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Damaged cerebro-cerebellar whitened matter connection as well as interactions with psychological function in individuals using schizophrenia.
INTRODUCTION With the advent of more minimally invasive procedures like endoscopic sleeve gastroplasty (ESG) for weight loss and metabolic disorders, we are seeing more cases of patients presenting with sub-optimal results for consideration of alternative weight loss surgery. The report aims to describe our experience in converting ESG to laparoscopic sleeve gastrectomy and highlight our suggested technique, challenges and pitfalls. PRESENTATION OF CASES We described two bariatrics cases detailing our findings on initial endoscopy along with methods used to reverse ESG hardware, followed by issues encountered during sleeve gastrectomy 1 month later. Case 1 being of a 33 year old female (BMI - 50.7) with previous laparoscopic band removal and 2 ESG attempts, while case 2 is a 31 year old female (BMI 44.6) with previously failed gastric balloon and ESG. DISCUSSION ESG reversal was performed without difficulty via endoscopy with visible sutures cut and hardware removed with snares. In both cases, the stomach was easily endoscopically distensible. During sleeve gastrectomy, extra-gastric adhesions along with more gastro-gastric sutures were encountered in case 1. In case 2, ESG hardware was noted on the external surface of stomach with misfiring of 3rd stapler reload during sleeve gastrectomy likely related to unidentified retained hardware. No post-operative complications occurred in either of the cases with adequate weight loss on one month follow up. CONCLUSION In our experience, ESG conversion to sleeve gastrectomy is feasible and for the most part, uncomplicated. In our case series, we described a two staged approach to conversion although a single staged conversion is theoretically feasible. INTRODUCTION Penetrating cervical spinal cord injury (SCI) is a rare clinical entity that requires a multitude of health care specialists for proper management. The unpredictable nature of penetrating SCI and complex systemic sequela contribute to the high mortality rates of penetrating SCI. PRESENTATION OF CASE An 18-year-old-male patient was admitted to the emergency department with tetraparesis following a penetrating injury to the neck. Radiological examination revealed fractures of C4 and C5 spinous processes and extensive intradural pneumorrhachis. The patient was managed operatively with laminectomy, vertebral augmentation, and duroplasty. An acute decreased level of consciousness was observed four days after the operation. Laboratory investigation revealed critically low plasma sodium level. The patient remained decerebrated despite electrolyte correction and pronounced brain dead on the seventh postoperative day. DISCUSSION Metabolic derangements and pulmonary physiologic changes following trauma are lethal complications. Hyponatremic encephalopathy and disrupted pulmonary function caused by high cervical compression by the extensive pneumorrhachis contributes to the morality in this case report. CONCLUSION This case report presents a rare clinical entity along with its' complications. Prompt clinical stabilization, strict biochemical monitoring, and multidisciplinary care from health care specialists are mandatory for SCI patients. PURPOSE The 8th edition of the American Joint Committee on Cancer (AJCC) pathological staging system for breast cancer considers biologic factors in addition to the anatomical features included in the previous systems. The purpose of this study was to determine the validity of the 8th AJCC staging system for T1-2N1 breast cancer and to assess the effect of additional chemotherapy and radiotherapy according to the new pathologic stages. METHODS The cohort included patients from the Surveillance, Epidemiology, and End Results program (2010-2012) who had stage T1-2N1 invasive breast carcinoma and underwent mastectomy. All patients were restaged using the 8th AJCC staging system. The Kaplan-Meier method, Cox proportional hazards regression, and competing risks models were used for data analysis. RESULTS We identified 9908 patients including 3022 (30.5%), 3131 (31.6%), 1940 (19.6%), 1194 (12.1%), and 621 (6.3%) were classified with stage IA, IB, IIA, IIB, and IIIA disease, respectively. PI3K inhibitor The 5-year breast cancer-specific survival (BCSS) was 97.3%, 94.3%, 88.3%, 84.0%, and 71.1% for stage IA, IB, IIA, IIB, and IIIA disease, respectively. Higher pathological stage was associated with a significantly higher risk of breast cancer-related death. Chemotherapy was associated with better BCSS regardless of the pathological stage, but radiotherapy was only associated with better BCSS in stage IIIA disease. CONCLUSIONS The 8th AJCC pathological staging system provides more refined stratification for T1-2N1 breast cancer patients after mastectomy and may meet the needs of the current trend of individualized decision making for chemotherapy and radiotherapy in this patient subset. BACKGROUND Invasive micropapillary carcinoma (IMPC) is a rare histological subtype of breast cancer. The outcome of IMPC remains controversial; we conducted a meta-analysis of propensity score matching (PSM) studies to evaluate the prognostic difference between IMPC and invasive ductal carcinoma (IDC). METHODS We searched PubMed, EMBASE and the Cochrane library for PSM studies comparing survival data between IMPC and IDC. The summarized odds ratios (ORs) and 95% confidence interval (95% CI) are calculated by STATA software utilizing fixed-effect or random-effect models, depending on the heterogeneity of the eligible studies. RESULTS Eight PSM studies including 2102 IMPC patients are included in the meta-analysis. Compared with IDC, IMPC has a similar overall survival (OS) (estimated OR = 0.87, 95% CI 0.61-1.25), but a shorter relapse free survival (RFS) (estimated OR = 1.31, 95% CI 1.06-1.61); the shorter RFS might owe to the significantly higher loco-regional recurrence rate of IMPC (estimated OR = 3.60, 95% CI 1.99-6.52). Funnel plots and Egger's tests are used to evaluate publication bias and the p value for OS and RFS are 0.036 and 0.564 respectively. CONCLUSIONS Our results demonstrate that compared with IDC, IMPC exhibits a similar, even favorite OS, but a shorter RFS; and the shorter RFS might owe to the significantly higher loco-regional recurrence rate of IMPC. These results could contribute to the individualized therapy and follow-up strategies for IMPC patients.
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