Hospital Emergency Service dealt with 77.1% of the cases, and referred 15.4% to the Otorhinolaryngology Unit and 7.5% to the Paediatrics Unit. Within the subgroup of patients referred to the Otorhinolaryngology Unit, the most frequent diagnoses were problems related to inflammatory ear disease (25.6%), followed by cervicofacial trauma (15.4%) and bleeding with otorhinolaryngologic symptoms (12.5%). The percentage of hospital admissions for the entire sample was 3%, while for patients referred to the Otorhinolaryngology Unit this figure was 6.8%.

Conclusions

A large percentage of patients presenting at the Hospital Emergency Service do so with otorhinolaryngologic symptoms, and the vast majority are treated effectively by the physicians in that service and are referred to the specialist services on the basis of sound criteria.

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Depth of invasion alone as an indication for postoperative radiotherapy in small oral squamous cell carcinomas: An International Collaborative Study

Abstract

Background

We aimed to investigate whether depth of invasion (DOI) should be an independent indication for postoperative radiotherapy (PORT) in small oral squamous cell carcinomas (SCC).

Methods

Retrospective analysis of DOI (<5, 5 to <10, ≥10 mm) and disease‐specific survival (DSS) in a multi‐institutional international cohort of 1409 patients with oral SCC ≤4 cm in size treated between 1990‐2011.

Results

In patients without other adverse factors (nodal metastases; close [<5 mm] or involved margins), there was no association between DOI and DSS, with an excellent prognosis irrespective of depth. In the absence of PORT, the 5‐year disease‐specific mortality was 10% with DOI ≥10 mm, 8% with DOI 5‐10 mm, and 6% with DOI <5 mm (P = .169), yielding an absolute risk difference of only 4%.

Conclusion

The deterioration in prognosis with increasing DOI largely reflects an association with other adverse features. In the absence of these, depth alone should not be an indication for PORT outside a clinical trial.

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Aktuelle medikamentöse Therapiekonzepte des metastasierten Prostatakarzinoms

Zusammenfassung

Hintergrund

Seit der Einführung der Androgendeprivationstherapie (ADT) vor mehr als 70 Jahren durch chirurgische Kastration hat sich die medikamentöse Therapie des metastasierten Prostatakarzinoms (PCa) erheblich diversifiziert. Durch neues Verständnis der Resistenzmechanismen gegenüber ADT sowie Chemotherapie stehen derzeit fünf zugelassene Medikamente zur Therapie zur Verfügung, die sich unterschiedlicher Wirkmechanismen bedienen.

Ergebnisse

Durch Verschiebung der Therapiezeitpunkte in Richtung frühen Einsatz beim metastasierten hormonsensitiven PCa (mHSPC) konnten weitere, signifikante Überlebensvorteile beobachtet werden. Neue Studien zu Sequenz und/oder Kombination der vorhandenen Präparate setzen weiteres Potenzial der Therapieoptimierung des metastasierten kastrationsresistenten PCa (mCRPC) frei. Diese Untersuchungen werden möglicherweise durch innovative Therapiekonzepte weiterhin verbessert und neue Zulassungen werden insbesondere beim M0 CRPC erwartet. Zudem laufen Studien, die den Stellenwert der Primariustherapie und/oder Metastasenbehandlung auf Symptome und Prognose untersuchen.

Schlussfolgerung

Aus Sicht der Autoren wird die Therapie des metastasierten PCa in Zukunft multimodal, interdisziplinär und individuell gestaltet werden müssen, um eine Chronifizierung der Tumorerkrankung bei guter Lebensqualität zu erreichen.

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Transpedicular Endoscopic Surgery for Highly Downmigrated L5-S1 Disc Herniation

Endoscopic surgery for highly downmigrated disc herniation at level L5-S1 is a challenging technique. Most surgeons prefer the interlaminar access because of the special anatomy of the L5-S1 disc level, i.e., narrow neuroforamen and large interlaminar window. Transforaminal access to the neuroforamen L5-S1 is difficult in cases with high iliac crest. Here, the access to the highly downmigrated disc herniation with the recently reported technique of transpedicular endoscopic surgery by Krzok et al. was described. In 3 cases with highly downmigrated disc herniation of L5-S1, the sequester was removed successfully through the bone hole of S1 pedicle. This technique is demanding for experienced endoscopic surgeons.

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Validation of web‐based thyroid imaging reporting and data system in atypia or follicular lesion of undetermined significance thyroid nodules

Abstract

Background

Atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS) show variable malignancy risk. We validated the web‐based predictive models and the scoring system by the American College of Radiology (ACR) for AUS/FLUS nodules to stratify the malignancy risk.

Methods

From January 2011 to November 2014, 275 consecutive nodules diagnosed as AUS/FLUS were enrolled. The discrimination and calibration ability of a web‐based scoring with inclusion of biopsy result and sonographic features, old web‐based scoring model without biopsy result, and ACR models were assessed.

Results

The areas under the receiver operating characteristic curve of the validation set were 0.670 for the new web‐based model, 0.710 for the old web‐based model, and 0.732 for the ACR scoring risk‐stratification model. All models were well calibrated.

Conclusion

The web‐based scoring risk‐stratification model using the combined information of ultrasonography features and biopsy result for AUS/FLUS nodules to stratify malignancy risk presents an acceptable predictive accuracy.

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