[Identification of differentiated dysplasia improves prediction of oral leukoplakia at increased risk of malignant progression]. / Onderkenning van gedifferentieerde dysplasie voor het voorspellen van de kans op maligne ontaarding van orale leukoplakie.

Oral leukoplakia is the most common potentially malignant disorder of the oral mucosa with a rate of malignant transformation into oral squamous cell carcinoma of 1-2% annually. The presence or absence of dysplasia as defined by the WHO is an important histological marker for malignant transformation risk assessment, but is not sufficiently accurate for patient stratification. We investigated whether identifying differentiated dysplasia contributes to oral leukoplakia malignant transformation risk assessment. We investigated whether classic or differentiated dysplasia were present in 84 oral leukoplakias. In 25 of these patients a squamous cell carcinoma developed during follow-up. Risk of malignant progression of oral leukoplakia increased from 3.3 (HR, p = 0.002) when only classic dysplasia was considered to 7.4 (HR, p = 0.001) when both classic and differentiated dysplasia were combined. This study demonstrates that identifying differentiated dysplasia as a separate type of dysplasia is important for the prognosis and stratification of patients with oral leukoplakia.

Optimal patient position for percutaneous nephrolithotomy in horseshoe kidneys: Traditional prone or supine?

OBJECTIVE: Although it was stated that supine percutaneous nephrolithotomy (PCNL) was associated with relatively shorter surgical times and comparable success and complication rates, there is no consensus in the current literature concerning the safety and efficacy of supine PCNL in patients with horseshoe kidneys. We aimed to compare supine and prone PCNL regarding safety and efficacy in patients with horseshoe kidneys. METHODS: Data of the patients with horseshoe kidneys who underwent PCNL for renal stones larger than 2 cm between January 2010 and May 2021 were retrospectively reviewed. The study patients were categorized as Group 1 (i.e., supine PCNL-SPCNL) and Group 2 (i.e., prone PCNL-PPCNL). Both groups were compared regarding demographic, clinical, and surgical data. RESULTS: Sixty-five patients were included. Among these patients, 31 (47.7%) were in Group 1, while 34 (52.3%) were in Group 2. Both groups were statistically similar in terms of demographic data, stone characteristics, perioperative parameters, and complication rates (p > 0.05). There was no statistical difference in terms of additional treatment rates, stone-free rates in the postoperative second-day and third-month evaluations (p > 0.05). Mean surgical time was significantly longer in Group 2 (113 ±â€¯17.1 min) than in Group 1 (90.6 ±â€¯11.3 min) (p = 0.000). CONCLUSION: Although it is traditionally performed in the prone position, the supine approach is as safe and effective as the prone approach. In addition, the supine approach is associated with significantly shorter surgical times.

Randomized clinical trial of an enhanced recovery after surgery programme versus conventional care in laparoscopic Roux-en-Y gastric bypass surgery.

Background: Enhanced recovery after surgery (ERAS) programmes have led to a decreased duration of hospital stay in several surgical fields, but have not been fully tested in patients undergoing laparoscopic Roux-en-Y gastric bypass (LRYGB) for obesity. This study aimed to investigate an ERAS programme versus standard care in these patients. Methods: Between January 2013 and July 2014, patients undergoing LRYGB were randomized to ERAS or conventional care. The primary outcome was functional hospital stay, defined as the time between end of surgery and when predefined discharge criteria (pain adequately controlled, fever and postoperative nausea and vomiting (PONV) absent, full liquid diet tolerated, mobilized and feeling fit for discharge) were met. Secondary outcomes were total length of hospital stay, 30-day complication and mortality rates, duration of surgery, time spent on the recovery ward and health-related quality of life. Results: A total 220 patients were randomized to ERAS (110 patients) or conventional (110) care. Patients in the ERAS group had shorter functional hospital stay (17·4 versus 20·5 h; P < 0·001), quicker pain control, tolerated liquid diet earlier, had earlier control of PONV, mobilized sooner and were comfortable with discharge sooner than those receiving conventional care. Total length of hospital stay, duration of surgery, time spent on the recovery ward, health-related quality of life, complication and readmission rates did not differ between the study groups. There were no deaths. Conclusion: Patients under ERAS care recovered faster after LRYGB surgery than those receiving conventional care, with no increase in readmission and postoperative morbidity rates. Registration number: NTR3853 (http://www.trialregister.nl/).

Mixed germ cell tumor of the ovary with sarcomatous component.

Germ cell tumors constitute a very complicated group of tumors of the ovary and their histogenesis is not yet clarified. Besides their histological heterogeneity, sarcomatous areas have also been described. A right ovarian mass was found in a 23-year-old female, who was being treated in the hospital for miscarriage. Disseminated omental metastases were detected during abdominal laparotomy. Pathological examination of the dissected material revealed the tumor to be a mixed germ cell tumor (immature teratoma and dysgerminoma) with sarcomatous component. Areas resembling granulosa cell tumor were also encountered. This ovarian tumor with many different histopathological features is presented with a review of the literature. The importance of thorough sampling in determining the type and extent of the malignant components is also emphasized due to their direct relation with the prognosis.

Fine needle aspiration of malignant bone lesions.

OBJECTIVE: To determine the role of fine needle aspiration (FNA) cytology in the early diagnosis of malignant bone lesions. STUDY DESIGN: Thirty-eight bone lesions that were considered malignant clinically and radiographically were evaluated by FNA. The results were compared with the histopathology of the subsequent open biopsies. RESULTS: An accuracy rate of 89.5% was achieved by FNA. Eighty-four percent of the cases were consistent with the clinical and radiographic findings. Chondrosarcoma gave the greatest diagnostic difficulty in the differential diagnosis with other chondroid tumors. Giant cell tumor cases also produced some difficulty when the cytology was hemorrhagic and low in cellularity, displaying features of other benign bone lesions containing giant cells. Ewing's sarcoma and multiple myeloma could be identified when interpreted with their coexistent clinical findings. The metastatic carcinoma cases were also easy to define, forming another group with a high rate of accuracy. CONCLUSION: FNA plays a valuable role in the initial diagnosis of malignant bone lesions. Cytologic assessment with the clinical and radiologic findings, together with the experience of the cytopathologist, can yield almost the same diagnostic accuracy in the majority of the lesions.

Clearance of Tc-99m DTPA aerosol in mismatched and matched pulmonary perfusion defects.

PURPOSE: To evaluate clearance changes of Tc-99m DTPA aerosol in mismatched and matched pulmonary perfusion defects. MATERIALS AND METHODS: Twenty-one patients (14 women, 7 men; mean age, 51 +/- 14 years) with possible pulmonary embolism were included in the study. On the day after perfusion (Q) scintigraphy with 5 mCi Tc-99m MAA, radioaerosol inhalation scintigraphy was performed using 45 mCi Tc-99m DTPA. Immediately and 45 minutes after the inhalation, early and delayed inhalation images (EI and DI, respectively) were obtained. Group 1 included 11 patients with mismatched defects who had a high probability of pulmonary embolism according to the Q/EI scan results. Group 2 included 10 patients with matched defects who had a low probability of PE. Contralateral normal lungs of 7 patients in group 2 served as controls (group 3). In groups 1 and 2, regions of interest were drawn over the mismatched and matched perfusion defects where they were best visualized, and this region of interest was mirrored to the same region on EI and DI images. For the control group, this was done in the contralateral normal lung. Mean counts in each region of interest were used for quantitative analysis, and the percentage clearance ratio was calculated using the following formula: early counts - late counts/early counts x 100. RESULTS: The average percentage clearances for the three groups were as follows: group 1, 37% +/- 10%; group 2, 21% +/- 4%; group 3, 24% +/- 7%. Differences between groups 1 and 3 were significant, as were those between groups 1 and 2 (P < 0.05). Patients with mismatched perfusion defects had increased DTPA clearance compared with the control group and those with matched defects. CONCLUSIONS: Vascular occlusion may lead to impairment of the alveolar-capillary barrier and consequently an increase in the clearance of Tc-99m DTPA aerosol in embolized regions. Immediately after inhalation, Tc-99m DTPA imaging should be started in the projection where perfusion defects are best seen to avoid potential misinterpretation of pulmonary embolism.