Acta medica academica最新文献

Objective: This article reviews the literature on the anatomy, incidence, and clinical significance of the corona mortis, especially in minimally invasive surgery, where inadvertent surgical complications are more likely to occur.

Methods: A systematic search was performed using the PubMed, Google Scholar, and ScienceDirect databases. Studies with the term "corona mortis" in the title and/or abstract published between 2000 and 2025 that were relevant to the aim of this study were included in this review. Studies published in languages other than English were excluded. The studies were analyzed using narrative data synthesis.

Results: This study reviews the relevant literature and provides a thorough overview of the anatomy of the corona mortis vessels, including different classifications, incidence, location, and size of the vessels. There was a significant discrepancy in the reported prevalence of the corona mortis between studies, especially cadaveric and intraoperative studies. Both arterial and venous 'corona mortis' vessels have been reported, with a greater frequency of venous vessels, which are present in approximately 20% and 40% of hemipelvises, respectively. A number of case reports were evaluated regarding injury to the corona mortis vessels during minimally invasive procedures. These case reports highlight that current surgical practices and techniques seem to adequately prevent damage to these structures.

Conclusion: While there is a relative scarcity of reports showcasing adverse events due to the corona mortis, the moderately high incidence of this variable vessel in approximately half of the hemipelvises necessitates detailed anatomical knowledge and consideration when planning a minimally invasive procedure in the retropubic pelvic space.

Objective: This paper aims to present the perioperative anesthetic challenges in an infant with Lodder-Merla syndrome.

Case report: We present a case report of a 7-month-old infant with Lodder-Merla syndrome, a pacemaker, epileptic spasms, and severe reflux, who was scheduled for open gastrostomy and gastrojejunal tube insertion. Such an intervention would constitute a second consecutive procedure under general anesthesia, shortly after pacemaker implantation. Perioperatively, emphasis was given to maintaining respiratory and cardiac stability, avoiding drugs with parasympathomimetic effects, preventing aspiration, optimizing ventilation, and controlling seizures.

Conclusion: Since Lodder-Merla syndrome affects many organs, perioperative multidisciplinary collaboration and optimization of the affected systems are fundamental.

Objective: This narrative review aimed to investigate the potential differences in antenatal care provision, perinatal outcomes, and administration of obstetric neuraxial analgesia between migrant women and their native counterparts in high-income countries.

Methods: Between March and July 2024, we searched four electronic databases through Ovid and PubMed: Medline, Embase, Global Health, and Maternity and Infant Care. The search terms used included "migrant", "refugee", "asylum seeker", "perinatal", "antenatal", "pregnancy", "neonate", "obstetric anaesthesia", "neuraxial analgesia", and "outcome". We included peer-reviewed articles published in English that presented data on the provision of antenatal and perinatal care, as well as the administration of obstetric neuraxial analgesia to refugee mothers who migrated to high-income countries.

Results: Among the 795 screened records, 41 studies met the inclusion criteria. Of these, ten focused on obstetric neuraxial analgesia administration, while the remaining studies highlighted the differences in antenatal care and perinatal outcomes.

Conclusion: Access to antenatal care, utilisation of neuraxial analgesia, and perinatal and neonatal outcomes for migrant women differ from those of their native counterparts, reflecting the significant challenges encountered during the perinatal period.

Objective: Locally advanced pancreatic cancer (LAPC) represents a significant subset of pancreatic cancers and is characterized by a poor prognosis and limited treatment options. Conventional therapies, including chemoradiotherapy, have demonstrated limited success, prompting interest in innovative strategies, such as immunotherapy. This review evaluates the role of immunotherapy in LAPC.

Materials and methods: For this review, a comprehensive search of the PubMed database was conducted in August 2024. After applying the exclusion criteria, 26 studies were included in the analysis.

Results: Immune checkpoint inhibitors have produced inconsistent clinical outcomes, with modest improvements in progression-free survival and significant side effects. Cancer vaccines, particularly GVAX in combination regimens, have demonstrated potential, as have fibroblast activation protein (FAP) and mKRAS-specific amphiphile vaccines in preclinical and clinical settings. Chimeric antigen receptor (CAR) T-cell therapies targeting various antigens have yielded encouraging outcomes but have faced safety and efficacy challenges. Emerging approaches, including Toll-like receptor agonists, tumor-associated macrophage targeting, and radioimmunotherapy, have also shown preclinical promise but require further study. Despite numerous investigations, the overall impact of immunotherapy on LAPC remains limited. Some combination therapies involving checkpoint inhibitors, vaccines, and CAR T cells have shown positive outcomes; however, many are hindered by the immunosuppressive environment and toxicity of tumors. Recent studies emphasize the need for further research to refine these strategies and improve treatment options.

Conclusion: LAPC remains one of the deadliest malignancies, with immunotherapy offering potential but constrained by limited survival benefits and adverse effects. Further studies focusing on novel agents, refined combinations, and overcoming tumor resistance mechanisms are critical to improve outcomes for this challenging disease.

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 study aimed to thoroughly assess and evaluate recent studies comparing radiofrequency ablation (RFA) and surgical resection in older patients with hepatocellular carcinoma (HCC).

Methods: We searched the databases PubMed, Scopus, and Cochrane for articles published up to 31 October 2024. This review included studies comparing RFA and surgical resection in individuals with HCC aged 65 years or older. The exclusion criteria were non-human research, case reports, editorials, and studies involving patients with liver metastases or cholangiocarcinoma.

Results: We found four retrospective cohort studies. The derived data showed no difference in one-year survival rates. However, the RFA group exhibited a better disease-free survival rate and a lower mortality rate than the surgical resection group.

Conclusion: RFA outperformed surgical resection in terms of overall and disease-free survival rates while showing no appreciable variation in the occurrence of complications. However, this study underscores the need for more extensive research utilizing larger sample sizes, particularly in low- and middle-income countries.

Objective: This case report describes a young female who developed agranulocytosis with blast cells in peripheral blood following prolonged metamizole use after ankle surgery.

Case report: A 17-year-old female patient was admitted to the Department of Infectious Diseases due to high fever and sore throat. Initial diagnostics revealed agranulocytosis, followed by occurrence of blast cells and left shifted neutrophils in the peripheral blood, in subsequent days. Extensive further diagnostics were performed due to suspicion of leukaemia, which was excluded after flow cytometry and cytogenetic analysis of bone marrow aspirate. After all tests were completed, the patient disclosed that she had been using metamizole for four months following ankle surgery.

Conclusion: In cases of agranulocytosis, involving a prolonged history of metamizole use accompanied by the presence of blast cells and granulocyte precursors in peripheral blood, we would recommend an initial diagnostic approach that includes a complete blood count with differential and flow cytometry of peripheral blood. Bone marrow aspiration may be postponed or deemed unnecessary if peripheral blood flow cytometry shows no aberrant populations and there are no other signs of leukaemia.

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: 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: This study describes mutations of genes that stimulate and regulate cell growth, programmed cell death, DNA repair, and cell growth suppression in a boy with osteosarcoma.

Case report: We report a case of bone sarcoma in a 9-year-old boy with possible familial predisposition. In our patient, only a subset of tumor cells expressed the ATRX protein, which is known to control the expression of several genome regions. The function of the p53 protein, which acts as a transcription factor that regulates the DNA damage repair response, cell cycle progression, and apoptosis pathways, is lost in 40-50% of malignant cells. Retinoblastoma was positive in the predominant subset of tumor cells. Deletion is found on chromosome 9, cytoband 9p21.3, where the genes for CDKN2A and CDKN2B are located. Neoplastic cells were SATB2-positive in a substantial subset, with nuclear staining. The SATB2 protein is a DNA-binding protein involved in transcriptional regulation and chromatin remodeling. Chromosomal losses of 8p and 19q11-q13.43 were also found. These regions contain several tumor suppressor genes, including NKX3.1, whose reduced expression correlates with 8p loss in high-grade tumors. Although there was no known cancer syndrome in the family, the maternal grandfather had a similar tumor requiring amputation.

Conclusion: Chromosomal instability is a hallmark of osteosarcoma and is characterized by heterogeneous and extensive genetic complexity. Various numerical and structural genomic rearrangements have been described in cancer cells. However, there is little consistent genetic change to understand the etiopathogenesis of this aggressive tumor.