Acta medica academica最新文献

Objective: This literature review aims to present anatomical variations in the primary and secondary auditory cortex, and an analysis of the categories (or classifications) of variation.

Background: Many types of variation of the auditory cortex have been described, but there is a need to classify these variations and reveal their clinical implications.

Methods: A detailed search in PubMed medical database was conducted, from October 2023 to November 2024 using the terms ("anatomical") AND ("variations" OR "categories" OR "types" OR "differences") AND ("human" OR "man") AND ("auditory cortex" OR "auditory cortex" [MeSH]) and 44 articles were found. Applying the inclusion and exclusion criteria, 29 articles were finally selected.

Results: A number of asymmetries have been recorded related to the size of the cortex between the two hemispheres, the number of Heschl's gyri and Heschl's gyrus surface variations, the distribution of gray and white matter, and the surface and size of the secondary auditory cortex. Reviews, and all prospective and retrospective studies, as well as case reports, were eligible for this review.

Discussion: Variations were found amongst patients of reduced auditory ability and the non-hearing impaired, musicians, amateur musicians, and non-musicians, right and left-handed people, men and women, and people with high and low pitch perception ability. Furthermore, variations were detected in people with dyslexia and learning disabilities.

Conclusion: A significant number of anatomical variations of the auditory cortex have been recorded, and closer research will contribute to our comprehension of the origin of some discrepancies in everyday clinical practice.

Objective: We describe a rare case of satisfactory renal allograft function without immunosuppressive therapy following allogeneic hematopoietic stem cell transplantation (alloHSCT).

Case report: The patient was a 64-year-old male who had undergone a kidney transplant from a sibling donor in 2007. After 16 years, he required alloHSCT for acute myeloid leukemia (AML), with the same sibling serving as the donor for both transplants. HLA was a 50% match. Post-alloHSCT, immunosuppressive therapy was discontinued, and the renal allograft function remained stable. The patient later developed severe complications and succumbed to infection. Insights into the precise tolerance mechanisms were limited because laboratory evaluation for chimerism was not performed.

Conclusion: There is potential for immunosuppressive-free renal allograft function after alloHSCT. This case underscores the significant risk of infection-related mortality. To achieve the best outcome, rigorous patient selection, tailored conditioning regimens, robust infection prevention strategies, and the possibility of combined transplantation for carefully selected patients are needed.

Objective: This historical vignette aims to elucidate the contributions of Professor Theodoros Aretaios (1829-1893) to orthopedic surgery in nineteenth-century Greece.

Methods: Documentary research was conducted of Aretaios' personal patient archives, preserved in the National Library of Greece, to validate and evaluate his surgical practices.

Results: The archival records revealed a total of 22 orthopedic cases. Aretaios primarily performed upper and lower limb amputations and dislocation reductions. Reconstructive bone and joint operations were less frequent in his practice.

Conclusion: The role which may be played by the archival records is demonstrated within this historical vignette. The work of Theodoros Aretaios highlights the procedures performed in 19th century orthopedics in the new Greek state. Aretaios contributed to the establishment of the Greek school of surgical practice and many of the surgeons of his era followed his steps.

Objective: The aim of the research was to determine the frequency of BI-RADS category 3 findings in ultrasound examinations in relation to the total number of patients, the frequency of malignant lesions, and their average size at the time of detection in BI-RADS 3 ultrasound findings.

Patients and methods: A cross-sectional study was performed on 335 patients (aged 40-75 years) classified in BI-RADS category 3, at the Tuzla Breast Center, University Clinical Center, in the period from March 2017 to November 2020. A total of 13,760 ultrasound examinations were performed, using a Toshiba Xario 100 ultrasound machine with a 12 MHz linear probe. Patients were divided into premenopausal and postmenopausal groups, excluding patients with symptoms and those with previous breast cancer surgery. The images were stored using the Institution's Pictures Activation and Communication System.

Results: BI-RADS category 3 findings accounted for 27% of all ultrasound examinations (N=3.715). Of these, 9.02% (N=335) underwent recommended short-term follow-up. Malignancy was identified in 1.49% of these cases (N=5), with an average tumor size of 13.6 mm at detection. The malignancy rate did not differ significantly between premenopausal and postmenopausal patients (P=0.412). The overall diagnostic yield for malignancy in BI-RADS 3 findings was low, but clinically significant.

Conclusion: While the malignancy rate for BI-RADS category 3 findings is low (1.49%), careful monitoring and adherence to follow-up guideline are essential to balance early detection with avoidance of unnecessary biopsies and associated costs.

Objective: The aim of this article is to demonstrate that the anesthetic challenges faced by patients with Huntington's disease (HD) undergoing major surgery, can be successfully managed using modern, opioid-sparing, multimodal strategies.

Case report: We present two case studies involving HD patients who received general anesthesia. The first patient also suffered from alcohol use disorder (AUD) and underwent thoracoscopic pleural biopsy. The second patient was scheduled for laparoscopic hemicolectomy. Due to the unavailability of ultrasound and excessive choreic movements, locoregional anesthetic techniques were not feasible. Both patients were successfully managed using similar opioid-sparing, multimodal anesthetic-analgesic strategies, and had uncomplicated postoperative courses. In both patients, a dexmedetomidine infusion was used, and both reported a brief amelioration of their chorea postoperatively.

Conclusion: This is the first reported case of a patient with Huntington's disease with concurrent AUD undergoing general anesthesia using modern, opioid-sparing, multimodal, anesthetic-analgesic strategies. Even when the advantages of locoregional anesthesia are not available, HD patients can be safely and effectively treated using modern anesthetic methods that minimize opioid use and its associated side effects.

Objective: A wide range of lesions, including a mesothelial cyst of the uterine round ligament, are included in the differential diagnosis of a groin mass. Our study emphasizes the rarity of this ailment and the significance of correct preoperative diagnosis in guiding our treatment approach.

Case report: A 43-year-old female patient, presented to our hospital with a five-year history of swelling and slight discomfort in the right groin. A nonreducible inguinal mass with greater projection during a Valsalva maneuver was found. An abdominal CT scan revealed a well-defined lesion located near the right horn of the uterus and extending through the inguinal canal. The patient was brought to the operating room with the clinical suspicion of an inguinal hernia. A soft mass measuring 4.5×2×1.8cm was discovered in the right round ligament, and it was surgically removed. Histopathological examination confirmed a mesothelial cystic lesion. The patient's condition, after a period of 12 months, continues to be satisfactory.

Conclusion: Few cases of uterine round ligament mesothelial cysts have been reported worldwide. Their cause is unknown, and preoperative diagnosis is unreliable. Resection relieves symptoms, and histological examination of the surgical specimen confirms the diagnosis. Additional clinical cases are needed to create a systematic clinical approach.

Background: This study characterizes lymphomas presenting as palpable head and neck masses and evaluates the role of fine needle aspiration (FNA) and flow cytometry (FC) in diagnosis.

Design: A 5-year retrospective review of FNAs performed by pathologists in an ENT clinic identified cases with a predominant lymphoid population that lacked an epithelial component. Cytology, FC, and subsequent surgical pathology diagnoses were correlated.

Results: Of 821 FNAs, 154 (19%) met selection criteria. Reactive lymph nodes accounted for 43% (67/154), with most diagnosed as 'negative for malignancy,' except one 'atypical' (ATY) case. Lymphoma was confirmed in 57% (87/154) of cases, categorized as ATY (55%), suspicious for lymphoma (SFM) (36%), or positive for lymphoma (PFM) (9%). Lymphoma patients were older (median 66 vs. 46 years). Thyroid and salivary gland lymphomas typically indicated systemic involvement, except for two cases of marginal zone lymphoma (MZL) in patients with Sjögren syndrome. FC alone had a sensitivity of 67.5% for detecting lymphoma, but when combined with cytology, the sensitivity increased to 100%. The combined approach maintained a specificity of 98%. More abnormal clonal cells were identified by FC in PFM cases compared to SFM or ATY cases (P=0.004). Cytologic atypia with negative FC occurred in 29% of lymphomas, including Hodgkin and diffuse large B-cell lymphoma (DLBCL).

Conclusion: Lymphomas presenting as neck masses are diverse, with FNA playing a key diagnostic role. Cytologic atypia and FC complement each other, as some cases show minimal atypia but positive FC, while others show significant atypia with negative FC.

Objective: The external jugular vein drains a considerable part of the head and neck and constitutes a vessel implicated in various procedures in the cervical region. The aim of this study is to present an uncommon anatomical variation of the external jugular vein, and discuss the clinical implications of its presence.

Case report: We present a rare case of an ectopic external jugular vein terminating into the axillary vein, that we came across during routine dissection of a male cadaver of Greek origin.

Conclusion: The venous system of the external jugular vein is used during procedures for the treatment of various conditions such as cardiac arrhythmias, hydrocephalus and defects of the head and neck. Hence, encountering the unpredictable course of a variant draining into the axillary vein may complicate these interventions, leading to multiple manipulations and undesirable results. Surgeons should be aware of the alternate anatomy of the venous system of the cervical region, and mindful of the possibility of encountering them.

The aim is to understand the clinical significance of these variations in surgeries and diseases. To conduct this review, we used the PubMed database, considering factors such as the availability of full texts, the language and relevance to the topic, in order to acquire comprehensive and detailed findings. After applying our exclusion criteria, we narrowed the findings down to 11 useful results. Throughout our study, we observed significant variations concerning the obturator nerve. The nerve displays diverse paths and trajectories, leading to deviations from the commonly accepted anatomical description. Additionally, we identified variations in the division point of the obturator nerve and the resulting innervation patterns that it provides for muscles, joints, and skin. More precisely, we discovered differences regarding the path, the source and the level of composition. Moreover, the muscles innervated by the obturator nerve's anterior branch and posterior branch may vary. Furthermore, variations were observed in the innervation of both the skin and joints. CONCLUSION: Our research demonstrates that the obturator nerve is susceptible to many forms of variations. Accurate knowledge of these variations is crucial for minimizing iatrogenic complications and ensuring patient care.

Objective: The purpose of this protocol is to clearly describe the process for the scoping review we plan to conduct on the topic of polygenic risk scores (PRS) in common neurodegenerative diseases. We will present the review's objective, the strategy for evidence search, the data extraction and analysis procedure, and how the results will be presented.

Methods: The inclusion criteria for the planned scoping review will focus on evidence sources that involve PRS applied to neurogenerative diseases such as Multiple sclerosis, Parkinson's disease, Alzheimer's disease, and Amyotrophic lateral sclerosis in any phase of translational research, from early development to clinical implementation. This includes its use in risk prediction, early diagnosis, prognosis, and treatment decision-making. The research questions were created based on the population, context, and concept framework. We will consider both peer-reviewed papers and grey literature published in English or German for inclusion. Two independent reviewers will search for information.

Concluison: The findings from the scoping review will be presented descriptively and summarized according to the research questions to illustrate the current status of translational research on PRS in common neurodegenerative diseases.