Seronegative cat-scratch disease diagnosed by PCR detection of Bartonella henselae DNA in lymph node samples

AbstractCat scratch disease (CSD), the typical clinical manifestation of Bartonella infections usually follows a typical benign self-limited course. Nevertheless, a variety of unusual clinical manifestations and confusing imaging features can lead to misinterpretations and render the disease a diagnostic dispute. Routine laboratory tests exhibit varying reported sensitivity and are usually unhelpful in diagnosis, as serology fails in terms of specificity and/or sensitivity. Herein we report a case of seronegative Bartonella infection presenting as symptomatic suppurative lymphadenitis with abscess formation, which was surgically drained. Diagnosis was established by PCR analysis from lymph nodes samples obtained during the procedure. PCR detection of specific DNA fragments from lymph node biopsy provides a sensitive detection of disease. The technique should be considered for patients with suspected CSD and negative serology, since serological assays exhibit low sensitivity. In ambiguous cases, surgical exploration may provide tissue for diagnosis; it is well tolerated and affords improved recovery

Two Cases of Primary Splenic Hydatid Cyst in Greece

Cystic disease of the spleen is an uncommon entity in general population. Most cases result from parasitic infection by Echinococcus granulosus, a form called splenic hydatid disease (SHD), with a reported frequency of 0.5-6.0% within abdominal hydatidosis. On the contrary, an isolated splenic involvement of hydatid disease is very uncommon even in endemic regions. Two cases of primary SHD managed with open and laparoscopic radical surgery in our department are reported herein. Primary SHD is a rare entity with non-specific symptoms underlying clinical suspicion by the physician for prompt diagnosis. Surgical treatment is the mainstay therapy, while laparoscopic approach when feasible is safe, offering the advantages of laparoscopic surgery

ENDOSCOPIC TREATMENT OF COMMON BILE DUCT STONES

BETWEEN 1989 AND 1994, 578 PATIENTS WITH BILE DUCT STONES WERE REFERRED FOR ENDOSCOPIC TREATMENT IN OUR UNIT. CHLOLANGIOGRAPHY WAS SUCCESSFUL IN 564 /578 (98%) PATIENTS, OF WHOM 482 HAD VISIBLE STONES AND 82 HAD DILATED BILE DUCT BUT NO VISIBLE STONES. ENDOSCOPIC SPHINCTEROTOMY WAS SUCCESSFUL IN 556/564 (98%). IN 482 PATIENTS (85%) STONES WERE REMOVED USING STANDARD DORMIA BASKETS AND BALLOON CATHETERS. MECHANICAL LITHOTRIPSY WAS APPLIED IN 26 PATIENTS WITH SUCCESSRATE 88% AND EXTRACORPOREAL LITHOTRIPSY IN 2 WITH SUCCESS RATE 88% AND EXTRACORPOREAL LITHOTRIPSY IN 2 WITH SUCCESS 1/2 (50%). IN 43 PATIENTS WITH NON EXTRACTABLE STONES TWO PIG-TAIL STENTS 7 FR WERE PLACED AND URSODEAXYCHOLIC ACID WAS GIVEN ORALLY. FINALLY 543/564 (96%) PATIENTS WERE TREATED ENDOSCOPICALLY WITH SUCCESS AND OPERATION WAS NEEDED IN ONLY 21 PATIENTS (4%) FOR DEFINITE TREATMENT. COMPLICATION OCCURED IN 31 PATIENTS (5,5%) WITH NO PROCEDURE RELATED MORTALITY IN 30 DAYS. CONCLUSIVELY THE LOW MORBIDITY AND MORTALITY RATE, THE SHORT HOSPITAL STAY AND QUICK CONVALESCENCE HAVE MADE ENDOSCOPIC SUPERIOR TO TRADITIONAL SURGICAL THERAPY OF BILE DUCT STONES.ΚΑΤΑ ΤΗ ΔΙΑΡΚΕΙΑ ΤΗΣ ΠΕΡΙΟΔΟΥ 1989-1994 ΠΑΡΑΠΕΜΦΘΗΚΑΝ ΣΤΟ ΙΠΠΟΚΡΑΤΕΙΟ ΝΟΣΟΚΟΜΕΙΟ ΓΙΑ ΘΕΡΑΠΕΥΤΙΚΗ ΕΝΔΟΣΚΟΠΗΣΗ 578 ΑΣΘΕΝΕΙΣ ΜΕ ΤΗ ΔΙΑΓΝΩΣΗ ΤΗΣ ΛΙΘΙΑΣΗΣ ΤΟΥ ΧΟΛΗΔΟΧΟΥ ΠΟΡΟΥ. Η ΧΟΛΑΓΓΕΙΟΓΡΑΦΙΑ ΗΤΑΝ ΕΠΙΤΥΧΗΣ ΣΕ 564/578 (98%). Η ΕΝΔΟΣΚΟΠΙΚΗ ΣΦΙΓΚΤΗΡΟΤΟΜΗ ΗΤΑΝ ΕΠΙΤΥΧΗΣ ΣΕ 556/564 (98%). ΣΕ 482 ΑΣΘΕΝΕΙΣ (85%) ΟΙ ΛΙΘΟΙ ΑΦΑΙΡΕΘΗΚΑΝ ΜΕ ΤΗ ΧΡΗΣΗ ΚΑΘΕΤΗΡΑ ΜΠΑΛΟΝΙ Η BASKET. ΜΗΧΑΝΙΚΗ ΛΙΘΟΤΡΙΨΙΑ ΕΦΑΡΜΟΣΤΗΚΕ ΣΕ 26 ΚΑΙ ΗΤΑΝ ΕΠΙΤΥΧΗΣ ΣΕ 23 (88%) ΚΑΙ ΕΞΩΣΩΜΑΤΙΚΗ ΣΕ 2 ΚΑΙ ΠΕΤΥΧΕ ΣΤΟΝ 1(50%). ΣΕ 43 ΑΣΘΕΝΕΙΣ ΠΟΥ ΗΤΑΝ ΑΔΥΝΑΤΗ Η ΑΦΑΙΡΕΣΗ ΤΩΝ ΛΙΘΩΝ ΜΕ ΤΙΣ ΥΠΑΡΧΟΥΣΕΣΜΕΘΟΔΟΥΣ ΤΟΠΟΘΕΤΗΘΗΚΑΝ 2 ΕΝΔΟΠΡΟΘΕΣΕΙΣ ΤΥΠΟΥ PIG-TAIL. ΤΕΛΙΚΑ Η ΕΝΔΟΣΚΟΠΙΚΗ ΑΝΤΙΜΕΤΩΠΙΣΗ ΗΤΑΝ ΕΠΙΤΥΧΗΣ ΣΕ 542/564 (96%) ΕΝΩ ΣΕ 21 ΑΣΘΕΝΕΙΣ (4%) ΑΠΑΙΤΗΘΗΚΕ ΧΕΙΡΟΥΡΓΙΚΗ ΕΠΕΜΒΑΣΗ ΓΙΑ ΤΗΝ ΟΡΙΣΤΙΚΗ ΑΝΤΙΜΕΤΩΠΙΣΗ ΤΗΣ ΧΟΛΗΔΟΧΟΛΙΘΙΑΣΗΣ. ΕΠΙΠΛΟΚΕΣ ΣΥΝΕΒΗΣΑΝ ΣΕ 31 ΑΣΘΕΝΕΙΣ (5,5%) ΚΑΙ ΔΕΝ ΣΗΜΕΙΩΘΗΚΕ ΘΑΝΑΤΟΣ ΟΦΕΙΛΟΜΕΝΟΣ ΣΤΗΝ ΕΝΔΟΣΚΟΠΙΚΗ ΕΠΕΜΒΑΣΗ. ΣΥΜΠΕΡΑΣΜΑΤΙΚΑ Η ΥΨΗΛΗ ΑΠΟΤΕΛΕΣΜΑΤΙΚΟΤΗΤΑ ΚΑΙ ΑΣΦΑΛΕΙΑ, Η ΒΡΑΧΕΙΑ ΝΟΣΗΛΕΙΑ ΚΑΙ ΤΑΧΕΙΑ ΑΝΑΡΡΩΣΗ ΕΧΟΥΝ ΚΑΤΑΣΤΗΣΕΙ ΤΗΝ ΕΝΔΟΣΚΟΠΙΚΗ ΘΕΡΑΠΕΙΑ ΑΝΩΤΕΡΗ ΤΗΣ ΧΕΙΡΟΥΡΓΙΚΗΣ Η ΟΠΟΙΑ ΠΛΕΟΝ ΠΡΕΠΕΙ ΝΑ ΕΦΑΡΜΟΖΕΤΑΙ ΜΟΝΟ ΣΕ ΑΠΟΤΥΧΙΑ ΤΗΣ ΠΡΩΤΗΣ

Pancreatic intraductal papillary mucinous neoplasm masquerading as ampullary adenoma: a diagnostic puzzle

Intraductal papillary mucinous neoplasm (IPMN) is the most common pancreatic cystic lesion, remaining mostly asymptomatic. An atypical presentation of such a lesion, initially thought to be an ampullary adenoma, is presented herein. A 78-year-old white male with painless jaundice was treated in a tertiary hospital. Imaging and endoscopic investigations pointed towards an ampullary adenoma obstructing and causing dilatation of both bile and pancreatic ducts. Endoscopic papillectomy was carried out and histology revealed tubulovillous adenoma. Followup duodenoscopy 3 months later showed a recurrent lesion with mucous leaking from the pancreatic duct. Cytology revealed mucin-rich atypical cells, consistent with main-duct IPMN. Pancreatoduodenectomy was performed, finally revealing main-duct IPMN protruding through Vater's ampulla. Cystic pancreatic lesions are increasingly found and IPMN is the most common of these. On the other hand, the management of ampullary adenomas has been revolutionized by endoscopic treatment and the advent of endoscopic papillectomy, with expanding indications. Meticulous clinical and imaging work up of these patients is essential to avoid suboptimal treatment. IPMN should be included in the differential diagnosis of ampullary adenomas, especially in the presence of a grossly dilated pancreatic duct

An Automated Prognostic Model for Pancreatic Ductal Adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) constitutes a leading cause of cancer-related mortality despite advances in detection and treatment methods. While computed tomography (CT) serves as the current gold standard for initial evaluation of PDAC, its prognostic value remains limited, as it relies on diagnostic stage parameters encompassing tumor size, lymph node involvement, and metastasis. Radiomics have recently shown promise in predicting postoperative survival of PDAC patients; however, they rely on manual pancreas and tumor delineation by clinicians. In this study, we collected a dataset of pre-operative CT scans from a cohort of 40 PDAC patients to evaluate a fully automated pipeline for survival prediction. Employing nnU-Net trained on an external dataset, we generated automated pancreas and tumor segmentations. Subsequently, we extracted 854 radiomic features from each segmentation, which we narrowed down to 29 via feature selection. We then combined these features with the Tumor, Node, Metastasis (TNM) system staging parameters, as well as the patient’s age. We trained a random survival forest model to perform an overall survival prediction over time, as well as a random forest classifier for the binary classification of two-year survival, using repeated cross-validation for evaluation. Our results exhibited promise, with a mean C-index of 0.731 for survival modeling and a mean accuracy of 0.76 in two-year survival prediction, providing evidence of the feasibility and potential efficacy of a fully automated pipeline for PDAC prognostication. By eliminating the labor-intensive manual segmentation process, our streamlined pipeline demonstrates an efficient and accurate prognostication process, laying the foundation for future research endeavors

Novel Endoscopic Management of Eroding Laparoscopic Adjustable Gastric Band: A Case Series

Complications of laparoscopic adjustable gastric bands include migration and slippage of the band, dilation of the proximal gastric pouch, troublesome gastroesophageal reflux symptoms, and erosion of the stomach. The latter occurs in 0.6-12.7% of cases and necessitates removal of the band. Several open and laparoscopic surgical techniques have been described for band extraction, while fully endoscopic techniques have emerged and proven safe. Three cases of eroding gastric bands treated in a single center with fully endoscopic removal of the band are analyzed in this study. Novel use of the duodenoscope and endoscopic retrograde cholangiopancreatography instruments and accessories is described, in order to perform endoscopic division of the plastic band and retraction through the mouth. All three cases were successfully treated utilizing this novel technique. Gastric wall erosion from the band has nonspecific symptoms and various predisposing factors. Removal of the foreign material is required. Endoscopic procedures are effective in 77-92% of cases, avoiding general anaesthesia with low surgical morbidity. As a result patients are discharged early resolving quicker to a normal diet

Seronegative cat-scratch disease diagnosed by PCR detection of Bartonella henselae DNA in lymph node samples

Cat scratch disease (CSD), the typical clinical manifestation of Bartonella infections usually follows a typical benign self-limited course. Nevertheless, a variety of unusual clinical manifestations and confusing imaging features can lead to misinterpretations and render the disease a diagnostic dispute. Routine laboratory tests exhibit varying reported sensitivity and are usually unhelpful in diagnosis, as serology fails in terms of specificity and/or sensitivity. Herein we report a case of seronegative Bartonella infection presenting as symptomatic suppurative lymphadenitis with abscess formation, which was surgically drained. Diagnosis was established by PCR analysis from lymph nodes samples obtained during the procedure. PCR detection of specific DNA fragments from lymph node biopsy provides a sensitive detection of disease. The technique should be considered for patients with suspected CSD and negative serology, since serological assays exhibit low sensitivity. In ambiguous cases, surgical exploration may provide tissue for diagnosis; it is well tolerated and affords improved recovery

Methods of safe laparoscopic cholecystectomy for left-sided (sinistroposition) gallbladder: A report of two cases and a review of safe techniques

INTRODUCTION: Left-sided gallbladder is a rare anatomical variation. Usually it is discovered intra-operatively and is accompanied by anatomic variations that can prove quite challenging during laparoscopy. PRESENTATION OF CASE: From a total of almost 3000 laparoscopic cholecystectomies performed in our institution, two cases of left sided gallbladder were unexpectantly identified intraoperatively. There were no indications for the ectopy preoperatively. In both cases modifications of the standard laparoscopic technique were mandatory. They were performed safely with no post-operative complications. Modifications consisted of transposition of the subxiphoid entry port and alteration in the direction of traction of the rest of the graspers. A review of the literature for methods of safe laparoscopic cholecystectomy was conducted. DISCUSSION: The surgeon must be aware of the anatomic variances in the rare occasion of a left sided gallbladder, since preoperative diagnosis is very difficult. CONCLUSION: Knowledge of potential hazards and modifications of laparoscopic technique is mandatory in order to avoid complications