Laparotomic myomectomy for a huge cervical myoma in a young nulligravida woman: A case report and review of the literature

Background: A huge cervical myoma (rare) in a young woman is a nightmare of every gynecologist owing to the associated technical challenges in performing a myomectomy. Moreover, the 2014 US Food and Drug Administration prohibited power morcellation during laparoscopic myomectomy due to the inadvertent spread of occult malignancy and an increased risk of iatrogenic parasitic leiomyoma negatively affected the overall rate of a minimally invasive surgery. Case: This report described our experience with a case of a huge anterior cervical myoma (473 gr) in a young nulligravida woman who successfully underwent laparotomic myomectomy. After an initial diagnosis by Magnetic resonance imaging (MRI), we performed preoperative ureteric catheterization. The myoma was enucleated following the footsteps of Victor Bonney, the pioneer of myomectomy, combined with simple additional steps. We did not use preoperative gonadotropin-releasing hormone analog, intraoperative vasopressin injection, or uterine artery ligation. A 6-month follow-up MRI revealed an intact cervical canal in midline position with no evidence of residual fibroid. Conclusion: Based on our experience, the review of the relevant literature, and the US Food and Drug Administration's prohibition of power morcellation during laparoscopic myomectomy, a laparotomic myomectomy for a huge cervical myoma still plays a vital role in fertility preservation. We propose the mnemonic "MUSIC" as a helpful guide for a consistent strategy: M (preoperative MRI), U (prophylactic ureteric catheterization), S (shell out the myoma following Bonney's principles i.e. start-up and stay intracapsular), I (immediate suction to clarify dead space) and C (close the cavity by spiraling stitch). Key words: Cervix, Fibroid, Leiomyoma, Myomectomy

Magnetic resonance imaging with perfusion and diffusion in assessment of intra-spinal lesions

Abstract Background MRI is the imaging modality of choice in detecting and evaluating spinal lesions. However, advanced techniques as diffusion and perfusion studies can help more in differentiation between neoplastic and non-neoplastic lesions. Our study aimed to detect the role of diffusion and T2* perfusion weighted imaging in characterization of different spinal lesions by measuring the relative cerebral blood volume (rCBV) and apparent diffusion coefficient value (ADC) of all lesions, comparing perfusion of lesion in relation to normal cord and detection of diffusion pattern of each lesion by observing its signal intensity at diffusion images and ADC map. Results Fifty patients were included in this study. Twenty-five patients were with non-neoplastic lesions and twenty-five patients were with neoplastic lesions. The cutoff value of rCBV was 1.2 in differentiation between neoplastic and non-neoplastic lesions with 92% sensitivity and 100% specificity. The cutoff value of ADC was 1 in differentiation between neoplastic and non-neoplastic lesions with 56% sensitivity and 80% specificity. Conclusions Diffusion and perfusion weighted images help in differentiation between neoplastic and non-neoplastic spinal lesions

Applications of MR fiber tractography imaging in multiple scleros

Aim of the study: To evaluate role of fiber tractography in the assessment of white matter (WM) fiber tract affection in patient with multiple sclerosis (MS). Patient and methods: Using fiber tractography, WM tract fibers were evaluated in 12 patients with MS and 8 healthy controls in correlation with motor disability in variants of MS, ages range 35–50 years, mean 40.9 ± 5.2. MRI imaging was obtained by using 1.5 T whole-body scanner. Fiber tractography was acquired after routine sequences. Data postprocessing and fiber tracking method were applied including fractional anisotropy (FA) and mean diffusivity (MD) for three regions. Results: Bilateral WM tract fiber affection was detected in 7 patients, however only 3 showed left sided lesion and 2 patients on right side. WM tract fiber was decreased in all patients; FA and MD for patients were significantly lowered compared to control on all regions (mean values of control FA = 1.07 ± 0.34, MD = 1.27 ± 0.36, with P < 0.05 for all differences). Conclusion: Fiber tractography is a promising non-invasive method for assessing the WM tract affection in patients with MS. It provides an accurate characterization of tissue injury including demyelination and axonal injury

Reliability of magnetic susceptibility weighted imaging in detection of cerebral microbleeds in stroke patients

AbstractObjectiveWe investigated the reliability of susceptibility weighted imaging (SWI) in detecting cerebral microbleeds in stroke patients which predicts future recurrence and judges thrombolytic drugs.MethodsA total of 124 patients referred from stroke unit underwent conventional MRI and SWI. Two observers reviewed twice the SWI separately to identify presence, anatomical location and count of cerebral microbleeds. Inter and intraobserver agreement were calculated using Kappa statistics.ResultsIn SWI, intraobserver agreement for presence of CMBs in any brain location was almost perfect for both observers (K=0.86, p<0.01, 95% CI=0.83–0.89) (K=0.94, p<0.01, 95% CI=0.92–0.96), the interobserver agreement was almost perfect for first and second times (k=0.95, p<0.01, 95% CI=0.94–0.96), (k=0.84, p<0.01, 95% CI=0.8–0.89). Intraobserver agreement was almost perfect for the identified CMBs in each of the three main brain locations : lobar (k=0.9, p<0.01 95% CI=0.8–1), deep (k=0.81 p<0.01, 95% CI=0.71–0.91) and infratentorial (k=0.95 p<0.01, 95% CI=0.9–1).ConclusionSWI is an important reliable technique allows accurate detection of CMBs occurring in association with hemorrhage in acute and chronic stroke and should be included in the protocols for assessment of stroke to help in choice of proper treatment and prediction of future attacks

ARIA masterclass 2018 : from guidelines to real-life implementation

Over the past 20 years, ARIA (Allergic Rhinitis and its Impact on Asthma) has developed various guidelines for the treatment of allergic rhinitis (AR) and asthma multimorbidity. Over time, the ARIA initiative has evolved to ensure the highest level of best-practices adoption in real life settings. It has evolved towards Integrated Care Pathways (ICPs) using mobile technology, and has now entered a new phase in which change management is key to provide an active and healthy life to all AR patients. With that in mind, the first ARIA masterclass was held on 12th September 2018 in Brussels, Belgium. The masterclass aimed at informing clinicians about the principles of change management, providing unbiased education on diagnosis and treatments, sharing the most recent research data on AR and multimorbidities, and creating a snowball effect to increase the adoption of best practices around the globe. This report provides an overview of the ARIA masterclass concept, summarizes the key lectures and discussions, and gives an outline of the future key development

ARIA masterclass 2018: From guidelines to real-life implementation

Over the past 20 years, ARIA (Allergic Rhinitis and its Impact on Asthma) has developed various guidelines for the treatment of allergic rhinitis (AR) and asthma multimorbidity. Over time, the ARIA initiative has evolved to ensure the highest level of bestpractices adoption in real life settings. It has evolved towards Integrated Care Pathways (ICPs) using mobile technology, and has now entered a new phase in which change management is key to provide an active and healthy life to all AR patients. With that in mind, the first ARIA masterclass was held on 12th September 2018 in Brussels, Belgium. The masterclass aimed at informing clinicians about the principles of change management, providing unbiased education on diagnosis and treatments, sharing the most recent research data on AR and multimorbidities, and creating a snowball effect to increase the adoption of best practices around the globe. This report provides an overview of the ARIA masterclass concept, summarizes the key lectures and discussions, and gives an outline of the future key development.status: publishe