Surgical Management of Sportsman's Hernia in Professional Soccer Players

Soccer players frequently experience acute and chronic groin pain. Sportsman's hernia is a common injury in professional soccer players, that causes inguinal pain. The authors discuss their experience with the management of sportsman's hernia in professional soccer players competing in national and international competition in a retrospective review of prospectively collected data. Between March 2004 and December 2009, seventy-one professional soccer players were surgically treated for sportsman's hernia. Average age at surgery was 24 years, and average duration of symptoms from onset to surgical repair was 11 months. Conservative treatment improved symptoms temporarily or to some extent in 18 athletes. All athletes underwent a bilateral open hernia repair with concurrent adductor tendon release. Average follow-up was 4 years, and average time to return to competitive sport was 4 months. At final follow-up, 95% of soccer players were still active, 48 at the same level and 19 at a lower level. Four athletes had stopped their careers because of another injury (n=2) or recurrence (n=2).Sportsman's hernia is a potentially career-ending injury in professional soccer players. Conservative management is often unsuccessful. An open surgical hernia repair combined with an adductor longus tenotomy relieves the symptoms caused by a sportsman's hernia and restores activity in 95% of athletes. This study offers insight into the management of sportsman's hernia and offers a successful treatment to salvage the careers of professional soccer players.     

Results of surgical treatment of athletes with sportsman's hernia

Chronic groin pain in athletes is a difficult diagnostic and therapeutic condition. Between March 2004 and December 2009, 241 male athletes (mean age: 25.8 years, range: 16-41) in whom chronic sportsman's hernia was diagnosed, were surgically treated using a standardised technique. In this retrospective study, charts were analyzed for preoperative duration of symptoms and prior treatment. Perioperative complications were noted. Patients were contacted and were asked to answer a telephone questionnaire: 162 patients agreed to be questioned as part of the current study. A surgical intervention with reinforcement of the posterior inguinal wall and tenotomy of the adductors has lead to satisfactory results in over 90% of athletes with chronic groin pain who failed to improve with conservative treatment.     

Intrapulmonary glomus tumor in a young woman

A 21-year-old female patient presented with pneumonia and on chest roentgenogram a solitary pulmonary nodule was incidentally found. After an observation period she underwent left upper lobectomy because of documented tumor growth. Pathology showed an intrapulmonary glomus tumor of the proper type, which is a very rare occurrence. Literature review revealed only 11 published cases of this subtype. Radiological investigation is helpful for localization and characterization of the tumor. However, pathological examination is required for definitive diagnosis. Complete surgical excision is the treatment of choice. Although uncommon, glomus and carcinoid tumors should be considered in the differential diagnosis of solitary pulmonary nodules in young patients.     

Step-up approach in emphysematous hepatitis: A case report

BACKGROUNDEmphysematous hepatitis (EH) is a rare, rapidly progressive fulminant gas-forming infection of the liver parenchyma. It is often fatal and mostly affects diabetes patients.CASE SUMMARYWe report a case of EH successfully managed by a step-up approach consisting of aggressive hemodynamic support, intravenous antibiotics, and percutaneous drainage, ultimately followed by laparoscopic deroofing. Of 11 documented cases worldwide, only 1 of the patients survived, treated by urgent laparotomy and surgical debridement.CONCLUSIONEH is a life-threatening infection. Its high mortality rate makes timely diagnosis essential, in order to navigate treatment accordingly.     

Predictors of gastrointestinal perforation in patients undergoing coronary artery bypass graft (CABG) surgery in Tehran, Iran.

BACKGROUND: Gastrointestinal perforation after coronary artery bypass graft (CABG) surgery is often difficult to diagnose and is associated with high morbidity and mortality rates. The aim of this study was to determine risk factors for this complication in the studied population to further improve prophylaxis and diagnosis in the region of study. METHODS: Of 8,975 consecutive patients undergoing CABG during 10 years (1995-2005), 15 (0.16%) developed gastrointestinal perforation requiring laparatomy. Data from patients who experienced gastrointestinal perforation were analyzed using univariate tests in a controlled retrospective design. RESULTS: Prolonged bypass time and preoperative heparin administration were found to be significant (P<0.05) risk factors. CONCLUSION: Low splanchnic blood flow and vasoconstriction might be underlying factors associated with both predictors. With current findings, however, clear inference about preoperative and postoperative predictors and their relation is not possible. With more information, the next step would be to build a prediction model in recognition of gastrointestinal perforation after CABG on the basis of the predisposing factors.     

Is pneumosinus dilatans an osteogenic disease that mimics the formation of a paranasal sinus?

Purpose

Pneumosinus dilatans is a disease that produces an abnormal expansion of a paranasal sinus cavity, which contains only air and is lined by normal mucosa, and whose bony walls are displaced outwardly to cause facial embossing or intracranial, orbital or ethmoidal encroachment. Objective was to evaluate the hypothesis that pneumosinus dilatans is primarily an osteogenic disease.

Methods

A detailed clinical history of three consecutive patients with pneumosinus dilatans was taken. Each patient also underwent computed tomography (CT), fluorine-deoxyglucose positron emission tomography-CT (FDG PET-CT), fluorine 18-labeled sodium fluoride PET-CT (NaF PET-CT), and bone pathology.

Results

The FDG PET-CT and pathology confirmed that the mucosa inside the pneumosinus dilatans was normal and devoid of inflammatory cell infiltrate. Significant uptake of ¹⁸F-NaF on PET-CT images correlated well with bone pathology, showing intense and diffuse bone remodeling. At a 1-year follow-up, following a frontotomy for case #1 and a middle antrostomy for case #2, there was a marked resolution of the patients’ clinical symptoms and deformities, new bone formation on the walls, stabilization of the new sinus shape and volume, and persistence of significant uptake of ¹⁸F-NaF.

Conclusions

Pneumosinus dilatans is a rare disease. Its diagnosis is based on CT scan images. This study has shown that ¹⁸F-NaF PET-CT and bone pathology are useful modalities for the positive diagnosis of difficult cases. Pneumosinus dilatans appears to be an osteogenic disease. Further research is needed to investigate a possible link between mechanisms involved in paranasal sinus formation and those involved in pneumosinus dilatans.     

Effect of eye-blinks on a self-paced brain interface design.

OBJECTIVE: To test the performance of an EEG-based self-paced brain interface when data contaminated with eye-blink artefacts are included in the evaluation. METHODS: Two different designs of a self-paced brain interface (the low frequency-asynchronous switch design, LF-ASD) are evaluated and compared using offline data from eight subjects. The true positive rates of the two designs are compared for three cases: (a) data containing eye-blink artefacts are excluded from the input; (b) all data, including eye-blinks, are included as input but the output decisions are inactivated during eye-blink artefacts; (c) all the data, including eye-blinks, are included as input and the output decisions are reported in all times including during eye-blink artefacts. RESULTS: The true positive rates of one design of the LF-ASD (LF-ASD-V5) for case (c) and of another design (LF-ASD-V4) for case (b) are 40.5% and 42.4%, respectively, for false positive rates of 1%. CONCLUSIONS: The true positive rates of LF-ASD-V5 when eye-blinks are included in the analysis deteriorate slightly compared to when the output during eye-blink artefacts is inactivated in LF-ASD-V4. SIGNIFICANCE: LF-ASD-V5 allows the device to be functional at all times and can handle artefacts better than LF-ASD-V4. If a slight decrease in true positive rates is acceptable, no further devices are needed to record the electro-oculogram (EOG) for detecting eye-blinks.     

Dermoscopy as a useful tool for evaluating melasma and assessing the response to 1064‐nm Q‐switched Nd:YAG laser

Melasma is a hard‐to‐manage disorder with considerable relapsing behavior. Dermoscopy emerged to help in comprehensive evaluation of pigmentary disorders and melasma. The aim of the study was to evaluate the potential role of dermoscopy in assessing melasma and monitoring the efficacy of 1064‐nm low‐fluence Q‐switched neodymium:yttrium‐aluminum‐garnet (QS Nd:YAG) laser. A total of 31 patients with facial melasma were included. A total of five laser sessions were performed with 2‐week intervals. Patients were evaluated at baseline and 2 weeks after the last session (at the 10th week) by using digital photography, modified melasma area and severity index (mMASI), and colorimetry, as well as dermoscopic score for pigment and vascular elements. Adverse effects were reported. Postlaser sessions, mMASI scores as well as the colorimetric melanin and erythema indices had showed significant improvement. The “dermoscopic score of pigmentary and vascular elements” displayed significant change and confirmed the improvement. Side effects were tolerable. mMASI, colorimetry, and dermoscopy had ascertained the efficacy of low‐fluence 1064‐nm QS Nd:YAG laser in melasma; however, dermoscopy is superior to other assessments as it can help in the diagnosis of melasma besides the follow‐up assessment and can precisely detect the detailed changes in response to treatment.     

High-resolution and quantitative spatial analysis reveal intra-ductal phenotypic and functional diversification in pancreatic cancer

A ‘classical’ and a ‘basal-like’ subtype of pancreatic cancer have been reported, with differential expression of GATA6 and different dosages of mutant KRAS. We established in situ detection of KRAS point mutations and mRNA panels for the consensus subtypes aiming to project these findings to paraffin-embedded clinical tumour samples for spatial quantitative analysis. We unveiled that, next to inter-patient and intra-patient inter-ductal heterogeneity, intraductal spatial phenotypes exist with anti-correlating expression levels of GATA6 and KRAS^G12D. The basal-like mRNA panel better captured the basal-like cell states than widely used protein markers. The panels corroborated the co-existence of the classical and basal-like cell states in a single tumour duct with functional diversification, i.e. proliferation and epithelial-to-mesenchymal transition respectively. Mutant KRAS^G12D detection ascertained an epithelial origin of vimentin-positive cells in the tumour. Uneven spatial distribution of cancer-associated fibroblasts could recreate similar intra-organoid diversification. This extensive heterogeneity with functional cooperation of plastic tumour cells poses extra challenges to therapeutic approaches. © 2023 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.     

Prediction of prolonged length of stay in the intensive care unit after cardiac surgery: the need for a multi-institutional risk scoring system

Abstract   Background and aim of the study: Predictive models for the length of stay (LOS) in the intensive care unit (ICU) following cardiac surgery have been developed in the last decade. These risk models use different endpoint and risk factor definitions. This review discusses the need for a uniform multi-institutional risk scoring system for a prolonged ICU LOS. Methods: The MEDLINE database was searched for studies assessing the prognostic value of clinical variables predicting ICU LOS. Information on study design, patient population, extended ICU LOS definition, and predictors was retrieved. Results: There is no consensus on the definition of a prolonged ICU LOS. This is mainly because some studies take the continuous variables of "days in the intensive care unit" and try to make it dichotomous when actually the LOS should be analyzed as a "continuous variable." We also report a cardiac surgeon-related component. The most important risk factors were: increased age, no elective surgery, type of cardiac surgery, low left ventricular ejection fraction, recent myocardial infarction, history of pulmonary disease, history of renal disease, and reoperation/reexploration. Conclusions: There is a need for the development of a multi-institutional risk scoring system for prolonged ICU LOS following cardiac surgery. This predictive model could aid in quality assessment, practice improvement, patient counseling, and decision making. In order to develop this risk model, uniformed and standardized definitions are needed.