A Pelvis Hydatid Cyst Disease Presenting with Perforated Peptic Ulcer Symptoms

Introduction/Objective: Hydatid parasitic infection in humans can be caused by the parasite Echinococcus. Hydatid cysts form mainly in the liver and lungs. Cysts can rarely be found in other organs. Hydatid cyst in the pelvis can be secondary to rupture of the hydatid cyst in the spleen or kidneys. Primary pelvic hydatid cysts are very rare. Complications and symptoms of hydatid cyst depend on its location. Surgery is the basis of treatment for hydatid cysts.

Multiple Primary Intracranial and Spinal Juvenile Xanthogranuloma: A Case Report

Juvenile Xanthogranuloma (JXG) is a rare histiocytic disorder that belongs to the non-Langerhans cell histiocytosis family. It commonly occurs in the skin of young children, particularly the head and neck region. Occasional cases with extracutaneous involvement have been described. However, involvement of the central nervous system without cutaneous lesions is extremely rare. We present a case of an 11-year-old male child with multiple intracranial and spinal JXGs. At 30 months follow up, after administration of chemotherapy, the patient had passed away. The broad clinical spectrum of JXG and the morphological resemblance to other histiocytic lesions prompt a cautious approach for the diagnosis. Immunohistochemically, those lesions were positive for CD68 and negative for S100 and CD1a. A revised classification for histiocytosis was recently proposed, based on the underlying molecular characteristics. The diagnosis of extracutaneous or disseminated JXG with MAPK-activating mutation or ALK translocations was considered as Erdheim-Chester disease. However, our study did not fit into the proposed classification due to the absence of BRAF-V600E gene mutation and ALK gene rearrangement. Chemotherapy with or without radiotherapy has been suggested as treatment options for unresectable central nervous system lesions.

Extended Segmentectomy for Small Lung Nodule with Image-Guided Video-Assisted Thoracoscopic Surgery

Patients with clinical T1aN0M0 Non-Small Cell Carcinoma (NSCLC) or poor pulmonary function may benefit more from segmentectomy compared to lobectomy. However, there is question about segmentectomy provides not enough safe margin, especially for nodules situated at the intersegmental area. We describe a novel technique using image-guided Video-Assisted Thoracoscopic Surgery (iVATS) to accomplish extended segmentectomy for central lung nodules. This technique helps to overcome the challenges of nodules situated at the intersegmental area.

Efficacy and Safety of Ibutilide for the Cardioversion of Atrial Fibrillation: A Systematic Review and Meta-Analysis

Background: Ibutilide has been approved for cardioversion of Atrial Fibrillation (AF), but its side-effects include a high risk of torsade de pointes, besides, one recent meta-analysis showed ibutilide was inferior to vernakalant for conversion (AF<7 days). Hence, the aim of this study is to evaluate the efficacy and safety of ibutilide for the cardioversion of AF within 90 days. Methods: The Embase, PubMed, Web of Science, Cochrane Central databases and clinical trials.gov were comprehensively searched for relevant studies from January 1991 to May 2020 using the keywords “ibutilide” and “atrial fibrillation”. Only Randomized Controlled Trials (RCTs) comparing ibutilide with placebo or other Anti-Arrhythmic Drugs (AADs) for the termination of AF (duration of AF ≤90 days) were included. The primary outcome was successful cardioversion in response to ibutilide versus placebo or other AADs within 4h. Related adverse events were defined as secondary outcomes. Results: A total of 1712 patients in 13 RCTs met the eligibility criteria. Four trials compared ibutilide to placebo; nine trials compared ibutilide to other active drugs. The results revealed that ibutilide had a higher success rate for the termination of recent-onset atrial fibrillation compared to placebo within 4h [Risk Ratio (RR), 4.64; 95% Confidence Interval (CI), 1.30-16.56, P=0.006]; and ibutilide also showed superiority to DL-sotalol, Propafenone, Procainamide for successful termination of recent-onset AF within 4h. As compared to other active drugs, Ibutilide was associated with a lower risk of hypotension (RR 0.23, 95% CI 0.09-0.57, P=0.002); but significantly increased the incidence of Polymorphic ventricular tachycardia (RR 3.78, 95% CI 1.08-13.23, P=0.04). Conclusion: Intravenous ibutilide could be an accessible choice for the cardioversion of recent-onset AF patients without contraindications, but under strict monitored condition is needed for at least 6 hours.