Minimally invasive treatment of causes and complications of biliary pancreatitis

We report a case of a 52-year-old man admitted to our hospital because of acute biliary pancreatitis caused by cholelithiasis. The patient also had choledocholithiasis complicated with pancreatic pseudocyst. Endoscopic retrograde cholangiopancreatography (ERCP) was performed and a large number of common bile duct stones were extracted with Dormia basket upon papillotomy. Pancreatic pseudocyst as a major complication of acute pancreatitis was also managed endoscopically by transpapillary stenting. Laparoscopic cholecystectomy with choledochotomy and choledochoscopy was performed for the final removal of biliary stones. Postoperative subhepatic abscess was resolved by ultrasound-guided percutaneous drainage. In this case biliary pancreatitis with all its complications was treated through minimally invasive endoscopic, percutaneous and surgical procedures. Minimally invasive techniques are much better because they reduce surgical stress, caused by reduction of flow through the splanchnic, which can also be reinforced by general endotracheal anesthesia. In the case when relative hypoxia occurs and acute serous pancreatitis transfers to acute necrotic pancreatitis, minimally invasive technique is the first and the best choice for surgical procedure.     

Ultrasound diagnosis of serous surface papillary borderline ovarian tumor: A case series with a review of the literature

Serous surface papillary borderline ovarian tumors (SSPBOTs) are a rare morphologic variant of serous ovarian tumors that are typically confined to the ovarian surface, while the ovaries themselves tend to appear normal in size and shape. In this report, we describe the findings from five premenopausal women diagnosed with SSPBOTs, in whom ultrasound showed grossly normal ovaries that were partially or wholly covered with irregular solid tumors. In all five cases, histologic examination showed evidence of borderline serous tumors. These findings demonstrate that SSPBOTs can be diagnosed on a preoperative sonographic examination, which could facilitate conservative, fertility‐sparing surgery in young women affected by this condition. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 43 :573–577, 2015     

Surfactant-assisted microwave processing of ZnO particles: a simple way for designing the surface-to-bulk defect ratio and improving photo(electro)catalytic properties

ZnO nanopowders were produced using microwave processing of a precipitate and applied as a photoanode for photoelectrochemical water splitting. Two different surfactants, cetyltrimethylammonium bromide (CTAB) as the cationic and Pluronic F127 as the non-ionic one, were employed to in situ adjust the surface-to-bulk defect ratio in the ZnO crystal structure and further to modify the photo(electro)catalytic activity of the ZnO photoanode. The crystal structure, morphological, textural, optical and photo(electro)catalytic properties of ZnO particles were studied in detail to explain the profound effects of the surfactants on the photoanode activity. The ZnO/CTAB photoanode displayed the highest photocurrent density of 27 mA g⁻¹, compared to ZnO (10.4 mA g⁻¹) and ZnO/F127 photoanodes (20 mA g⁻¹) at 1.5 V vs. SCE in 0.1 M Na₂SO₄ under visible illumination of 90 mW cm⁻². A significant shift of the overpotential toward lower values was also observed when photoanodes were illuminated. The highest shift of the overpotential, from 1.296 to 0.248 V vs. SCE, was recorded when the ZnO/CTAB photanode was illuminated. The ZnO/CTAB photoanode provides efficient charge transfer across the electrode/electrolyte interface, with a longer lifetime of photogenerated electron–hole pairs and reduced possibility of charge recombination. The photoconversion efficiency was improved from 1.4% for ZnO and 0.9% for ZnO/F127 to 4.2% for ZnO/CTAB at 0.510 mV. A simple procedure for the synthesis of ZnO particles with improved photo(electro)catalytic properties was established and it was found that even a small amount of CTAB used during processing of ZnO increases the surface-to-bulk defect ratio. Optimization of the surface-to-bulk defect ratio in ZnO materials enables increase of the absorption capacity for visible light, rendering of the recombination rate of the photogenerated pair, as well as increase of both the photocurrent density and photoconversion efficiency.

Employing CTAB in the microwave synthesis of ZnO particles enables improvement of their visible light absorption capacity and photo(electro)catalytic activity.     

Use of figure of eight suture for groin closure with no heparin reversal in patients undergoing cryoballoon ablation for atrial fibrillation

Purpose

We aimed to demonstrate the feasibility of figure of eight (FoE) suture for groin access closure in cryoballoon (CB) ablation and its impact on the lab workflow.

Methods

We retrospectively analyzed all patients who underwent CB ablation in our institution from June 2018. From June 2019, we have been consistently using FoE suture for hemostasis (FoE+ group), and before that conventional manual compression was utilized (FoE- group). Ablations were performed under uninterrupted oral anticoagulant strategy. Both femoral veins were punctured, and a single introducer was placed in each vein. In the FoE- group, after ablation, protamine was administered, and manual compression was applied. In the FoE+ group, the suture was placed in both groins without protamine administration and manual compression. All patients were in decubitus position until the next morning.

Results

A total of 190 consecutive patients (73.2% male, 59.7?±?11.0 years old) were evaluated, 90 being in the FoE+ group. There was no difference in the mean procedure duration between two groups (72.7?±?23.1 min vs 73.7?±?27.1 min, p?=?0.784). However, the total lab time was significantly longer in FoE- group (132.9?±?35.3 min vs 109.9?±?32.6 min, p?<?0.0001). There was no difference in complication rates. No major vascular complications were found in our cohort.

Conclusions

Utilization of FoE sutures for hemostasis seems to be a safe and effective after cryoballoon ablation. It abolishes the need for protamine administration which can cause serious adverse events. As manual compression is unrequired, EP lab workflow improves due to significantly shortened total lab time per patient.

     

Impaired arterial elasticity in young patients with white-coat hypertension

BACKGROUND: Conflict still exists over whether patients with white-coat hypertension are at increased risk of developing target organ damage compared with normotensive individuals. METHODS: We studied vascular distensibility in 117 young-to-middle age patients with white-coat hypertension, 174 patients with sustained hypertension, and 51 normotensive controls. To obtain a measure of compliance, a model was used that divides the total systemic compliance into large artery (C1) and small artery (C2) compliance. With this aim, radial arterial pulse waves were recorded with a tonometer sensor array by means of an HDI CR2000 device (Eagan, Minnesota, USA). Moreover, pulse wave velocity and the augmentation index were measured using the Specaway DAT system (St Pauls, Sydney, Australia). RESULTS: Patients with sustained hypertension had a greater body mass index than patients with white-coat hypertension (P=0.04) or the normotensive individuals (P=0.01). C1 and C2 were decreased in the two hypertensive groups as compared with those in the normotensive group (P=0.0002 and 0.03, respectively, versus sustained hypertension; P=0.00007 and 0.0004, respectively, versus white-coat hypertension). Pulse wave velocity and aortic augmentation index were increased in the white-coat hypertension patients compared with the normotensive individuals (P=0.02 and 0.004, respectively). Aortic augmentation index (P=0.008) but not pulse wave velocity was increased in the sustained hypertensive patients compared with that in the normotensive individuals. All indexes of arterial distensibility were similar in the two hypertensive groups. CONCLUSIONS: Indexes of arterial distensibility are impaired in the white-coat hypertensive group and similar to those in the sustained hypertensive group, indicating that early changes in the arterial wall can occur in white-coat hypertension. This may account for the higher risk of stroke that has been described in this condition.     

Patients’ Assessments of Tooth Sensitivity Increase One Day Following Different Whitening Treatments

ObjectivesThe aim of this clinical study was to compare tooth sensitivity scores and color change values before and 1 day following whitening treatments using different concentrations of whitening agents for in-office and at-home procedures.Materials and methodsA total of 60 participants divided into 3 groups were included in this study. A whitening procedure was carried out in groups using 40% hydrogen peroxide (HP) in in-office treatment, 16% and 10% carbamide peroxide (CP), respectively. Participants rated their tooth sensitivity at the baseline and 1 day following the treatment. The CIEl_ab values were recorded and color differences were calculated.ResultsWithin each of the whitening treatments, the tooth sensitivity scores significantly increased following the procedure (p<0.05). The largest significant increase in scores was noted in 40% HP in-office whitening treatment, while the lowest increase was noted in 10% CP at-home whitening treatments (p<0.05). The highest color change 1 day following the procedure was found in the 40% HP in-office whitening treatment group (3.3) and it significantly differed from both 16% CP and 10% CP at-home whitening treatments whose color difference was both 2.0, respectively (p<0.05).Conclusion1 day following the procedure, a low concentrate CP agent for at-home whitening causes the least tooth sensitivity compared to higher concentrate CP for at-home and HP for in-office agents, with the same color change efficacy as higher concentrate CP agent. In case with slight tooth sensitivity reported at the baseline, a 10% CP whitening treatment should be recommended.     

A novel homozygous synonymous variant further expands the phenotypic spectrum of POLR3A-related pathologies

Pathogenic biallelic variants in POL3RA have been associated with different disorders characterized by progressive neurological deterioration. These include the 4H leukodystrophy syndrome (hypomyelination, hypogonadotropic hypogonadism, and hypodontia) and adolescent-onset progressive spastic ataxia, as well as Wiedemann–Rautenstrauch syndrome (WRS), a recognizable neonatal progeroid syndrome. The phenotypic differences between these disorders are thought to occur mainly due to different functional effects of underlying POLR3A variants. Here we present the detailed clinical course of a 37-year-old woman in whom we identified a homozygous synonymous POLR3A variant c.3336G>A resulting in leaky splicing r.[3336ins192, =, 3243_3336del94]. She presented at birth with intrauterine growth retardation, lipodystrophy, muscular hypotonia, and several WRS-like facial features, albeit without sparse hair and prominent scalp veins. She had no signs of developmental delay or intellectual disability. Over the years, above characteristic facial features, she showed severe postnatal growth retardation, global lipodystrophy, joint contractures, thoracic hypoplasia, scoliosis, anodontia, spastic quadriplegia, bilateral hearing loss, aphonia, hypogonadotropic hypogonadism, and cerebellar peduncles hyperintensities in brain imaging. These manifestations partially overlap the clinical features of the previously reported POLR3A-associated disorders, mostly mimicking the WRS. Thus, our study expands the POLR3A-mediated phenotypic spectrum and suggests existence of a phenotypic continuum underlying biallelic POLR3A variants.     

Missed cervical spine subluxation leading to bilateral facet dislocation with severe deformity requiring 360 fixation

A 41 year-old male that presented after a fall downstairs and the initial imaging was misinterpreted, missing a subtle abnormality, C5/6 subluxation. The patient presented later with neck pain and further imaging demonstrated bilateral facet dislocation with severe deformity requiring 360 spinal fixation.