Should Spring Water Cysts of the Mediastinum Require Excisional Resection?

Complete surgical excision is the standard therapy for mediastinal cysts. Translucent cysts containing crystal-clear fluid are called “spring water cysts.” We considered that these cysts can be treated adequately using fenestration with minimal bleeding and damage to existing structures. We experienced a case of mediastinal spring water cyst fenestrated under video-assisted thoracoscopy with a miniaturized endoscope (mini-VATS), instead of excisional resection. Fenestration of the non-neoplastic mediastinal cyst under mini-VATS might be a less invasive radical procedure and an alternative to complete resection. We discuss the indication for surgery and the surgical procedure for non-neoplastic mediastinal cyst with crystal-clear fluid.

Occult parametrial metastasis in operable cancer cervix: is a routine radical hysterectomy justified?

Background: Operable Ca cervix is treated by a Type III Radical hysterectomy(RH) with pelvic lymphadenectomy and comprises of a complex parametrial resection (PR) due to the possibility of occult parametrial metastasis(OPM) leading to high post-operative and delayed morbidity especially after adjuvant radiotherapy(RT). If risk factors for OPM were known, a less radical procedure could be performed in low risk patients thus minimizing the morbidity.Methods: A retrospective study was carried out to evaluate the incidence of OPM in operated patients and to study the risk factors associated with OPM and explore the theoretical feasibility of doing a type I hysterectomy in low risk patients.Results: The incidence of OPM was 16.1% in all stages (0% in IA, 10.71% in IB1, 33.3% in Stage IB2 and 18.8 % in IIA1). Primary tumor diameter (PTD) and LNM were the most statistically significant risk factors for OPM. 90% of patients with OPM also had lymph node metastasis (LNM). In this study, all patients with OPM had other risk factors for adjuvant treatment.Conclusions: Small size early stage tumors may be considered for less radical surgery in the absence of obvious intermediate risk factors. A node dissection with negative frozen section during surgery can finally select patients for a simple hysterectomy(SH). More evidence from randomized trials are needed to evaluate the oncological safety of a less radical procedure and define the type of surgery to be done.

Intramolecular radical non-reductive alkylation of ketones via transient enamines

A five-minute one-pot cyclization of dichloro-acetamide-tethered ketones was achieved under microwave activation through a radical procedure involving a transient enamine.

Multigramme synthesis and asymmetric dihydroxylation of a 4-fluorobut-2E-enoate

Esters of crotonic acid were brominated on a multigramme scale using a free radical procedure. A phase transfer catalysed fluorination transformed these species to the 4-fluorobut-2E-enoates reproducibly and at scale (48–53%, ca. 300 mmol). Asymmetric dihydroxylation reactions were then used to transform the butenoate, ultimately into all four diastereoisomers of a versatile fluorinated C4 building block at high enantiomeric-enrichment. The (DHQ)2AQN and (DHQD)2AQN ligands described by Sharpless were the most effective. The development and optimisation of a new and facile method for the determination of ee is also described; 19F{1H} spectra recorded in d-chloroform/diisopropyl tartrate showed distinct baseline separated signals for different enantiomers.