Intraoperative Incidental Finding of Meckel's Diverticulum: A Report of Two Cases.

Meckel's diverticulum (MD), a prevalent congenital gastrointestinal anomaly affecting about 2% of the population, arises from the incomplete closure of the vitelline duct. It encompasses all layers of the small intestine and can lead to various complications like obstruction, hemorrhage, and perforation. When symptomatic, it presents challenges in diagnosis due to the low sensitivity of imaging techniques. Comprehensive understanding and accurate diagnosis are crucial for managing the complications associated with MD and forming the scientific rationale for publishing this case report. We present two cases, one of them being the case of a 73-year-old male who presented for an ileostomy closure procedure. Intra-operatively, a 4.5 cm diverticulum was identified 10 cm from the stomatal opening on the efferent limb. This finding led to segmental resection of the intestines. Later, pathology was compatible with MD, which didn't contain any malignant cells or heterotopic tissue. The second case was that of a 40-year-old female who presented for severe abdominal pain, abdominal distention, and obstipation for two days. Radiographic imaging was suspicious of a foreign object compatible with fish bone with local inflammation in the small bowel. Laparoscopic exploration showed an inflamed MD with fish bone lodged inside. In front of an incidental MD, the decision to resect is still controversial. Those who are against resection of uncomplicated believe that complications from resecting an uncomplicated MD are higher than the complications that arise if resection is not performed. Those who support resection say that the complications that arise following the resection of a complicated MD are worse than those after resecting an incidental one. Criteria have been put in place to help guide the decision for resection.

Use of Subfascial Passive Bile Bag Drainage for the Management of Durotomies in Spine Surgery.

INTRODUCTION: Historically, the use of subfascial drains for the management of durotomies was avoided due to concerns about the creation of cerebrospinal fluid (CSF) fistulas. Currently, there are limited series utilizing subfascial drainage for CSF leak management, many of which utilize suction drainage. We report our experience with the use of subfascial passive drainage in the management of such leaks. OBJECTIVE: To demonstrate the efficacy of a passive subfascial bile bag for diversion of CSF post-operatively in concert with a post-operative head of bed (HOB) protocol for the management of durotomies in spine surgery. METHODS: We performed a retrospective chart review of patients who underwent spinal surgery at a single institution performed by one surgeon. Cases utilizing a passive subfascial bile bag for durotomies were identified. A total of 1,882 consecutive surgeries were reviewed, and 108 met the inclusion criteria. The primary outcome was return to the operating room (OR) and/or the need for lumbar drain placement. Patient sociodemographic information and pre-, intra-, and post-operative clinical characteristics were reviewed. RESULTS: A total of 108 patients underwent subfascial bile bag CSF diversion after intra-operative durotomy. Four patients (3.7%) experienced post-operative CSF leakage requiring lumbar drain placement, while only two (1.9%) patients required a return to the OR. One patient returned to the OR for symptomatic pseudomeningocele and the other for ongoing CSF drainage from their wound. CONCLUSION:  Durotomies are known to increase complication rates, including reoperation. The use of subfascial passive bile bag drainage in concert with a post-operative HOB protocol is a safe and effective manner to manage durotomies while minimizing the need for reoperation.

Incidental pulmonary nodules: Natural language processing analysis of radiology reports.

BACKGROUND: Pulmonary nodules are a common incidental finding on chest Computed Tomography scans (CT), most of the time outside of lung cancer screening (LCS). We aimed to evaluate the number of incidental pulmonary nodules (IPN) found in 1 year in our hospital, as well as the follow-up (FUP) rate and the clinical and radiological features associated with FUP. METHODS: We trained a Natural Language Processing (NLP) tool to identify the transcripts mentioning the presence of a pulmonary nodule, among a large population of patients from a French hospital. We extracted nodule characteristics using keyword analysis. NLP algorithm accuracy was determined through manual reading from a sample of our population. Electronic health database and medical record analysis by clinician allowed us to obtain information about FUP and cancer diagnoses. RESULTS: In this retrospective observational study, we analyzed 101,703 transcripts corresponding to the entire CTs performed in 2020. We identified 1,991 (2 %) patients with an IPN. NLP accuracy for nodule detection in CT reports was 99 %. Only 41 % received a FUP between January 2020 and December 2021. Patient age, nodule size, and the mention of the nodule in the impression part were positively associated with FUP, while nodules diagnosed in the context of COVID-19 were less followed. 36 (2 %) lung cancers were subsequently diagnosed, with 16 (45 %) at a non-metastatic stage. CONCLUSIONS: We identified a high prevalence of IPN with a low FUP rate, encouraging the implementation of IPN management program. We also highlighted the potential of NLP for database analysis in clinical research.

Association between incidental perirenal fat stranding on CT and metabolic syndrome in otherwise healthy adults.

PURPOSE: To investigate the association between metabolic syndrome and perirenal fat stranding (PRFS), which is defined as linear or curvilinear soft tissue densities in the perirenal fat on computed tomography (CT). MATERIAL AND METHODS: Adults who had abdominal CT for health screening at a single institution between October 2022 and March 2023 were included retrospectively. Two radiologists assessed the extent of PRFS for each CT and graded it as absent, mild/moderate, and severe. Logistic regression analyses were used to investigate the associations between PRFS and metabolic syndrome-related factors, as well as age and gender. RESULTS: Among 701 participants (mean age, 56.8 years ± 9.7; 336 women and 365 men), 87 (12.4%) had mild (n = 80) or moderate (n = 7) PRFS. None had severe PRFS. The presence of PRFS was independently associated with higher body mass index (odds ratio [OR], 2.561 and 9.842 for overweight and obese, respectively; p ≤ 0.001), elevated blood pressure with or without anti-hypertensive medication (OR, 2.232; p = 0.015), anti-diabetic medication (OR, 3.129; p < 0.001), and lipid-lowering medication (OR, 1.919; p = 0.019), older age (OR, 4.545 and 9.109 for 50-59 years and ≥ 60 years, respectively; p ≤ 0.002), and male gender (OR, 10.065; p < 0.001). Sixty three of 87 (72.4%) participants with PRFS had metabolic syndrome, while 265 of 614 (43.2%) participants without PRFS did (p < 0.001). CONCLUSION: Incidental mild or moderate PRFS may be associated with the presence of metabolic syndrome or related disorders in otherwise healthy adults.

Incidental parathyroidectomy after thyroid surgery and relationship with postoperative hypocalcemia: a single tertiary center analysis.

Incidental parathyroidectomy (IP) is a complication seen at varying rates after thyroid surgery, and its relationship with postoperative hypocalcemia has not been clarified. In this study, our goal was to identify the frequency and risk factors for IP in a large patient cohort and assess its correlation with postoperative hypocalcemia. A total of 4052 patients who underwent thyroid surgery between 2008 and 2020 were reviewed retrospectively. The patients were divided into two groups, the IP and non-IP groups, and compared in terms of demographics, surgical procedures, pathological diagnosis, and specimen weight. The relationships between IP and hypocalcemia were also evaluated. There were 587 (14.5%) IPs out of 4052 cases. In these patients, mostly one gland was removed (84.6%), and 23.2% of these glands were intrathyroidal. The rate of transient hypocalcemia was 39.9%, and that of permanent hypocalcemia was 1.7%. Female gender, malignancy, lower preoperative thyroid volume, presence of central lymph node dissection, lower specimen weight, presence of autotransplantation and capsule invasion in malignant cases were determined to be risk factors for IP. After excluding hemithyroidectomy and autotransplantation, transient and permanent hypocalcemia were found to be significantly higher in cases with IP (p < 0.001). Multivariate analysis showed that female sex, no multinodular goiter, central dissection, and low thyroid volume were risk-adjusted independent variables. Our findings highlight the significant role of IP in postoperative hypocalcemia. Given that most IPs are located in the perithyroidal region, precise surgical dissection is vital to preserve parathyroid gland function and prevent IP and subsequent hypocalcemia.

Incidental Carcinoid Tumor Arising in a Meckel's Diverticulum.

This case report describes a patient who presented with concern for a closed-loop small bowel obstruction (SBO). During exploratory laparotomy, an area of ischemic bowel due to closed loop obstruction was resected, along with an incidentally discovered inflamed-appearing Meckel's diverticulum (MD). The resected specimen contained a well-differentiated carcinoid tumor of benign behavior with a maximum diameter of 0.6 cm, which invaded the submucosal layer (pT1b and pN0). Over the last several years, there has been a debate with little consensus regarding the proper surgical management in the case of an asymptomatic MD that is discovered incidentally during abdominal exploration. The intention of sharing this case is to underline the importance of the decision-making process in treating patients with this intraabdominal pathologic condition found incidentally at the time of surgery.

When is it necessary to perform biopsy in asymptomatic postmenopausal women with incidental finding of thickened endometrium?

OBJECTIVE: To determine the cutoff value for endometrial thickness (ET) that prompts a biopsy in asymptomatic postmenopausal women with an incidental finding of thickened endometrium, and to develop a risk prediction model. METHODS: This is a retrospective cohort analysis of the clinical records of the Hysteroscopic Center of Fu Xing Hospital, Capital Medical University, Beijing, China. We collected asymptomatic postmenopausal women who presented with an ET of ≥4 mm (double-layer) as an incidental finding. We stratified the participants into non-malignant and malignant groups based on pathology results and assessed differences between the two groups. A receiver operating characteristic curve (ROC) was used to identify the cutoff value of ET for predicting endometrial malignancy. Logistic regression models were also constructed to predict the risk of malignancy. RESULTS: A total of 581 consecutive eligible cases were included. The optimal cutoff value for ET was 8 mm, with a maximum area under the curve (AUC) of 0.755 (95 % CI: 0.645-0.865). In addition to ET, the regression model incorporated diabetes, blood flow signal, BMI, and hypertension to predict the risk of malignancy. A ROC curve constructed for the model yielded an AUC of 0.834 (95 % CI: 0.744-0.924). CONCLUSION: It is reasonable to offer hysteroscopy and visually-directed endometrial biopsy for asymptomatic postmenopausal women when ET is 8 mm or above. For those with an ET between 4 and 8 mm, further decision to perform biopsy should be determined on an individual basis, considering risk factors and blood flow signals of the endometrium.

Radical cholecystectomy without liver resection for peritoneal side early incidental gallbladder cancer.

Gallbladder cancer (GBC) is a rare disease with a poor prognosis. Simple cholecystectomy may be an adequate treatment only for very early disease (Tis, T1a), whereas reoperation is recommended for more advanced disease (T1b and T2). Radical cholecystectomy should have two fundamental objectives: To radically resect the liver parenchyma and to achieve adequate clearance of the lymph nodes. However, recent studies have shown that compared with lymph node dissection alone, liver resection does not improve survival outcomes. The oncological roles of lymphadenectomy and liver resection is distinct. Therefore, for patients with incidental GBC without liver invasion, hepatic resection is not always mandatory.

Incidental Findings Following Dental Implant Procedures in the Mandible: A New Post-Processing CBCT Software Analysis.

Background/Objectives: The aim of this study was to evaluate incidental findings in the mandible after the placement of dental implants using a new cone-beam computed tomography (CBCT) software. Methods: The initial sample consisted of 2872 CBCT scans of patients of both sexes. The parameters evaluated in this study were the location of the implants in the mandible, implant length, anatomical relationship of the implant with the mandibular canal, presence or absence of damage to the adjacent teeth, presence or absence of implant fractures, and presence or absence of bone support. Fisher's exact test was performed to compare the variables. The significance level was set at p = 0.05. Results: Out of 2872 CBCT scans, 214 images of patients with an average age of 44.5 years were included. The most frequent location of the implants was the posterior region (93.5%), with 54% of the implants having a length between 9 and 14 mm. It was found that 92% of the implants were positioned above the mandibular canal. Damage to adjacent teeth was observed, with no correlation with the implant positioning (p = 1.000). In 100% of cases of implants in the anterior region, there was bone support. Fracture was observed in 1.7% of implants with a length between 9 and 14 mm. Conclusions: The installation of implants in the mandible occurs more frequently in the posterior region, with a high presence of bone support and a low incidence of damage to adjacent teeth, anatomical structures, and fractures.

Are diagnoses of unruptured intracranial aneurysms associated with quality of life, psychological distress, health anxiety, or use of healthcare services in untreated individuals? A longitudinal, nested case-control study.

Introduction: Increasing imaging examination rates leads to a corresponding rise in the detection rates of unruptured intracranial aneurysms (UIAs). There is limited knowledge on how the detection of UIA affects health-related outcomes in untreated patients. Research question: Is the diagnosis of UIA associated with psychosocial outcomes, healthcare services utilisation, or sick leave in untreated individuals? Material and methods: Nested case-control study with 96 participants diagnosed with UIAs through magnetic resonance angiography (MRA) screening, not receiving preventive aneurysm obliteration. Comparisons were made with Control1 (192 participants with negative MRAs) and Control2 (192 individuals not MRA screened). Quality of life, psychological distress, and health anxiety were assessed using EQ-5D-5L including EQ VAS, Hopkins Symptom Checklist-10, and Whiteley Index-6, respectively. Healthcare service utilisation and sick leave was measured using registry data. Median follow-up was 32-55 months for the different outcomes. Results: UIA were in general not associated with psychosocial outcomes, neither compared to pre-screening values nor to controls. The exemption was a lower mean EQ VAS score at follow-up for cases (76.7) versus Control1 (80.0), regression coefficient -3.87 (95% CI (-7.60, -0.14). Cases had significantly higher rates of radiology exams compared to controls, with 1.47 (95% CI 1.25, 1.74) exams per person-year versus 0.91 (C95% CI 0.75, 1.09) for Control1 and 0.95 (95% CI CI 0.79, 1.14) for Control2. No significant differences were observed in other psychosocial outcomes, healthcare services utilisation, or sick-leave. Discussion and conclusions: The overall impact of untreated UIAs appears to be limited when assessed years after diagnosis.

Reviving the Rarity of Cecal Lymphangioma: A Case Report.

The present case report describes the incidental discovery of cecal lymphangioma, a rare benign neoplasm originating from malformations of lymphatic vessels. Lymphangiomas are uncommon in the gastrointestinal tract, and their presence in the colon is particularly unusual. This finding adds to the limited literature on colonic lymphangiomas and emphasizes recognizing these unusual lesions. Further research is needed to understand better their clinical characteristics, potential complications, and optimal management strategies, especially in atypical locations such as the colon.

Corrigendum: How incidental and intentional news exposure in social media relate to political knowledge and voting intentions.

[This corrects the article DOI: 10.3389/fpsyg.2023.1250051.].

Is episodic-like memory like episodic memory?

Episodic memory involves the conscious recollection of personally experienced events and when absent, results in profound losses to the typical human conscious experience. Over the last 2.5 decades, the debate surrounding whether episodic memory is unique to humans has seen a lot of controversy and accordingly has received significant research attention. Various behavioural paradigms have been developed to test episodic-like memory; a term designed to reflect the behavioural characteristics of episodic memory in the absence of evidence for consciously experienced recall. In this review, we first outline the most influential paradigms that have been developed to assess episodic-like memory across a variety of non-human taxa (including mammals, birds and cephalopods), namely the what-where-when memory, incidental encoding and unexpected question, and source memory paradigms. Then, we examine whether various key features of human episodic memory are conceptually represented in episodic-like memory across phylogenetically and neurologically diverse taxa, identifying similarities, differences and gaps in the literature. We conclude that the evidence is mixed, and as episodic memory encompasses a variety of cognitive structures and processes, research on episodic-like memory in non-humans should follow this multifaceted approach and assess evidence across various behavioural paradigms that each target different aspects of human episodic memory.This article is part of the theme issue 'Elements of episodic memory: lessons from 40 years of research'.

Mental time travel in the rat.

I outline the perspective that searching the contents of memory is a form of mental time travel (MTT) in non-humans that is relatively tractable because it focuses on the contents of memory. I propose that an animal model of MTT requires three elements: (i) the animal remembers multiple events using episodic memory, (ii) the order of events in time is included in the representation, and (iii) the sequence of events can be searched to find a target that occurred at a particular time. I review experiments suggesting that rats represent multiple items in episodic memory (element 1) in order of occurrence (element 2) and engage in memory replay to search representations in episodic memory in sequential order to find information at particular points in the sequence (element 3). The cognitive building blocks needed for MTT may be quite old in the evolutionary timescale.This article is part of the theme issue 'Elements of episodic memory: lessons from 40 years of research'.

Ectopic Pancreatic Tissue in the Gallbladder.

Background: Ectopic pancreatic tissue, also referred to as heterotopic pancreas, is defined as the presence of pancreatic tissue in an organ outside the pancreas. Ectopic pancreatic tissue, a rare embryologic abnormality, has been reported in the stomach, duodenum, colon, and Meckel diverticulum and is usually discovered incidentally. Case Report: We report a case of ectopic pancreatic tissue in the gallbladder of a 37-year-old female who underwent a cholecystectomy after a clinical diagnosis of chronic cholecystitis. Histopathologic findings were chronic cholecystitis with cholesterolosis and pyloric metaplasia. The gallbladder wall showed ectopic pancreatic tissue composed of acini, ducts, and islets of Langerhans. The histopathologic examination confirmed the diagnosis of ectopic pancreatic tissue. Conclusion: Making a preoperative diagnosis of ectopic pancreatic tissue is clinically and radiologically challenging. Meticulous histopathologic examination is required for the diagnosis of this rare condition.

Incidental detection of non-melanoma neoplasms in sentinel lymph node biopsy for melanoma staging: A retrospective case series.

BACKGROUND: Patients with malignant melanoma have an increased risk of developing secondary hematologic malignancy, and patients with hematologic malignancies have an increased risk of developing melanoma. Rarely, sentinel lymph node biopsies (SLNBs) collected for melanoma staging might harbor lymphoma or even carcinoma, which may represent a second primary malignancy (SPM). Biopsied lymph node(s) might serve as the first site of recognition for a SPM. Yet, there has been little systematic investigation regarding the characteristics of incidental SPMs detected on SLNB for melanoma staging. METHODS: A series of cases of lymphomas and carcinomas were detected incidentally during SLNB for melanoma staging from two tertiary academic centers between 2000 and 2021. RESULTS: Fifteen cases of incidentally detected SPMs were reviewed, comprising 12 lymphomas and three carcinomas. The most common incidentally detected second malignancy was chronic lymphocytic leukemia/small lymphocytic lymphoma (60%, 9/15). There were three cases of incidentally detected metastatic carcinoma. Of all incidentally detected malignancies, 2/3 carcinomas and 4/12 lymphomas represented first-time diagnoses of SPM in a melanoma patient. Forty percent of cases (6/15) also harbored metastatic melanoma in the sentinel lymph node. CONCLUSIONS: It is possible to incidentally detect SPMs in SLNBs for melanoma staging. Early detection of SPMs in melanoma patients has implications for the treatment of both incidental SPM and melanoma.

Incidental findings in research brain MRI: Definition, prevalence and ethical implications.

Radiological incidental findings (IFs) are previously undetected abnormalities which are unrelated to the original indication for imaging and are unexpectedly discovered. In brain magnetic resonance imaging (MRI), the prevalence of IFs is increasing. By reviewing the literature on IFs in brain MRI performed for research purposes and discussing ethical considerations of IFs, this paper provides an overview of brain IF research results and factors contributing to inconsistencies and considers how the consent process can be improved from an ethical perspective. We found that despite extensive literature regarding IFs in research MRI of the brain, there are major inconsistencies in the reported prevalence, ranging from 1.3% to 99%. Many factors appear to contribute to this broad range: lack of standardised definition, participant demographics variance, heterogenous MRI scanner strength and sequences, reporter variation and results classification. We also found significant discrepancies in the review, consent and clinical communication processes pertaining to the ethical nature of these studies. These findings have implications for future studies, particularly those involving artificial intelligence. Further research, particularly in relation to MRI brain IFs would be useful to explore the generalisability of study results.

A Modern Collaborative Behavior Analytic Approach to Incidental Naming.

An important distinction has been drawn within the behavior-analytic literature between two types of naming. Naming that is reinforced is referred to as bidirectional naming, and naming that is not reinforced is referred to as incidental bidirectional naming. According to verbal behavior development theory children who demonstrate incidental naming have developed a verbal behavioral cusp, and often learn new language more rapidly as a result. A growing body of research has assessed incidental naming using what is described as an incidental naming experience, in which novel stimuli are presented and named by a researcher but with no direct differential reinforcement for subsequent naming responses by the participant. According to relational frame theory, such studies on incidental naming have typically involved presenting contextual cues that likely serve to establish the name relations between an object and its name. As such, contextual cues may play a critical role in the emergence of incidental naming responses, but there are no published studies that have systematically tested the potential role of contextual cues in relation to incidental naming. The current article provides a narrative review of the incidental naming literature, highlighting variables that remain to be explored in future research.

Relating in the Wild: Toward an Analysis of Equivalence Relations Under More Naturalistic Conditions.

Since the first proposal 50 years ago, numerous experiments have documented how arbitrarily related stimuli can become functionally interchangeable. These studies have sought to understand how different variables can moderate the probability of equivalence class formation. However, the well-established evidence regarding this phenomenon in experimental settings does not necessarily guarantee an understanding about how equivalence relations are produced in natural settings. In typical experiments, experimenters control critical variables to produce equivalence relations, such as, the requirement of proficiency with baseline relations, the number of opportunities to relate two or more stimuli, the efforts to promote stimulus control topography coherent with the experimenter-defined relations, etc. All these variables, however, are not controlled in our daily lives. The present article elucidates how some differences between experimental and natural settings can likely affect how the phenomenon of equivalence relations can occur in noncontrolled, naturalistic environments. Furthermore, we suggest new areas of research to promote the generalization of basic experimental data to contingencies in our daily lives.

The outcomes of total knee arthroplasty following the incidental finding of tuberculosis and its treatment: A prospective study.

INTRODUCTION: Extrapulmonary tuberculosis (EPTB) accounts for 16 % of tuberculosis cases globally, with knee joint tuberculosis more prevalent in underdeveloped nations. Total knee arthroplasty (TKA) is commonly used to treat tubercular arthritis of knee, however, there is a marked paucity of research on the outcomes after an incidental diagnosis. The aim of the study is to investigate the outcomes of total knee arthroplasty after an incidental diagnosis of tuberculosis and its management. METHODS: A prospective-observational study was conducted in NCR-Delhi from May 2019 to June 2023, wherein 533 patients had synovial tissue abnormalities and 11 patients reported with positive histopathological examination (HPE) for knee tuberculosis. All the patients whose informed consent was obtained were put on a twelve-month standard treatment (2HRZE or S/10HR) according to World Health Organization (WHO) guidelines for extrapulmonary TB after TKA and were monitored for the outcome of treatment, any postoperative complication, or implant failure. RESULT: The mean age of the patients was 63 ± 13 years and 72.7 % of patients were female. The mean hemoglobin, Body Mass Index (BMI), and Erythrocyte Sedimentation Rate (ESR) values were 10.29 ± 1.36 mg/dl, 29.78 ± 6.1 kg/m2, and 37.37 mm/h respectively and the median of the C-reactive protein (CRP) value was 11 mg/dl at the time of operative procedure. All patients presented with knee-joint pain and swelling and were operated for knee-joint replacement surgery. After one year of standard treatment (2HRZE or S/10HR), no relapses, pain, or progressive radiolucency around the component, or postoperative neurologic or vascular complications were observed. The median range of motion (ROM) was improved from 10 - to 100 to 0-115, the average knee score improved from 44.9 ± 8.9 to 84.9 ± 7.73 points and the average function score improved from 28.82 ± 15.56 to 94.0 ± 7.68 points which were statistically significant at 95 % CI (p < 0.0001). CONCLUSION: We concluded from this study that any abnormalities in ESR, CRP level prior to, and bone tissue or synovial tissue during operative procedure should be considered for articular tuberculosis and managed according to guidelines. This will make replacement procedures more sustainable and effective by lowering the risk of post-operative infection or implant-related complications and improving patients' quality of life.