Giant cavernous aneurysms occluded by aneurysmal thrombosis,calcification,parent artery occlusion:A case report and review of literature

BACKGROUND Patients with giant intracranial aneurysms(GIAs)are at a high risk of rupture,morbidity,and mortality even after surgical or endovascular treatment.We described a case of a spontaneously occluded GIA secondary to gradual growth of the GIA,continuously progressed aneurysmal thrombosis,complete aneurysmal calcification and complete occlusion of the parent artery-the right internal carotid artery(RICA).CASE SUMMARY A 72-year-old female patient complained of sudden pain in her right eye upon admission to our hospital.She had been diagnosed with a GIA[30 mm(axial)×38 mm(coronal)×28 mm(sagittal)]containing an aneurysmal thrombus located in the cavernous sinus segment of RICA diagnosed by magnetic resonance imaging(MRI),enhanced MRI,and magnetic resonance angiography more than 14 years ago.Later,with slow growth of the cavernous carotid GIA,aneurysmal thrombosis progressed continuously,spontaneous occlusion of the RICA,complete aneurysmal calcification,and occlusion of the GIA occurred gradually.She had no history of subarachnoid hemorrhage but missed the chance for endovascular therapy at an early stage.As a result,she was left with severe permanent sequelae from the injuries to the right cranial nerves Ⅱ,Ⅲ,Ⅳ,V1/V2,and Ⅴ.CONCLUSION The risk of rupture of the cavernous carotid GIAs was relatively low and possibly further be reduced by the stasis flow and spontaneous occlusion of the parent artery internal carotid artery(ICA)induced by the mass effect of the cavernous carotid GIAs and the extremely rare aneurysmal calcification.However,nowadays,it is advisable to recommend early endovascular treatment for the cavernous carotid GIAs to prevent injuries to the surrounding intracranial nerves and occlusion of the ICA,mainly caused by the mass effect of the cavernous carotid GIAs.

Intestinal anisakiasis treated successfully with conservative therapy:Importance of clinical diagnosis

Intestinal anisakiasis is not only a rare parasitic disease,but is also difficult to diagnose.The symptoms are not specific and are often very severe and abrupt,and the findings of clinical imaging are very remarkable.Therefore,intestinal anisakiasis is often misdiagnosed as acute abdomen or intestinal obstruction and is treated surgically.However,if intestinal anisakiasis could be diagnosed correctly,it is well treated conservatively.We experienced three cases of intestinal anisakiasis,which were diagnosed correctly and treated successfully with conservative therapy.A correct clinical history and imaging interpretation helped us diagnose intestinal anisakiasis correctly and thus treat the patients successfully with conservative therapy.

BREAST CONSERVING THERAPY IN STAGE T_1 & T_2 BREAST CANCER PATIENTS

Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.

Liquorrhoea associated with intrapelvic meningocele resection successfully treated by conservative therapy: a case report

Asymptomatic intrapelvic meningocele is rare. Here, we report the case of a 30-year-old Chinese man who underwent sigmoidectomy due to megacolon. During the operation, an intrapelvic cyst was found and resected. Meningocele was confirmed by histological examination. The patient recovered well postoperatively with the ex- ception of liquorrhoea. Conservative therapy was initiated, including draining, anti-infection and specific posture maintenance. During the following week, liquorrhoea was generally relieved and the patient was discharged. This is the first known report of liquorrhoea associated with intrapelvic meningocele resection successfully treated by conservative therapy. Our case indicates that conservative treatment may be considered for similar cases so that a second surgery is avoided.

Hypopharyngeal cancer trends in a high-incidence region:A retrospective tertiary single center study

BACKGROUND Hypopharyngeal cancer has the bleakest prognosis among head and neck cancers due to its extensive submucosal involvement,advanced tumor stage,and limited surgical reconstruction options.Its primary causes include alcohol consumption,tobacco use,genetic predisposition,1`diet,and socioeconomic conditions.While squamous cell carcinoma(SCC)accounts for 95%of hypopharyngeal tumors,it remains a rare form,comprising only 3%-5%of all SCC cases in the head and neck region.Globally,Central and Eastern Europe have the highest incidence rates for males(3.9 per 100000)and the third highest for females(2.26 per 100000),underscoring the significance of this seemingly uncommon condition.In Romania,hypopharyngeal cancer ranked 24th in incidence rate,with 634 new cases in 2020.AIM To study the incidence,treatment and survival rates of hypopharyngeal tumor cases in a major ear,nose,throat(ENT)surgical center.METHODS A retrospective epidemiological clinical study was conducted on patients diagnosed and treated for hypopharyngeal cancer at the ENT department of"Carol Davila Central University Emergency Military Hospital"in Bucharest between January 2018 and August 2022.The study included 53 patients and was authorized by the Ethics Committee of Titu Maiorescu Doctoral School(Bucharest,Romania)and the Ethics Committee of Carol Davila Central University Emergency Military Hospital(Bucharest,Romania).Inclusion criteria required a positive histopathological diagnosis of hypopharyngeal cancer,tumor localization in the hypopharyngeal region,and informed consent for data usage.Exclusion criteria involved major psychiatric pathologies and disagreement for data usage.Diagnosis was based on ENT assessment,imaging reports,and laboratory data.Treatment methods were determined based on various factors.Additional tools,such as Adult Comorbidity Evaluation-27 and Karnofski Performance Status Scale,were used for risk assessment and functional capacity evaluation.Quality of life aspects were measured using the European Organisation for Reasearch and Treatment of Cancer Quality of Life Questionnaire Head and Neck-35 questionnaire.RESULTS Our retrospective study examined 53 patients with hypopharyngeal cancer between January 2018 and August 2022.The majority of patients were male(94.3%),with an average age at diagnosis of 62.5 years.Among the patients,20.75%were employed,66.03%were retired,and 9.43%were unemployed.Smoking was prevalent among 69.81%of patients,while alcohol consumption was frequent in 32.07%of cases.The tumors were mostly diagnosed at an advanced stage(stage IV)and were predominantly SCC.Comorbidities were present in 83.01%of patients,with cardiovascular diseases being the most common.Dysphagia and neck mass were the most common symptoms reported.Treatment methods included surgery,radiation therapy,and chemotherapy.A favorable treatment response was observed in 22.64%of cases,while relapse occurred in 6 cases.Follow-up data was unavailable for some patients.CONCLUSION In summary,our findings align with existing literature;however,we observed a higher severity.

Efficacy comparison between conservative therapy and septal ablation in patients with hypertrophic obstructive cardiomyopathy

Objective To compare the effects of septal ablation(SA)versus conservative medication(CM)on the hemodynamic,clinical status and survival in patients with hypertrophic obstructive cardiomyopathy(HOCM).Methods This retrospective study included 350 consecutive patients with HOCM(mean age(51.3±13.5)years old)hospitalized in Anzhen Hospital between

Clinical manifestations and managements of post-neck dissection chylothorax

Neck and head neoplasm, such as thyroid carcinoma, often has a high rate of regional lymph nodemetastasis.L Neck dissection is a conventmnal optmn m management of head and neck neoplasm with confirmed or suspected neck lymph node metastasis. Chylothorax represents a relatively rare early post-operative complication of neck dissection） We retrospectively analyzed neck dissection associated chylothorax in patients with thyroid carcinoma in our hospital. Published reports on neck dissection associated chylothorax were also summarized to describe clinical manifestations and optimal managements. METHODS Patients with primary thyroid carcinoma, who underwent surgery were retrospectively analyzed in the database of the Second Affiliated Hospital of Zhejiang University from June 1, 2009 to June 1, 2011. Clinical data were further analyzed in detail to determine if lateral neck dissections were performed and postoperative chylothorax occurred. Postoperative chylothorax was determined through both chest imaging manifestations and pleural effusion biochemical results. RESULTS A total number of 242 patients diagnosed as thyroid carcinoma with confirmed or suspected neck lymph node metastasis underwent lateral neck dissection. Five patients accompanied with postoperative chylothorax with an incidence of 2.07%. Symptoms occurred between the second to eighth post-operative day. Detailed clinical information was listed in Table 1. One patient with synchronous chylous leak and liquid collection in the surgical area underwent thoracic duct ligation and drainage tubes re-insertion under local anesthesia in cervical region on the third post-operative day. After re-operation, she underwent conservative therapeutics and finally got cured. The other four patients were successfully managed with conservative therapeutics. All five patients did not undergo any chronic complications of chylothorax during their 12-month follow-up durations.

Treatment of patients older than 60 years with symptomatic vertebrobasilar artery stenosis

Background Vertebrobasilar artery stenosis is an important cause of ischemic posterior circulation strokes. This study aimed at evaluating the safety and efficacy of treatment including conservative therapy alone and conservative plus endovascular therapy for elderly patients with symptomatic vertebrobasilar artery stenosis.Methods Patients older than 60 years with symptomatic vertebrobasilar artery stenosis （ ≥50%） confirmed by cerebral angiography were enrolled. All of them were treated with medical therapy and some with additional stent-assisted angioplasty （the stenting subgroup）. Their clinical, imaging, intervention and follow-up data were analyzed.Results One hundred and seventeen consecutive elderly patients （100 men, mean age （68.1 ±5.1） years） were enrolled and followed up for a mean time of 28.4 months; 81.7% of them were symptomatically resolved or improved; a stroke rate of 5.1% and a stroke-related death rate of 1.7% were found among them during the hospitalization and follow-up. In the stenting subgroup, 78 balloon expandable stents were employed in the 70 patients with a technical success rate of 98.7% and the mean degree of stenosis was significantly reduced from （81.7±14.3）% before stenting to （8.3±4.2）% after stenting （P 〈0.001）. Four （5.7%） periprocedural strokes occurred, of whom two led to death within 30 days after the procedure. During the follow-up （mean 27.7 months）, sixty of the surviving 68 patients in the stenting subgroup were symptomatically resolved or improved. Only one （1.5%） posterior circulation stroke occurred, while duplex ultrasound scan of 34 patients demonstrated 10 （29.4%） in-stent restenosis.Conclusions Appropriate utilization of conservative therapy alone and conservative plus endovascular therapy may improve short-term clinical outcomes for elderly patients with symptomatic vertebrobasilar artery stenosis. Furthermore, stent-assisted angioplasty is technically feasible and relatively safe in elderly patients.

A massive dentigerous cyst of the mandible in a young patient:a case report

Cysts of the jaw present as swellings of jaws and midface.Of the different varieties,the dentigerous cyst is the most common type of noninflammatory odontogenic cyst and the frequent cause of a lytic lesion associated with an impacted tooth.The cyst develops from epithelial remnants of the tooth forming organ.The obstruction of venous flow due to compression of tooth follicle by developing tooth causes fluid accumulation between the follicular epithelium and the crown of the developing or unerupted tooth resulting in a cyst.Most small dentigerous cysts manifest in early age,usually as an incidental discovery in radiographic examinations.However,they can grow extremely large,asymptomatically,and remain undetected until they enlarge enough,causing bony expansion and asymptomatic facial swelling.We present a challenging case of massive dentigerous cyst in a 13-year-old female child involving half of the mandible,which was successfully treated with conservative therapy.This case report illustrates the effectiveness of simplified surgical treatment for a large dentigerous cyst in the mixed dentition period.