Leiomyosarcoma of the Duodeno-Jejunal Angle: Two Case Reports and Literature Review

The duodenal leiomyosarcoma is a rare tumor. Its location in the duodenum makes diagnosis difficult and often delayed. Surgical treatment is not consensual because it must take into account anatomical imperatives which vary depending on the duodenal portion and oncological requirements that are not currently well known especially with regard to the utility of lymphadenectomy. We report 2 cases of leiomyosarcomas located at the angle of Treitz. This location is exceptional and only few cases were reported in the literature. From these 2 new cases and a review of the literature, we analyze the clinical features, diagnosis and treatment of duodenal leiomyosarcoma.

Does wet-cupping therapy improve repeated sprint ability,perceived wellness,and rating of perceived exertion in young active males?

Wet-cupping therapy(WCT)is one of the oldest known medical techniques,used as a traditional and complementary therapy with a wide application all around the world for general health.Research on the effects of WCT on sports performance are sparse and inconsistent.Thus,we aimed to explore the effects of WCT on repeated sprint ability,wellness,and exertion in young active males.Forty-nine active adult males(age:[28±5]years;body height[177±8]cm;body mass:[79±7]kg;body mass index:[25.4±1.8]kg/m^(2))were selected for the study.The participants performed a running-based sprint test on two separate occasions(Control and Post-WCT).WCT was performed 24 h before the testing session.They completed the Hooper questionnaire to assess their well-being(i.e.,sleep,stress,fatigue,and soreness)before each session.The rating of perceived exertion(RPE)was collected after each testing session.A higher maximum power(p<0.05,effect size[ES]=0.6),mean power(p<0.01,ES=0.5)and minimum power(p<0.01,ES=0.6)were recorded post-WCT as compared to Control session along with a better perceived sleep(p<0.01,ES=0.85).Perceived stress(p<0.01,ES=0.6)and RPE(p<0.001;ES=1.1)were lower during the post-WCT compared to the Control session.The present findings demonstrated that WCT moderately enhanced repeated sprint ability and had positive effects on perceived sleep,stress,and exertion.WCT may be an effective ergogenic aid to improve repeated sprint ability and general wellbeing in young adult males.Future large-scale multicentric clinical studies are paramount to confirm the results of our study.

Predictors of perioperative respiratory adverse events among children with upper respiratory tract infection undergoing pediatric ambulatory ilioinguinal surgery:a prospective observational research

Objectives Anesthesia for children with an upper respiratory tract infection(URI)has an increased risk of perioperative respiratory adverse events(PRAEs)that may be predicted according to the COLDS score.The aims of this study were to evaluate the validity of the COLDS score in children undergoing ilioinguinal ambulatory surgery with mild to moderate URI and to investigate new predictors of PRAEs.Methods This was a prospective observational study including children aged 1-5 years with mild to moderate symptoms of URI who were proposed for ambulatory ilioinguinal surgery.The anesthesia protocol was standardized.Patients were divided into two groups according to the incidence of PRAEs.Multivariate logistic regression was performed to assess predictors for PRAEs.Results In this observational study,216 children were included.The incidence of PRAEs was 21%.Predictors of PRAEs were respiratory comorbidities(adjusted OR(aOR)=6.3,95%CI 1.19 to 33.2;p=0.003),patients postponed before 15 days(aOR=4.3,95%CI 0.83 to 22.4;p=0.029),passive smoking(aOR=5.31,95%CI 2.07 to 13.6;p=0.001),and COLDS score of>10(aOR=3.7,95%CI 0.2 to 53.4;p=0.036).Conclusions Even in ambulatory surgery,the COLDS score was effective in predicting the risks of PRAEs.Passive smoking and previous comorbidities were the main predictors of PRAEs in our population.It seems that children with severe URI should be postponed to receive surgery for more than 15 days.

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients:enhancing the outcomes of a university hospital in a low-income and middle-income country

Objective Assessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes.The aim of this study is to assess our experience in the management of pediatric subclavian vein catheters(SVCs)and to investigate the main risk factors for complications.Methods In this prospective observational study,we included children aged 3 months to 14 years who underwent infraclavicular subclavian vein catheterization consecutively using the anatomic landmark technique.Patients were divided into two groups:group 1 included complicated catheters and group 2 included noncomplicated catheters.The management protocol was standardized for all patients.After comparing the two groups,univariate and multivariate logistic regression were used to investigate the risk factors for complications.Results In this study,we included 134 pediatric patients.The rate of complications was 32.8%.The main complications were central line-associated bloodstream infection(63.6%),bleeding and/or hematoma(22.7%),mechanical complications(13.6%),and vein thrombosis(13.6%).After adjustment for confounding factors,predictors of catheter-related complications were difficult insertion procedure(adjusted odds ratio(aOR)=9.4;95%confidential interval(CI):2.32 to 38.4),thrombocytopenia(aOR=4.43;95%CI:1.16 to 16.86),comorbidities(aOR=2.93;95%CI:0.58 to 14.7),and neutropenia(aOR=5.45;95%CI:2.29 to 13.0).Conclusions High rates of complications were associated with difficult catheter placement and patients with comorbidities and severe thrombocytopenia.To reduce catheter-related morbidity,we suggest an ultrasoundguided approach,a multidisciplinary teaching program to improve nursing skills,and the use of less invasive devices for patients with cancer.

Infected urachal cyst: an uncommon cause of severe sepsis in a neonate

Urachal anomalies are rare conditions caused by the failure of complete obliteration of the urachus during gestation.The most common of these conditions is urachal cyst.1 Urachal cyst is often misdiagnosed leading to complications,such as sepsis,fistula formation,and rupture.We report a rare case of infected urachal cyst leading to severe sepsis in a neonate.

Acute pancreatitis revealing duodenal duplication in a child

A 3-year old female child with a history of intermittent abdominal pain and postprandial vomiting presented with fever,vomiting,and abdominal pain.The epigastrium was mildly sensitive on examination.Laboratory studies showed elevated leukocyte count(13000/L),amylase(667 U/L),and lipase(2332 U/L).Abdominal CT showed pancreatitis with a cystic lesion repressing the pancreatic head.