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Roux-en-Y Intussusception: A Case Report.
IF 1 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-27 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.78088
Lina Ibrahim, Santosh Potdar

Roux-en-Y gastric bypass (RYGB) is a bariatric surgical procedure commonly performed in adults to treat severe obesity. While RYGB is generally safe, it occasionally leads to rare but significant complications, including intussusception, a form of bowel obstruction caused by the invagination of an intestine segment from the proximal to the adjacent distal portion. We report a case of intussusception in a 74-year-old female patient who underwent RYGB 12 years prior. A computed tomography (CT) scan revealed jejunal intussusception accompanied by internal herniation, which was subsequently confirmed through exploratory laparotomy. The segments in intussusception were successfully reduced without any complications. Postoperative follow-up demonstrated the absence of recurrence or any additional complications.

{"title":"Roux-en-Y Intussusception: A Case Report.","authors":"Lina Ibrahim, Santosh Potdar","doi":"10.7759/cureus.78088","DOIUrl":"https://doi.org/10.7759/cureus.78088","url":null,"abstract":"<p><p>Roux-en-Y gastric bypass (RYGB) is a bariatric surgical procedure commonly performed in adults to treat severe obesity. While RYGB is generally safe, it occasionally leads to rare but significant complications, including intussusception, a form of bowel obstruction caused by the invagination of an intestine segment from the proximal to the adjacent distal portion. We report a case of intussusception in a 74-year-old female patient who underwent RYGB 12 years prior. A computed tomography (CT) scan revealed jejunal intussusception accompanied by internal herniation, which was subsequently confirmed through exploratory laparotomy. The segments in intussusception were successfully reduced without any complications. Postoperative follow-up demonstrated the absence of recurrence or any additional complications.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e78088"},"PeriodicalIF":1.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143069567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Correction: Hemorrhagic Stroke in a 24-Year-Old Male With Polycythemia Vera: A Case Report and Literature Review.
IF 1 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-27 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.c208
Josephine M Rivera, Paul Vincent Opinaldo

[This corrects the article DOI: 10.7759/cureus.76294.].

{"title":"Correction: Hemorrhagic Stroke in a 24-Year-Old Male With Polycythemia Vera: A Case Report and Literature Review.","authors":"Josephine M Rivera, Paul Vincent Opinaldo","doi":"10.7759/cureus.c208","DOIUrl":"https://doi.org/10.7759/cureus.c208","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.7759/cureus.76294.].</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"c208"},"PeriodicalIF":1.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Intractable Recurrent Abscess Around the Nipple Caused by Mastitis Remitted by Kampo Medicine Treatment: A Case Report.
IF 1 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-27 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.78105
Shin Takayama, Tsukushi Kaji, Akihiko Furuta, Kaolu Sato

We present a case of a 46-year-old woman with recurrent breast abscess resistant to conventional treatments. Initial diagnosis of mastitis led to antibiotic therapy; however, abscess formation recurred. Subsequent interventions, including incision, drainage, and various antibiotics, were insufficient because of recurrent infections. Due to the side effects of long-term antibiotic use, the patient was referred to the Kampo medicine department to address the premenstrual symptoms and recurrent infections. Treatment with Kampo medicines resulted in significant symptom reduction within a month. After treatment, the patient experienced mild symptoms, and breast abscess recurrence was prevented for more than two years. This case highlights the potential role of Kampo medicine in the management of refractory breast abscesses associated with premenstrual symptoms. Further research is required to explore the efficacy and mechanisms of action of Kampo medicines in similar cases.

{"title":"Intractable Recurrent Abscess Around the Nipple Caused by Mastitis Remitted by Kampo Medicine Treatment: A Case Report.","authors":"Shin Takayama, Tsukushi Kaji, Akihiko Furuta, Kaolu Sato","doi":"10.7759/cureus.78105","DOIUrl":"10.7759/cureus.78105","url":null,"abstract":"<p><p>We present a case of a 46-year-old woman with recurrent breast abscess resistant to conventional treatments. Initial diagnosis of mastitis led to antibiotic therapy; however, abscess formation recurred. Subsequent interventions, including incision, drainage, and various antibiotics, were insufficient because of recurrent infections. Due to the side effects of long-term antibiotic use, the patient was referred to the Kampo medicine department to address the premenstrual symptoms and recurrent infections. Treatment with Kampo medicines resulted in significant symptom reduction within a month. After treatment, the patient experienced mild symptoms, and breast abscess recurrence was prevented for more than two years. This case highlights the potential role of Kampo medicine in the management of refractory breast abscesses associated with premenstrual symptoms. Further research is required to explore the efficacy and mechanisms of action of Kampo medicines in similar cases.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e78105"},"PeriodicalIF":1.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11773294/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143060953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Is Routine Group and Save Sampling Necessary for Emergency Laparoscopic Appendicectomy?
IF 1 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-27 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.78086
Simeon Harrow, Aaruran Nadarajasundaram

Background Laparoscopic appendicectomy is a commonly used approach for the surgical management of acute appendicitis. If complications arise, a blood transfusion may be necessary for patients undergoing emergency appendicectomy. The need for routine group and save (G&S) sampling prior to emergency laparoscopic appendicectomy remains a subject of ongoing discussion. The aim of this study was to evaluate whether routine G&S sampling is needed prior to emergency laparoscopic appendicectomy. Methods The present study retrospectively reviewed G&S sampling for emergency laparoscopic appendicectomy cases over a six-month period at two hospital sites in the United Kingdom: Croydon University Hospital (June 1, 2024, to November 30, 2024) and Tunbridge Wells Hospital (October 1, 2023, to April 30, 2024). A total of 304 patients across both sites were included in the review. Results In 2023, 23 procedures (7.6%) were performed, while 279 procedures (92.4%) occurred in 2024. The patient population consisted of 46.4% males (n = 141) and 53.6% females (n = 163), with a mean age of 37.1 years (median 33, range 6-84). A total of 406 G&S samples were collected, of which 351 (86.5%) were processed and 55 (13.5%) were rejected by the blood bank. From the sample size, only one patient received a blood transfusion prior to surgery due to a low hemoglobin level of 72 g/L, likely resulting from the delayed presentation of a perforated appendix. Conclusion This study suggests that omitting routine G&S sampling is safe for patients undergoing emergency laparoscopic appendicectomy. Hence, an individualized risk assessment approach should be used to identify high-risk patients requiring preoperative G&S sampling.

{"title":"Is Routine Group and Save Sampling Necessary for Emergency Laparoscopic Appendicectomy?","authors":"Simeon Harrow, Aaruran Nadarajasundaram","doi":"10.7759/cureus.78086","DOIUrl":"https://doi.org/10.7759/cureus.78086","url":null,"abstract":"<p><p>Background Laparoscopic appendicectomy is a commonly used approach for the surgical management of acute appendicitis. If complications arise, a blood transfusion may be necessary for patients undergoing emergency appendicectomy. The need for routine group and save (G&S) sampling prior to emergency laparoscopic appendicectomy remains a subject of ongoing discussion. The aim of this study was to evaluate whether routine G&S sampling is needed prior to emergency laparoscopic appendicectomy. Methods The present study retrospectively reviewed G&S sampling for emergency laparoscopic appendicectomy cases over a six-month period at two hospital sites in the United Kingdom: Croydon University Hospital (June 1, 2024, to November 30, 2024) and Tunbridge Wells Hospital (October 1, 2023, to April 30, 2024). A total of 304 patients across both sites were included in the review. Results In 2023, 23 procedures (7.6%) were performed, while 279 procedures (92.4%) occurred in 2024. The patient population consisted of 46.4% males (<i>n = 141</i>) and 53.6% females (<i>n = 163</i>), with a mean age of 37.1 years (median 33, range 6-84). A total of 406 G&S samples were collected, of which 351 (86.5%) were processed and 55 (13.5%) were rejected by the blood bank. From the sample size, only one patient received a blood transfusion prior to surgery due to a low hemoglobin level of 72 g/L, likely resulting from the delayed presentation of a perforated appendix. Conclusion This study suggests that omitting routine G&S sampling is safe for patients undergoing emergency laparoscopic appendicectomy. Hence, an individualized risk assessment approach should be used to identify high-risk patients requiring preoperative G&S sampling.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e78086"},"PeriodicalIF":1.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774625/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143070440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Evaluating the Performance of ChatGPT-4o Oncology Expert in Comparison to Standard Medical Oncology Knowledge: A Focus on Treatment-Related Clinical Questions.
IF 1 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-27 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.78076
Oguzcan Kinikoglu, Deniz Isik

Integrating artificial intelligence (AI) into oncology can revolutionize decision-making by providing accurate information. This study evaluates the performance of ChatGPT-4o (OpenAI, San Francisco, CA) Oncology Expert, in addressing open-ended clinical oncology questions. Thirty-seven treatment-related questions on solid organ tumors were selected from a hematology-oncology textbook. Responses from ChatGPT-4o Oncology Expert and the textbook were anonymized and independently evaluated by two medical oncologists using a structured scoring system focused on accuracy and clinical justification. Statistical analysis, including paired t-tests, was conducted to compare scores, and interrater reliability was assessed using Cohen's Kappa. Oncology Expert achieved a significantly higher average score of 7.83 compared to the textbook's 7.0 (p < 0.01). In 10 cases, Oncology Expert provided more accurate and updated answers, demonstrating its ability to integrate recent medical knowledge. In 26 cases, both sources provided equally relevant answers, but the Oncology Expert's responses were clearer and easier to understand. Cohen's Kappa indicated almost perfect agreement (κ = 0.93). Both sources included outdated information for bladder cancer treatment, underscoring the need for regular updates. ChatGPT-4o Oncology Expert shows significant potential as a clinical tool in oncology by offering precise, up-to-date, and user-friendly responses. It could transform oncology practice by enhancing decision-making efficiency, improving educational tools, and serving as a reliable adjunct to clinical workflows. However, its integration requires regular updates, expert validation, and a collaborative approach to ensure reliability and relevance in the rapidly evolving field of oncology.

{"title":"Evaluating the Performance of ChatGPT-4o Oncology Expert in Comparison to Standard Medical Oncology Knowledge: A Focus on Treatment-Related Clinical Questions.","authors":"Oguzcan Kinikoglu, Deniz Isik","doi":"10.7759/cureus.78076","DOIUrl":"10.7759/cureus.78076","url":null,"abstract":"<p><p>Integrating artificial intelligence (AI) into oncology can revolutionize decision-making by providing accurate information. This study evaluates the performance of ChatGPT-4o (OpenAI, San Francisco, CA) Oncology Expert, in addressing open-ended clinical oncology questions. Thirty-seven treatment-related questions on solid organ tumors were selected from a hematology-oncology textbook. Responses from ChatGPT-4o Oncology Expert and the textbook were anonymized and independently evaluated by two medical oncologists using a structured scoring system focused on accuracy and clinical justification. Statistical analysis, including paired t-tests, was conducted to compare scores, and interrater reliability was assessed using Cohen's Kappa. Oncology Expert achieved a significantly higher average score of 7.83 compared to the textbook's 7.0 (p < 0.01). In 10 cases, Oncology Expert provided more accurate and updated answers, demonstrating its ability to integrate recent medical knowledge. In 26 cases, both sources provided equally relevant answers, but the Oncology Expert's responses were clearer and easier to understand. Cohen's Kappa indicated almost perfect agreement (κ = 0.93). Both sources included outdated information for bladder cancer treatment, underscoring the need for regular updates. ChatGPT-4o Oncology Expert shows significant potential as a clinical tool in oncology by offering precise, up-to-date, and user-friendly responses. It could transform oncology practice by enhancing decision-making efficiency, improving educational tools, and serving as a reliable adjunct to clinical workflows. However, its integration requires regular updates, expert validation, and a collaborative approach to ensure reliability and relevance in the rapidly evolving field of oncology.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e78076"},"PeriodicalIF":1.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11771770/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Physical Activity and Incident Pancreatic Cancer: Results From the UK Biobank Prospective Cohort.
IF 1 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-26 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.78040
Borna A Assarian, Christopher D Byrne, Declan McDonnell, Zaed Hamady

Background The relationship between physical activity and incident pancreatic cancer is poorly defined, and the evidence to date is inconsistent, largely due to small sample sizes and insufficient incident outcomes. Using the UK Biobank cohort dataset, the association between physical activity levels at recruitment and incident pancreatic ductal adenocarcinoma (PDAC) at follow-up was analysed. Method Physical activity, the key exposure, was quantified using Metabolic Equivalent Task (MET) values and categorised into walking, moderate, and vigorous activity. These categories were each analysed in quartiles. Summed activity was analysed both in quartiles and using International Physical Activity Questionnaire (IPAQ) activity levels (low, moderate, high). Univariate hazard ratios (HRs) and multivariable-adjusted HRs (aHRs) with 95% confidence intervals (CIs) were calculated using Cox regression analyses. Results A total of 542 incident PDAC cases and 2,139 controls (1:4 matching for age and sex) with a median (IQR) follow-up of 6.8 (1.7) years were analysed. No significant association was found in walking, moderate, and vigorous activities. In summed activity, only the 3rd quartile showed a statistically significant inverse association with PDAC risk (aHR 0.67, 95% CI 0.52-0.86, p<0.01). For IPAQ activity, the moderate and high activity groups showed borderline statistically significant associations with incident PDAC (aHR 0.80, 95% CI 0.63-1.00, p=0.05, and aHR 0.80, 95% CI 0.64-1.01, p=0.06, respectively). Conclusion The large UK Biobank cohort study did not show a strong association between physical activity levels and the development of incident PDAC.

{"title":"Physical Activity and Incident Pancreatic Cancer: Results From the UK Biobank Prospective Cohort.","authors":"Borna A Assarian, Christopher D Byrne, Declan McDonnell, Zaed Hamady","doi":"10.7759/cureus.78040","DOIUrl":"10.7759/cureus.78040","url":null,"abstract":"<p><p>Background The relationship between physical activity and incident pancreatic cancer is poorly defined, and the evidence to date is inconsistent, largely due to small sample sizes and insufficient incident outcomes. Using the UK Biobank cohort dataset, the association between physical activity levels at recruitment and incident pancreatic ductal adenocarcinoma (PDAC) at follow-up was analysed. Method Physical activity, the key exposure, was quantified using Metabolic Equivalent Task (MET) values and categorised into walking, moderate, and vigorous activity. These categories were each analysed in quartiles. Summed activity was analysed both in quartiles and using International Physical Activity Questionnaire (IPAQ) activity levels (low, moderate, high). Univariate hazard ratios (HRs) and multivariable-adjusted HRs (aHRs) with 95% confidence intervals (CIs) were calculated using Cox regression analyses. Results A total of 542 incident PDAC cases and 2,139 controls (1:4 matching for age and sex) with a median (IQR) follow-up of 6.8 (1.7) years were analysed. No significant association was found in walking, moderate, and vigorous activities. In summed activity, only the 3rd quartile showed a statistically significant inverse association with PDAC risk (aHR 0.67, 95% CI 0.52-0.86, p<0.01). For IPAQ activity, the moderate and high activity groups showed borderline statistically significant associations with incident PDAC (aHR 0.80, 95% CI 0.63-1.00, p=0.05, and aHR 0.80, 95% CI 0.64-1.01, p=0.06, respectively). Conclusion The large UK Biobank cohort study did not show a strong association between physical activity levels and the development of incident PDAC.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e78040"},"PeriodicalIF":1.0,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770282/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054632","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Understanding Parental Perspectives on Childhood Hearing Impairment and Timely Interventions.
IF 1 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-26 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.78025
Nada Alharbi, Daniyah Baqalaqil, Hams Alharthi, Nouf Almalki, Samar Altoukhi, Nawaf Alzahrani, Abdullah Sanedi, Farees Almohaimeed, Abdulrahman AlOtaibi, Hosam Amoodi

Objectives: Hearing impairment during childhood is a widespread health issue. Prompt recognition and timely intervention are vital for the advancement of language skills. Insufficient parental knowledge can lead to a delay in diagnosing and treating a condition, which can have a negative impact on academic performance. The goals of our study were to assess the knowledge levels of parents regarding childhood hearing loss and to evaluate their attitudes toward the availability of hearing services.

Methods: A cross-sectional study was conducted using an online questionnaire. Participants, totaling 339, were recruited from various regions across Saudi Arabia through a stratified random sampling technique to ensure diverse representation. Recruitment was conducted via social media platforms, including Twitter, and WhatsApp. The data were examined using Microsoft Excel (Microsoft® Corp., Redmond, WA) and Statistical Product and Service Solutions (SPSS, version 26.0; IBM SPSS Statistics for Windows, Armonk, NY).

Result: This study consisted of 339 participants, of whom 295 (87.0%) were female. The 41-50 age group was the most represented at 35.7% (121/339). A total of 76.1% of the participants demonstrated inadequate knowledge regarding childhood hearing loss and its connection to developmental delay. Although the participants had limited knowledge, a significant majority of 82.9% expressed a favorable disposition toward hearing services.

Conclusions: This study emphasizes the existence of significant gaps in knowledge and diverse attitudes toward childhood hearing loss among caregivers. This underscores the urgent need for public health initiatives to tackle these gaps through educational and awareness campaigns. By promoting a well-informed and optimistic approach to hearing health, we can improve the results of early detection and intervention, thereby reducing the long-term effects on speech, language, and cognitive development.

{"title":"Understanding Parental Perspectives on Childhood Hearing Impairment and Timely Interventions.","authors":"Nada Alharbi, Daniyah Baqalaqil, Hams Alharthi, Nouf Almalki, Samar Altoukhi, Nawaf Alzahrani, Abdullah Sanedi, Farees Almohaimeed, Abdulrahman AlOtaibi, Hosam Amoodi","doi":"10.7759/cureus.78025","DOIUrl":"10.7759/cureus.78025","url":null,"abstract":"<p><strong>Objectives: </strong>Hearing impairment during childhood is a widespread health issue. Prompt recognition and timely intervention are vital for the advancement of language skills. Insufficient parental knowledge can lead to a delay in diagnosing and treating a condition, which can have a negative impact on academic performance. The goals of our study were to assess the knowledge levels of parents regarding childhood hearing loss and to evaluate their attitudes toward the availability of hearing services.</p><p><strong>Methods: </strong>A cross-sectional study was conducted using an online questionnaire. Participants, totaling 339, were recruited from various regions across Saudi Arabia through a stratified random sampling technique to ensure diverse representation. Recruitment was conducted via social media platforms, including Twitter, and WhatsApp. The data were examined using Microsoft Excel (Microsoft® Corp., Redmond, WA) and Statistical Product and Service Solutions (SPSS, version 26.0; IBM SPSS Statistics for Windows, Armonk, NY).</p><p><strong>Result: </strong>This study consisted of 339 participants, of whom 295 (87.0%) were female. The 41-50 age group was the most represented at 35.7% (121/339). A total of 76.1% of the participants demonstrated inadequate knowledge regarding childhood hearing loss and its connection to developmental delay. Although the participants had limited knowledge, a significant majority of 82.9% expressed a favorable disposition toward hearing services.</p><p><strong>Conclusions: </strong>This study emphasizes the existence of significant gaps in knowledge and diverse attitudes toward childhood hearing loss among caregivers. This underscores the urgent need for public health initiatives to tackle these gaps through educational and awareness campaigns. By promoting a well-informed and optimistic approach to hearing health, we can improve the results of early detection and intervention, thereby reducing the long-term effects on speech, language, and cognitive development.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e78025"},"PeriodicalIF":1.0,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11770164/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143054635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Association Between Venous Invasion and Distant Metastasis in Head and Neck Squamous Cell Carcinoma.
IF 1 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-26 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.78023
Takumi Okuda, Takayuki Kawabata

Background: In surgically treated cases of head and neck squamous cell carcinoma (HNSCC), even pathological N0 (pN0) cases according to the Tumor, Node, and Metastasis (TNM) Classification, distant metastases can occur relatively early postoperatively. Therefore, we hypothesized that hematogenous distant metastasis may be related to the degree of venous invasion. Lymphatic invasion is considered to be a poor prognostic factor in HNSCC, but knowledge about venous invasion is scarce. We therefore investigated the association between venous invasion and distant metastasis, an important poor prognostic factor, in cases of HNSCC from our institution.

Subjects and methods: Between April 2020 and December 2023 (four years and nine months), there were 89 cases in which a postoperative pathological evaluation of microvascular invasion was conducted after HNSCC surgery at our institution. Of these, 73 were retrospectively reviewed, after excluding six cases with positive margins and 10 cases with extranodal extension of metastatic lymph nodes. The observation period ranged from 13 to 54 months (mean: 32.5 months). The correlations between the presence/absence of venous or lymphatic invasion at the primary site and distant metastasis were investigated.

Results: Among the 73 cases, venous invasion was found at 31 primary sites, and lymphatic invasion was observed in 38 cases. Distant metastases were found in 10 cases. All cases showed both venous out lymphatic invasion, and none of the cases where these were negative showed distant metastasis. There were significantly more distant metastases in both the venous invasion-positive group (p=0.001) and the lymphatic invasion-positive group (p=0.004).

Conclusion: The absence of distant metastasis in cases that were negative for venous invasion and venous invasion being present in all cases with distant metastasis indicated that venous invasion by the primary tumor is an important factor in distant metastasis. Venous invasion was also found to increase in frequency as the T and N stages progressed.

{"title":"The Association Between Venous Invasion and Distant Metastasis in Head and Neck Squamous Cell Carcinoma.","authors":"Takumi Okuda, Takayuki Kawabata","doi":"10.7759/cureus.78023","DOIUrl":"10.7759/cureus.78023","url":null,"abstract":"<p><strong>Background: </strong>In surgically treated cases of head and neck squamous cell carcinoma (HNSCC), even pathological N0 (pN0) cases according to the Tumor, Node, and Metastasis (TNM) Classification, distant metastases can occur relatively early postoperatively. Therefore, we hypothesized that hematogenous distant metastasis may be related to the degree of venous invasion. Lymphatic invasion is considered to be a poor prognostic factor in HNSCC, but knowledge about venous invasion is scarce. We therefore investigated the association between venous invasion and distant metastasis, an important poor prognostic factor, in cases of HNSCC from our institution.</p><p><strong>Subjects and methods: </strong>Between April 2020 and December 2023 (four years and nine months), there were 89 cases in which a postoperative pathological evaluation of microvascular invasion was conducted after HNSCC surgery at our institution. Of these, 73 were retrospectively reviewed, after excluding six cases with positive margins and 10 cases with extranodal extension of metastatic lymph nodes. The observation period ranged from 13 to 54 months (mean: 32.5 months). The correlations between the presence/absence of venous or lymphatic invasion at the primary site and distant metastasis were investigated.</p><p><strong>Results: </strong>Among the 73 cases, venous invasion was found at 31 primary sites, and lymphatic invasion was observed in 38 cases. Distant metastases were found in 10 cases. All cases showed both venous out lymphatic invasion, and none of the cases where these were negative showed distant metastasis. There were significantly more distant metastases in both the venous invasion-positive group (p=0.001) and the lymphatic invasion-positive group (p=0.004).</p><p><strong>Conclusion: </strong>The absence of distant metastasis in cases that were negative for venous invasion and venous invasion being present in all cases with distant metastasis indicated that venous invasion by the primary tumor is an important factor in distant metastasis. Venous invasion was also found to increase in frequency as the T and N stages progressed.</p>","PeriodicalId":93960,"journal":{"name":"Cureus","volume":"17 1","pages":"e78023"},"PeriodicalIF":1.0,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11774542/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143061383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
A Novel Approach to the Management of an Intra-abdominal Abscess: A Case Report and Literature Review.
IF 1 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-26 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.78022
Maria F Guevara-Kissel, Kenechukwu Egbuonu, Sebastian Valdivieso, Shamon Gumbs, Max Murray-Ramcharan, Maxwell Kissel, Osti Narayan, Hadley Cadot

Exploratory laparotomies for blunt or penetrating trauma often result in significant morbidity. Despite advancements in resuscitation, surgical techniques, and antibiotics, intra-abdominal abscesses remain a serious complication, contributing to poor outcomes and extended hospital stays. Percutaneous computed tomography-guided drainage is the standard treatment for abscesses, offering high success rates and low morbidity. However, its efficacy depends on factors such as abscess location and radiologist expertise. In cases where drainage is inaccessible, open or laparoscopic surgery may be required, which carries substantial risks. In rare situations, administering tissue plasminogen activator (tPA) via an abdominal drain has been shown to resolve abscesses effectively. This report discusses a 37-year-old male patient with a gunshot wound to the left upper abdomen, resulting in hemoperitoneum, gastric injury, and lacerations to the kidney and pancreas. Following surgical repair and placement of a Jackson-Pratt drain, the patient developed sepsis and a subphrenic abscess that could not be accessed for interventional radiology drainage. After weighing the risks and benefits, tPA was administered via the Jackson-Pratt drain, leading to clinical improvement. This innovative approach may offer an alternative for managing difficult-to-drain intra-abdominal collections, potentially reducing surgical intervention and associated morbidity. Currently, no large-scale studies or consensus exist regarding tPA use and dosing for abdominal collections, highlighting the need for further research. Insights from intrapleural tPA application could inform its broader use in intra-abdominal treatments.

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引用次数: 0
Comparing the Efficacy of a Unique Advanced Bioengineered Type-I Collagen-Based Skin Substitute Versus an Amnion Graft With Standard of Care in the Treatment of Non-healing Diabetic Foot Ulcers: A Randomized Clinical Trial.
IF 1 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2025-01-26 eCollection Date: 2025-01-01 DOI: 10.7759/cureus.78021
David G Armstrong, Jason Hanft, Maria Surprenant, Adam Isaac, Marissa Carter, Charles Zelen, Subramanian Gunasekaran

The increased cost and morbidity associated with diabetic foot ulcers (DFUs) place a substantial strain on the entire global healthcare system. In this trial, 24 subjects with a chronic DFU, Wagner grade 1 (University of Texas grade 1A), were treated with Standard of Care (SOC) therapy and randomized, one-half to receive advanced high-purity Type-I collagen-based skin substitute (HPTC; manufactured by Encoll Corp., Fremont, CA, USA), and the other half to receive a dehydrated human amnion/chorion membrane (dHACM) or viable cryopreserved human placental membrane (vCHPM). The primary study endpoint was percentage wound area reduction (PAR) over the five-week treatment period. Secondary endpoints included healing time, proportion of wounds closed, and mean number of graft applications. By four weeks post-randomization, the mean PAR for the HPTC group was 83.9 versus 71.3 for dHACM or vCHPM. By four weeks, 6/12 (50%) of wounds receiving HPTC healed, compared to 3/12 (25%) in the comparator group (dHACM or vCHPM). There were no adverse events reported in either group. The results of this study suggest that HPTC shows great promise in wound healing in people with DFUs, with the given limitations. We look forward to future studies that will confirm these encouraging results.

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引用次数: 0
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Cureus
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