Cutaneous metastases from cholangiocarcinoma following percutaneous transhepatic biliary drainage: Case report and literature review

AbstractPercutaneous transhepatic biliary drainage (PTBD) is commonly used in the management of cholangiocarcioma. Major and minor complications of PTBD such as cholangitis, haemorrhage and catheter dislocation are well documented. A lesser reported complication are cutaneous metastases following PTBD for cholangiocarcinoma.We report a case of a 79 year old man who presented with right upper quadrant pain, jaundice and weight loss, with dilated intra-hepatic bile ducts on imaging. The cytology results from a sample taken during endoscopic retrograde cholangiopancreatography were highly suspicious of cholangiocarcioma. A PTBD was subsequently performed and bilateral metal biliary stents were placed without external drainage. Five months after the PTBD he was found to have a hard nodule under the PTBD puncture site. The nodule was excised and the histology confirmed a cholangiocarcinoma metastasis.A review of the literature identified twelve cases of cutaneous metastases from cholangiocarcinoma, following PTBD. In addition, tumour seeding along the catheter tract following PTBD, with metastatic deposits on the abdominal wall, peritoneoum, chest wall, pleural space, and liver parenchyma have also been reported.Health care professionals should be aware of this rare complication and offer appropriate management options to patients

The <SPP> Green function and SU(3) breaking in Kl3 decays

Using the 1=/N-C expansion scheme and truncating the hadronic spectrum to the lowest-lying resonances, we match a meromorphic approximation to the Green function onto QCD by imposing the correct large-momentum falloff, both off- shell and on the relevant hadron mass shells. In this way we determine a number of chiral low-energy constants of O(p(6)), in particular the ones governing SU(3) breaking in the K-l3 vector form factor at zero momentum transfer. The main result of our matching procedure is that the known loop contributions largely dominate the corrections of O(p(6)) to f(+)(0). We discuss the implications of our final value f(+)(K0 pi-) (0) = 0.984 +/- 0.012 for the extraction of V-us from K-l3 decays

Lower limit on the neutralino mass in the general MSSM

We discuss constraints on SUSY models with non-unified gaugino masses and R_P conservation. We derive a lower bound on the neutralino mass combining the direct limits from LEP, the indirect limits from gmuon, bsgamma, Bsmumu and the relic density constraint from WMAP. The lightest neutralino (mneutralino=6GeV) is found in models with a light pseudoscalar with MA<200GeV and a large value for $tan\beta$. Models with heavy pseudoscalars lead to mneutralino>18(29)GeV for $\tan\beta=50(10)$. We show that even a very conservative bound from the muon anomalous magnetic moment can increase the lower bound on the neutralino mass in models with mu<0 and/or large values of $\tan\beta$. We then examine the potential of the Tevatron and the direct detection experiments to probe the SUSY models with the lightest neutralinos allowed in the context of light pseudoscalars with high $\tan\beta$. We also examine the potential of an e+e- collider of 500GeV to produce SUSY particles in all models with neutralinos lighter than the W. In contrast to the mSUGRA models, observation of at least one sparticle is not always guaranteed.Comment: 37 pages, LateX, 16 figures, paper with higher resolution figures available at http://wwwlapp.in2p3.fr/~boudjema/papers/bound-lsp/bound-lsp.htm

Phase Separation of Rigid-Rod Suspensions in Shear Flow

We analyze the behavior of a suspension of rigid rod-like particles in shear flow using a modified version of the Doi model, and construct diagrams for phase coexistence under conditions of constant imposed stress and constant imposed strain rate, among paranematic, flow-aligning nematic, and log-rolling nematic states. We calculate the effective constitutive relations that would be measured through the regime of phase separation into shear bands. We calculate phase coexistence by examining the stability of interfacial steady states and find a wide range of possible ``phase'' behaviors.Comment: 23 pages 19 figures, revised version to be published in Physical Review

Systematic Review of Medicine-Related Problems in Adult Patients with Atrial Fibrillation on Direct Oral Anticoagulants

New oral anticoagulant agents continue to emerge on the market and their safety requires assessment to provide evidence of their suitability for clinical use. There-fore, we searched standard databases to summarize the English language literature on medicine-related problems (MRPs) of direct oral anticoagulants DOACs (dabigtran, rivaroxban, apixban, and edoxban) in the treatment of adults with atri-al fibrillation. Electronic databases including Medline, Embase, International Pharmaceutical Abstract (IPA), Scopus, CINAHL, the Web of Science and Cochrane were searched from 2008 through 2016 for original articles. Studies pub-lished in English reporting MRPs of DOACs in adult patients with AF were in-cluded. Seventeen studies were identified using standardized protocols, and two reviewers serially abstracted data from each article. Most articles were inconclusive on major safety end points including major bleeding. Data on major safety end points were combined with efficacy. Most studies inconsistently reported adverse drug reactions and not adverse events or medication error, and no definitions were consistent across studies. Some harmful drug effects were not assessed in studies and may have been overlooked. Little evidence is provided on MRPs of DOACs in patients with AF and, therefore, further studies are needed to establish the safety of DOACs in real-life clinical practice

Systematic review of primary total hip arthroplasty using titanium-titanium modular-neck prostheses: the true risk of revision

Aims: Modular-neck femoral implants are used to enable more variability in femoral neck version, offset and length. It has been reported that these implants carry a higher rate of revision. The aim of this review was to assess the overall and cause-specific revision rate of titanium-titanium alloy modular-neck implants in primary total hip arthroplasty (THA). Methods: A systematic review was conducted following PRISMA guidelines and utilising multiple databases. All results were screened for eligibility. Studies published from 2000 onwards, using a current-generation, titanium-titanium, modular-neck implant were included. Overall and cause-specific revision rates were analysed, comparing to fixed-neck prostheses where applicable. Results: 920 studies were screened. After applying exclusion criteria, 23 were assessed in full and 14 included. These consisted of 12 case series and 2 joint registry analyses. 21,841 patients underwent a modular-neck implant with a weighted mean follow-up of 5.7 years, mean age of 62.4 years, and average body mass index (BMI) of 28.4kg/m2. The overall revision rate was 3.95% and 2.98% for modular and fixed-neck prostheses, respectively. For studies with &amp;gt;5 years follow-up the mean revision rate was 3.08%. There was no difference in cause-specific revision rates by implant design. Mean improvement in Harris Hip Score was 41.9. Conclusions: At medium-term, revision rates for titanium-titanium primary modular-neck THA are acceptable. These prostheses are a sensible management option in patients with considerable anatomical hip deformity not amenable to correction with standard fixed-neck implants. Patients of male gender, high BMI and requiring prostheses with a larger neck, offset or head are at higher risk of implant failure. © The Author(s) 2020