Giant frontal paranasal mucocele : case report and review of the literature

Teaching point: Giant mucocele is a rare expansile lesion that may mimic other locally aggressive lesions of the cranial vault. Giant frontal mucoceles with massive osteolytic destruction mimicking an aggressive lesion are rare compared to smaller mucoceles. This article reports a giant mucocele of the frontal sinus and reviews the literature. Important imaging clues pointing toward the diagnosis of a mucocele on computed tomography (CT) and magnetic resonance imaging (MRI) are a well-defined expansile mass, an intimate relationship with the frontal sinus, subtle peripheral rim enhancement, and slow progression on serial imaging. The density on CT and signal on MRI may vary along with the lesion content. The potential role of -diffusion-weighted imaging should be elaborated in future reports

Implementing preoperative Botulinum toxin A and progressive pneumoperitoneum through the use of an algorithm in giant ventral hernia repair

Background Repair of large ventral hernias with loss of domain can be facilitated by preoperative Botulinum toxin A (BTA) injections and preoperative progressive pneumoperitoneum (PPP). The aim of this study is to evaluate the outcomes of ventral hernioplasty using a standardized algorithm, including component separation techniques, preoperative BTA and PPP. Methods All patients between June 2014 and August 2018 with giant hernias (either primary or incisional) of more than 12 cm width were treated according to a previously developed standardized algorithm. Retrospective data analysis from a prospectively collected dataset was performed. The primary outcome was closure of the anterior fascia. Secondary outcomes included complications related to the preoperative treatment, postoperative complications, and recurrences. Results Twenty-three patients were included. Median age was 65 years (range 28-77) and median BMI was 31.4 (range 22.7-38.0 kg/m(2)). The median loss of domain was 29% (range 12-226%). For the primary and secondary endpoints, 22 patients were analyzed. Primary closure of the anterior fascia was possible in 82% of all patients. After a median follow-up of 19.5 months (range 10-60 months), 3 patients (14%) developed a hernia recurrence and 16 patients (73%) developed 23 surgical site occurrences, most of which were surgical site infections (54.5%). Conclusion Our algorithm using both anterior or posterior component separation, together with preoperative BTA injections and PPP, achieved an acceptable fascial closure rate. Further studies are needed to explore the individual potential of BTA injections and PPP, and to research whether these methods can prevent the need for component separation, as postoperative wound morbidity remains high in our study

Заява Спілки Археологів України щодо проекту Закону України “Про відродження унікального Символу православ’я — церкви Богородиці (Десятинної) в місті Києві” (№ 9196)

The Milankovitch theory of climate change is widely accepted, but the registration of the climate changes in the stratigraphic record and their use in building high-resolution astronomically tuned timescales has been disputed due to the complex and fragmentary nature of the stratigraphic record. However, results of time series analysis and consistency with independent magnetobiostratigraphic and/or radio-isotopic age models show that Milankovitch cycles are recorded not only in deep marine and lacustrine successions, but also in ice cores and speleothems, and in eolian and fluvial successions. Integrated stratigraphic studies further provide evidence for continuous sedimentation at Milankovitch time scales (10^4 years up to 10^6 years). This combined approach also shows that strict application of statistical confidence limits in spectral analysis to verify astronomical forcing in climate proxy records is not fully justified and may lead to false negatives. This is in contrast to recent claims that failure to apply strict statistical standards can lead to false positives in the search for periodic signals. Finally, and contrary to the argument that changes in insolation are too small to effect significant climate change, seasonal insolation variations resulting from orbital extremes can be significant (20% and more) and, as shown by climate modelling, generate large climate changes that can be expected to leave a marked imprint in the stratigraphic record. The tuning of long and continuous cyclic successions now underlies the standard geological time scale for much of the Cenozoic and also for extended intervals of the Mesozoic. Such successions have to be taken into account to fully comprehend the (cyclic) nature of the stratigraphic record

Radiographic/MR imaging correlation of soft tissues

MR imaging is nowadays regarded as the preferred imaging modality for evaluation of soft tissue lesions. As plain radiographs are often the first step in evaluation of musculoskeletal disorders, identification of subtle soft tissue signs may be helpful to select patients who need to be referred for subsequent MR imaging. Although not very sensitive, certain plain film findings, such as intralesional calcification or gas, may allow one to make to a more specific tissue diagnosis and may obviate the need for invasive diagnostic procedures and potential harmful treatment