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Histopathological approval as well as specialized medical correlates of hippocampal subfield volumetry according to T2-weighted MRI inside temporary lobe epilepsy along with hippocampal sclerosis.
INTERPRETATION The Norwegian Breast Cancer Screening Program does not provide sufficient information for women to be able to make informed, independent choices. Women are nudged to participate by prescheduled appointments, and the information is insufficiently balanced and nuanced.BACKGROUND Long-term ECG recording is a commonly used test. https://www.selleckchem.com/products/tepp-46.html However, there are no clear guidelines on who should be examined using this method, and we lack an overview of the results of testing and their therapeutic implications. MATERIAL AND METHOD All long-term ECG recordings performed at Sørlandet Hospital Arendal in the period 2017-18 were included in the study. The tests were identified by searching the medical records system for relevant procedure codes, and all medical records related to the test were subsequently reviewed. Patient characteristics, referrer, indication, results, further assessment, and treatment were recorded. RESULTS A total of 1 262 long-term ECG recordings were performed at Sørlandet Hospital Arendal in the period 2017-18. The median age of those tested was 60 years, and 48 % of tests were performed in women. A total of 253 (20 %) recordings revealed arrhythmias and 168 (13 %) had therapeutic implications. For patients without known heart disease or a history of stroke (n = 619 (49 %)), the test had therapeutic implications in 32 (5 %) cases. INTERPRETATION Long-term ECG recording was often used to test patient populations with limited cardiac arrhythmia, and the results rarely had therapeutic implications. The findings of the study may indicate that long-term ECG recording should be used to a greater extent in patients for whom positive findings would have therapeutic and prognostic implications, such as those in whom stroke prophylaxis would be indicated if they were found to have atrial fibrillation.BACKGROUND Immunoglobulin G4-related disease (IgG4-RD) is a systemic disease which can potentially affect any organ system. IgG4-related sclerosing cholangitis and inflammatory pseudotumour in the hepatobiliary system is rare, but is probably underdiagnosed. CASE PRESENTATION We present the case of a 52-year-old male who was admitted with obstructive jaundice and weight loss. He presented with a mass lesion in the porta hepatis mimicking hilar cholangiocarcinoma. The patient underwent extended right hepatectomy with hepaticojejunostomy. Severe liver failure developed postoperatively, and the patient underwent liver transplantation. The resected specimen showed infiltration of IgG4 positive plasma cells in the liver hilum, and immunohistochemical staining demonstrated a ratio of IgG4/IgG-positive plasma cells of more than 40 %. Postoperative serological testing showed elevated levels of serum IgG4 6.0 g/L (0.03-2.01), and the CT imaging revealed chronic pancreatitis and bilateral enlargement of the submandibular glands. The patient was ultimately diagnosed with IgG4-related disease. INTERPRETATION It is difficult to distinguish benign bile duct strictures in the porta hepatis from hilar cholangiocarcinoma, and serum IgG4 is unreliable as a diagnostic marker due to low sensitivity and specificity. Greater awareness of IgG4-RD is needed in order to avoid surgery.Oncoplastic breast-conserving surgery extends the indication for breast-conserving surgery. Oncoplastic techniques are used to reshape or replace breast tissue during cancer surgery, in order to retain quality of life and a natural breast that also tolerates necessary post-surgical treatment. This treatment is considered to be oncologically safe, compared to traditional breast-conserving surgery and mastectomy.Bağrul D. Syncope due to acute rheumatic fever with pacemakerlike syndrome. Turk J Pediatr 2019; 61 810-814. The prolongation in the PR interval on the electrocardiogram is one of the minor criteria of Jones. Abnormal increases in the PR interval lead to hemodynamic impairments caused by atrioventricular asynchrony and is called pseudo-pacemaker or pacemaker-like syndrome in the literature. A 13-yearold boy who had polyarthralgia for six weeks was referred to the emergency room because of syncope while exerting effort. In the electrocardiography, the P wave was regularly seen at the onset of the T wave immediately after the QRS wave with extremely prolonged PR interval and mild tachycardia. Also, 24 hours rhythm Holter recording showed atrioventricular dissociation. The echocardiography revealed findings of severe carditis. Diagnosis of acute rheumatic fever accompanying pacemaker-like syndrome was made. Although the recommendation for marked first-degree atrioventricular block that causes hemodynamic impairment is pacemaker implantation, a significant improvement in the PR prolongation was observed in the short term with anti-inflammatory treatment because the impairment of conduction in the patient was due to inflammation. The pacemaker-like syndrome in a child is being reported for the first time in the literature.Boybeyi Türer Ö, Demir N, Ciecieraga T, Günaydın RÖ, Soyer T. Assessment of pediatric cricopharyngeal achalasia with high resolution manometry. Turk J Pediatr 2019; 61 804-809. Cricopharyngeal achalasia (CPA) is an uncommon cause of oropharyngeal dysphagia (OPD) which is the failure of upper esophageal sphincter (UES) to relax during bolus passage. The diagnostic challenges in OPD have been overcome with the use of high resolution manometry (HRM) in children where a catheter based biomechanical evaluation testing of the oropharyngeal swallowing is performed. Herein, we present a case with severe dysphagia diagnosed as CPA utilizing HRM testing. An 8-year-old boy was seen in our clinic with a two-year history of difficult swallowing, recurrent respiratory tract infections, hypoxia and seizure secondary to aspiration. Esophagography revealed an indentation of the cricopharangeal muscle (CPM) in the cervical part of the esophagus. Videofluroscopic swallow studies (VFSS) revealed cricopharyngeal bar at level of Cphageal dilatation and BTI. HRM has become gold standard diagnostic tool in OPD that provides objective evaluation of pharyngeal and UES motility in children.
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