Primary scrotal tuberculosis: A rare but intriguing entity

Introduction

Tuberculosis (TB) of the genitourinary tract is usually secondary to a primary site in another part of the body. Primary scrotal TB is an extremely rare condition and it may mimic viral orchitis, epididymitis, hydrocele, spermatocele, testicular torsion, scrotal trauma, or a tumour.

Case presentation

A 45-year-old man presented with a 3-month history of diffuse scrotal enlargement followed a month later by swelling in the left groin. Scrotal ultrasonography revealed a 4 cm x 4 cm hypoechoic, heterogeneous, inflammatory mass with multiple fistulae at the bottom of the scrotum without any extension to the deeper structures, and bilateral multiple inguinal adenopathy.

Discussion

Genitourinary TB may present with adrenal insufficiency, renal disease, obstructive uropathy and chronic cystitis with sterile pyuria. Although scrotal USG is very helpful, it is not a definitive diagnostic tool. Histopathology is mandatory either in the form of FNAB or formal biopsy. Most cases respond well to antitubercular drugs only.

Conclusion

An optimum diagnostic and therapeutic protocol is urgently needed for cases of primary scrotal TB to prevent misuse of costly investigations and treatments and to avoid unnecessary surgical interventions when the patient can be cured by antitubercular treatment only.     

Epilepsy classification using optimized artificial neural network

ABSTRACT

Objectives: An Electroencephalogram (EEG) is the result of co-operative actions performed by brain cells. In other words, it can be defined as the time course of extracellular field potentials that are generated due to the synchronous action of cells. It is widely used for the analysis and diagnosis of several conditions. But this clinical data use to be multi-dimensional, context-dependent, complex, and it causes a concoction of various computing related research challenges. The objective of this study was to develop a computer-aided diagnosis system for epilepsy detection using EEG signals to ease the diagnosis process.

Materials: In this study, EEG datasets for epilepsy disease detection were taken from a public domain (Bonn University, Germany). These EEG recordings contain 100 single-channel EEG signals with maximum duration of 23.6 seconds. This data set was recorded intra-cranially and extra-cranially with the help of a 128-channel amplifier system using a common reference point.

Results: For a unique set of EEG signal features, the Optimized Artificial Neural Network model for classification and validation was developed with optimum neurons in the hidden layer. Results were tested on the basis of accuracy, sensitivity, precision, and specificity for all classes. The proposed Particle Swarm Optimized Artificial Neural Network provided 99.3% accuracy for EEG signal classification.

Discussion: Our results indicate that artificial neural network has efficiency to provide higher accuracy for epilepsy detection if the statistical features are extracted carefully. It is also possible to improve results for real time diagnosis by using optimization technique for error reduction.

Abbreviations: EEG: Electroencephalogram CAD: Computer-Aided Diagnosis ANN: Artificial Neural Network PSO: Particle Swarm Optimization FIR: Finite Impulse Response IIR: Infinite Impulse Response MSE: Mean Square Error.     

Implementation of an HDR brachytherapy–based breast IORT program: Initial experiences

PurposeA multidisciplinary team at our institution developed a novel method of intraoperative breast radiation therapy (precision breast intraoperative radiation therapy [PB-IORT]) that uses high-dose-rate brachytherapy with CT on-rails imaging to deliver high-dose, customized radiotherapy to patients with early-stage breast cancer. This report summarizes our program's experience developing and implementing PB-IORT.Methods and MaterialsLiterature on PB-IORT was reviewed including published articles and abstracts. To evaluate case volume, all patients with a breast cancer diagnosis who underwent breast surgery or breast radiation (2010–2017) at our academic institution were identified. Patients were stratified into pre-IORT and post-IORT eras with initiation of our PB-IORT program in October 2013. Overall trends in surgical and radiation therapy volume in each era were analyzed by linear regression. Travel distance for all surgical patients was calculated using Google Maps (Alphabet Inc.) and then compared between IORT and non-IORT patients.ResultsData from a PB-IORT Phase 1 trial found that the primary endpoints were met and that PB-IORT is feasible and safe. The direct health system's delivery costs for PB-IORT exceed those of 16-fraction whole-breast irradiation when accounting for consumable supplies (multilumen balloon applicator = $2,750 per patient). There was a significant increase in yearly growth of breast cancer surgical volume with PB-IORT.ConclusionsAccrual rates for the ongoing Phase II trial have been quicker than expected in an area where more research is needed. The rapid accrual indicates patient interest and demand for this treatment and that it is very feasible to get more data from randomized trials.     

One stage slide cricotracheoplasty and repair of complete atrioventricular septal defect

Successful single stage repair of complete atrioventricular septal defect and cricotracheal stenosis in an 8-month-old baby with Trisomy 21 is described. The case is notable for rarity of cricoid stenosis being managed together with the long segment tracheal narrowing using the technique of slide cricotracheoplasty.