Hemangiomatous Ameloblastoma: A Rare Variant

Ameloblastoma is a true neoplasm of enamel organ type tissue. It is the most common odontogenic neoplasm with more frequency in the mandible. A 20 years old male patient presented with a swelling in the right side of the mandible of 10 months duration. Orthopantomograph revealed multilocular radiolucency extending from the region of 46 to the condyle. Incision biopsy revealed features of plexiform ameloblastoma. Numerous vascular spaces of varying size were seen throughout the stroma. Excision biopsy also revealed similar findings. Based on these findings, a diagnosis of hemangiomatous plexiform ameloblastoma was made. Hemangiomatous ameloblastoma (HA) is still a controversial entity, with some pathologists ruling it out as a  separate lesion. This paper discusses the possibility that HA might be an aggressive variant of ameloblastoma and reviews relevant literature.&nbsp

Cervical lymph node metastasis in high-grade transformation of head and neck adenoid cystic carcinoma: a collective international review

Adenoid cystic carcinoma (AdCC) is among the most common malignant tumors of the salivary glands. It is characterized by a prolonged clinical course, with frequent local recurrences, late onset of metastases and fatal outcome. High-grade transformation (HGT) is an uncommon phenomenon among salivary carcinomas and is associated with increased tumor aggressiveness. In AdCC with high-grade transformation (AdCC-HGT), the clinical course deviates from the natural history of AdCC. It tends to be accelerated, with a high propensity for lymph node metastasis. In order to shed light on this rare event and, in particular, on treatment implications, we undertook this review: searching for all published cases of AdCC-HGT. We conclude that it is mandatory to perform elective neck dissection in patients with AdCC-HGT, due to the high risk of lymph node metastases associated with transformation

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

PANC Study (Pancreatitis: A National Cohort Study): national cohort study examining the first 30 days from presentation of acute pancreatitis in the UK

Abstract Background Acute pancreatitis is a common, yet complex, emergency surgical presentation. Multiple guidelines exist and management can vary significantly. The aim of this first UK, multicentre, prospective cohort study was to assess the variation in management of acute pancreatitis to guide resource planning and optimize treatment. Methods All patients aged greater than or equal to 18 years presenting with acute pancreatitis, as per the Atlanta criteria, from March to April 2021 were eligible for inclusion and followed up for 30 days. Anonymized data were uploaded to a secure electronic database in line with local governance approvals. Results A total of 113 hospitals contributed data on 2580 patients, with an equal sex distribution and a mean age of 57 years. The aetiology was gallstones in 50.6 per cent, with idiopathic the next most common (22.4 per cent). In addition to the 7.6 per cent with a diagnosis of chronic pancreatitis, 20.1 per cent of patients had a previous episode of acute pancreatitis. One in 20 patients were classed as having severe pancreatitis, as per the Atlanta criteria. The overall mortality rate was 2.3 per cent at 30 days, but rose to one in three in the severe group. Predictors of death included male sex, increased age, and frailty; previous acute pancreatitis and gallstones as aetiologies were protective. Smoking status and body mass index did not affect death. Conclusion Most patients presenting with acute pancreatitis have a mild, self-limiting disease. Rates of patients with idiopathic pancreatitis are high. Recurrent attacks of pancreatitis are common, but are likely to have reduced risk of death on subsequent admissions. </jats:sec

A synoptic picture of the impact of the 26th December 2004 Indian Ocean tsunami on the coast of Sri Lanka

A numerical simulation of the 26th December 2004 Indian Ocean tsunami for the entire coast of Sri Lanka is presented. The simulation approach is based on a fully nonlinear Boussinesq tsunami propagation model and a robust coseismic source. The simulation is first confronted to available measured wave height. The agreement between observations and the predicted wave heights allowed a reasonable validation of the simulation. As a result a synoptic picture of the tsunami impact is provided over the entire coast of Sri Lanka. It is found that amplification due to shoaling applies mainly in the Eastern and Southern coast because, here, the wave is propagating across the sea floor slope, while propagating along the slope for the Western coast. Spots of high waves are due to wave focusing in some coastal areas while local submarine canyons in other areas inhibit the wave amplification

Numerical modeling of the 26th December 2004 India Ocean tsunami at Andaman and Nicobar Islands

International audienceA numerical simulation of the 26th December 2004 Indian Ocean tsunami for the Andaman and Nicobar Islands case study is presented. The simulation approach is based on a fully nonlinear Boussinesq tsunami propagation model and included an accurate computational domain and a robust coseismic source. The simulation is first confronted to available tide gauge and run-up observations. The agreement between observations and the predicted wave heights allowed a reasonable validation of the simulation. As a result a full picture of the tsunami impact is provided over the entire coastal zone of Andaman and Nicobar Islands. The processes responsible for coastal vulnerability are discussed