Primary synovial sarcoma of the kidney: use of PET/CT in diagnosis and follow-up

Primary renal synovial sarcoma is a rarely seen renal neoplasm. An experienced uropathologist is needed to make the pathological diagnosis. A patient, operated on with a prediagnosis of renal cell carcinoma, the pathology of which was reported as synovial sarcoma, is presented in this article. 18F-fluoro-deoxyglucose positron emission tomography and computed tomography were performed preoperatively and in the postoperative follow-up to detect the primary tumor and lymph node metastases.     

Long‐term oxygen treatment need is less frequent in eosinophilic COPD patients

IntroductionEosinophilic airway inflammation is a recognized inflammatory pattern in subgroups of patients with chronic obstructive pulmonary disease (COPD). However, there are still conflicting results between various studies concerning the effect of eosinophils in COPD patients. Our aim with this study was to evaluate eosinophilic inflammation and its relation to the clinical characteristics in a group of COPD patients.MethodsStable COPD patients with FEV₁% predicted < 50 or with ≥ 1 exacerbation leading to hospital admission or ≥2 moderate or severe exacerbation history were consecutively enrolled from outpatient clinics.ResultsWe included 90 male COPD patients, with a mean age of 63.3 ± 9.2. Mean FEV₁% predicted was 35.9 ± 11.3. Eosinophilic inflammation (eosinophil percentage ≥2%) was evident in 54 (60%) of the patients. Participants with eosinophilic inflammation were significantly older and had better FEV₁ predicted % values. Eosinophilic COPD patients were characterized with better quality of life and fewer symptoms. COPD patients with noneosinophilic inflammation used supplemental long‐term oxygen therapy (LTOT) more frequently compared to patients with eosinophilic inflammation (36.1% vs. 14.8%, p = 0.01). Eosinophilic inflammation is associated with less dyspnea severity measured by mMRC (OR: 0.542 95% CI: 0.342–0.859, p = 0.009) and less LTOT use (OR: 0.334 95% CI: 0.115–0.968, p = 0.04) regardless of age, severity of airflow limitation, and having frequent exacerbation phenotype.ConclusionOur study supports the growing evidence for a potential role of eosinophilic inflammation phenotype in COPD with distinctive clinical characteristics. Eosinophilic inflammation is inversely associated with dyspnea severity measured by mMRC and LTOT use independently from age, total number of exacerbations, St. George Respiratory Questionnaire (SGRQ) total score and FEV₁% predicted.     

Short-term perioperative outcomes after robot-assisted and laparoscopic distal pancreatectomy

Robotic surgery offers potential technical advantages that may facilitate pancreatic resection. The aim of this study was to evaluate the learning curve and short-term perioperative outcomes in patients who underwent laparoscopic and robot-assisted distal pancreatectomy. All perioperative variables were evaluated and compared retrospectively between laparoscopic (LDP) (n = 23) and robot-assisted (RDP) (n = 11) distal pancreatectomy. The mean total operative time was shorter in LDP (194 vs. 225 min; p = 0.017). All other perioperative criteria were similar between LDP and RDP patients (blood loss, transfusion rate, conversion, pancreatic fistula, postoperative morbidity, and duration of hospitalization). Non-adjusted CUSUM curve for composite events including operative time, conversion, postoperative morbidity and reoperation rates showed that the RDP learning curve corresponded to the first seven consecutive patients. During early experience, RDP was associated with longer operative time but similar short-term perioperative outcomes compared to conventional distal pancreatectomy.     

A new treatment modality for unilateral athelectasis: Recruitment maneuver with endobronchial blocker

Atelectasis is a commonly seen complication during the post-operative period in intensive care units. The treatment of atelectasis depends on the underlying cause. We aimed to share our experience on the treatment of right total atelectasis in our intensive care unit applied with the help of the endobronchial blocker.     

Cephalic vein thrombosis

An 83‐year‐old male patient presented to the outpatient clinic with complaint of swelling at right antecubital area. Ultrasonographic examination of the right upper extremity revealed a mass lesion within the right cephalic vein, which was consistent with thrombus. A computed tomography (CT) venography showed contrast enhancement in cephalic vein at distal arm and an aneurysmatic thrombus area displaying regular borders with a size of 28*30 mm; there was no contrast enhancement at more proximal levels at the cephalic vein.     

A rare cause of retinal artery embolism: Accessory mitral valve tissue

A 42‐year‐old female patient was referred our clinic for investigation of a history of acute retinal artery occlusion. Transthoracic echocardiography showed a cyst‐like, mobile formation on posterior mitral valve leaflet. 2D and real time 3D transesophageal echocardiography showed a flexible circular mobile structure which was attached to posterior mitral valve leaflet. Echocardiographic appearance and morphological characteristics were suggestive of accessory mitral valve tissue.