Retraction: Urachal Abscess: A Rare Etiology of Acute Abdominal Pain in Adults.

[This retracts the article DOI: 10.7759/cureus.18193.].

Urachal Abscess: A Rare Etiology of Acute Abdominal Pain in Adults.

Abdominal pain is a common cause of emergency department visits. It often poses a diagnostic challenge for physicians given the broad spectrum of its possible medical and surgical etiologies. We report the case of a 32-year-old man who presented to the emergency department with a complaint of lower abdominal pain for one week. Abdominal examination revealed suprapubic mass and tenderness. Laboratory investigation revealed elevated leukocyte count and inflammatory markers. An abdominal ultrasound examination showed a collection with poorly defined borders. Additionally, CT demonstrated a soft tissue mass adjacent to the anterior abdominal wall with an upward track to the umbilicus, conferring the diagnosis of a urachal abscess. The patient underwent successful management of the abscess with surgical excision. This case highlights the importance for clinicians to be aware of congenital urachal anomalies since early recognition of the urachal cyst is essential to determine the proper surgical management.

Perinatal Transmission and Clinical Outcomes of Neonates Born to SARS-CoV-2-Positive Mothers.

BACKGROUND: The aim of the study was to investigate the clinical outcomes and rate of virus detection in neonates born to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive mothers. METHODS: This prospective study included neonates born to SARS-CoV-2-positive mothers, documenting their viral polymerase chain reaction results and clinical outcomes. RESULTS: Of the 130 neonates born to 122 SARS-CoV-2-positive mothers, 12% tested positive. Most (62%) neonates were delivered via cesarean section at an average gestational age of 36 weeks, with a birth weight of 2,900 g. Only 38% neonates required admission. SARS-CoV-2-positive infants were born at a significantly lower gestational age; had a significantly lower birth weight; and had significantly higher admission rates, surfactant therapy, and bradycardia than SARS-CoV-2-negative infants. There was no significant difference in mortality rates. CONCLUSION: This study documents perinatal transmission of SARS-CoV-2. It reports for the first time the occurrence of neonatal bradycardia as a complication of maternal SARS-CoV-2 infection. Despite that, neonates born to SARS-CoV-2-positive mothers had relatively good short-term outcomes.

Collision prediction for intracranial stereotactic radiosurgery planning: An easy-to-implement analytical solution.

PURPOSE: Gantry collision is a concern in linac-based stereotactic radiosurgery (SRS). Without collision screening, the planner may compromise optimal planning, unnecessary re-planning delays can occur, and incomplete treatments may be delivered. To address these concerns, we developed a software for collision prediction based on simple machine measurements. MATERIALS AND METHODS: Three types of collision were identified; gantry-couch mount, gantry-couch and gantry-patient. Trigonometric formulas to calculate the distance from each potential point of collision to the gantry rotation axis were generated. For each point, collision occurs when that distance is greater than the gantry head to gantry rotational axis distance. The colliding arc for each point is calculated. A computer code incorporating these formulas was generated. The inputs required are the couch coordinates relative to the isocenter, the patient dimensions, and the presence or absence of a circular SRS collimator. The software outputs the collision-free gantry angles, and for each point, the shortest distance to the gantry or the colliding sector when collision is identified. The software was tested for accuracy on a TrueBEAM® machine equipped with BrainLab® accessories for 80 virtual isocenter-couch angle configurations with and without a circular collimator and a parallelepiped phantom. RESULTS: The software predicted the absence of collision for 19 configurations. The mean absolute error between the measured and predicted gantry angle of collision for the remaining 61 cases was 0.86 (0.01-2.49). CONCLUSION: This tool accurately predicted collisions for linac-based intracranial SRS and is easy to implement in any radiotherapy facility.

NATIONAL DIAGNOSTIC REFERENCE LEVELS IN INTERVENTIONAL RADIOLOGY SUITES IN LEBANON: A MULTICENTER SURVEY.

Air kerma-area product (PKA), cumulative air kerma at patient entrance reference point, fluoroscopy time and number of images were retrospectively collected from 15 hospitals in Lebanon for 11282 fluoroscopically-guided interventional (FGI) procedures between March 2016 and November 2018. National diagnostic reference levels (NDRLs) were established based on the third quartile of the distribution of median values of exposure parameters per department for 27 types of FGI procedures. NDRLs were in line with international DRLs except for coronary angiography (CA), percutaneous coronary interventions (PCI) and transcatheter aortic valve implantation (TAVI) which require optimisation. Additionally, following the National Council on Radiation Protection and Measurements report 168, PCI, TAVI, triple chamber pacemaker implantation, endovascular aortic repair, nephrostomy, kyphoplasty and percutaneous transhepatic biliary drainage were classified as potentially high-dose procedures with >5% of the patients with PKA exceeding 300 Gycm2. The established NDRLs will promote dose optimisation and patient radiation protection.

MEASUREMENT OF PATIENT SKIN DOSE DISTRIBUTIONS IN THREE LEBANESE INTERVENTIONAL CARDIOLOGY SUITES.

Using a mesh of 30 thermoluminescent dosemeters, adults' patient skin doses were measured for 99 coronary angiography (CA) and 89 percutaneous coronary interventions (PCI) performed in three Lebanese hospitals. Average peak skin dose (Dskin,max) were 152 mGy (range: 16-1144) for CAs and 576 mGy (range: 7-3361) for PCIs. While only four patients had a Dskin,max value exceeding the 2 Gy threshold for skin injuries, several patients had skin dose values above 1 Gy at several distinct locations proving that Dskin,max alone is not sufficient for repetitive procedures; 2D dose maps are required instead. Dskin,max correlated well with total air kerma-area product (PKA,T) for PCI in Hospitals 1 and 2 (R = 0.91 and 0.76, respectively) enabling the setup of an alert level at PKA,T = 240 and 210 Gy cm2, respectively, corresponding to a Dskin,max of 2 Gy. This was not possible for Hospital 3 due to weak correlations between Dskin,max and PKA,T.

OCCUPATIONAL DOSES FOR THE FIRST AND SECOND OPERATORS IN LEBANESE INTERVENTIONAL CARDIOLOGY SUITES.

The study monitored occupational dose for 12 interventional cardiologists (first operators) and 10 technicians (second operators), from 10 different Lebanese hospitals performing coronary angiography and precutaneous coronary interventions exclusively on adult patients. Each individual wore dosemeters under and over the lead apron at chest and collar level, respectively, on the wrist and next to the left eye. The total follow-up period for each first/second operator varied between two to six bimonthly monitoring periods. For the first operator, the mean (range) effective, hand and eye lens doses were of 6 (1-41), 112 (10-356) and 15 (5-47) µSv/procedure, respectively. These were of 2.3 (0.1-8), 16 (2-109) and 7 (2-14) µSv/procedure for the second operator. Extrapolated annual eye lens doses revealed that both first and second operators may exceed 3/10th of the annual eye lens dose permissible limit thus supporting the need for dedicated eye lens monitoring.

Tooth loss strongly associates with malnutrition in chronic kidney disease.

BACKGROUND: In chronic kidney disease (CKD), inadequate nutritional intake, inflammation, and increased oxidative stress have been the major contributing factors in malnutrition pathogenesis. However, there is still a paucity of evidence assessing the magnitude of the effect of tooth loss on malnutrition in CKD populations. The authors hypothesize that among patients with CKD, tooth loss may affect nutritional status, using the National Health and Nutrition Examination Survey 1988 to 1994 (NHANES III). METHODS: Glomerular filtration rate (GFR) was estimated based on cystatin C levels using the relevant equation. Urinary albumin-to-creatinine ratio (albuminuria) was calculated in milligrams per gram with a cutoff point of 30 mg/g. CKD was defined based on estimated GFR <60 mL/minute/1.73m(2) and albuminuria ≥30 mg/g. The cutoff point for serum albumin was set at 3.7 g/dL. Tooth loss categories were based on the number of missing and replaced teeth. RESULTS: A total of 2,749 patients was included and stratified based on their oral health status. There was a statistically significant correlation between tooth loss and the proportion of patients with low protein and caloric intake (P = 0.02 and 0.01, respectively). Serum albumin reached a frequency peak in the fully edentulous group without dentures (group 4, 19.2%). In the same group, individuals had lower protein (30.1%) and caloric intake (30.2%) (P = 0.01 and 0.02, respectively). Furthermore, logistic regression analysis confirmed the significant role of tooth loss on serum albumin and protein and energy intake in this population even after adjusting for confounding variables. CONCLUSION: Tooth loss independently predicts low energy and protein intake, as well as serum albumin levels, biomarkers of malnutrition in CKD.

Characteristics and financial costs of patients with respiratory failure at bronchoscopy.

BACKGROUND: A case-control study was conducted to identify the possible risk factors for acute respiratory failure in patients undergoing bronchoscopy. We also aimed to estimate the financial costs incurred in the care of high-risk patients. METHODS: All hypoxic respiratory complications that occurred during bronchoscopy between January 2005 and March 2009 were reviewed. Mild hypoxia was defined as the need for up to 6 L of nasal cannula, moderate hypoxia as requiring up to 100% nonrebreather face mask, and severe hypoxia requiring intubation and mechanical ventilation to maintain pulse oximetry above 90%. The Wilcoxon 2-sample test was used to compare continuous groups. Categorical variables were assessed using χ(2), Fischer exact, and Kruskal-Wallis tests. We calculated the cost of medical care for patients admitted to the intensive care unit after bronchoscopy. RESULTS: During our study period, 26 patients were reported to have hypoxia with bronchoscopy. The mean age for our study group was 66.1 years, and body mass index 26.1 kg/m(2) (SD, 7.6). The study group's mean albumin was 2.9 g/dL (SD, 0.6) compared with 3.3 g/dL (SD, 0.7, P=0.0019), the study group's hematocrit was 32.4% (SD, 5.7) compared with 37.9% (SD, 5.5, P=0.0241), the study group's forced expiratory volume to forced vital capacity ratio ratio was 65.0 (SD, 15.8) compared with 78.0 (SD, 18.8, P=0.0133), and the study group's forced expiratory volume was 59.5% compared with 71.2% (P=0.0606). The study group's mean pCO(2) was 53.7 mm Hg (SD, 18.6). Six patients required intensive care unit admission after bronchoscopy and the total cost of care for this group was $80,353. CONCLUSIONS: Prescreening of selected patients may reduce respiratory failure and possibly the total cost of medical care.

Clostridium difficile infections among Jordanian adult hospitalized patients.

This prospective study investigated the important epidemiologic aspects of Clostridium difficile infections (CDIs) among Jordanian adult hospitalized patients. A total of 300 stool specimens were investigated using culture and polymerase chain reaction methods for detection of C difficile, its toxins, and fluoroquinolone resistance. C difficile-positive cultures were found in 13.7% of the patients, and 73% of the isolates carried tcdA and/or tcdB toxin genes, and all C difficile isolates were negative for binary toxin. The isolates showed moderate level of resistance to both ciprofloxacin and levofloxacin, whereas metronidazole and vancomycin were highly susceptible. This study indicates the need for early detection of CDIs and prevention of its severe disease in hospitalized patients.

The Long-term Prognosis of Patients With the Diagnosis of Nonmalignant Pleural Effusions After Pleuroscopy.

PURPOSE: Several studies have demonstrated the diagnostic yield of medical thoracoscopy (pleuroscopy) in making the diagnosis of malignant pleural effusion (MPE). No previous studies, however, have reported long-term outcomes for patients undergoing diagnostic pleuroscopy in whom no malignancy was demonstrated either with cytologic examination of pleural fluid or pathologic examination of thoracoscope-guided pleural biopsies. We report the results of long-term follow-up (at least 3 y) of patients with the diagnosis of nonmalignant pleural effusions (NMPEs) after pleuroscopy. METHODS: One hundred and nineteen patients underwent the procedure between 1994 and 2003 at Lahey Clinic. We report a retrospective review of 25 of those patients diagnosed with NMPE after diagnostic pleuroscopy. All 25 patients underwent thoracoscopic pleural biopsy and cytologic examination of the effusion. Outcomes were assessed using review of the medical records, appointment scheduler, social security death index, and/or telephone conversation with primary care providers. RESULTS: Mean age±SD was 68 years (range, 34 to 87 y). Median survival time was estimated at 114 months. Concomitant illness was also evaluated: 40% (n=10) diabetes, 64% (n=16) coronary artery disease, 40% (n=10) congestive heart failure, 20% (n=5) liver disease, 20% (n=5) renal disease, and 36% (n=9) pulmonary disease. Final diagnoses after pleuroscopy most commonly included chronic pleuritis (n=7) and pleural plaques (n=5). Survival was found at 1 year to be 88% (22/25), 3 years 80% (20/25), and 5 years 74.7% (19/25). None of the 25 patients developed subsequent MPE. CONCLUSIONS: Patients with NMPE after pleuroscopy have a favorable prognosis and are unlikely to be subsequently diagnosed with an MPE.

A disposable immunosensor for detection of 17beta-estradiol in non-extracted bovine serum.

This paper reports the assembly of a disposable immunosensor based on the direct competitive enzyme-linked immunosorbent assay (ELISA), for simple and fast measurement of 17beta-estradiol (17beta-E2) in bovine serum, using screen-printed electrodes (SPEs) and a Palm-Sens portable electrochemical detector. The immunosensor strip was assembled immobilising, by passive adsorption, anti-rabbit IgG onto the surface of the working SPE electrode. After the interaction between anti-rabbit IgG and rabbit anti-17beta-E2 polyclonal antibodies (PAb), the competition was performed using 17beta-estradiol-alkaline phosphatase conjugate (17beta-E2-AP) synthesised in our laboratory. The enzymatic substrate used for signal generation was 1-naphthylphosphate and its conversion to an electroactive product (1-naphthol) was measured using differential pulse voltammetry (DPV). To develop a prototype for field measurements, the entire competitive protocol has been optimised directly in a blank non-extracted bovine serum. According to the new EU criteria established by the Commission Decision 2002/657/EC for qualitative and quantitative screening methods, the detection capability (CCbeta), was determined. The CCbeta value resulted below the action limit (40 pg mL(-1)) fixed for 17beta-E2) Spiked and real samples were analysed using the electrochemical immunostrips obtaining precision values (relative standard deviation, R.S.D.%) ranging from 8.6 to 17.0% and a recovery (R%) from 88.2 to 120.0%. Results obtained on real samples were confirmed by liquid chromatography coupled on-line with tandem mass spectrometry (LC-MS/MS) using an atmospheric pressure chemical ionisation (APCI) source and a heated nebulizer (HN) interface; this is the method currently used to confirm illegal hormone administration for regulatory purposes. The disposable immunosensor appears suitable as a screening tool for field analysis of bovine serum estradiol.

[Acute toxicity in 50 patients with prostate cancer treated with conformal radiation therapy]. / Evaluation de latoxicité aiguë chez 50 patients atteints de cancer de la prostatetraités par radiothérapie conformationnelle.

PURPOSE: To report our experience with 3D conformal radiotherapy for prostate cancer. MATERIAL AND METHODS: We reviewed our first 50 patients diagnosed with prostate cancer. Median follow-up was 27 months (16-40 m). Median age 68 (52-74). T stage was: T1c = 12 ; T2a = 14; T2b = 10; T2c = 2; T3a = 10; T3b = 1 and T3c = 1. Gleason score (GS) 4-6 50% and GS 7-8 50%. Pretreatment PSA value of < 10 ng/ml 36%, 10-20 ng/ml 32% and > 20 ng/ml 32%. Forty patients received androgen ablation therapy 2 to 6 months before radiation. 3D conformal radiotherapy was used to allow a smaller amount of rectum and bladder to be in the high dose volume. An 18 Mv linear accelerator was used. The first 21 patients received 66 Gy, 28 patients received 70 Gy and one 74 Gy. RESULTS: The mean prostate volume was 45 cc for patients who received androgen ablation and 54 for the others (p = 0.02). The percentage of volume receiving more than 50 Gy (V50) was calculated for the rectum and bladder. The median V50 was 30% (10-55) for the rectum and 36% (5-70) for the bladder. Based on the RTOG grading (gr) for acute toxicity, there was no gr 3 gastrointestinal (GI) toxicity and only 1 gr 3 genitourinary (GU) toxicity. There were 9 gr 1 and 5 gr 2 GI toxicity, 10 gr 1 and 5 gr 2 GU toxicity. With our actual follow-up we have 2 late morbidities: gr 2 GU and one erectile failure. CONCLUSION: 3D conformal radiotherapy for prostate cancer has a good toxicity profile. Longer follow-up is needed to assess late toxicity and clinical outcome in this series.

[Epidemiology of profound neurosensory deafness in Lebanese children]. / Epidémiologie de la surdité neurosensorielle profonde de l'enfant au Liban.

The prevalence of profound sensorineural deafness in childhood is about 1/1000. 274 children attending seven specialized Lebanese institutions were examined. The aim of this study is to evaluate the distribution of the different etiologies of this type of deafness in Lebanon: 51.82% are of genetic causes (25.2% due to consanguinity); 32.84% of acquired causes, the most frequent etiologies were rubella and perinatal meningitis; 15.32% of unknown etiologies. The new acquisitions in term of genetic counseling are discussed.

Combined use of FLUKA and MCNP-4A for the Monte Carlo simulation of the dosimetry of 10B neutron capture enhancement of fast neutron irradiations.

Boron neutron capture enhancement (BNCE) of the fast neutron irradiations use thermal neutrons produced in depth of the tissues to generate neutron capture reactions on 10B within tumor cells. The dose enhancement is correlated to the 10B concentration and to thermal neutron flux measured in the depth of the tissues, and in this paper we demonstrate the feasibility of Monte Carlo simulation to study the dosimetry of BNCE. The charged particle FLUKA code has been used to calculate the primary neutron yield from the beryllium target, while MCNP-4A has been used for the transport of these neutrons in the geometry of the Biomedical Cyclotron of Nice. The fast neutron spectrum and dose deposition, the thermal flux and thermal neutron spectrum in depth of a Plexiglas phantom has been calculated. The thermal neutron flux has been compared with experimental results determined with calibrated thermoluminescent dosimeters (TLD-600 and TLD-700, respectively, doped with 6Li or 7Li). The theoretical results were in good agreement with the experimental results: the thermal neutron flux was calculated at 10.3 X 10(6) n/cm2 s1 and measured at 9.42 X 10(6) n/cm2 s1 at 4 cm depth of the phantom and with a 10 cm X 10 cm irradiation field. For fast neutron dose deposition the calculated and experimental curves have the same slope but different shape: only the experimental curve shows a maximum at 2.27 cm depth corresponding to the build-up. The difference is due to the Monte Carlo simulation which does not follow the secondary particles. Finally, a dose enhancement of, respectively, 4.6% and 10.4% are found for 10 cm X 10 cm or 20 cm X 20 cm fields, provided that 100 micrograms/g of 10B is loaded in the tissues. It is anticipated that this calculation method may be used to improve BNCE of fast neutron irradiations through collimation modifications.

[Chondroblastoma of the temporal bone. Apropos of a case]. / Chondroblastome de l'os temporal. A propos d'un cas.

A case of temporal bone chrondroblastoma is reported. The presenting symptom was a serious otitis. The finding on physical examination was partial facial palsy. The tumor was removed through a middle fossa approach. Chondroblastoma is a rare tumor that represents 1% of all primary bone tumors. In the temporal bone only 34 cases have been reported. The histologic diagnostic should be difficult. Radical excision is suggested regarding its tendency to recur.

[Sudden deafness disclosing acoustic neuroma. Apropos of 16 cases]. / Surdité brusque révélant un neurinome de l'acoustique. A propos de 16 cas.

We performed a retrospective review of the audiologic, radiologic and clinical data on 239 patients operated on for acoustic neuroma from 1987 to 1995 at Beaujon Hospital. In 16 patients or 6.6% of the total group, we identified as having experienced sudden hearing loss by history. The 16 tumors involved were 1 stade I; 8 stade II, 5 stade III and 2 stade IV. In 14 cases, the tumor was removed by translabyrinthine approach, 1 case by masto-retrosigmoid approach and 1 case by middle fossa approach. The hearing was preserved in the two latter cases. The purpose of this study is to illustrate and reaffirm the importance of a thorough neurotologic evaluation and to discuss the diagnostic methods in this select patient population.

Pathological fractures due to metastases.

The authors review the literature and report on the treatment of metastatic pathological fractures, on the basis of their own experience of 51 operations. They review the radiological and pathological aspects of the lesions, and the methods of investigation. They stress the need for close collaboration between oncologists, radiologists and orthopedic surgeons, and emphasize the role of surgical treatment in the restoration of function and the relief of pain, by stable synthesis of the affected part. The methods employed are those used in traumatology, together with arthroprosthetic replacement. The importance of ensuring a stable synthesis, for the patients' limited life expectancy, justifies the use of acrylic cement, which often establishes continuity that otherwise would not be attainable. The indications for operation are not related to prolonging life but only to improvement in the quality of remaining life as measured by absence of pain and recovery of function. The results should be assessed primarily from the patient's point of view, the aim being to restore his mode of living before the fracture occurred. This has psychological as well as functional value.