"Bezoar Egg"-A Rare Cause of Small Bowel Obstruction.

Small bowel obstruction is a frequent medical condition with various causes, the most common being postoperative adhesions, volvulus, intussusception, hernias, and tumors. A bezoar-induced blockage of the small intestine is a rare condition that accounts for approximately 4% of all small bowel obstruction cases. Herein, we present the case report of a 71-year-old patient with diffuse abdominal pain caused by a small bowel obstruction due to a calcified bezoar (bezoar egg) resulting from a post-radiation intestinal stricture. The patient underwent a small bowel excision with the extraction of the bezoar, after which a full recovery was made.

MRI Tumor Regression Grade Combined with T2-Weighted Volumetry May Predict Histopathological Response in Locally Advanced Rectal Cancer following Neoadjuvant Chemoradiotherapy-A New Scoring System Proposal.

Modern studies focus on the discovery of innovative methods to improve the value of post-treatment magnetic resonance imaging (MRI) in the prediction of pathological responses to preoperative neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). The aim of this study was to assess the potential benefits of combining magnetic resonance tumor regression grade (mrTRG) with T2-weighted volumetry in the prediction of pathological responses to nCRT in LARC. This was a cohort study conducted on patients with histopathologically confirmed LARC in a period from 2020 to 2022. After histopathological verification, all patients underwent initial MRI studies, while the follow-up MRI was performed after nCRT. Tumor characteristics, MRI estimated tumor regression grade (mrTRG) and tumor volumetry were evaluated both initially and at follow-up. All patients were classified into responders and non-responders according to pathological tumor regression grade (pTRG) and mrTRG. A total of 71 patients, mostly male (66.2%) were included in the study. The median tumor volume reduction rate was significantly higher in nCRT-responders compared to non-responders (79.9% vs. 63.3%) (p = 0.003). Based on ROC analysis, optimal cut-off value for tumor volume reduction rate was determined with an area under the curve (AUC) value of 0.724 (p = 0.003). Using the tumor volume reduction rate ≥75% with the addition of response to nCRT according to mrTRG, a new scoring system for prediction of pTRG to preoperative nCRT in LARC was developed. Diagnostic performance of prediction score was tested and the sensitivity, PPV, specificity, and NPV were 81.8%, 56.3%, 71.4%, and 89.7%, respectively. The combination of mrTRG and T2-weighted volumetry increases the MRI-based prediction of pTRG to preoperative nCRT in LARC. The proposed scoring system could aid in distinguishing responders to nCRT, as these patients could benefit from organ-preserving treatment and a "watch and wait" strategy.

Laparoscopic approach in the treatment of splenic angiolipomatous hamartoma: the first report of a case.

Angiolipomatous hamartoma is a benign mesenchymal proliferation of unknown aetiology. Only a few cases have been documented in the published literature. This current case report describes a 57-year-old female patient who was hospitalized for an assessment of a previously radiologically-verified splenic lesion and further treatment. The patient had been surgically treated 10 years previously; a lobectomy of the superior left pulmonary lobe had been performed in order to remove a verified tumour lesion. A complete radiological examination was undertaken, which verified a spleen of a size that was within the physiological range, with a centrally-located lobular tumour lesion. Given the risk of splenic rupture, as well as the fact that the lesion's aetiology was still undetermined, and finally the fact that differential diagnostics indicated the possibility of a metastasis, the patient was treated surgically. Laparoscopic splenectomy, in the treatment of splenic diseases, even rare ones such as this, is not a novelty. Indeed, it needs to be applied as the standard approach, with the well-known benefits that the minimalized approach offers.

Early Maladaptive Schemas and the Accuracy of Facial Emotion Recognition: A Preliminary Investigation.

Different developmental experiences related to deep-rooted beliefs about oneself and others may significantly affect individual social emotional competencies, such as the accuracy of facial emotion recognition and detection. This study presents a preliminary examination of the relationship between early maladaptive schemas (EMSs) and the accuracy of recognizing facial expressions showing basic emotions, neutral faces, and discrimination between neutral and emotional faces. The sample consisted of 138 psychology students (M = 20.33; SD = 1.33, 27 of the respondents were male). Japanese and Caucasian facial expressions of emotion and neutral faces and JACNeuF (Matsumoto & Ekman, 1988) were used as stimulus material for assessing the facial emotion recognition of seven basic emotions (anger, contempt, disgust, fear, sadness, happiness, and surprise) and neutral faces. The Young Schema Questionnaire-Short Form 3 (YSQ-S3; Young, 2005) was administered as a measure of EMSs. The findings demonstrate that all schema domains affect the accuracy of recognizing facial expressions showing negative emotions (anger, contempt, disgust, fear, and sadness). The Dependence/Incompetence and Entitlement/Grandiosity schemas were significant predictors for detecting neutral faces and discriminating between faces with and without emotion, while the Abandonment/Instability schema additionally proved significant for recognizing neutral faces. Limitations and suggestions for future elaboration are acknowledged.

Hepatocellular Carcinoma Presenting Simultaneously with Echinococcal Cyst Mimicking a Single Liver Lesion in a Non-Cirrhotic Patient: A Case Report and Review of the Literature.

A coexistance of liver cystic echinococcosis (CE) and hepatocellular carcinoma (HCC) is very rare. HCC is the leading cause of cancer-related mortality worldwide, while CE is a globally endemic zoonosis caused by the cestode tapeworm Echinococcus granulosus. The association between these two diseases is still not well-defined. A preoperative diagnosis may be challenging, especially if HCC and CE present as a single lesion and if atypical imaging features are present. Herein, we present a case of the patient that was initially diagnosed as an extensive necrotic tumor in the left liver lobe and highly suspicious of being HCC associated with peritumoral hematoma. Left hemihepatectomy was performed, and the histopathological findings showed the collision of two lesions: a hydatid cyst and HCC.

Fatal gastrointestinal bleeding associated with acute pancreatitis as a complication of Covid-19: a case report.

Clinical manifestations of Covid-19 vary widely among patients. Recent studies suggest that up to 15% of patients with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infections develop gastrointestinal symptoms. The location of virus-host cell receptors angiotensin-converting enzyme 2 and transmembrane serine protease 2 has an important role in the pathophysiology and presentation of disease. They are expressed in the respiratory tract, as well as other organs and tissues including exocrine and endocrine pancreatic cells. These cells are therefore a possible target for the virus, which could explain the relationship between SARS-CoV-2 infection and pancreatic injury. We report a disastrous collateral effect of the Covid-19 pandemic on a 33-year-old man with chronic renal insufficiency and asymptomatic SARS-CoV-2 infection, who developed acute pancreatitis. Inflammation progressed rapidly toward necrosis and the development of a peripancreatic pseudoaneurysm which subsequently ruptured, causing death.

Splenectomy for Visceral Leishmaniasis Out of an Endemic Region: A Case Report and Literature Review.

Visceral leishmaniasis (also known as kala-azar) is characterized by fever, weight loss, swelling of the spleen and liver, and pancytopenia. If it is not treated, the fatality rate in developing countries can be as high as 100% within 2 years. In a high risk situation for perioperative bleeding due to severe thrombocytopenia/coagulopathy, we present a rare challenge for urgent splenectomy in a patient with previously undiagnosed visceral leishmaniasis. A histologic examination of the spleen revealed a visceral leishmaniasis, and the patient was successfully treated with amphotericin B.

Isolated Splenic Metastasis of Primary Lung Cancer Presented as Metachronous Oligometastatic Disease-A Case Report.

Modern oncology practice and new antitumor drugs prolonged disease-free intervals in patients with lung cancer. Patients with distant metastatic disease are treated only with palliative intent. The International Association for the Study of Lung Cancer, in the 8th edition of the TNM classification, for the first time includes oligometastatic disease as a clinical state that describes the patients with distant metastasis, limited in number and organ sites, who may have more indolent biology. In this paper, we present a case of a 56-year-old man who was admitted to our clinic regarding a radiologically diagnosed splenic lesion of uncertain nature, and who underwent a left upper lobectomy for primary lung cancer 12 years before. After a detailed radiological diagnosis, it was concluded that it is highly suspected metastatic lesion of the spleen and the patient underwent a splenectomy. While no definitive protocols exist on the management of isolated splenic metastasis from lung cancer, splenectomy, in suitable patients, with reasonable survival expectations, improves patient disease-free survival and can prevent potentially life-threatening complications, such as splenic rupture. 18F-FDG PET has very high sensitivity and specificity for differentiating benign and malignant splenic lesions especially in patients who are in the follow up protocol due to primary malignancy.

Intolerance of uncertainty and distress in women with delayed IVF treatment due to the COVID-19 pandemic: The mediating role of situation appraisal and coping strategies.

The COVID-19 pandemic has caused delays of numerous medical procedures, including IVF. This study investigates the relationship between Intolerance of Uncertainty (IU), situation appraisal-the perceived threat that COVID-19 poses for infertility treatment, coping strategies, and general distress among women with a delayed IVF procedure. SEM showed that situation appraisal is a partial mediator of the relationship between IU and avoidance, as well as the relationship between IU and general distress. The connection between situation appraisal and general distress is partially mediated by avoidance. In this challenging context for mental health, situation appraisal and coping strategies determine the level of distress, where IU, as a dispositional variable, represents the main determinant of the entire reaction.

Encapsulated Omental Necrosis as an Unexpected Postoperative Finding: A Case Report.

Postsurgical fat necrosis is a frequent finding in abdominal cross-sectional imaging. Epiploic appendagitis and omental infarction are a result of torsion or vascular occlusion. Surgery or pancreatitis are conditions that can have a traumatic and ischemic effect on fatty tissue. The imaging appearances may raise concerns for recurrent malignancy, but percutaneous biopsy and diagnostic follow-up assist in the accurate diagnosis of omental infarction. Herein we describe a case of encapsulated omental necrosis temporally related to gastric surgery. Preoperative CT and MRI findings showed the characteristics of encapsulated, postcontrast nonviable tumefaction in the epigastrium without clear imaging features of malignancy. Due to the size of the lesion and the patient's primary disease, tumor recurrence could not be completely ruled out, and the patient underwent surgery. Histopathological analysis confirmed the diagnosis of steatonecrosis of the omentum.

The role of quantitative diffusion-weighted imaging in characterization of hypovascular liver lesions: A prospective comparison of intravoxel incoherent motion derived parameters and apparent diffusion coefficient.

BACKGROUND: The utility of intravoxel incoherent motion (IVIM) related parameters in differentiation of hypovascular liver lesions is still unknown. PURPOSE: The purpose of this study was to evaluate the value of IVIM related parameters in comparison to apparent diffusion coefficient (ADC) for differentiation among intrahepatic mass-forming cholangiocarcinoma (IMC), and hypovascular liver metastases (HLM). METHODS: Seventy-four prospectively enrolled patients (21 IMC, and 53 HLM) underwent 1.5T magnetic resonance examination with IVIM diffusion-weighted imaging using seven b values (0-800 s/mm2). Two independent readers performed quantitative analysis of IVIM-related parameters and ADC. Interobserver reliability was tested using a intraclass correlation coefficient. ADC, true diffusion coefficient (D), perfusion-related diffusion coefficient (D*), and perfusion fraction (ƒ) were compared among the lesions using Kruskal-Wallis H test. The diagnostic accuracy of each parameter was assessed by receiver operating characteristic (ROC) curve analysis. RESULTS: The interobserver agreement was good for ADC (0.802), and excellent for D, D*, and ƒ (0.911, 0.927, and 0.942, respectively). ADC, and D values were significantly different among IMC and HLM (both p < 0.05), while there was no significant difference among these lesions for ƒ and D* (p = 0.101, and p = 0.612, respectively). ROC analysis showed higher diagnostic performance of D in comparison to ADC (AUC = 0.879 vs 0.821). CONCLUSION: IVIM-derived parameters in particular D, in addition to ADC, could help in differentiation between most common hypovascular malignant liver lesions, intrahepatic mass-forming cholangiocarcinoma and hypovascular liver metastases.

Perforated Appendicitis and Bowel Incarceration within Morgagni Hernia: A Case Report.

Morgagni hernia (MH) is a result of abdominal organ protrusion through the congenital defect in the anterior retrosternal aspect of the diaphragm. The colon and omentum are the most commonly involved organs, followed by the small intestine, stomach and liver. Symptoms of MH may be absent, although the majority of patients will experience mild dyspnea or abdominal discomfort. We present a case of MH complicated with intrathoracic acute perforated appendicitis and intestinal obstruction.

Aggressiveness in Judokas and Team Athletes: Predictive Value of Personality Traits, Emotional Intelligence and Self-Efficacy.

Combat sports and martial arts are often associated with aggressiveness among the general public, although data on judo and/or martial arts and aggressiveness seem to be unclear. This research aims to compare athletes who have trained judo for a prolonged time (minimum 5 years) and athletes from various team sports, primarily regarding the manifestation of aggression, but also regarding personality traits, emotional intelligence, and self-efficacy. Also, the potential predictive value of personality traits, emotional intelligence, and self-efficacy for aggression within subsamples of judokas and team athletes was tested. The research findings showed that professional judo athletes are characterized by a low degree of aggression, especially low indirect and physical manifestations of aggression. In addition, the personality traits Honesty-Humility and Openness to experience are well expressed, contrary to Emotionality and Extraversion, which are less pronounced. They are also characterized by moderate general self-efficacy. On the other hand, members of team sports produced the opposite results, as they are characterized by increased aggression, pronounced traits of Emotionality and Extraversion, somewhat less pronounced traits of Honesty-Humility, Openness to new experience, and less pronounced general self-efficacy. The percentage of explained variability of aggression is slightly higher in the subsample of team sports and constitutes 49.9% of the variability, while in the subsample of judokas it constitutes 47.8% of the variability of the criteria. Practical implications, limitations, and future research directions were discussed.

Successful Embolization of Posterior Inferior Pancreaticoduodenal Artery Pseudoaneurysm on the Grounds of Chronic Pancreatitis-Case Report and Literature Review.

Pancreatic pseudoaneurysm is a rare but life-threatening clinical entity. In this paper, we present a case of a 74-year-old man, who was admitted to our clinic with a diagnosis of an acute on chronic pancreatitis complicated by walled-off-pancreatic-necrosis, with subsequent development of peripancreatic pseudoaneurysm. After initial conservative management, the patient recovered and was discharged from the hospital. However, he soon returned feeling anxious due to a pulsatile abdominal mass. Abdominal Color-Doppler examination, CT scan, and angiography revealed large pancreatic necrotic collection in the total size of 9 cm, with centrally enhancing area of 3.5 cm that corresponded to pseudoaneurysm originating from the posterior pancreaticoduodenal vascular arcade. Considering the size, location of the pseudoaneurysm, feeding vessel, and poor general patients condition, we opted for minimally invasive treatment. Pseudoaneurysm was successfully managed by endovascular coil embolization, i.e., "sandwich technique".

Pancreatic Hydatid Cyst Misdiagnosed as Mucinous Cystadenoma: CT and MRI Findings.

Isolated hydatid cysts of the pancreas are rare lesions, even in endemic regions. In this report, we present the case of a 76-year-old patient who was admitted to our clinic with a diagnosis of a cystic lesion in the tail of the pancreas. On preoperative computed tomography (CT) and magnetic resonance (MR) examination, the cyst was characterized as a mucinous cystadenoma. A laparoscopic distal pancreatectomy followed. A histopathological examination revealed a large hydatid cyst in the tail of the pancreas.

Facial Emotion Recognition and Persecutory Ideation in Paranoid Schizophrenia.

The recognition of facial signals has a crucial role in social interaction. It is well known that people suffering from paranoid schizophrenia have problems in the social domain, predominantly related to misinterpreting the intentions, emotions, and actions of others. The aim of this study was to examine whether there are differences in facial emotion recognition between people with paranoid schizophrenia and healthy controls. In addition, we examined the correlation between facial emotion recognition and the expression of persecutory ideation in people suffering from paranoid schizophrenia. The study involved 60 participants, 30 of whom suffered from paranoid schizophrenia and 30 healthy controls, equalized by gender, age, and education. The following instruments were used: Japanese and Caucasian Facial Expressions of Emotion and Neutral Faces and the Persecutory Ideation Questionnaire. Compared with the controls, people suffering from paranoid schizophrenia were significantly less accurate in recognizing the following emotions: surprise, contempt, sadness, disgust, and emotionally neutral faces. Since the attribution of emotions to emotionally neutral faces is an important finding that could be linked with the social (dis)functionality of people suffering from paranoid schizophrenia, we analyzed and compared the wrong answers given by the two groups and found some differences between them. The results show that persecutory ideation has a statistically significant negative correlation with the successful recognition of emotionally neutral faces. All of the findings lead to the conclusion that paranoid schizophrenia, and within it the existence of persecutory ideation, leads to problems in recognizing the basic facial signals that form the foundation of everyday social interaction.

Sodium thiosulphate and progression of vascular calcification in end-stage renal disease patients: a double-blind, randomized, placebo-controlled study.

BACKGROUND: Sodium thiosulphate (NaTS) is mostly used in haemodialysis (HD) patients with calcific uraemic arteriolopathy. This double-blind, randomized, placebo-controlled study assessed the effect of NaTS on progression of cardiovascular calcifications in HD patients. METHODS: From 65 screened patients, we recruited 60 patients with an abdominal aorta Agatston calcification score ≥100. Thirty patients were randomized to receive NaTS 25 g/1.73 m2 and 30 patients to receive 100 mL of 0.9% sodium chloride intravenously during the last 15 min of HD over a period of 6 months. The primary endpoint was the absolute change of the abdominal aortic calcification score. RESULTS: The abdominal aortic calcification score and calcification volume of the abdominal aorta increased similarly in both treatment groups during the trial. As compared with the saline group, patients receiving NaTS exhibited a reduction of their iliac artery calcification score (-137 ± 641 versus 245 ± 755; P = 0.049), reduced pulse wave velocity (9.6 ± 2.7 versus 11.4 ± 3.6; P = 0.000) and a lower carotid intima-media thickness (0.77 ± 0.1 versus 0.83 ± 00.17; P = 0.033) and had better preservation of echocardiographic parameters of left ventricular hypertrophy. No patient of the NaTS group developed new cardiac valve calcifications during the trial as compared with 8 of 29 patients in the saline group. By univariate analysis, NaTS therapy was the only predictor of not developing new valvular calcifications. No adverse events possibly related to NaTS infusion were noted. CONCLUSIONS: While NaTS failed to retard abdominal aortic calcification progress, it positively affected calcification progress in iliac arteries and heart valves as well as several other cardiovascular functional parameters.