A prenatally detected adrenal cyst treated by adrenal-sparing surgery: case report and review of the literature

A neonatal case of left adrenal cyst detected in utero and successfully treated by adrenal-sparing surgery is presented and discussed with review of the literature. Incidentally discovered prenatal adrenal masses present a diagnostic dilemma. Benign and malignant conditions can present as a fetal suprarenal mass. There is a wide spectrum of management modalities ranging from followup by serial sonographic scanning during pregnancy to early primary excision of the mass. We report a neonate with prenatal diagnosis of a cystic mass arising from the left adrenal gland. Postnatal excision of the mass without adrenalectomy was carried out. Frozen sections of the mass and a biopsy of the left adrenal gland confirmed the benign nature of the cyst and normal adrenal tissue. The uniloculated cyst was reported as a pseudocyst. After surgery, the recovery was uneventful, and the patient was discharged 4 days postoperatively in good condition. On the basis of this case and review of the literature, we may conclude that early primary surgical excision is recommended for either diagnosis or treatment if the results of prenatal or postnatal imaging studies are unreliable for the precise diagnosis of suprarenal mass. Adrenal-sparing surgery is recommended if pathological evaluation of frozen sections has confirmed the benign nature of the mass.Keywords: adrenal-sparing surgery, neonates, prenatal diagnosis, suprarenal cys

Congenital diaphragmatic hernia and retinoids: searching for an etiology

Congenital diaphragmatic hernia (CDH) is a major life-threatening cause of respiratory failure in the newborn. Recent data reveal the role of a retinoid-signaling pathway disruption in the pathogenesis of CDH. We describe the epidemiology and pathophysiology of human CDH, the metabolism of retinoids and the implications of retinoids in the development of the diaphragm and lung. Finally, we describe the existing evidence of a disruption of the retinoid-signaling pathway in CDH

Comparative validation of machine learning algorithms for surgical workflow and skill analysis with the HeiChole benchmark

Purpose: Surgical workflow and skill analysis are key technologies for the next generation of cognitive surgical assistance systems. These systems could increase the safety of the operation through context-sensitive warnings and semi-autonomous robotic assistance or improve training of surgeons via data-driven feedback. In surgical workflow analysis up to 91% average precision has been reported for phase recognition on an open data single-center video dataset. In this work we investigated the generalizability of phase recognition algorithms in a multicenter setting including more difficult recognition tasks such as surgical action and surgical skill. Methods: To achieve this goal, a dataset with 33 laparoscopic cholecystectomy videos from three surgical centers with a total operation time of 22 h was created. Labels included framewise annotation of seven surgical phases with 250 phase transitions, 5514 occurences of four surgical actions, 6980 occurences of 21 surgical instruments from seven instrument categories and 495 skill classifications in five skill dimensions. The dataset was used in the 2019 international Endoscopic Vision challenge, sub-challenge for surgical workflow and skill analysis. Here, 12 research teams trained and submitted their machine learning algorithms for recognition of phase, action, instrument and/or skill assessment. Results: F1-scores were achieved for phase recognition between 23.9% and 67.7% (n = 9 teams), for instrument presence detection between 38.5% and 63.8% (n = 8 teams), but for action recognition only between 21.8% and 23.3% (n = 5 teams). The average absolute error for skill assessment was 0.78 (n = 1 team). Conclusion: Surgical workflow and skill analysis are promising technologies to support the surgical team, but there is still room for improvement, as shown by our comparison of machine learning algorithms. This novel HeiChole benchmark can be used for comparable evaluation and validation of future work. In future studies, it is of utmost importance to create more open, high-quality datasets in order to allow the development of artificial intelligence and cognitive robotics in surgery

MIKROBIYOLOJI BULTENI

The emergence of Staphylococcus aureus strains with intermediate resistance (VISA) and heterogen resistance (hVISA) to vancomycin leads to the occurence of severe therapeutic problems. The aim of this study was to investigate the vancomycin resistance in methicillin resistant S.aureus (MRSA) and coagulase-negative staphylococci (MRCoNS) isolated from clinical samples in Bacteriology Laboratory of Microbiology and Clinical Microbiology Department of Celal Bayar University Faculty of Medicine, Manisa (located in western Anatolia, Turkey). A total of 120 staphyloccoccal strains (92 MRSA and 28 MRCoNS) isolated from different clinical specimens (tracheal aspirate, blood, abscess, wound swabs, sputum, catheter tips, etc) between the period of June 2005 to December 2006 were included to the study. Vancomycin resistance were determined by agar screening method using brain hearth infusion agar plates containing 6 mu g/mL vancomycin. Standard E-test and macro E-test methods were performed for 17 (14%) staphylococcal strains (10 MRSA and 7 MRCoNS) which had grown in agar screening plates. Vancomycin and teicoplanin minimal inhibitory concentration (MIC) ranges of those strains were found as 1.5-4 mu g/mL and 2-4 mu g/mL, respectively, by standard E-test method. In our study, no VISA and hVISA isolates were detected when MIC value of >= 8 mu g/mL for vancomycin and teicoplanin, or >= 22 mu g/mL for teicoplanin only were accepted as the criteria for hVISA determination. Agar screening method which is preferably used in routine laboratories for practical and economical reasons, lower sensitivity and specificity than E-test. It can be concluded that, since agar screening method is not reliable for the detection of vancomycin resistance, further multi-center studies with the use of standard methods are needed in order to clarify the vancomycin resistance patterns of staphylococci in our country