26 research outputs found
Metastasis of spindle cell malignant melanoma in gallbladder
Malignant melanoma is an aggressive neoplasm with a high tendency to metastasize.
Gastrointestinal metastases, although described in the literature, are infrequent. We present the case of a 51-year-old male
patient with a surfcial spreading melanoma stage IIIc with BRAF mutation who presented a gallbladder outgrowth lesion,
compatible with a polyp. A signifcant growth of the lesion was observed in subsequent TC studies and a laparoscopic
cholecystectomy was performed. The anatomopathological study of the specimen confrmed the diagnosis of gallbladder
metastasis due to epithelioid and spindle cell malignant melanoma. The presence of a gallbladder lesion in the context of a
patient diagnosed with melanoma should establish the diagnostic suspicion of metastasis, and an early extension study and
laparoscopic cholecystectomy should be considered. The palliative surgical approach to avoid hepatobiliary symptomatology can be considered
The BIDIAP index: a clinical, analytical and ultrasonographic score for the diagnosis of acute appendicitis in children
Background: Pediatric acute appendicitis (PAA) continues to be a diagnostic challenge today. The diagnostic performance of classical indices is only moderate, especially in pediatric population. This study aimed to define a clinical, radiological and analytical index for the diagnosis of PAA.
Materials and methods: This prospective study included 151 patients divided into two groups: (1) 53 patients with non-surgical abdominal pain (NSAP) and (2) 98 patients with a confirmed PAA. Sociodemographic and clinical characteristics were compared between groups using the Mann-Whitney U test and the Fisher exact test. To identify the predictors of PAA, we performed a multivariable logistic regression using a forward stepwise analysis and we assigned multiples of integer values to the selected variables. The diagnostic performance of the index was assessed by calculating the area under the receiver operating characteristic curve. Intra-cohort calibration was assessed with the Hosmer-Lemeshow test.
Results: We developed the BIDIAP index (BIomarkers for the DIagnosis of Appendicitis in Pediatrics), which included three variables that independently predicted higher odds of PAA: appendiceal caliber (≥ 6.9 mm), systemic immune-inflammation index (≥ 890) and peritoneal irritation, which scored 4, 3 and 2 points, respectively. Mean (SD) score of the participants was 2.38 (2.06) in group 1 and 7.89 (1.50) in group 2. The area under the ROC was 0.97 (95% CI 0.95-0.99). The cut-off point was established at 4 points, resulting in a sensitivity of 98.98% and a specificity of 77.78%.
Conclusions: The BIDIAP index has an exceptional diagnostic performance in PAA. The importance of these results lies in its novelty and in the simplicity of the index. Although external validation will be necessary, initial results look promising
Alterations and diagnostic performance of capillary ketonemia in pediatric acute appendicitis: a pilot study
Introduction: The diagnostic performance of capillary ketonemia (CK) has been previously evaluated in context of pediatric acute gastroenteritis. To our knowledge, there is no literature on its performance in the setting of pediatric acute appendicitis (PAA).
Materials and methods: In this study, 151 patients were prospectively included and divided into two groups: (1) patients with non-surgical abdominal pain in whom the diagnosis of PAA was excluded (n : 53) and (2) patients with a confirmed diagnosis of PAA (n : 98). In 80 patients (Group 1, n : 23 and group 2, n : 57) a CK was measured at the time of diagnosis. The PAA group was further classified into complicated (n : 18) and uncomplicated PAA (n : 39). Quantitative variables were compared between groups using the Mann-Whitney U test. Diagnostic performance of CK was evaluated with ROC curves.
Results: CK values were 0.3 [0.1-0.9] mmol/L in group 1 and 0.7 [0.4-1.4] mmol/L in group 2 (p = 0.01). Regarding the type of PAA, CK values were 0.6 [0.4-0.9] mmol/L in uncomplicated PAA and 1.2 [0.8-1.4] mmol/L in complicated PAA (p : 0.02). The AUC for the discrimination between groups 1 and 2 was 0.68 (95/100 IC 0.53-0.82) (p : 0.24) and the AUC for the discrimination between uncomplicated PAA and complicated PAA was 0.69 (95/100 IC 0.54-0.85) (p : 0.04). The best cut-off point (group 1 vs group 2) resulted in 0.4 mmol/L, with a sensitivity of 80.7/100 and a specificity of 52.2/100. The best cut-off point (non-complicated vs complicated PAA) resulted in 1.1 mmol/L, with a sensitivity of 61.1/100 and a specificity of 76.9/100.
Conclusions: This study found significantly higher levels of CK in patients with PAA than in those with NSAP. Similarly, significantly higher levels were observed in patients with complicated than in those with uncomplicated PAA. Nevertheless, the diagnostic performance of CK was only moderate in the two settings analyzed. The potential usefulness of CK determination as a tool to guide the preoperative rehydration regimen of patients with PAA to prevent postoperative hyporexia and vomiting is a promising line of research and should be evaluated in future studies
Leucine-Rich Alpha-2-Glycoprotein as a non-invasive biomarker for pediatric acute appendicitis: a systematic review and meta-analysis
The aim of this study was to analyze the diagnostic performance of Leucine-Rich Alpha-2-Glycoprotein (LRG1) in pediatric
acute appendicitis (PAA). We conducted a systematic review of the literature in the main databases of medical bibliography.
Two independent reviewers selected the articles and extracted relevant data. Methodological quality was assessed using
the QUADAS2 index. A synthesis of the results, standardization of the metrics and 4 random-effect meta-analyses were
performed. Eight studies with data from 712 participants (305 patients with confirmed diagnosis of PAA and 407 controls)
were included in this review. The random-effect meta-analysis of serum LRG1 (PAA vs control) resulted in a significant
mean difference (95% CI) of 46.76 μg/mL (29.26–64.26). The random-effect meta-analysis for unadjusted urinary LRG1
(PAA vs control) resulted in a significant mean difference (95% CI) of 0.61 μg/mL (0.30–0.93). The random-effect metaanalysis (PAA vs control) for urinary LRG1 adjusted for urinary creatinine resulted in a significant mean difference (95%
CI) of 0.89 g/mol (0.11–1.66).
Conlusion: Urinary LRG1 emerges as a potential non-invasive biomarker for the diagnosis of PAA. On the other hand,
due to the high between-study heterogeneity, the results on serum LRG1 should be interpreted with caution. The only study
that analyzed salivary LRG1 showed promising results. Further prospective studies are needed to confirm these findings
A bilateral whitish lesion on the mucosa of the cheek
An 8-year-old girl with no medical history presented
with a bilateral whitish lesion on the mucosa of the
cheek, evident since early childhood. There was no
relevant family history, and her parents had not presented
similar lesions. They reported a progressive growth of the
lesion in the last months, for which she had been evaluated
by maxillofacial surgery, the lesion being oriented as a
frictional keratosis. However, the use of occlusal splint was
not associated with any improvement. She was otherwise
asymptomatic. Physical examination revealed a bilateral,
whitish, well-demarcated cheek mucosal plaque, which
partially coincided with the dental occlusion line. The lesion
did not detach with scratching (Figure 1). No other
alterations were observed in the oral cavity or in the
systematic physical examination
Diagnostic performance of serum pentraxin-3 in pediatric acute appendicitis: a prospective diagnostic validation study
Introduction
Pediatric acute appendicitis (PAA) is a pathology with a high rate of diagnostic error. The search for new diagnostic tools is justified by the high morbidity and healthcare costs associated with diagnostic error.
Methods
We designed a prospective study to validate serum pentraxin-3 (PTX3) as a diagnostic tool in PAA. Participants were divided into three groups: (1) patients with no underlying pathology (2) patients with non-surgical abdominal pain and (3) patients with a confirmed diagnosis of PAA. For further analyses, patients in group 3 were divided into complicated or uncomplicated PAA. Quantitative variables were expressed as medians and interquartile ranges and categorical variables as percentages. Quantitative variables were compared using the Kruskal–Wallis test and the Mann–Whitney U test. Diagnostic performance was evaluated with ROC curves.
Results
This study included 215 patients divided into group 1 (n : 63), group 2 (n : 53) and group 3 (n : 99). Median serum PTX3 values were 2.54 (1.70–2.95) ng/mL, 3.29 (2.19–7.64) ng/mL and 8.94 (6.16–14.05) in groups 1, 2 and 3, respectively (p : 0.001). Patients with complicated PAA showed significantly higher values than patients with uncomplicated PAA (p = 0.04). The AUC (group 2 vs. 3) was 0.77 (95/100 CI 0.69–0.85) and the best cut-off point was at 7.28 ng/mL, with a sensitivity of 61.3/100 and a specificity of 73.1/100. The AUC (complicated vs. uncomplicated PAA) was 0.65 (95/100 CI 0.54–0.77) and the best cut-off point was 12.33 ng/mL, with a sensitivity of 51.72/100 and a specificity of 72.73/100.
Conclusions
The diagnostic ability of serum PTX3 in PAA is only moderate and therefore it cannot be considered a definitive diagnostic test. The discriminatory ability of PTX3 between complicated and uncomplicated PAA is poor. These findings, which contrast with those reported to date, should be validated with future properly designed prospective studies
Pediatric splenic torsion in an orthotopic spleen without fixation elements
A 4-year-old girl presented with acute left upper quadrant abdominal pain and anorexia of 4 days’ duration. She had no relevant medical history and no trauma history was reported. Findings of the physical examination showed abdominal guarding and peritoneal irritation in the left upper quadrant. The rest of the examination was normal
ValoraciĂłn de la aplicabilidad clĂnica y de la rentabilidad diagnĂłstica de un panel de biomarcadores en sangre perifĂ©rica en la apendicitis aguda pediátrica
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ValoraciĂłn de la aplicabilidad clĂnica y de la rentabilidad diagnĂłstica de un panel de biomarcadores en sangre perifĂ©rica en la apendicitis aguda pediátrica
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A novel method of minimally invasive repair of pectus excavatum (MIRPE) in patients with bilateral breast prostheses: a report of two patients
The literature on minimally invasive repair of pectus excavatum in patients with breast prostheses is very scarce, with only one report to date. We present two cases treated in our center in which this technique was performed without prior removal of the breast prostheses. In one of the patients, a sternal zenithal traction system was additionally used to facilitate retrosternal dissection. In this work, we present the technical details of the procedure. One of the patients presented with postoperative Dressler’s syndrome which resolved with conservative measures. We found no correlation between this complication and the presence of breast prostheses. After 4 and 2 years respectively, both patients are asymptomatic, with an adequate correction of the defect, and being followed up. Minimally invasive repair of pectus excavatum technique is safe and feasible in patients with bilateral breast prostheses. The placement of breast prostheses prior to the correction of rib cage deformities leads to an unpredictable aesthetic result in certain aspects, such as the exact positioning of the nipple areola complex. The approach to this pathology by a pediatric surgeon, who considers not only the aesthetic aspect but also the rib cage involvement and the potential presence of additional malformations (for example, a Poland sequence), is, in the authors’ opinion, beneficial to the overall outcome of these patients