Omphalitis with Umbilical Abscess in an Adult with a Urachal Remnant

Case Reports in Gastroenterology ◽

10.1159/000518870 ◽

2021 ◽

pp. 966-971

Author(s):

Antonios Tawk ◽

Ali Abdallah ◽

Paul Meouchy ◽

Joanna Salameh ◽

Salem Khoury ◽

...

Keyword(s):

Ct Scan ◽

Surgical Resection ◽

Purulent Discharge ◽

Incision And Drainage ◽

Urachal Remnant

Omphalitis is an inflammation of the umbilicus and is seldom diagnosed in adults. It is even rarer when it results from an infection of the urachus, an embryological remnant that connects the umbilicus to the dome of the bladder. Patients with omphalitis present with erythema, edema, tenderness, and purulent discharge form the umbilical stump. Workup includes ultrasonography and CT scan of the abdomen and pelvis. Management consists of antibiotics and incision and drainage of the umbilical abscess, followed by surgical resection of the urachal remnant. In this article, we report a case of omphalitis complicated by umbilical abscess in a 20-year-old female with a urachal remnant.

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Differences in Clinical Features and Diagnostic Strategies Between IgG4-Related Autoimmune Cholangitis and Cholangiocarcinoma

Frontiers in Oncology ◽

10.3389/fonc.2021.540904 ◽

2021 ◽

Vol 11 ◽

Author(s):

Ke Zhu ◽

Jin Yang ◽

Ying-zhen Chen ◽

Xue-rong Zhang ◽

Xian-huan Yu ◽

...

Keyword(s):

Ct Scan ◽

Surgical Resection ◽

Plasma Cells ◽

Diagnostic Value ◽

The Sun ◽

Autoimmune Cholangitis ◽

Diagnostic Strategies ◽

Preoperative Diagnostic ◽

Clinical Strategy

IgG4-related autoimmune cholangitis (IgG4-AIC) is often difficult to distinguish from cholangiocarcinoma (CCA). This study aimed to determine a practical clinical strategy for distinguishing between IgG4-AIC and CCA to avoid unnecessary surgical resection. We retrospectively collected and compared the clinicopathological data between IgG4-AIC and CCA patients, including the clinical, serological, and radiological characteristics, to follow up on these patients to investigate the prognosis. Among the 377 patients who received surgical resection for suspecting CCA at the Sun Yat-Sen Memorial Hospital between June 2004 and June 2014, 14 patients were diagnosed as IgG4-AIC through histochemistry after surgery. Immunohistochemistry revealed that IgG4 was up-regulated in the plasma cells of IgG4-AIC tissues in 13 out of 14 patients. The serum CA19-9 level was significantly lower than in the CCA group. Patients with IgG4-AIC can only see slight or no enhancement under the contrast enhancement CT scan, while there are no signs of ring-like or delayed enhancement that is unique to CCA. Thirteen patients were followed up, and the time was 12 to 92 months. Three of them were regularly treated with prednisone after surgery, and original symptoms disappeared. Our study demonstrated that the combination of imaging with serum CA19-9 could improve the preoperative diagnostic value and reduce the rate of unnecessary resection.

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Bilateral suppurative parotitis in a neonate: a case report

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192049 ◽

2019 ◽

Vol 6 (3) ◽

pp. 1383

Author(s):

Srilakshmi M. Chordia ◽

Arulkumaran Arunagirinathan ◽

Karthik S. Bhandary

Keyword(s):

Hospital Stay ◽

Late Complications ◽

Purulent Discharge ◽

Acute Phase Reactants ◽

Incision And Drainage ◽

Sensitivity Pattern ◽

Culture Sensitivity ◽

Parotid Swelling ◽

Supportive Management

Acute suppurative parotitis is a very rare ailment to be encountered in the neonatal period. Here, we report a 13-day old hemodynamically stable neonate, who presented to us with bilateral tender, erythematous parotid swelling and purulent discharge exuding from stensen’s duct. He was exclusively breast fed and had no other risk factors. Provisional diagnosis of acute suppurative parotitis was made with clinical examination. On investigating, there was neutrophilic leukocytosis, elevated acute phase reactants, ultrasonogram showed hypoechoic areas and a heavy growth of Staphylococcus aureus was isolated on pus culture. Baby underwent incision and drainage on the day of admission and was started on appropriate parenteral antibiotics along with supportive management. There was a significant clinical response over next 24 hours. He was doing well throughout the hospital stay and antibiotic course was completed based on culture sensitivity pattern. He neither had any immediate complications during hospital stay nor developed any late complications on follow up. Prognosis of the condition is excellent with adequate timely management. Authors would like to report this case for its rarity and to emphasize on fact that though the condition is uncommon, acute neonatal parotitis should be included in the differentials of any unilateral or bilateral neonatal parotid swelling, as early diagnosis and prompt management of this entity is mandated for a favorable outcome and to limit complications drastically.

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Prevalence of radiologic evidence of metastatic pancreatic ductal adenocarcinoma (PDAC) at first post-operative restaging studies in patients (pts) undergoing pancreatic cancer surgery with curative intent.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.4_suppl.225 ◽

2016 ◽

Vol 34 (4_suppl) ◽

pp. 225-225

Author(s):

Sofia Palacio ◽

Peter Joel Hosein ◽

Joe U Levi ◽

Jaime R. Merchan ◽

Jorge Monge ◽

...

Keyword(s):

Ct Scan ◽

Disease Progression ◽

Surgical Resection ◽

Metastatic Disease ◽

Disease Recurrence ◽

Early Recurrence ◽

Ductal Adenocarcinoma ◽

Comprehensive Cancer Center ◽

Cancer Center ◽

Curative Intent

225 Background: Surgical resection is the only potentially curative modality for PDAC. However, even after a successful surgical resection outcomes are poor due to both local and distant disease recurrence. Patients with early recurrence likely derive no benefit from surgery and could be considered for a non-surgical approach as initial therapy. Since the incidence of recurrent/metastatic disease at first post-operative staging scan is not well documented, our aim was to determine this incidence. Methods: This IRB-approved analysis identified all pts diagnosed with resectable PDAC that underwent surgery with intent to cure at the University of Miami/Sylvester Comprehensive Cancer Center between 2010 and 2012. Patients with imaging before and within 6 months after surgery were included. All post-operative CT scans performed within 3 months after surgery were reviewed for the presence of recurrent and/or metastatic disease. Progression-free survival (PFS) and overall survival (OS) were analyzed using the Kaplan-Meier method. Results: Data from105 pts were analyzed. Mean age was 61, 63% were male, 91% had adenocarcinoma, 84% had disease in the head of the pancreas. 11 out of 85 (13%) pts had recurrent/metastatic disease detected on first post-operative CT scan; 64% stage IIB and 73% had positive lymph nodes. 54 out of 105 (51%) had disease progression. 60% had local recurrence, 40% had distant metastasis. The mean time from preoperative CT scan to surgery was 35 days. Patients with early and late recurrence had similar OS from diagnosis (median 27.7 and 27.1 months, respectively) but worse than those with no disease recurrence (median not reached, OS rate 78% at 36 months). Conclusions: The relatively high incidence (13%) of early recurrence in this retrospective cohort suggests that further studies aimed at improving patient selection for surgery are warranted and provides a strong rationale for the use of neoadjuvant therapy to select patients with early disease progression who would not have benefitted from surgery.

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Bronchoscopic Voriconazole Instillation in Pulmonary Aspergilloma: A Single Center Experience

Nepalese Medical Journal ◽

10.3126/nmj.v2i1.24495 ◽

2019 ◽

Vol 2 (1) ◽

pp. 173-176

Author(s):

Prajowl Shrestha ◽

Ashesh Dhungana

Keyword(s):

Ct Scan ◽

Surgical Resection ◽

Bronchial Artery ◽

Symptom Control ◽

Optimal Dose ◽

Study Data ◽

Dose Frequency ◽

Single Center Experience ◽

Pulmonary Aspergilloma

Introduction: Saprophytic growth of Aspergillus species in preexisting lung cavities commonly presents with hemoptysis. Surgical resection is the preferred treatment for hemoptysis control in pulmonary aspergilloma. In patients, who are not candidates for surgical resection bronchoscopic Voriconazole instillation, is an effective option.Materials and Methods: In this retrospective study, data of patients presenting with active hemoptysis, radiological evidence of aspergilloma and those undergoing bronchoscopic Voriconazole instillation at National Academy of Medical Sciences from January 2018 to December 2018 were retrieved. Clinical details including the severity of hemoptysis, number, size and location of aspergilloma, number of Voriconazole instillation sessions and symptom control were assessed. Follow up CT scan after four to six sessions were also evaluated to compare the size of aspergilloma.Results: A total of 11 patients presented with aspergilloma and hemoptysis. Of these, five (45.4%) patients underwent at least four sessions of bronchoscopic Voriconazole instillation. Two patients required six sessions whereas one required nine sessions for hemoptysis control. The procedure was successful in all patients; however, one had a recurrence after 3 months and required bronchial artery embolisation. In four patients there was a reduction in the size of aspergilloma on follow up CT scan. The procedure was well tolerated by all the patients, except for a mild increase in cough in the immediate post-procedure period.Conclusions: Intrabronchial Voriconazole instillation is a safe and effective option for hemoptysis control in patients with pulmonary aspergilloma. However, the optimal dose, frequency, and duration of Voriconazole instillation need to be further evaluated.

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Clinical study of non epidermoid malignancies of the paranasal sinuses

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20190773 ◽

2019 ◽

Vol 5 (2) ◽

pp. 421

Author(s):

Y. Prabhakar Rao ◽

Punga Amreeta Kaur

Keyword(s):

Ct Scan ◽

Paranasal Sinuses ◽

Nasal Endoscopy ◽

Purulent Discharge ◽

Age Group ◽

Soft Tissue Density ◽

Female Ratio ◽

Non Hodgkins Lymphoma ◽

Male To Female

Background: Malignancy of paranasal sinuses post challenging issues not only for surgeons but also for radiologists. Patients also try to avoid and neglect the condition. Hence clinical studies are more pertinent on this issue. Objective was to study clinical picture of non epidermoid malignancies of the paranasal sinuses.Methods: This was a retrospective hospital based study of 30 patients with non epidermoid malignancies of the paranasal sinuses from two hospitals over a period of more than four years. Clinical characteristics were studied. CT scan, diagnostic nasal endoscopy, histopathology was done for all patients. Data was analyzed using proportions. Results: Majority affected were males. The male to female ratio was 2:1. Maximum cases were found in the age group of 51-60 years and all of them were males. Left side was most commonly affected. The most common presenting feature was nasal obstruction in 50% of the cases. Nasal endoscopy findings has shown that there were five cases each of pinkish red polypoid mass, pinkish grey fleshy mass, pinkish red proliferative mass, pink fleshy mass, purulent discharge and fleshy pinkish red mass. Heterogeneous soft tissue density was the most common CT scan finding. Non Hodgkins lymphoma was more common. Half of the cases were managed by maxillectomy and half of the cases were managed by radiotherapy. There was no recurrence of the tumor after 6-9 months of follow up.Conclusions: Males are more commonly affected than females. Appropriate management of cases prevents recurrence of the tumors.

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The Congenital Sternoclavicular Sinus: a Single-institution Retrospective Study of 88 Patients

10.21203/rs.3.rs-122654/v1 ◽

2020 ◽

Author(s):

Gang Yang ◽

Taozhen He

Keyword(s):

Salivary Gland ◽

Surgical Resection ◽

Histopathological Examination ◽

Recurrent Infection ◽

Ciliated Epithelium ◽

Incision And Drainage ◽

Dermoid Sinus ◽

Clinical Presentations ◽

Histological Characteristics ◽

Branchial Cleft

Abstract Background Sinus near the sternoclavicular joint was considered as a rare congenital neck abnormality. Though it was reported as a dermoid sinus in some literatures, the embryological origin of the sinus was unclear. This study aimed at reviewing the clinical and histological characteristics and analyzing the possible embryological origin of this malformation in children.Methods The medical records of all patients with congenital sternoclavicular sinus who underwent surgical resection between March 2018 through June 2020 were reviewed retrospectively. The clinical presentations, complications, histological examination, and treatment were analyzed.Results Of the 88 patients with congenital sternoclavicular sinus included, the mean age of surgery was 2.73 ± 1.71 years old. The sinuses occurred on the left side in 73 (83.0%) cases. Sixty-three patients experienced sinus infection and 44 patients underwent incision and drainage before excision. All patients received surgical resection with one patient recurred after surgery. Histopathological examination showed that the sinuses were lined by squamous epithelium in most patients. However, ciliated epithelium was observed in one patient and salivary gland was detected in two patients.Conclusions The congenital sternoclavicular sinus should be excised promptly to prevent recurrent infection. According to the ciliated epithelium and salivary gland were found in the wall of sinus, it should be viewed as the skin side remnant of the fourth branchial cleft rather than a dermoid cyst/sinus.

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P-P58 The role of PET-CT in the management of pancreatic cancer. A Northern Ireland experience

British Journal of Surgery ◽

10.1093/bjs/znab430.280 ◽

2021 ◽

Vol 108 (Supplement_9) ◽

Author(s):

Lauren Laverty ◽

Stephen McCain ◽

Lloyd McKie

Keyword(s):

Pancreatic Cancer ◽

Northern Ireland ◽

Ct Scan ◽

Surgical Resection ◽

Metastatic Disease ◽

Time Interval ◽

Resectable Disease ◽

Number Of Patients ◽

Pet Ct ◽

The Impact

Abstract Background Diagnosis and staging has proven to be difficult in 10-20% of patients with pancreatic cancer. The PET-PANC study found that PET-CT significantly influenced the staging and management of pancreatic cancer and therefore the NICE guidelines now advise PET-CT in all patients who have localised potentially resectable disease. This study aimed to investigate the impact of PET-CT on the management of pancreatic cancer patients in a single tertiary referral centre. Methods There were 288 patients with pancreatic cancer discussed at the Northern Ireland Regional Hepatobiliary MDM from January 2020 to March 2021. Of these patients, 176 were deemed to have inoperable disease based on initial CT, 5 had borderline resectable disease, 1 had holding chemotherapy due to COVID restrictions and 57 were excluded from surgical resection for a variety of reasons. These included the patient being unfit for surgery, the patient declining operative intervention and an alternative treatment offered as result of COVID-19 pandemic. Therefore, there were 49 patients with pancreatic adenocarcinoma which the MDT concluded should be considered for surgical resection. Results A total of 27 patients who were due to undergo a curative resection had a pre-operative PET-CT scan (55.1%). This demonstrated metastatic disease in 9 cases (33.3%). Four patients who did not have a preoperative PET-CT were found to have metastatic disease at operation (9.7%). This equated to a total metastatic incidence of 26.5% in those who had been initially deemed resectable based on CT scan alone. The time interval from MDM decision to surgery averaged 25.4 days in those who did not have a PET/CT compared to 40.43 days in those who did. This was an average delay of 15.07 days until treatment. Conclusions This study demonstrates the important role the PET-CT has in the management of patients with pancreatic cancer. A significant number of patients avoided an unnecessary operation which would have delayed the commencement of chemotherapy. However, there are limitations to PET-CT, demonstrated in the patient with an inconclusive result, who was found to have liver metastases at surgery. The introduction of PET-CT in the staging process does undoubtedly cause delays to surgical resection and a more streamlined pathway needs to be developed to limit the delay to curative treatment.

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A Late Presenting Urachal Remnant Tumour: Rare Adenocarcinoma Originated from Developmental Defect

International Journal of Medical and Pharmaceutical Case Reports ◽

10.9734/ijmpcr/2019/v12i130096 ◽

2019 ◽

pp. 1-8

Author(s):

Ipsita Dey ◽

Chhaya Roy ◽

Tushar Kanti Das

Keyword(s):

Ct Scan ◽

Residual Disease ◽

Histopathological Examination ◽

Bladder Wall ◽

Disease Diagnosis ◽

Urachal Cyst ◽

Developmental Defect ◽

Urachal Remnant ◽

Contrast Enhanced Ct ◽

Urachal Adenocarcinoma

Occupying only 0.01% of all adult cancer patients, the rare entity urachal adenocarcinoma constitutes 22-35% of adenocarcinomas originating from urinary bladder. Though with the gradual descend of the bladder in the course of development urachus should turn into median umbilical ligament, exceptional persistence of it can give rise to urachal cyst or urachal adenocarcinoma in adulthood. With only 43% of survival rate for 5 years and mean survival between 12 and 24 months urachal carcinoma is a devastating disease. Diagnosis of it is based on the MD Anderson Cancer Centre (MDACC) criteria. Computed Tomography (CT) Scan and/or Magnetic Resonance Imaging (MRI) Scan of abdomen and pelvis are the major imaging modalities to proceed towards diagnosis and staging. Not only histopathological examination but also immune-histochemical expression of both CK7 and CK20 suffice to clinch the diagnosis. Though surgical intervention forms the mainstay of treatment, several regimens of chemotherapy have also been tried to fight against unresectable, residual, extensive urachal carcinomas. This case took place in a 52 years old male patient who was presented with a gradually enhancing infra-umbilical swelling with slow growing urinary symptoms. By dint of Ultrasonography (USG) and Contrast Enhanced CT (CECT) scan of whole abdomen the tumour was detected involving the bladder wall and the anterior abdominal wall. Cystoscopy was followed by upfront cytoreductive surgery. Histopathological examination revealed the diagnosis of an adenocarcinoma which was further confirmed to be an urachal remnant carcinoma with the help of immunohistochemistry. Post-operative CT scan showed residual disease involving bladder wall and was treated with an adjuvant platin based chemotherapy regimen.

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The congenital sternoclavicular sinus: a single-institution retrospective study of 88 patients

Orphanet Journal of Rare Diseases ◽

10.1186/s13023-021-01691-x ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Gang Yang ◽

Taozhen He

Keyword(s):

Surgical Resection ◽

Histopathological Examination ◽

Recurrent Infection ◽

Ciliated Epithelium ◽

Incision And Drainage ◽

Dermoid Sinus ◽

Clinical Presentations ◽

Histological Characteristics ◽

Branchial Cleft ◽

The Mean

Abstract Background Sinus near the sternoclavicular joint was considered as a rare congenital neck abnormality. Though it was reported as a dermoid sinus in some literatures, the embryological origin of the sinus was unclear. This study aimed at reviewing the clinical and histological characteristics and analyzing the possible embryological origin of this malformation in children. Methods The medical records of all patients with congenital sternoclavicular sinus who underwent surgical resection between March 2018 through June 2020 were reviewed retrospectively. The clinical presentations, complications, histological examination, and treatment were analyzed. Results Of the 88 patients with congenital sternoclavicular sinus included, the mean age of surgery was 2.73 ± 1.71 years old. The sinuses occurred on the left side in 73 (83.0%) cases. Sixty-three patients experienced sinus infection and 44 patients underwent incision and drainage before excision. All patients received surgical resection with one patient who recurred after surgery. Histopathological examination showed that the sinuses were lined by squamous epithelium in most patients. However, ciliated epithelium was observed in one patient and salivary glands were detected in two patients. Conclusions The congenital sternoclavicular sinus should be excised promptly to prevent recurrent infection. According to the ciliated epithelium and salivary gland were found in the wall of sinus, it should be viewed as the skin side remnant of the fourth branchial cleft rather than a dermoid cyst/sinus.

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