Complete Polyp Resection with Cold versus Hot snare Polypectomy for Polyps sized 4-9 mm: A randomized controlled trial

Background and study aims: Endoscopic screening with polypectomy reduces colorectal cancer (CRC) incidence. Incomplete polyp removal may attenuate the effect of screening. This randomized trial compared cold snare polypectomy (CSP) with hot snare polypectomy (HSP) regarding complete polyp resection. Patients and methods: We included patients ≥ 40 years at 8 hospitals in 4 countries who had at least one 4-9 mm non-pedunculated polyp detected at colonoscopy. Patients were randomized 1:1 to CSP or HSP. Biopsies from the resection margins were obtained systematically after polypectomy in both groups. We hypothesized that CSP would be non-inferior to HSP with a non-inferiority margin of 5%. Logistic regression models were fitted to identify factors explaining incomplete resection. Results: In total, 425 patients, with 608 polyps were randomized to either CSP or HSP. Of 318 polyps removed by CSP and 283 polyps removed by HSP, 34 (10.7%) and 21 (7.4%) were incompletely resected, respectively, with an adjusted risk difference of 3.2% (95% CI -1.4 – 7.8). There was no difference between the groups in terms of post-polypectomy bleeding, perforation, or abdominal pain. Independent risk factors for incomplete removal were serrated, odds ratio (OR) 3.96, (95% CI 1.63-9.66) and hyperplastic histology, OR 2.52 (95% CI 1.30-4.86)) in adjusted analyses. Conclusion: In this randomized trial, non-inferiority for cold snare polypectomy could not be demonstrated. Polyps with serrated histology are more prone to incomplete resection compared to adenomas. Cold snare polypectomy for small polyps can be used safely in routine colonoscopy practise.

Incomplete Removal and Accidental Retention of Temporary Epicardial Pacing Wires in the Chest after Heart Surgery: A Case Report

Temporary pacemaker wires are commonly used for the diagnosis and treatment of arrhythmias in the acute postoperative period. We herein describe a 65-year-old woman with a history of coronary artery bypass graft surgery who was referred to the hospital with a purulent discharge in the lower third of the sternal region while on antibiotics. Two years later, following treatment failure, 2 sternal wires were removed. Several years after the surgery, the patient developed a purulent discharge. On suspicion of rib osteomyelitis, the last left cartilage attached to the sternum was excised and removed together with an infectious tract. During the operation, the right ventricle was torn, and tampons were used to control bleeding. The patient was placed under cardiopulmonary bypass via the cannulation of the left femoral artery and the right femoral vein. The sternum was opened, and the rupture site was repaired. A temporary epicardial pacing wire was found at the site of the right ventricular rupture. Several days later, the patient was taken from the intensive care unit to the operating room due to a pulsatile hematoma in the left groin and a diagnosis of a pseudoaneurysm of the femoral artery. After a week, the purulent discharge at the lower sternum improved, and the patient was discharged. At 1 month’s post-discharge follow-up, the infection was eradicated

Adsorption of Diclofenac Sodium Using Low-Cost Activated Carbon in a Fixed-Bed Column

In recent years, the presence of pharmaceutical contaminants, such as diclofenac sodium (DCF) in water bodies and their potential influence on aquatic organisms gained much attention. As a result of high demand and usage by consumers, in addition to incomplete removal during wastewater treatment, pharmaceutical contaminants will end up on water surfaces. To mitigate this problem, the elimination of DCF by employing activated carbon derived from Dillenia Indica peels was evaluated. The adsorption of DCF was performed in a continuous process. The findings showed that the adsorption of DCF was favorable at a lower flow rate, greater bed height, and initial DCF concentration, with the highest removal percentage of 44.93%. To assess the characteristics of the breakthrough curve of DCF, the adsorption data were used to match three distinct adsorption models, namely, Boharts and Adam, Yoon-Nelson, and Thomas. The breakthrough results were well-fitted with these models, as the values of R2 for all models and parameters were higher than 0.88. Thus, it was concluded that the activated carbon from Dillenia Indica can effectively remove DCF from an aqueous solution.

Oral Reactive Lesions Associated to Incomplete Removal of Natal Teeth: Case Report

Natal teeth are infrequent at birth. Dental extraction is the most recommended treatment to avoid complications. Reactive soft tissue lesions associated to natal tooth or its incomplete removal are rare. A five-month-old female presented natal teeth #71 and #81 which were removed the day after the birth. The baby evolved with two nodules in the region of #71 and #81, pedunculated, 10 and 9 mm, respectively, covered by a pink mucosa, firm in consistency. Periapical radiography showed two radiopaque areas, suggestive of root fragments. After 30 days the nodule located in the region of #81 became purple in color and ulcerated. Both lesions were removed with high intensity diode laser. Histopathological analysis was compatible with inflammatory fibrous hyperplasia (#71) and pyogenic granuloma (#81). Early diagnosis of oral lesions in newborns by means of histopathological examination and a minimum invasive treatment, such as laser surgery, should be of primary concern.

Challenges and Recent Advances in Enzyme-Mediated Wastewater Remediation—A Review

Different classes of artificial pollutants, collectively called emerging pollutants, are detected in various water bodies, including lakes, rivers, and seas. Multiple studies have shown the devastating effects these emerging pollutants can have on human and aquatic life. The main reason for these emerging pollutants in the aquatic environment is their incomplete removal in the existing wastewater treatment plants (WWTPs). Several additional treatments that could potentially supplement existing WWTPs to eliminate these pollutants include a range of physicochemical and biological methods. The use of enzymes, specifically, oxidoreductases, are increasingly being studied for their ability to degrade different classes of organic compounds. These enzymes have been immobilized on different supports to promote their adoption as a cost-effective and recyclable remediation approach. Unfortunately, some of these techniques have shown a negative effect on the enzyme, including denaturation and loss of catalytic activity. This review focuses on the major challenges facing researchers working on the immobilization of peroxidases and the recent progress that has been made in this area. It focuses on four major areas: (1) stability of enzymes upon immobilization, enzyme engineering, and evolution; (2) recyclability and reusability, including immobilization on membranes and solid supports; (3) cost associated with enzyme-based remediation; and (4) scaling-up and bioreactors.

Chronic Macular Oedema as a Late MIRAgel-Related Complication

Background: MIRAgel® (MIRA, Waltham, MA, USA) is a hydrogel scleral buckle introduced in 1979 to treat rhegmatogenous retinal detachments. Its use was discontinued because late complications that require surgical removal were reported. Methods: Case report. Results: We report a case of left eye MIRAgel® buckle surgery 28 years ago presenting with a tender palpable erythematous swelling at the lower lid, with marked conjunctival chemosis and progressive ophthalmoplegia. Imaging revealed a large, well-defined, horseshoe-shaped lesion in the extraconal space of the left orbit with globe distortion, with histological confirmation of an expanded hydrogel buckle. He recovered well following removal of the explant but developed chronic macular oedema a year later, which persisted despite sub-Tenon’s triamcinolone injections. Repeat imaging demonstrated remaining hydrogel explant. Macular oedema settled well upon successful surgical removal with no recurrence to date. Conclusion: Our case is the first to describe macular oedema as a late MIRAgel-related complication, with complete removal of the explant being the definitive treatment. Macular oedema indicates postoperative inflammation secondary to the remaining explant fragments. Given the friability of hydrolysed MIRAgel®, we recommend ophthalmologists to warn patients regarding the possibility of further inflammation in the globe or the orbit in case of incomplete removal.

Spatial substantiation of linear parameters of biopsy in histological examination of pigmented skin neoplasms in children

Usually the lower part of melanocyte nevi is at a depth of not more than 1–2 mm or more, which is typical for congenital nevi, as well as for large pigmented tumors that protrude significantly above the skin surface and have a pronounced intradermal part. Incomplete removal of pigmented nevi occurs during their superficial removal with insufficient capture of healthy tissues. When excision of pigmented nevi by acute method means in the vast majority of cases of incomplete removal can be avoided, and primarily because the suturing of the edges of the postoperative wound requires much deeper excision of tissues. Рurpose – to increase the effectiveness of surgical treatment of pigmented skin tumors in children by using a mathematical model. Materials and methods. The study was conducted on the basis of the oncohematology department of Vinnytsia Regional Children’s Clinical Hospital, a mathematical model for calculating the parameters of operational access was conducted on the Microsoft Excel platform. Results. Using the proposed mathematical model, the following parameters of the operating material were calculated: the area of the resection edges of the operating material; the area of the base of the operating material; the total area of morphological examination of the surface of the surgical material; determining the difference in the volume of surgical material to be histologically examined by different methods of its collection. In all cases, the tumor for three-dimensional histological examination was excised in the form of an ellipse with a safety zone (healthy tissue around the tumor). The surgical direction of the incision was formed with an inclination to the surface of the skin towards the tumor with the formation of an acute angle with it, while the upper part of the dermis was cut less than its lower part. This approach to the formation of the profile of the surgical wound improves the conditions for further reconstructive wound defect closure. Conclusions. Comparative mathematical calculation according to the proposed spatial geometric model of the biopsy in the form of a truncated elliptical cone convincingly shows an increase in the useful volume of surgical material in the planned histological examination compared with the cylindrical elliptical configuration of the biopsy due to involvement in the field of microscopic structures «residual structures» (processes) corresponding to melanocyte nevi, under the guise of which the development of the initial stages of melanoma may occur. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: children, melanocyte nevi, operative accesses.

Radiosurgical treatment of patients with intracranial pilocytic astrocytomas

The study objective is to assess the outcomes after stereotactic radiosurgical treatment (SRS) in patients with pilocytic astrocytomas after non-radical surgery and after continued tumor growth.Materials and methods. The report includes 56 patients (37 males and 19 females) who have undergone SRS in N. N. Burdenko National Medical Research Center of Neurosurgery from March 2005 to January 2018.Results. The majority of patients (75 %) were children. Almost 43 % of patients underwent SRS as part of the primary treatment after biopsy or incomplete removal, other patients – in the event of continued tumor growth after non-total surgery. Tumors involved the cerebellum (41 %), brainstem (23 %), thalamus (19.6 %) and cerebral hemispheres (16.1 %). The median tumor volume was 1.9 cm3 (0.14–19.00 cm3), 23 % of patients had cysts in the tumor. The prescribed dose was 12 to 22 Gy (median 18 Gy) over 50–80 % isodose line. The follow-up was available for 54 (96.4 %) patients. The median follow-up was 67 months (3–151 months). All patients were alive at the end of the follow-up examination. In 14 (25 %) patients, the development of pseudo-progression (PSP) was noted. The median detection of PSP is 11 months (3–65 months). Of these, in 7 (50 %) patients PSP was accompanied by clinical deterioration: in 5 – an increase in general cerebral symptoms and in 1 patient – an episode and an increase in cerebellar symptoms. Eight (57 %) patients with PSP were reoperated: 4 underwent removal of the tumor, 4 – emptying of the cyst and placement of the Ommaya reservoir, which led to regression of the existing symptoms. No other toxicity was observed in patients. At the time of the completion of the follow-up examination (with a given median follow-up), no relapses were detected. There was no clinical deterioration after SRS.Conclusion. Radiosurgical treatment is an effective and safe method of radiation treatment for patients with primary pilocytic astrocytomas and recurrent pilocytic astrocytomas, providing control over tumor growth in all patients with a low risk of complications.

Extradural Glomus Tumor of the Thoracic Spine: Case Report and Literature Review

Background: Glomus tumors are rare lesions that can arise anywhere along the spinal axis. Only thirteen cases have been reported. We report a case of a patient with a rare glomangioma of the thoracic spine. Following a review of the twelve previous cases is a discussion of a spinal glomus tumor with regard to clinical presentation, diagnosis, and treatment. Methods: A single, recent case arising from the extradural space of the thoracic spine is described, followed by a literature review of spinal glomus tumors.Results: Including our case, thirteen cases of a glomus tumor have been reported. The mean age at the time of diagnosis was 44.6 years (range: 22–73 years) and the male-to-female (M:F) ratio was 1.17:1. The lesion was located in the cervical spine in 1 patient, the thoracic spine in 7 patients, the lumbar spine in 4 patients, and the sacrum in 1 patient. All the tumors were benign; however, there was one report of local recurrence because of incomplete removal. There were no malignant transformations, metastases, or deaths reported with a mean follow-up of 20.09 ± 28.43 months (range: 2–90 months).Conclusions: Spinal glomus tumor are rare, and the preoperative diagnosis is difficult. An overwhelming majority of glomus tumors are benign and are cured by simple local excision. Patients undergoing complete resection have an excellent long-term prognosis.Trial registration: Not applicable.