Validation of low-cost models for minimal invasive surgery training of congenital diaphragmatic hernia and esophageal atresia

BackgroundMinimal invasive surgery (MIS) is increasingly used for the correction of congenital diaphragmatic hernia (CDH) and esophageal atresia (EA). It is important to master these complex procedures, preferably preclinically, to avoid complications. The aim of this study was to validate recently developed models to train these MIS procedures preclinically.MethodsTwo low cost, reproducible models (one for CDH and one for EA) were validated during several pediatric surgical conferences and training sessions (January 2017–December 2018), used in either the LaparoscopyBoxx or EoSim simulator. Participants used one or both models and completed a questionnaire regarding their opinion on realism (face validity) and didactic value (content validity), rated on a five-point-Likert scale.ResultsOf all 60 participants enrolled, 44 evaluated the EA model. All items were evaluated as significantly better than neutral, with means ranging from 3.7 to 4.1 (p < 0.001). The CDH model was evaluated by 48 participants. All items scored significantly better than neutral (means 3.5–3.9, p < 0.001), with exception of the haptics of the simulated diaphragm (mean 3.3, p = 0.054). Both models were considered a potent training tool (means 3.9).ConclusionThese readily available and low budget models are considered a valid and potent training tool by both experts and target group participants.Type of studyProspective study.Level of evidenceLevel II.     

Overview and update on molecular testing in non-small cell lung carcinoma utilizing endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) samples

Lung carcinoma remains one of the most frequent and aggressive human neoplasms. Fortunately, in the last decades, the increasing knowledge of the molecular mechanisms leading to cancer development has allowed the use of targeted therapies with improvement of prognosis in many patients. Clinical management has also changed after the introduction of endobronchialultrasonographic bronchoscopy that allows a conservative staging of lung tumors, avoiding the need of mediastinoscopy for lymph node staging. Lung pathologists and cytopathologists are facing the challenge of giving the more comprehensive prognostic and predictive information with ever smaller tissue or cytological samples. The aim of this review is to summarize the molecular testing for non-small cell lung carcinoma and how pathologists can contribute to the patient's outcome with a conscious management of biological samples.     

Osteosarcomatosis

A review of the 690 cases of osteosarcoma in the radiographic file of the Armed Forces Institute of Pathology revealed 29 cases of "osteosarcomatosis" (multiple skeletal sites of osteosarcoma). Fifteen of these patients were 18 years old and under and manifested rapidly appearing, usually symmetric, sclerotic metaphyseal lesions. The remaining 14 patients were more than 18 years old and had fewer, asymmetric sclerotic lesions. In most patients (28 of 29), a radiographically dominant skeletal tumor was seen. Pulmonary metastases occurred in the majority of patients and were detected at the same time as the bone lesions. These 29 patients were studied with regard to demographic data and skeletal distribution and radiographic appearance of their lesions. As a result of the findings, a metastatic origin from a primary dominant osteosarcoma is favored over a multifocal origin as the basis for osteosarcomatosis. Osteosarcomatosis is more commonly encountered in the mature skeleton than has been previously recognized.     

Detection of polyglutamine expansion in a new acidic protein: a candidate for childhood onset schizophrenia?

Polyglutamine expansion (PGE) encoded by a CAG repeat underlies eight inherited neurodegenerative diseases, among which is Huntington's disease. CAG expansion has also been reported in schizophrenia, suggesting a role for PGE. To investigate the potential role of PGE as a candidate for schizophrenia, we searched for PGE in nuclear families comprising a patient affected by childhood onset schizophrenia (COS, a rare and severe form of the disease) as a variation of the candidate gene approach for identifying susceptibility genes. We tested lymphoblastoid cell lines from COS patients (n = 32) by Western blot analysis with 1C2, a monoclonal antibody that specifically recognizes long polyglutamines. Eight of 11 unrelated black American COS patients showed a 60-kDa (approximately) band indicative of PGE. A strong 60-kDa band (suggestive of a large PGE) was detected in two of the eight positive patients. A weaker 60-kDa band (suggestive of a smaller and non pathogenic PGE) was detected in some unaffected parents or sibs of these two COS patients, and in six other black American COS patients. The strong and weak PGE signals were found to correspond to two different proteins. Unrelated black Americans unaffected by COS (n = 38) were negative for the strong 60-kDa PGE signal. Healthy white Americans (n = 53) were negative for both the strong and weak 60-kDa PGE signals. Two-dimensional gel analysis suggested that the strong PGE signal corresponds to an acidic (pI 4 approximately) protein and resulted in a more precise estimation (52-57 kDa) of its relative mass. This protein appeared to be not represented in Genbank, as suggested by the exclusion of several candidate CAG repeats. Our data suggest that this acidic protein might be a candidate for COS.     

Suprahepatic inferior vena cava cannulation

Inadequate venous drainage may represent a major problem in operations on the descending thoracic aorta performed with the aid of cardiopulmonary bypass. We herein describe an alternative technique of venous cannulation, which allows steady performances and high pump flows.     

Magnetic resonance appearance of asbestos-related benign and malignant pleural diseases

OBJECTIVES: This study describes the magnetic resonance findings of benign and malignant pleural diseases in asbestos-exposed subjects. METHODS: Thirty patients with a history of asbestos exposure and pleural lesions in chest X-rays and computed tomography scans were examined with a 0.5- and a 1.5-T magnetic resonance unit. The examination protocol included cardiac-gated proton density and T2-weighted images, unenhanced and enhanced (Gd-DTPA; 0.1 mmol/ kg) T1-weighted images in the axial plane and sometimes in another orthogonal plane (sagittal or coronal or both). All the magnetic resonance images were reviewed by 3 experienced observers, who visually evaluated morphologic features, signal intensity, and contrast enhancement of pleural lesions. The diagnosis was established by means of percutaneous biopsy, thoracotomy, and combined clinical and radiological follow-up for at least 3 years. RESULTS: Eighteen patients affected with multiple pleural plaques showed low signal intensity on both unenhanced and enhanced T1-weighted and proton density and T2-weighted images. In 2 of these patients an acute pleural effusion was observed. All the malignant lesions (11 mesotheliomas) and a solitary benign pleural plaque revealed high signal intensity on the proton density and T2-weighted images and inhomogeneous contrast enhancement in the postcontrast T1-weighted images. The sensitivity, specificity, and diagnostic accuracy of the magnetic resonance imaging in classifying a lesion as suggestive of malignancy were 100%, 95% and 97%, respectively. CONCLUSIONS: The results point out 2 magnetic resonance signal intensity patterns for asbestos-related pleural lesions: (i) low-signal intensity on unenhanced and enhanced T1-weighted and proton density and T2-weighted images for benign plaques and (ii) nonhomogeneous hyperintensity in T2-weighted and enhanced T1-weighted images for malignant mesotheliomas.