Comparison of single- and multi-incision minimally invasive esophagectomy (MIE) for treating esophageal cancer: a propensity-matched study.

OBJECTIVE: To compare the perioperative outcome of minimally invasive (MIE) esophagectomy performed with a single- or a multi-incision in treating esophageal cancer. METHOD: Patients with esophageal cancer who underwent MIE from 2006 to 2016 were evaluated. A 3-4-cm incision was created in both the thoracoscopic and the laparoscopic phases during the single-incision MIE procedures. A propensity-matched comparison was made between the two groups of patients. RESULTS: We analyzed a total of 48 pairs of patients with propensity-matched from the cohort of 360 patients undergoing MIE during 2006-2015. There is no statistical difference in terms of postoperative ICU and hospital stay, number of dissected lymph nodes and presence of major surgical complications (anastomotic leakage and pulmonary complications) between the two groups of patients. The pain score one week after surgery was significantly lower in the single-incision group (p < 0.05). There was no surgical mortality in the single-incision MIE group. CONCLUSION: Minimally invasive esophagectomy performed with a single-incision approach is feasible for treating patients with esophageal cancer, with a comparable perioperative outcome with that of multi-incision approaches. The postoperative pain one week after surgery was significantly reduced in patients undergoing single-incision MIE.

[Factors associated with self-care behaviors in middle-aged adults and elderly with diabetes mellitus].

BACKGROUND: Adequate self-care behavior in diabetic individuals is essential to reduce the progress of the condition and reduce diabetes related complications. Continued research to understand the factors associated with self-care behaviors is needed in order to reduce health care costs and the social burdens associated with diabetes. PURPOSE: To investigate factors associated with self-care behaviors in individuals with diabetes in the community. METHODS: Researchers used secondary data analysis to assess survey data on diabetic individuals obtained from the Community Integrated Screening conducted by the Meishan Township Public Health Center and adult health examinations. Descriptive statistics and multiple linear regression analyses evaluated the independent factors associated with self-care behaviors. RESULTS: A total of ninety-seven individuals with Type 2 diabetes met the inclusion criteria. Mean age was 67.1 years and 37.1% was male. Results from multiple linear regression analysis indicated self-care behavior as poorer in individuals who drank alcohol during the past six months (p=.001), smoked cigarettes during the past six months (p=.015), and/or practiced religious or spiritual beliefs (p=.003). CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Findings from this study can help understand factors affecting self-care behaviors in individuals with diabetes in the community. Medical and public health units should focus on providing effective advice on smoking and drinking cessation to individuals with diabetes. Units should also clarify potential conflicts between individuals' self-care behaviors and their religious or spiritual beliefs.

Isolated intraventricular aspergillosis in a schizophrenic patient.

Intracranial aspergillosis of the lateral ventricle is a rare condition and has not been reported in a schizophrenic patient. We report a 39-year-old male patient with underlying schizophrenia and a rapid deterioration of consciousness. Initial cranial computed tomographic images revealed focal dilatation of the posterior part of the right lateral ventricle with a severe mass effect and midline shift. The patient received an emergency endoscopic ventriculostomy, and the resected mass was proven to be aspergillus. The patient was postoperatively treated by prolonged external ventricular drainage and antifungal medication, with no recurrence of aspergillosis at the 12-month follow-up.

Endovascular treatment for bilateral mycotic intracavernous carotid aneurysms. Case report and review of the literature.

Bilateral mycotic aneurysms of the intracavernous segment of the internal carotid artery (ICA) are exceedingly rare. The authors present the case of a 46-year-old man with bilateral mycotic intracavernous carotid aneurysms, which were treated with a stent-assisted vessel wall remodeling technique with preservation of the parent arteries. The patient recovered quite satisfactorily after completing the whole course of treatment. Based on an extensive review of the literature, no reported case of bilateral mycotic aneurysm of the intracavernous segment of the ICA has been treated with this mode of endovascular therapy. This mode of treatment could be a therapeutic alternative for intracavernous mycotic aneurysms.

Unusual magnetic resonance characteristics of a cerebellopontine angle epidermoid cyst with upper cervical spinal canal extension.

We present a 27-year-old woman with an epidermoid cyst at the cerebellopontine (CP) angle with caudal extension into the upper cervical spinal canal. The lesion showed unusual hyperintensity on T1-weighted images, and hypointensity on T2-weighted images. We used microneurosurgical techniques for tumour dissection and excision. To our knowledge, this is the fifth example in Index Medicus/MEDLINE of histopathologically proven CP angle epidermoid with cervical spine extension.

Ictal and interictal 99mTc-HMPAO brain SPECT of a MELAS case presented with epilepsy-like visual hallucination.

A 55-year-old woman was diagnosed with the syndrome of mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS). She was referred for Tc-HMPAO brain SPECT because of visual hallucinations, which were suspected to be related to epileptic seizures. Ictal SPECT images showed remarkable hyperperfusion in the left occipital cortex, which returned to near-normal status on the interictal SPECT images after treatment with anticonvulsants. It is very rare to see such an ictal SPECT image of epileptic or epilepsy-like disorders, especially in the setting of MELAS syndrome with visual hallucination.

White Matter tract involvement in brain tumors: a diffusion tensor imaging analysis.

BACKGROUND: Characterization of WM alteration using MR imaging is important in the pre- and intraoperative assessment of brain tumors. This study characterizes the extent and severity of WM tract alterations near brain tumors using DTI in an effort to determine preoperative viability or resectability of the adjacent WM tracts. Fractional anisotropy is an important DTI-derived metric of MR imaging. METHODS: Twenty-one patients underwent MR DTI. Eighty-six WM tracts composed of 43 WM lesions paired with 43 contralateral WM hemispheric controls were categorized using FA. Neuroradiologists categorized the WM tracts as edematous, displaced, disrupted, or infiltrated with tumor using directionally encoded color maps. A mixed model analysis was used to compare FA. RESULTS: Of the lesioned tracts, 5 were scored as edema, 9 as infiltration, 18 as displacement, and 11 as disruption. A significant DeltaFA(%) was found between the lesioned and contralateral hemispheres only in WM disruption (P = .0056). Both edema FA and disruption FA are significantly less than displacement FA (P < .05). The FA change (DeltaFA(%) = [FA(lesion) - FA(normal)]/FA(normal) x 100%) on the lesioned side was calculated. A DeltaFA% less than -30% is likely to be associated with WM disruption. A positive DeltaFA% is likely to be associated with edema or displacement, and a DeltaFA% between 0% and -30% is likely to be associated with WM displacement or infiltration. CONCLUSIONS: Quantitative analysis of DTI data may provide insight as to whether WM tracts are salvageable preoperatively.