Myxopapillary ependymoma: cytomorphologic characteristics and differential diagnosis

Myxopapillary ependymoma (ME) is a rare tumor with a predilection for sacrococcygeal area of adults. We present the cytomorphology of one such case in a 21-yr-old man, diagnosed by fine-needle aspiration (FNA). The tumor disclosed biphasic morphology with nests and aggregates of epithelioid malignant cells as well as branching cords of myxohyaline material. Most noticeable was the presence of distinct hyaline globules surrounded by neoplastic cells. The differential diagnosis of ME includes chordoma, adenoid cystic carcinoma, mucinous adenocarcinoma, and germ cell tumor. An accurate preoperative diagnosis of ME on FNA can be achieved based on its distinctive cytomorphologic features.     

Immunogenicity of two doses of inactive COVID-19 vaccine and third booster dose mRNA vaccine in patients with cancer receiving active systemic therapy

We aimed to evaluate the seroconversion rates after two doses of inactive COVID-19 vaccine (CoronaVac) and the benefit of a third dose mRNA vaccine booster in patients with cancer receiving active treatment. Patients with solid tumors receiving active treatment (n = 101) and patients with no-cancer (n = 48) as the control group were included in the study. All the patients and controls had received two doses of CoronaVac and a third booster dose of the mRNA vaccine (Bnt162b2). Anti-SARS-CoV-2 Spike Receptor Binding Domain IgG antibody levels after the second and third dose were measured with quantitative ELISA. The median age of the patients was 66 (IQR 60-71). 79% of the patients were receiving chemotherapy, and 21% were receiving immunotherapy at the time of vaccination. Antibody levels measured after two doses of CoronaVac were significantly lower in patients with cancer than in the control group (median 0 μg/ml [IQR 0-1.17 μg/ml] vs median 0.91 μg/ml [IQR 0-2.24 μg/ml], respectively, P = .002). Seropositivity rates were 46.5% in patients with cancer and 72.9% in the control group (P = .002). Antibody measurement was performed in 26 patients after the third dose. Seroconversion rate increased from 46.5% to 88.5% (P < .001), and the antibody titers significantly increased with the third-dose booster (median 0 μg/ml [IQR 0-1.17 μg/ml] after two doses vs 12.6 μg/ml [IQR 1.8-69.1 μg/ml] after third booster dose, P < .001). Immunogenicity of CoronaVac is low in patients with cancer receiving active treatment, and administering a third dose of an mRNA vaccine is effective in terms of improving seroconversion rates.     

Effect of Defatted Dabai Pulp Extract in Urine Metabolomics of Hypercholesterolemic Rats

A source of functional food can be utilized from a source that might otherwise be considered waste. This study investigates the hypocholesterolemic effect of defatted dabai pulp (DDP) from supercritical carbon dioxide extraction and the metabolic alterations associated with the therapeutic effects of DDP using ¹H NMR urinary metabolomic analysis. Male-specific pathogen-free Sprague–Dawley rats were fed with a high cholesterol diet for 30 days to induce hypercholesterolemia. Later, the rats were administered with a 2% DDP treatment diet for another 30 days. Supplementation with the 2% DDP treatment diet significantly reduced the level of total cholesterol (TC), triglyceride, low-density lipoprotein (LDL), and inflammatory markers (C-reactive protein (CRP), interleukin 6 (IL6) and tumour necrosis factor-α (α-TNF)) and significantly increased the level of antioxidant profile (total antioxidant status (TAS), superoxide dismutase (SOD), glutathione peroxide (GPX), and catalase (CAT)) compared with the positive control group (PG) group (p < 0.05). The presence of high dietary fibre (28.73 ± 1.82 g/100 g) and phenolic compounds (syringic acid, 4-hydroxybenzoic acid and gallic acid) are potential factors contributing to the beneficial effect. Assessment of ¹H NMR urinary metabolomics revealed that supplementation of 2% of DDP can partially recover the dysfunction in the metabolism induced by hypercholesterolemia via choline metabolism. ¹H-NMR-based metabolomic analysis of urine from hypercholesterolemic rats in this study uncovered the therapeutic effect of DDP to combat hypercholesterolemia.     

Accuracy of pedicle and mass screw placement in the spine without using fluoroscopy: a prospective clinical study.

BACKGROUND CONTEXT: Spinal instrumentation is accompanied by various problems, including screw malpositioning. One way of preventing this is the employment of intraoperative biplanar fluoroscopy. However, screw malpositioning despite the use of fluoroscopy has been reported, and exposure to radiation is another burden of this method. Therefore, the purpose of this article was to compare the results of instrumentation applications without using scopy versus the harmful effects of radiation exposed during spinal instrumentation. PURPOSE: The aim of this article was to review the literature and this is the first prospective clinical study performed on this subject. STUDY DESIGN: Patient report. PATIENT SAMPLE: One hundred thirty-two patients with spinal instrumentations were included. OUTCOME MEASURES: Radiological investigation with computed tomography (CT) scans was performed 2 days after the procedure. METHODS: Craniosacral posterior spinal instrumentation was performed without using scopy at the Neurosurgery Clinic of Haseki Training and Research Hospital between January 2000 and January 2005. Postoperative CT analyses were performed to evaluate whether the 527 screws used during posterior instrumentation in a total of 132 patients were positioned correctly. In all cases, the screw applications were performed with regard to anatomic landmarks, whereas the distances were determined according to lesion localizations. Screw malpositioning and the functional effects and relations with interactions with neurovascular structures were examined. At the end of the operations, all patients were examined with direct lateral roentgenograms and CT scans for the evaluation of screw positions. RESULTS: According to their locations, 75 cervical screwing in 24 patients, 32 upper thoracic screwing in 7 patients, 30 midthoracic screwing in 7 patients, 306 thoracolumbar screwing in 54 patients, and 84 sacral screwing in 40 patients were performed by the senior spinal surgeon (KK). Among all posterior spinal instrumentation applications, the cervical region analyses revealed penetration of the medial wall of vertebral foramen with two (0.4%) screws, penetration of the lateral wall with one (0.2%) screw, and protrusion into the vertebral foramen without vascular penetration with one (0.2%) screw, whereas in the upper thoracic region there was penetration into the lateral pedicle wall with one (0.2%) screw and deviation toward the disc space through the superior end plate with two (0.4%) screws. In the midthoracic region, there was penetration into the disc space with two (0.4%) screws in only one case, whereas in the thoracolumbar complex, there was deviation toward the superior end plate with seven (1.4%) screws in four cases, deviation toward the disc space with two (0.4%) screws, medial wall penetration with six (1.2%) screws (two of which caused nerve root irritation in three cases), and penetration of the lateral wall of pedicle with four (0.8%) screws. In the sacral instrumentations, malpositioning occurred with only two (0.4%) screws because of deviation toward the medial wall. In summary, malpositioning occurred with 30 (5.6%) of the total 527 screws; none of the cases had neural or vascular damage. Two (1.5%) cases were revised for malpositioning and distance errors. The mean duration for preparation of screw introduction site and placement of the screw was 3 minutes. Infection occurred in only one (0.75%) case. CONCLUSIONS: Screw application without fluoroscopy is performed with calculation of all essential anatomic details, and because of the reduction of surgery time, the absence of exposure to radiation, and very low infection rates as a consequence of reduced surgery time, it is a method recommendable for surgeons experienced with screw placement. Besides, its malpositioning rates are within acceptable limits. Because screw malpositioning is also found after biplanar fluoroscopy, the prevention of screw malpositioning requires knowing the anatomic landmarks accurately.     

术前常规检查与选择性检查对白内障手术安全性的系统评价

目的系统评价术前常规检查与选择性检查对白内障手术的安全性。方法按Cochrane系统评价方法,计算机检索MEDLINE（1966—2008．10）、EMbase（1980～2008．10）、Cochrane协作网眼和视力组数据库（2008年3期）、中国生物医学文献数据库（1979～2008．10）,手工检索相关会议文献,纳入所有比较术前常规检查与选择性检查对白内障手术安全性的随机对照试验,并采用RevMan5．0软件进行Meta分析。结果共纳入4个随机对照试验,包括20490例患者。Meta分析结果显示,白内障手术患者,术前常规检查与选择性检查在术中全身并发症发生率[RR=1．05,95％CI（0．89,1．24）,P=0．59]、术后全身并发症发生率[RR=0．97,95％CI（0．80,1．18）,P=0．77]、术中眼部并发症发生率[RR=0．99,95％CI（0．74,1．33）,P=0．97]及术后眼部并发症发生率[RR=1．11,95％CI（0．76,1．60）,P=0．59]4方面,其差异均无统计学意义。结论术前常规检查与选择性检查相比,白内障手术患者术中、术后全身并发症发生率,以及术中、术后眼部并发症发生率差异均无统计学意义,但此结论对于危重病人的适用性有待于进一步研究。凶本系统评价纳入研究较少,上述结论有待更多设计严谨的大样本随机对照试验加以验证。关键词白内障;术前检查;安全性;随机对照试验     

Solitary pancreatic tuberculosis mimicking advanced pancreatic carcinoma

A 40-year-old woman was referred for pancreatic head carcinoma invading the portal vein. The dichotomy between the radiological findings and the general condition of the patient, as well as the laboratory results (no evidence of cholestasis), cast doubt on the diagnosis. There was no history of tuberculosis. The chest radiograph revealed no pathological findings. The anatomic relationships of the lesion entailed a high risk of vascular injury if tissue biopsy were to be done; therefore, diagnostic laparotomy was performed. Biopsy revealed granulomas with caseous necrosis, consistent with tuberculosis. After 6 months of antituberculosis treatment, the lesions had completely resolved. Tuberculosis should be considered in the differential diagnosis of pancreatic masses, particularly in regions where the disease is endemic. The condition usually resembles an advanced pancreatic tumor. Performing a biopsy of inoperable lesions and maintaining a reasonable skepticism in regard to the evaluation of operable lesions (attention to nonexclusive but helpful clues, such as young patient age, history of tuberculosis, absence of jaundice) will lead to the diagnosis in most patients. Diagnostic laparotomy may be required in a small subset of patients. The response to antituberculosis treatment is very favorable. The role of resection (e.g., pancreatoduodenectomy) is very limited. Received: December 1, 2000 / Accepted: January 25, 2001     

The utility of evaluating true vocal fold motion before thyroid surgery

OBJECTIVE: The objective of this study was to evaluate the utility of screening laryngoscopic examination in evaluating vocal fold (VF) mobility before thyroid surgery. METHODS: The authors conducted a retrospective chart review of 340 patients who have undergone thyroid surgery from January 1998 to June 2005 and had preoperative laryngoscopy by mirror, fiberoptic, or videostroboscopic examination. Reports of preoperative voice change or complaint and reports of preoperative VF examination, including the method of examination, were recorded. For patients with VF motion impairment, reports of the intraoperative condition of the recurrent laryngeal nerve (RLN), preoperative diagnosis based on fine needle aspiration, and final postoperative histopathologic examination results were recorded. RESULTS: Twenty-two patients were found to have preoperative VF motion impairment, of which seven (32%) patients were asymptomatic with no detectable subjective or objective voice problems. This differs significantly from the hypothesis that patients with VF motion impairment are always symptomatic (P=.009). Using voice symptoms as a screening test to predict VF motion impairment in 340 patients reveals that the sensitivity was 68%, specificity was 91%, positive predictive value (PPV) was 31%, and negative predictive value (NPV) was 98%. Among the 22 patients with preoperative VF motion impairment, five (72%) of the seven asymptomatic patients had benign, slowly progressive disease on their final histopathology reports. Six of these asymptomatic patients had their preoperative VF evaluation by fiberoptic examination, whereas one patient had indirect mirror laryngoscopy. Of 22 patients with preoperative VF motion impairment, five (22.5%) patients had abnormal VF mobility contralateral to the thyroid lesion on their preoperative evaluation, and only two of them had nerve injury reported after a previous thyroid surgery. This result differs significantly from the hypothesis that impaired mobility is ipsilateral to the side of the lesion (P=.05). CONCLUSIONS: Patients without voice complaints can have VF motion impairment. Patients can also have VF motion impairment contralateral to the thyroid lesion. Preoperative VF examination helps counsel patients appropriately about the risks of surgery and helps outline a plan for the extent of surgery while minimizing the medicolegal ramifications of iatrogenic RLN injury.