Outcomes after laser interstitial thermal ablation for temporal lobe epilepsy: a systematic review and meta-analysis.

Epilepsy is a common condition that affects approximately 1% of the world's population, with about one-third being refractory epilepsy. Temporal lobe epilepsy is the most common type of drug-resistant epilepsy, and laser interstitial thermal therapy (LITT) is an innovative treatment. In this systematic review and meta-analysis, we aimed to summarize the current evidence on outcomes after LITT, including seizure freedom rate, complication rate, and neurocognitive outcome. PubMed and OVID Medline search engines were systematically searched for all indexed publications in the English language up to July15, 2023. The search was limited to human studies. Proportions and 95% confidence interval (CI) values were calculated for seizure, neurocognitive outcome, and complication rate. A total of 836 patients were included. Overall seizure outcomes, regardless of the pathology, included Engel I outcome in 56% (95% CI, 52.4-59.5%), Engel II outcome in 19.2% (95% CI, 15.4-23.6%), Engel III outcome in 17.3% (95% CI, 13.5-21.8%), and Engel IV outcome in 10.5% (95% CI 6.3-17%) of the patients. The overall decline in verbal and visual memory regardless of laterality was 24.2 (95% CI 8.6-52%) and 25.2% (8.3-55.8%). For naming, the decline was 13.4% (6.6-25.4%). The results of the pooled analysis in comparison with available data in the literature showed that seizure outcomes after LITT were slightly inferior to published data after temporal lobectomy. Data on cognitive outcomes after LITT are scarce and heterogeneous.

Pancreatic Carcinoid Tumor in a Pediatric Patient.

BACKGROUND Carcinoid tumors are well-differentiated tumors that develop from neuroendocrine cells. They are rare tumors and occur most commonly in the gastrointestinal tract, followed by the pulmonary system. They usually present with abdominal pain or cough or persistent pneumonia. They are usually diagnosed with computed tomography (CT) or magnetic resonance imaging (MRI) of the chest or abdomen. The cornerstone of treatment is surgical resection. There are rare reported cases of carcinoid tumor presenting in the pancreas as gastrinoma or insulinoma and are associated with multiple endocrine neoplasia type 1 (MEN1). CASE REPORT We report a case of an otherwise healthy 9-year-old girl who presented with manifestations of Cushing syndrome (easy fatigability, weakness, back pain, easy bruising, hirsutism, acne, skin discoloration [pigmentation], and blurred vision). She was diagnosed with incidental carcinoid tumor in the pancreas based on hypertension and typical stigmata. She underwent distal pancreatectomy and splenectomy. The histopathology showed a well-differentiated neuroendocrine tumor with G2. The diagnosis of concurrent Cushing syndrome and carcinoid syndrome can be challenging, as it is rare. It is important to screen for MEN syndrome when Cushing syndrome occurs in a child, as there is a high rate of transition to malignancy. They are usually diagnosed with ACTH, cortisol, and imaging. CONCLUSIONS Incidental hypertension in children is not common and mandates further investigation and clinical work-up to look for endocrinopathies such as Cushing syndrome and carcinoid syndrome. As the literature on such cases is scant, further reporting of cases is needed.

Substance P/ Neurokinin-1 Receptor, Trigeminal Ganglion, Latency, and Coronavirus Infection-Is There Any Link?

Novel Severe Acute Respiratory Syndrome-Corona Virus-2 infection (SARS-CoV-2) is an acute respiratory and infectious disease. This perspective aims to provide a basic understanding of the inflammation caused by SARS-CoV-2 and its relation to the trigeminal ganglion (TG). The virus enters through the mucous membranes of the orofacial region and reaches the TG, where it resides and takes control of its peptides including Substance P (SP). SP is the main neuropeptide, neuromodulator, and neuro-hormone of TG, associated with nociception and inflammation under noxious stimulus. SP release is triggered and, consequently, affects the immune cells and blood vessels to release the mediators for inflammation. Hence, cytokine storm is initiated and causes respiratory distress, bronchoconstriction, and death in complicated cases. Neurokinin-1 Receptor (NK-1R) is the receptor for SP and its antagonists, along with glucocorticoids, may be used to alleviate the symptoms and treat this infection by blocking this nociceptive pathway. SP seems to be the main culprit involved in the triggering of inflammatory pathways in SARS-CoV-2 infection. It may have a direct association with cardio-respiratory rhythm, sleep-wake cycle, nociception, and ventilatory responses and regulates many important physiological and pathological functions. Its over-secretion should be blocked by NK-1R antagonist. However, experimental work leading to clinical trials are mandatory for further confirmation. Here, it is further proposed that there is a possibility of latency in SARS-CoV-2 virus infection if it is acting through TG, which is the main site for other viruses that become latent.

Analysis of 190 Female Patients after Appendectomy.

This study is a retrospective cohort review carried out at a single, private tertiary center. We included 190 female patients who underwent surgery for acute appendicitis between January 2016 and December 2018. Two groups of patients were analyzed based on the pregnancy. The main outcome measures were complication rate and risk of abortion during or after surgery. Out of 190 female patients, eight of them were pregnant (4.2%). The pregnant group more significantly underwent ultrasound investigation compared to the nonpregnant group. Complicated appendicitis present in two pregnant patients at advanced gestational age was not statistically significant from nonpregnant. Laparoscopic appendectomy was performed in 6/8 (75%) of pregnant compared to 158/182 (87%) in nonpregnant (p = 0.415). Compared to the nonpregnant, the pregnant group has a more fecolith, positive peritoneal fluid culture, and wound infection, with E. coli more frequently isolated in 25%. None of the pregnant patients had an abortion, preterm labor, or mortality during or after surgery. In conclusion, laparoscopic appendectomy is a low-risk operation for pregnant with acute appendicitis.

A Successful En Bloc Excision of a Giant Retroperitoneal Liposarcoma With Distal Splenopancreatectomy.

Retroperitoneal sarcomas are considered a rare type of malignant tumors, accounting for fewer than one-fifth of all cases. Among all malignancies, the incidence of soft tissue sarcomas is approximately 1%. It constitutes 38% of soft tissue sarcomas in liposarcomas. Putting it that way may better indicate that liposarcomas are a rare tumor. They are frequently asymptomatic until they become large enough to compress the adjacent organs. As a result, it must be validated using appropriate imaging modalities, for example, computed tomography (CT) abdomen or magnetic resonance imaging (MRI) abdomen with contrast. The preferred treatment is complete surgical resection. The patient presented with vague symptoms. She had a CT abdomen with contrast, as well as an MRI abdomen. Both images revealed the presence of a giant sarcoma displacing the pancreas and left kidney posteriorly and the transverse colon inferomedially. The patient underwent en bloc resection of the mass with distal splenopancreatectomy. The patient tolerated the procedure well and was discharged on day 6 postoperatively in a stable state. Giant liposarcoma is a rare and aggressive form of sarcoma. Because of the unique presentation, it is difficult to diagnose clinically. CT scans with MRIs are viable imaging modalities for determining tumor extent and ruling out any vascular invasion. Complete surgical resection of liposarcoma is a treatment of choice. En bloc resection of retroperitoneal sarcoma with distal splenopancreatectomy can be performed successfully and safely.

Case Report: Ectopic Liver (Choristoma) Discovered During Laparoscopic Cholecystectomy.

BACKGROUND Ectopic liver (EL) is liver tissue that is not attached to the mother liver, and is also known as choristoma and hepar succenturiatum. According to Watanabe's 1060-patient series, it has an incidence rate of less than 1% (0.47%). The absence of an anatomical attachment to the hepatic proper is a rare congenital departure from the norm, known as EL. EL is thought to be caused by abnormal hepatic tissue growth from the foregut diverticulum, particularly at cystic structures. CASE REPORT We report the successful management of a 47-year-old male patient, not known to have any medical illness, who was referred to the surgical team with a clinical picture of biliary colic. An ultrasound (US) abdomen was performed, and cholecystitis was confirmed. During a laparoscopic cholecystectomy, ET was identified by chance. He tolerated the operation well. Gallbladder histological examination revealed significant mucosal and wall ulcers, chronic inflammation, many black stones, no dysplasia or malignancy, and connected liver tissue measuring 12×5 mm. As a result, chronic calcular cholecystitis was confirmed, as was normal EL architecture and no evidence of malignancy. CONCLUSIONS We conclude that EL is a rare condition, but there have been cases reported in the literature. Imaging modalities such as US and computed tomography scans are recommended to rule out other underlying diagnoses and should be tailored to each individual when necessary. Because the presence of EL attached to the vesicle is a rare occurrence in the literature, a histological examination is required due to the elevated risk of hepatocellular carcinoma. Keeping such an abnormality in mind can help surgeons demarcate the embryological plane of dissection during cholecystitis to avoid tumor cell spillages if present.

Elevation of CA 19-9 in Mirizzi Syndrome in the Absence of Malignancy: A Case Report.

BACKGROUND Mirizzi syndrome (MS) is relatively a rare condition; incidence rates may increment with age. It is characterized as an obstruction of the common hepatic duct (CHD) auxiliary to outward compression of an infected stone in the cystic duct. Carbohydrate antigen (CA) 19-9 is a tumor marker that is usually related to upper-gastrointestinal malignancies. However, a few case reports have shown high levels of CA19-9 in the absence of malignancy. In this case, we report a case of a patient with MS, elevated CA19-9, and radiological findings suggesting gallbladder cancer, which shows the challenges of diagnosis and therapeutic procedures. CASE REPORT We report the case of a 71-year-old Saudi man who presented to the emergency department with signs of obstructive jaundice. Magnetic resonance cholangiopancreatography (MRCP) revealed cholelithiasis, with a huge cystic duct stone compressing the CHD, resulting in mild intra-/extrahepatic biliary dilatation and positive MRCP pearl necklace sign for adenomyomatosis of the gallbladder. Serum tumor markers revealed raised levels of CA19-9 to 21 068 u/ml. The patient underwent laparoscopic cholecystectomy. Biopsy results confirmed the diagnosis of acute calcular cholecystitis and adenomyosis with no malignancy. CONCLUSIONS We report what can be considered a rare case of Mirizzi syndrome with a very high CA19-9 marker, in an elderly patient, in the absence of malignancy. This illustrates that Mirizzi syndrome and cholangiocarcinoma are difficult to distinguish, and the diagnosis is considered challenging. Thus, a high index of suspension must be kept in mind, especially in elderly patients, to rule out the cause of malignancy and thus to create an appropriate management plan.

A Large Lipoma of the Labia Majora.

A 40-year-old woman presented with a huge right labial swelling that had been enlarging gradually for the last four years. A 10-cm labial swelling was revealed on clinical examination. Preoperative magnetic resonance imaging (MRI) was used to rule out other possible diagnoses, such as hernias, vulvar cysts and tumours. When it came to assessing and diagnosing soft tissue swelling, MRI was the method of choice. It determined that the swelling had a bright T1 and T2 signal intensity similar to that of subcutaneous fat, with a decline in signal in fat-saturated sequences, indicating a diagnosis of vulvar lipoma. The mass was surgically excised, and histopathology confirmed the diagnosis of a benign lipoma. Lipomas are considered the most common soft tissue tumours accounting for a prevalence of 1% in the population. Their occurrence in the vulva in premenopausal women is considered rare and only a few cases of vulvar lipomas have been reported in the literature. Herein, we report a rare case of a patient with vulvar lipoma and review the available literature.

Knowledge and attitudes towards Zika virus among medical students in King Abdulaziz University, Jeddah, Saudi Arabia.

Zika Virus (ZIKV) and its associated consequences remain vital public health challenge of international concerns. The current study was done to assess knowledge and attitudes towards ZIKV and the factors associated with good knowledge among medical students in King Abdulaziz University, Jeddah. A cross-sectional study was conducted among 426 students. They were selected through multistage stratified random sample method, 2016. A validated, confidential, interviewing questionnaire contained 25 knowledge and 10 attitude items was used. Descriptive and inferential statistics were done. Results revealed that Facebook was the commonest source of ZIKV information. About half of the participants correctly identified mosquito bites and vertical route as ZIKV transmission modes. However, smaller percentages recognized the sexual and blood transmission modes. Calculations of knowledge score revealed that 77.5%, 15.0%, and 7.5% of the participants obtained poor, fair, and satisfactory scores, respectively. Age, educational year and attending ZIKV training were significantly associated with good knowledge (p<0.05). Concerning attitudes, about half of the participants agreed that ZIKV could add new burden on healthcare system of the affected countries. Most of participants were interested in learning more about ZIKV, emerging diseases and travel epidemiology. In conclusion, medical students had limited knowledge about ZIKV, and good attitudes towards learning about it. Conduction of ZIKV educational programs, and development of courses about emerging disease epidemiology are required.