Biliary stent migration causing incarceration and perforation of the ileum in a previously uncomplicated inguinal hernia: Report of a case and review of literature

Endoscopic biliary stent insertion is a well-established minimally invasive procedure used in the management of hepatic, biliary or pancreatic disorders. Dislocation and migration of endoscopically inserted biliary stents is a late complication; it has a reported incidence of about 7%–10% of cases. Most of the migrated stents pass naturally without complications. Very occasionally, (less than 1%), the stent becomes stuck and produces gut perforation. Very few case reports in the literature describe plastic biliary stents perforating a bowel in a hernia. Herein, we report the case of a migrated plastic biliary stent that perforated an ileal loop inside a sac of a previously uncomplicated inguinal hernia.     

Efficiency of placental three dimentional power Doppler ultrasonography for predicting preeclampsia in early pregnancy

Purpose

to evaluate the role of three dimentional power doppler ultrasonography (3D PDUS) of the uteroplacental circulation in early pregnancy as a screening tool for prediction of preeclampsia.

Postoperative local fractionated radiotherapy for resected single brain metastases

Purpose

Evaluation of postoperative fractionated local 3D-conformal radiotherapy (3DRT) of the resection cavity in brain metastases.

Patients and methods

Between 2011 and 2016, 57 patients underwent resection of a single, previously untreated (37/57, 65%) or recurrent (20/57, 35%) brain metastasis (median maximal diameter 3.5?cm [1.1–6.5?cm]) followed by 3DRT. For definition of the gross tumor volume (GTV), the resection cavity was used and for the clinical target volume (CTV), margins of 1.0–1.5 cm were added. Median dose was 48.0?Gy (30.0–50.4?Gy) in 25 (10–28) fractions; most patients had 36.0–42.0?Gy in 3.0?Gy fractions (n?=?16, EQD2_10Gy 39.0–45.5?Gy) or 40.0–50.4?Gy in 1.8–2.0?Gy fractions (n?=?37, EQD2_10Gy 39.3–50.0?Gy).

Results

Median follow-up was 18 months. Local control rates were 83% at 1 year and 78% at 2 years and were significantly influenced by histology (breast cancer 100%, non-small lung cancer 87%, melanoma 80%, colorectal cancer 26% at 2 years, p?=?0.006) and resection status (p?<?0.0001), but not by EQD2_10Gy or size of the planning target volume (median 96.7?ml [16.7–282.8?ml]). At 1 and 2 years, 74% and 52% of the patients were free from distant brain metastases. Salvage procedures were applied in 25/27 (93%) of recurrent patients. Survival was 68% at 1 year and 41% at 2 years and was significantly improved in younger patients (p?=?0.006) with higher Karnofsky performance score (p?<?0.0001) and without prior radiotherapy (54% vs. 9% at 2 years, p?=?0.006). No cases of radiographic or symptomatic radionecrosis were observed.

Conclusion

Adjuvant fractionated local 3DRT is highly effective in radiosensitive, completely resected metastases and should be considered for treating large resection cavities as an alternative to postoperative stereotactic single dose or hypofractionated radiosurgery.

     

A controlled study of repetitive transcranial magnetic stimulation in medication-resistant major depression.

BACKGROUND: Repetitive transcranial magnetic stimulation (TMS) as a treatment for depression has shown statistically significant effects, but the clinical significance of these effects has been questioned. METHODS: Patients with medication-resistant depression were randomized to receive 15 sessions of active or sham repetitive TMS delivered to the left dorsolateral prefrontal cortex at 110% the estimated prefrontal cortex threshold. Each session consisted of 32 trains of 10 Hz repetitive TMS delivered in 5-second trains. The primary end point was treatment response defined as a >or=50% decrease in Hamilton Depression Rating Scale (HDRS) score at both 1 and 2 weeks following the final repetitive TMS treatment. Remission was defined as a HDRS score < 8. RESULTS: The response rate for the TMS group was 30.6% (11/35), significantly (p = .008) greater than the 6.1% (2/33) rate in the sham group. The remission rate for the TMS group was 20% (7/35), significantly (p = .033) greater than the 3% (1/33) rate in the sham group. The HDRS scores showed a significantly (p < .002) greater decrease over time in the TMS group compared with the sham group. CONCLUSIONS: Transcranial magnetic stimulation can produce statistically and clinically significant antidepressant effects in patients with medication-resistant major depression.     

Unusual case of difficult double-lumen endotracheal tube removal

A reusable Robertshaw red rubber double-lumen endotracheal tube (DLT) was placed to facilitate lung isolation for thoracoscopy in a 49-year-old atopic patient. In spite of its smooth insertion, it was then not possible to remove the DLT. Direct laryngoscopy showed severe laryngeal edema. After 48 hours of medical treatment with steroids, the trachea was extubated. The laryngeal edema could have been the result of physical and chemical irritation by the reusable rubber DLT itself, or from the substances formed during repeated cleaning and sterilization of the DLT. Atopic patients who are prone to developing latex allergy are also more liable to develop severe reactions to chemical, mechanical, and physical irritation from reusable red rubber DLTs or from the chemical solution used for its cleaning and sterilization.     

Physical activity and mental well-being during COVID-19 pandemic

The corona virus disease 2019 (COVID-19) pandemic has resulted in most nations deciding upon self-isolation and social distancing policies for their citizens to control the pandemic and reduce hospital admission. This review aimed at evaluating the effect of physical activity on mental well-being during the COVID-19 pandemic. It was concluded that the COVID-19 pandemic may lead to augmented levels of angiotensin-converting enzyme (ACE)-2 that led to cardiovascular and neurological disorders associated with highly inflammatory effects of viral infection affecting the brain tissues leading to damage of the nervous system and resulting in cognition dysfunction, insulin sensitivity reduction, and behavioral impairments. Anxiety and depression may lead to negative effects on various quality of life domains, such as being physically inactive. Regular physical activities may reduce inflammatory responses, improve ACE-2 responses, and improve mental well-being during self-isolation and social distancing policies related to the COVID-19 pandemic. Further studies should be conducted to assess the different intensities of physical activities on cardiovascular function, and mental well-being during the COVID-19 pandemic.