RESUMEN
The rare combination of tetralogy of Fallot (TOF), absent pulmonary valve syndrome (APVS), and absent left pulmonary artery (ALPA) is reviewed herein. Children with TOF with APVS and ALPA should be closely monitored, even if they are asymptomatic or mildly symptomatic, and should undergo elective surgery at the end of infancy.
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Anomalías Múltiples , Arteria Pulmonar/anomalías , Válvula Pulmonar/anomalías , Tetralogía de Fallot , Anomalías Múltiples/diagnóstico , Anomalías Múltiples/cirugía , Angiografía , Procedimientos Quirúrgicos Cardiovasculares , Ecocardiografía , Procedimientos Quirúrgicos Electivos , Femenino , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Lactante , Masculino , Arteria Pulmonar/cirugía , Válvula Pulmonar/cirugía , Estudios Retrospectivos , Síndrome , Tetralogía de Fallot/diagnóstico , Tetralogía de Fallot/cirugíaRESUMEN
Coronary artery fistulas are a rare clinical entity in cardiac anomalies, and in a significant portion of patients, the fistulas are accompanied by coronary aneurysm formation. In this article, we present a giant circumflex coronary artery aneurysm with a fistula into the coronary sinus.
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Fístula Arteriovenosa/complicaciones , Fístula Arteriovenosa/diagnóstico por imagen , Angiografía por Tomografía Computarizada , Aneurisma Coronario/complicaciones , Aneurisma Coronario/diagnóstico por imagen , Seno Coronario/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: This study was undertaken to determine whether methylprednisolone could improve myocardial protection by altering the cytokine profile toward an anti-inflammatory course in patients undergoing elective coronary artery bypass grafting (CABG) surgery with cardiopulmonary bypass (CPB). METHODS: Forty patients who were scheduled for elective CABG surgery were randomized into two groups: the study group (n = 20), who received 1 g of methylprednisolone intravenously before CPB, and the control group (n = 20), who underwent a standard CABG surgery without any additional medication. Blood samples were withdrawn prior to surgery (T1) and then 4 hours (T2), 24 hours (T3), and 36 hours (T4) after CPB. Plasma levels of interleukin (IL)-6, IL-10, creatine kinase isoenzyme MB (CK-MB), cardiac troponin-t (cTnT), and blood glucose as well as neutrophil counts were measured at each sampling time. RESULTS: A comparison of patients between both groups revealed significantly high levels of IL-6 in the control group at T2, T3, and T4 with respect to T1 (T2: P < .001; T3: P < .001; T4: P < .001). IL-10 levels were significantly higher in the study group at T2 compared with the control group (P = .007). CK-MB levels were significantly lower in the study group than in the control group at T4 (P = .001). The increase of cTnT was higher in the control group at T3 and T4 compared with the study group (T3: P = .002; T4: P = .001). CONCLUSIONS: This study demonstrates that methylprednisolone is effective for ensuring better myocardial protection during cardiac surgery by suppressing the inflammatory response via decreasing the levels of IL-6 and by increasing anti-inflammatory activity through IL-10.
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Puente Cardiopulmonar/efectos adversos , Puente de Arteria Coronaria/efectos adversos , Metilprednisolona/administración & dosificación , Miocarditis/etiología , Miocarditis/prevención & control , Premedicación/métodos , Anciano , Antiinflamatorios/administración & dosificación , Puente Cardiopulmonar/métodos , Cardiotónicos/administración & dosificación , Puente de Arteria Coronaria/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
A 70-year-old male patient with myasthenia gravis required coronary artery bypass grafting due to triple-vessel disease. The anesthetic management was performed with general anesthesia using reduced doses of muscle relaxants. He was extubated four hours after surgery and the postoperative course was uneventful. Coronary artery bypass surgery in myasthenic patients can be challenging to anesthesiologists and cardiac surgeons. In this rare condition, a meticulous assessment of the patient's neurologic and cardiac status, and careful perioperative anesthetic management were needed in order to avoid life-threatening complications in both intraoperative and postoperative periods.
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Anestesia General/métodos , Puente Cardiopulmonar/métodos , Puente de Arteria Coronaria/métodos , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/cirugía , Miastenia Gravis/complicaciones , Anciano , Anestésicos Generales/administración & dosificación , Humanos , Cuidados Intraoperatorios/métodos , Masculino , Relajantes Musculares Centrales/administración & dosificación , Atención Perioperativa/métodos , Resultado del TratamientoRESUMEN
OBJECTIVE: Tumors belonging to the mixed epithelial stromal tumor family (MESTF) are rare; thus clinicopathological experience about them are limited. Each epithelial and stromal component shows different patterns in these tumors. MATERIAL AND METHOD: Clinicopathological features of 11 MESTF cases that were diagnosed between 2000 and 2021 at a single center were evaluated. RESULTS: Ten of the 11 patients were female (F:M = 10:1). The mean age of the females was 47 (31-63) years; the male patient was 45 years old. The mean tumor diameter was 6.7 (3.5-19) cm. All tumors had varying proportions of cystic and solid components. Eight cases were well circumscribed, and the others had distinct but irregular borders. Two of the tumors with irregular borders were bulging into the renal sinus. The epithelial component was dominant in most cases. In the epithelial component, macrocyst, microcyst, and tubules were the most common patterns and the most common types of lining epithelium were flat, cuboidal and hobnail. The stromal component was variable in most cases and included hypocellular (mostly collagenous) and cellular areas. In most cases, the cellular stroma had an ovarian-like appearance. Among the other features observed, hyalinization and dystrophic calcification were common. The positivity for estrogen and progesterone receptor in the stromal component was observed in almost all female cases. CONCLUSION: MESTF, which has distinctive features, should be considered in the differential diagnosis of cystic kidney tumors.
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Neoplasias Renales , Neoplasias de los Tejidos Blandos , Adulto , Diagnóstico Diferencial , Femenino , Humanos , Riñón/patología , Neoplasias Renales/patología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Neoplasias de los Tejidos Blandos/patología , Células del Estroma/patologíaRESUMEN
In the title compound, C(16)H(14)N(4)O(4)S·H(2)O, the benzene and pyridine rings make a dihedral angle of 85.8â (1)°. Both enanti-omers of the chiral title compound are statistically disordered over the same position in the unit cell. The methyl and carbonyl group attached to the stereogenic center (C(5) of the thia-zolidine ring) were therefore refined with common site-occupation factors of 0.531â (9) and 0.469â (9), respectively, for each stereoisomer. In the crystal, inter-molecular N-Hâ¯O, O-Hâ¯O and O-Hâ¯N hydrogen bonds link the mol-ecules, forming a three-dimensional supra-molecular network. The crystal structure further shows π-π stacking inter-actions [centroid-centroid distance = 3.5063â (13)â Å] between the pyridine rings.
RESUMEN
The title compound, C(16)H(14)ClN(3)O(2)S, crystallizes with two mol-ecules in the asymmetric unit. In the 1,3-thia-zolidine rings, the carbonyl O atoms, the S atoms, the methyl groups and the ring carbon attached to the methyl groups are disordered with occupancy ratios of 0.509â (7):0.491â (7) in one mol-ecule and 0.464â (14):0.536â (14) in the other. The crystal structure is stabilized by inter-molecular N-Hâ¯N, C-Hâ¯O hydrogen bonds and C-Hâ¯Cl inter-actions. In addition, there is a π-π stacking inter-action [centroid-centroid distance = 3.794â (3)â Å] between the benzene and pyridine rings.
RESUMEN
In the title compound, C(16)H(14)BrN(3)O(2)S, the atoms of the 1,3-thia-zolidine group, except for the N and the C atoms attached to the bromo-benzene ring, are disordered over two sets of sites with occupancies of 0.605â (13) and 0.395â (13). The benzene and pyridine rings make a dihedral angle of 86.2â (2)°. In the crystal, mol-ecules are linked by inter-molecular N-Hâ¯N and C-Hâ¯O hydrogen bonds, forming a three-dimensional network. Furthermore, there is a π-π stacking inter-action [centroid-centroid distance = 3.758â (2)â Å] between the pyridine and benzene rings.
RESUMEN
Villous adenomas (VAs) in the female urethra are rare with only seven cases in the English literature to our knowledge. In patients with bladder augmentation cystoplasty, the neoplasia development risk increases and most of these develop in the neobladder or anastomosis line. Only two cases of VA developing from the native bladder mucosa have been reported. Physical examination of a 76-year-old female who had a history of augmentation cystoplasty revealed a caruncula-like structure protruding from the urethral meatus. The urinary USG showed that the lesion had no relation with the bladder. The lesion was excised. Microscopically, it consisted of villous structures covered with pseudostratified intestinal type epithelium. Low-grade dysplasia was present in the epithelium but high-grade dysplasia or in-situ/invasive carcinoma was not observed. Immunohistochemical study showed positivity for CK7, CK20, EMA, CEA and CDX2. The case was reported as VA of the urethra. We presented the first VA case arising in the urethra of a female patient with intestinal bladder augmentation. Excision is curative for pure VAs. Transformation to carcinoma or recurrence has not been reported. However, in one third of the cases, a malignant tumor may accompany the lesion. Therefore, all excision material should be examined carefully. Routine endoscopic follow-up should be performed in cases with bladder augmentation.
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Adenoma Velloso/etiología , Uretra/cirugía , Neoplasias Uretrales/etiología , Procedimientos Quirúrgicos Urogenitales/efectos adversos , Adenoma Velloso/química , Adenoma Velloso/patología , Adenoma Velloso/cirugía , Anciano , Biomarcadores de Tumor/análisis , Femenino , Humanos , Resultado del Tratamiento , Uretra/patología , Neoplasias Uretrales/química , Neoplasias Uretrales/patología , Neoplasias Uretrales/cirugíaRESUMEN
In the title compound, C(15)H(12)BrN(3)O(2)S, the dihedral angle between the pyridine and benzene rings is 73.17â (19)°. The five-membered 1,3-thia-zolidine ring has an envelope conformation, with the S atom displaced by 0.196â (1)â Å from the mean plane of the four other ring atoms. An intra-molecular C-Hâ¯N inter-action occurs. The crystal structure is stabil-ized by inter-molecular N-Hâ¯O and C-Hâ¯O hydrogen bonds and C-Hâ¯π inter-actions. In addition, a weak π-π stacking inter-action is also observed between the 1,3-thia-zolidine and pyridine rings [centroid-centroid distance = 3.805â (2)â Å].
RESUMEN
RATIONALE AND OBJECTIVES: This study aimed to investigate whether benign and malignant renal solid masses could be distinguished through machine learning (ML)-based computed tomography (CT) texture analysis. MATERIALS AND METHODS: Seventy-nine patients with 84 solid renal masses (21 benign; 63 malignant) from a single center were included in this retrospective study. Malignant masses included common renal cell carcinoma (RCC) subtypes: clear cell RCC, papillary cell RCC, and chromophobe RCC. Benign masses are represented by oncocytomas and fat-poor angiomyolipomas. Following preprocessing steps, a total of 271 texture features were extracted from unenhanced and contrast-enhanced CT images. Dimension reduction was done with a reliability analysis and then with a feature selection algorithm. A nested-approach was used for feature selection, model optimization, and validation. Eight ML algorithms were used for the classifications: decision tree, locally weighted learning, k-nearest neighbors, naive Bayes, logistic regression, support vector machine, neural network, and random forest. RESULTS: The number of features with good reproducibility was 198 for unenhanced CT and 244 for contrast-enhanced CT. Random forest algorithm demonstrated the best predictive performance using five selected contrast-enhanced CT texture features. The accuracy and area under the curve metrics were 90.5% and 0.915, respectively. Having eliminated the highly collinear features from the analysis, the accuracy and area under the curve values slightly increased to 91.7% and 0.916, respectively. CONCLUSION: ML-based contrast-enhanced CT texture analysis might be a potential method for distinguishing benign and malignant solid renal masses with satisfactory performance.
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Carcinoma de Células Renales , Neoplasias Renales , Teorema de Bayes , Carcinoma de Células Renales/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Neoplasias Renales/diagnóstico por imagen , Aprendizaje Automático , Reproducibilidad de los Resultados , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Cerebral injury is a well-known complication after cardiac surgery with cardiopulmonary bypass (CPB), especially in adult patients. Specific biochemical markers like neuron-specific enolase (NSE) and S-100beta protein were developed previously for early detecting neuronal damage after CPB. Corticosteroids are shown to reduce multisystemic deleterious effects of cardiopulmonary bypass due to their anti-inflammatory characteristics. The aim of this study is to demonstrate the decrease of serum neuron-specific enolase levels in patients who received corticosteroids before CPB. METHODS: Thirty patients scheduled for elective coronary bypass surgery were included in the study. Patients were divided randomly into two groups as the control group (n = 15) who underwent a standard coronary bypass surgery without any additional medication and the study group (n = 15) who received 1 gm of methylprednisolone before CPB. Blood samples for analysis of serum NSE, interleukin-6 (IL-6), and IL-10 were drawn before CPB, 4 and 24 hours after the end of extracorporeal circulation. RESULTS: Serum cytokine and NSE levels were significantly increased after CPB above their normal range in both groups. In the study group, IL-6 and NSE levels were significantly reduced while IL-10 levels were much higher after CPB. High NSE levels significantly correlated with IL-6 levels in the control group. CONCLUSION: The lower levels of NSE in patients who received methylprednisolone may suggest that corticosteroids might be useful in decreasing possible neuronal damage during heart surgery. However, we were not able to demonstrate an adverse neurological outcome.
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Puente de Arteria Coronaria , Metilprednisolona/uso terapéutico , Fármacos Neuroprotectores/uso terapéutico , Fosfopiruvato Hidratasa/sangre , Premedicación , Biomarcadores/sangre , Lesiones Encefálicas/sangre , Lesiones Encefálicas/prevención & control , Femenino , Humanos , Interleucina-10/sangre , Interleucina-6/sangre , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Human epidermal growth factor receptor 2 (HER2) protein overexpression or gene amplification has been shown in urothelial bladder cancer. This could be helpful when using targeted anti-HER2 therapy on these tumors. OBJECTIVE: To evaluate HER2 immunohistochemical expression in conventional urothelial carcinoma (UC), in situ UC, and UC variants primarily in micropapillary urothelial carcinoma (MPUC). DESIGN, SETTING, AND PARTICIPANTS: The study evaluated 60 MPUC cases; 25 invasive, 20 low-grade noninvasive, and 10 high-grade noninvasive UC cases; 8 in situ UC cases; and 69 UC variant cases. The immunohistochemistry staining was scored according to recommendations of the American Society of Clinical Oncology/College of American Pathologists 2013 HER2 test guideline established for breast cancer and only 3+ staining was considered HER2 overexpression. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: HER2 overexpression was determined by 3+ staining. RESULTS AND LIMITATIONS: 34 of 60 MPUC cases (56%) showed HER2 overexpression (3+ staining). We observed 3+ staining HER2 overexpression in nine of 25 conventional invasive UC cases (36%), four of eight in situ UC cases (50%), and three of six lipid cell variant cases (50%). 3+ staining HER2 overexpression was not seen in eight glandular, six small cell, and five sarcomatoid variant cases. HER2 overexpression was negative in the 20 low-grade noninvasive UC cases but positive in two of the 10 high-grade noninvasive UC cases (20%). We observed HER2 overexpression most commonly in MPUC cases. We also found HER2 overexpression in conventional invasive and in situ UC cases. CONCLUSIONS: Pure in situ UC and conventional invasive UC, especially MPUC, could be candidate tumors for treatment with anti-HER2 antibody (trastuzumab therapy). PATIENT SUMMARY: Targeted therapy has a limited place in treatment of bladder cancer. In this study, human epidermal growth factor receptor 2 (HER2) overexpression in bladder carcinomas was evaluated in a large number of cases. Anti-HER2 therapy could be used in bladder cancers, as in breast and gastric cancers.
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Carcinoma Papilar/metabolismo , Carcinoma de Células Transicionales/metabolismo , Receptor ErbB-2/antagonistas & inhibidores , Neoplasias de la Vejiga Urinaria/metabolismo , Urotelio/metabolismo , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/metabolismo , Carcinoma Papilar/patología , Carcinoma de Células Transicionales/patología , Femenino , Amplificación de Genes/genética , Humanos , Masculino , Persona de Mediana Edad , Terapia Molecular Dirigida/métodos , Invasividad Neoplásica/patología , Receptor ErbB-2/metabolismo , Trastuzumab/uso terapéutico , Neoplasias de la Vejiga Urinaria/patología , Urotelio/patologíaRESUMEN
Aldehyde dehydrogenase 1 (ALDH1) has been identified as a marker of cancer stem cells in breast cancer (BC). Recent studies showed that ALDH1 expression is correlated with poor prognostic parameters and worse clinical outcome in BC. We evaluated ALDH1 expression by immunohistochemistry in a series of 217 invasive BCs and investigated the correlation between ALDH1 expression and clinicopathological parameters, molecular subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 [HER2] type, and triple-negative BC [TNBC]), and patient survival. There was a significant association between ALDH1 expression and tumor grade (p < 0.001), i.e., the expression of ALDH1 was higher in high-grade tumors. ALDH1 expression was significantly associated with estrogen and progesterone receptor (ER and PR) negativity (p < 0.001) and HER2 positivity (p = 0.001). ALDH1 expression ratios were higher in HER2 type and TNBC. There was a statistically significant correlation between ALDH1 negativity and luminal A subtype (p < 0.001). The overall and disease free survival were shorter in ALDH1+ tumors, although without statistical significance. We confirm that ALDH1 is a potentially important, poor prognostic factor in BC, associated with high histological grade, ER/PR negativity and HER2 positivity. For more accurate results, ALDH1 expression should be evaluated in larger case series including various types/subtypes of BC.
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Biomarcadores de Tumor/genética , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/genética , Isoenzimas/genética , Retinal-Deshidrogenasa/genética , Adulto , Anciano , Anciano de 80 o más Años , Familia de Aldehído Deshidrogenasa 1 , Femenino , Humanos , Persona de Mediana Edad , Invasividad Neoplásica , Pronóstico , Receptor ErbB-2/análisis , Receptor ErbB-2/genética , Receptores de Estrógenos/análisis , Receptores de Progesterona/análisis , Análisis de Supervivencia , Neoplasias de la Mama Triple Negativas/diagnóstico , Neoplasias de la Mama Triple Negativas/genética , Adulto JovenRESUMEN
OBJECTIVE: There is no other screening program close to the success rate of PAP test. Cervical cytology constitutes a large workload so that quality control in cervical cytology is important for the quality assurance of pathology laboratories. MATERIAL AND METHOD: In this study, we collected the cervical cytology results from all over Turkey and discussed the parameters influencing the quality of the PAP test. The study was conducted with Turkish gynaecopathology working group and 38 centers (totally 45 hospitals) agreed to contribute from 24 different cities. The study was designed to cover the cervical cytology results during 2013. The results were evaluated from the data based on an online questionnaire. RESULTS: The total number of Epithelial Cell Abnormality was 18,020 and the global Epithelial Cell Abnormality rate was 5.08% in the total 354,725 smears and ranging between 0.3% to 16.64% among centers. The Atypical squamous cells /Squamous intraepithelial lesion ratios changed within the range of 0.21-13.94 with an average of 2.61. When the centers were asked whether they performed quality assurance studies, only 14 out of 28 centers, which shared the information, had such a control study and some quality parameters were better in these centers. CONCLUSION: There is an increase in the global Epithelial Cell Abnormality rate and there are great differences among centers. Quality control studies including the Atypical squamous cells/Squamous intraepithelial lesion ratio are important. Corrective and preventive action according to quality control parameters is a must. A cervical cytology subspecialist in every center can be utopic but a dedicated pathologist in the center is certainly needed.
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Detección Precoz del Cáncer/normas , Oncología Médica/normas , Control de Calidad , Neoplasias del Cuello Uterino/epidemiología , Frotis Vaginal/normas , Femenino , Humanos , Turquía/epidemiología , Neoplasias del Cuello Uterino/diagnósticoRESUMEN
BACKGROUND: Carotid body tumors are rare, highly vascularized neoplasms that arise from the paraganglia located at the carotid bifurcation. Surgery is the only curative treatment. However, treatment of bilateral carotid body tumors represents a special challenge due to potential neurovascular complications. CASE REPORT: We present the therapeutic management of a 34-year-old woman with bilateral carotid body tumors. The patient underwent surgical resection of the largest tumor. It was not possible to resect the tumor without sacrificing the ipsilateral vagal nerve. Due to unilateral vagal palsy, we decide to withhold all invasive therapy and to observe contralateral tumor growth with serial imaging studies. The patient is free of disease progression 5 years later. CONCLUSIONS: Treatment of bilateral CBTs should focus on preservation of the quality of life rather than on cure of the disease. In patients with previous contralateral vagal palsies, the choice between surgery and watchful waiting is a balance between the natural potential morbidity and the predictable surgical morbidity. Therefore, to avoid bilateral cranial nerve deficits, these patients may be observed until tumor growth is determined, and, if needed, treated by radiation therapy.
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Arteria Carótida Común/cirugía , Tumor del Cuerpo Carotídeo/cirugía , Diagnóstico por Imagen/métodos , Procedimientos Quirúrgicos Vasculares/métodos , Adulto , Angiografía , Biopsia , Tumor del Cuerpo Carotídeo/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Calidad de Vida , Factores de TiempoRESUMEN
Pure, benign epidermoid cysts of the abdominal viscera are rare. There have been only six reports of epidermoid cysts of the cecum in the literature. A 31-year-old female with a previous cesarean delivery was admitted to our hospital with inguinal pain. After admission to the hospital, she was operated with the initial diagnosis of adnexal mass. During the operation, no adnexal pathology was identified. A heterogeneous mass originated from the posterior surface of the cecum was observed. It had no connection with the lumen. The mass was then removed with dissection. Macroscopically, the mass was 9x7 cm in diameter and wall thickness was 0.1 cm. The inner and outer surfaces were smooth. It was filled with a dense yellow, thick-fatty material with no tooth, hair, bone, or calcification areas. On microscopic examination, the inner lining was composed of mature keratinized stratified squamous epithelium with a granular layer. In view of the later findings, the case was reported as epidermoid cyst of the cecum. Although epidermoid cysts are rarely seen in visceral organs, this case is the seventh case of cecum-originated epidermoid cyst that has been reported in the literature. The histogenesis of epidermoid cyst is unknown. These cysts are generally accepted to be sequestration cysts that may be either congenital or acquired. Acquired epidermoid cysts are believed to be traumatic or iatrogenic. The cesarean delivery may have been a cause of this condition in the present case. On ultrasonographic examination, these cysts can be misdiagnosed as ovarian cysts.
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Enfermedades del Ciego/diagnóstico , Errores Diagnósticos , Quiste Epidérmico/diagnóstico , Enfermedades de los Anexos/diagnóstico , Adulto , Enfermedades del Ciego/patología , Enfermedades del Ciego/cirugía , Endosonografía , Quiste Epidérmico/patología , Quiste Epidérmico/cirugía , Femenino , HumanosRESUMEN
Giant multilocular prostatic cystadenoma is a rare benign tumor that evolves from the prostate gland. Obstructive voiding symptoms occur in all reported cases. These lesions do not invade adjacent structures. Preoperative radiologic evaluation can define the benign nature of the lesion. Here we report a case of large cystic lesions identified by magnetic resonance imaging and sonographic findings that caused an extensive mass effect in the pelvis. When retrovesical, huge cystic lesions fill the pelvis completely in young men, with high levels of serum prostate-specific antigen, giant multilocular prostatic cystadenoma should be considered as a differential diagnosis. To our knowledge, this is the youngest case of prostatic cystadenoma reported in the literature.