Search Results (204)

Background and Clinical Significance: Aneurysmal bone cyst (ABC) is a benign but locally aggressive osteolytic lesion that typically arises in the metaphysis of long bones in children and adolescents. Extension across an open proximal humeral physis into the epiphysis is uncommon and creates a diagnostic challenge because unicameral bone cyst and telangiectatic osteosarcoma may show overlapping radiological features. Case Presentation: A 12-year-old girl presented with pain and restricted motion of the left shoulder after a bicycle-related fall. Radiographs demonstrated a large expansile lytic lesion of the proximal humerus with cortical thinning and pathologic fracture. CT showed cortical ballooning, septation-like internal architecture, and extension across the open proximal humeral physis into the epiphysis. MRI demonstrated a multiloculated cystic lesion with thin internal septa and thin peripheral/septal enhancement, without nodular solid enhancement or a bulky extraosseous soft-tissue component. Curettage, bone cement filling, and elastic intramedullary nailing were performed. Histopathology, immunohistochemistry, and USP6 FISH analysis supported the final integrated diagnosis of ABC, although USP6 rearrangement was not detected. At 40 months, the patient was pain-free, had essentially normal shoulder motion, had returned to normal school and daily activities, and required no further surgery; radiographs showed stable remodeling without aggressive re-expansion. Conclusions: A focused literature review supports that frank transphyseal ABC is rare, particularly in the proximal humerus. The diagnostic contribution of this case lies in the integration of radiography, CT, MRI, histopathology, ancillary testing, and long-term clinical and radiographic follow-up. In a skeletally immature patient with a proximal humeral cystic lesion, transphyseal extension should prompt careful multimodality assessment. Imaging can substantially narrow the differential diagnosis, but integrated radiologic–pathologic confirmation remains essential when malignant mimics are possible. Full article

Background/Objectives: Septate uterus is the most prevalent uterine malformation and is commonly associated with impaired reproductive outcomes. Hysteroscopic metroplasty is the gold standard treatment, but surgical management of complex septate uteri with associated cervical and vaginal anomalies remains challenging. This study aimed to evaluate surgical and reproductive outcomes following a standardized minimally invasive hysteroscopic approach using a 15 Fr bipolar mini-resectoscope across different subtypes. Methods: This retrospective single-center, single-surgeon study included women who underwent hysteroscopic correction of partial and complete septate uterus, with or without cervical and/or vaginal anomalies, between January 2021 and January 2025 at the Digital Hysteroscopic Clinic CLASS Hysteroscopy, Fondazione Policlinico A. Gemelli IRCCS, Rome, Italy. Preoperative assessment included three-dimensional transvaginal ultrasound and diagnostic hysteroscopy. All procedures were performed using a standardized hysteroscopic technique with a 15 Fr bipolar mini-resectoscope. Surgical outcomes included operative time and the need for second-step surgery. Reproductive outcomes included clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR). Results: A total of 154 patients were included, comprising 70 partial and 84 complete septate uteri; 52.4% of complete septa were associated with cervical and/or vaginal anomalies. Median operative time was 18.0 min for partial septa and 31.0 min for complete septa (p < 0.01), and a second surgical step was required in only 5/84 complete septa (5.9%) and in none of the partial septa. Reproductive outcomes were analyzed in a subgroup of 70 patients who attempted conception. After metroplasty, CPR increased from 35.7% to 84.3% (p < 0.01), LBR per pregnancy increased from 16.0% to 78.0% (p < 0.01), and MR per pregnancy decreased from 84.0% to 10.2% (p < 0.01). Postoperative reproductive outcomes appeared comparable between partial and complete septa and according to the presence of associated anomalies. Conclusions: A standardized hysteroscopic technique using a 15 Fr bipolar mini-resectoscope is feasible and effective for treating septate uterus, including complex cases associated with cervical and/or vaginal anomalies. Favorable reproductive outcomes can be achieved regardless of anomaly complexity when accurate preoperative diagnosis and a structured surgical approach are applied. Full article

Introduction. The superficial musculoaponeurotic system (SMAS) is fundamental for facial soft tissue support and surgical rejuvenation. Although its morphology in the midface and neck is well characterized, the structure of its cranial extension to the forehead remains a subject of terminological uncertainty. The aim of this study was to conduct a detailed histological and immunohistochemical examination of the forehead supporting structures to characterize their morphology and propose an expanded, region-specific classification of the SMAS. Material and methods. Full-thickness tissue specimens (n = 30) were obtained from five standardized facial regions (parotid, buccal, temporal, frontal, and cervical) from 12 male and 18 female body donors (aged 25–70 years). Specimens were processed for histological analysis using hematoxylin and eosin, van Gieson staining, and Masson’s trichrome. Immunohistochemical staining for S100 protein was used to identify neural structures. Morphometric analysis was performed on digitized sections to quantify interseptal distances and the depth of superficial nerve trunks. Results. The analysis confirmed the established SMAS types (I–V) in the cheek, parotid gland, and neck, confirming the validity of the method. Two distinct, sequentially arranged structures were identified on the forehead, proposed as new types. Type VI (neurovascular arborization) is a discrete fan-shaped structures with a central collagen core surrounding a neurovascular bundle, showing positive S100 staining. These structures, spaced approximately 2.2 mm apart, function as true retaining ligaments. Type VII (fibroseptal) SMAS patterns is vertically oriented, purely fibrous septa (retinacula cutis) connecting the aponeurosis to the dermis, devoid of neural elements, and spaced approximately 9.2 mm apart. Importantly, the superficial nerve trunks were located at an average depth of only 1.09 mm (range: 0.57–1.97 mm) from the skin surface. Conclusion. This study identified two novel SMAS patterns in the forehead—neurovascular arborization (type VI) and fibroseptal (type VII)—supporting the expanded functional seven-type classification of the SMAS. The extremely superficial location of the forehead nerves (average 1.1 mm) defines a critical “danger zone” for aesthetic procedures. These findings provide a refined anatomical basis for improving the precision and safety of both surgical and minimally invasive facial procedures. Full article

Background: Oral lipomas are uncommon benign tumors composed of mature adipocytes, accounting for roughly 1% of benign intraoral lesions. Common predilection sites are buccal mucosa, lips, and tongue, presenting as slow-growing, nodular masses, often with a yellow hue. As the size of most lesions does not exceed 10 mm, particularly larger lipomas may be misdiagnosed. We present two cases of large oral lipomas. Case reports: Case 1: A 58-year-old male with a painless, sessile nodular mass of approximately 2.5 cm in the left cheek, increasing in size and causing discomfort during mastication. After excision, histopathology revealed mature adipocytes with delicate fibrous septa. Case 2: A 47-year-old female with a tender yellow growth of approximately 2 cm in her lower lip, increasing in size and causing aesthetic problems with functional discomfort. After sharp dissection, the specimen presented acanthotic and parakeratotic epithelium with adipocytic tumorous tissue, permeated by collagenous cords. Conclusions: Oral lipomas are uncommon, mostly asymptomatic benign lesions. Mostly found in the buccal mucosa and lower lip, they can mimic more common growths. When located superficially, a conservative surgical excision leads to resolution with rare recurrences. Histopathological inspection is necessary to confirm the benign nature of the lesion. Full article

Walnut septum (WS), a major by-product of walnut processing, represents a promising source of bioactive compounds with potential antioxidant and antimicrobial properties. This study aimed to characterise the phytochemical composition of WS extracts from different habitat origins and evaluate their antimicrobial activity. Total amino acids were profiled by gas chromatography–mass spectrometry, while phenolic compounds were analysed using high-performance liquid chromatography. Both methods were evaluated according to ICH Q2 (R2) guidelines for analytical procedure validation. The results showed a complex composition of amino acids and polyphenols, including ellagic acid and quercitrin. However, it was clear that habitat variations in WS samples had a significant impact on the quantities and composition of phenolic compounds and total amino acids in WS extracts. Antimicrobial activity was assessed against Gram-positive and Gram-negative bacterial strains. Variations in antimicrobial efficacy were associated with differences in phenolic composition and content due to habitat differences in WS sample origins. Collectively, this study highlights the WS as a valuable agro-industrial by-product with potential applications as a natural source of antimicrobial compounds in food and pharmaceutical systems. Full article

Background: Cellulite is a highly prevalent aesthetic concern characterized by structural remodeling of subcutaneous adipose tissue and fibrous septa, resulting in visible skin irregularities. Despite the availability of many injectable treatments with documented efficacy, most standard approaches adopt uniform protocols that overlook interindividual anatomical variability, potentially limiting treatment precision and clinical outcomes. This retrospective case–control study evaluated the Modulated Insertion of Regenerative Activation (MIRA), a technique that individualizes needle length and injection angle according to ultrasound findings, modulating insertion parameters to stimulate regenerative responses within dermal and subcutaneous layers. Methods: Clinical and ultrasonographic data from 120 women with stage 3 cellulite were analyzed over a 30-day follow-up period. Stage 3A patients received carbon dioxide therapy (CDT), whereas stage 3B patients underwent injectable solution therapy (IST). Within each treatment, patients were allocated to MIRA or control groups. Results: Compared with controls, MIRA showed greater reductions in adipose tissue thickness (CDT: −1.6 mm; IST: −1.5 mm; p_adj = 0.002), nodules, pain, edema, and fibrosis, with improved fascia regularity. Patient satisfaction was higher in MIRA (CDT: 8.1 ± 1.6; IST: 8.5 ± 1.4; p_adj = 0.002), and over 76% reported improved skin quality. Conclusions: These explorative findings suggest that ultrasound-guided modulation of needle parameters with MIRA may enhance structural and esthetic outcomes compared with standard approaches. Prospective randomized trials are needed to confirm these results. Full article

High-altitude workers in the Los Andes Mountains, known as “the Chilean miner model,” are exposed to chronic intermittent hypobaric hypoxia (CIHH). This intermittent condition differs from other models of chronic hypoxia, mainly due to the hypoxic pattern and the cardiovascular and pulmonary effects. There are reports of cardiopulmonary dysfunction and remodeling in human and animal models. However, research on some mechanisms of vascular function and the consequences of lung remodeling induced by CIHH is still lacking. Therefore, this study aims to characterize the effects of CIHH exposure on lung structure and redox status in a rat model of the Chilean miner, involving intermittent exposure to chronic cycles of normoxia/hypobaric hypoxia (96 h/96 h) in an experimental hypoxic chamber. Our results demonstrate that CIHH acts as a primary driver of pulmonary vascular remodeling by significantly increasing the medial wall thickness of small pulmonary arteries (<100 μm) and promoting a shift toward a more muscularized phenotype in previously non-muscularized vessels. Structurally, this was characterized by a marked reduction in alveolar space and a significant increase in the thickness of the alveolar-capillary barrier, suggesting impaired gas exchange capacity. These structural changes were strongly associated with a pro-oxidant state, evidenced by increased lipid peroxidation (malondialdehyde levels) and a concomitant reduction in antioxidant enzyme activities, such as superoxide dismutase (SOD) and catalase (CAT), in lung tissue. In conclusion, the CIHH model effectively replicates the complex interplay between chronic oxidative damage and structural lung remodeling, identifying the thickening of the arterial medial wall and alveolar septa as key pathological features of probably CIHH-induced pulmonary hypertension. Full article

Background/Objectives: Cysts are the most common kidney lesions identified in patients undergoing abdominal imaging, with ultrasound (US) typically serving as the initial diagnostic tool. Contrast-enhanced ultrasound (CEUS) has emerged as a highly effective modality for the evaluation of cystic renal lesions, particularly when conventional B-mode ultrasound (US) or CE-CT are inconclusive. While simple renal cysts are readily characterised on US, cystic renal lesions require further assessment. Methods: The Bosniak classification, originally developed for CE-CT, remains the cornerstone for categorising cystic renal lesions, guiding management from surveillance to surgical intervention. Recent efforts to standardise CEUS-specific imaging parameters and adapt the Bosniak criteria aim to improve interobserver agreement, reduce subjectivity, and enhance diagnostic accuracy. Results: CEUS offers superior sensitivity for detecting slow blood flow and minimal vascularity within septa, wall or solid components, often outperforming CE-CT in real-time vascular assessment. However, the high sensitivity of CEUS can reveal additional septa or subtle enhancement, potentially leading to lesion overscoring, if the different sensitivity of CEUS and CT/MRI for detecting enhancement is not taken into account. CEUS also plays a crucial role in the follow-up of non-surgical cystic lesions, providing a radiation-free and cost-effective alternative for long-term monitoring. Certain scenarios, such as post-interventional changes, traumatic cystic rupture, or infected cysts, fall outside the scope of the Bosniak system and require careful clinical correlation. Conclusions: By integrating CEUS into the diagnostic pathway, sonologists can achieve accurate lesion characterisation, optimise patient management, and minimise unnecessary invasive procedures, reinforcing CEUS as an essential tool in the evaluation and follow-up of complex renal cystic masses. Full article

Background and Clinical Significance: Modern neuro-oncologists encounter a major challenge when dealing with glioblastomas located in the dominant hemisphere’s temporo-basal area, because their invasive nature disrupts the proximity to eloquent cortical areas (language and speech), as well as skull base venous structures, which can lead to a quick decline in function from the disruptions in these networks and the disconnection of corridor-level pathways. This manuscript illustrates the application of metric-based phenotyping, anatomically defined imaging, and venous-anchored microsurgical techniques that can aid in preserving the remaining functional reserve in patients with dominant hemisphere glioblastomas and demonstrate measurable outcomes through longitudinal follow-up data. Case Presentation: A 48-year-old right-handed male patient presented with a four-week history of progressively worsening symptoms consistent with a dominant hemisphere syndrome, resulting in a significant decrease in his independence (mRS 0 → 4; BI 55/100; IADL 2/8). His symptoms included non-fluent expressive aphasia with a marked inability to generate words and respond to verbal cues (BNT 8/30; SF 4 WPM). Additionally, he experienced prolonged lateralizing hemisensory decompensation and corticospinal tract dysfunction. Imaging studies revealed a large multiloculated cystic lesion located in the left temporo-basal region. The lesion displayed a thick irregular peripheral enhancement pattern with mural nodules and septa, and surrounding T2 hyperintensity extending into the temporal associative white matter, indicating disruption of the lexical–semantic networks and corridor-level tracts. Utilizing continuous SSEPS/MEPs during surgery, a skull base parallel ventral temporal corridor was developed to allow decompression of the cyst first, followed by cyst evacuation, inside-out cytoreduction, subpial dissection, and specific preservation of both superficial and deep temporal veins using selective capsular preservation at venous interface locations where necessary. Postoperative CT scans performed on POD #3 and POD #7 indicated stable decompression without hemorrhage or hydrocephalus complications, followed by rapid quantitative improvement in NIHSS (8 → 2), MoCA (18 → 26), BNT (8 → 26), SF (4 → 12), mRS (2 at discharge, 1 at follow-up), BI (85 at discharge, 95 at follow-up), and IADL (6/8 at discharge, 8/8 at follow-up). Histopathological examination confirmed a diagnosis of glioblastoma. Conclusions: This case study supports a model of a network- and vein-constrained glioblastoma of the dominant hemisphere in the temporo-basal region that can result in substantial restoration of language capabilities and preservation of functional reserves for additional therapies using venous-anchored subpial microsurgical approaches. The use of objective and quantifiable measures of phenotyping and longitudinal follow-up tracking could provide a reproducible method for measuring the degree of recovery of the affected network(s) and establishing safe boundaries for temporal glioma surgery. Full article

Background: Lipomas are common benign subcutaneous neoplasms treated surgically for cosmetic or symptomatic reasons. The minimal one-third incision and four-step (MOTIF) technique provides reliable excision with minimal scarring, but smaller proportional incisions remain unstudied. This study evaluates the minimal one-quarter incision and four-step (MOQIF) technique. Methods: Retrospective review of 82 patients undergoing MOQIF excision of histologically confirmed subcutaneous lipomas by a single surgeon from July 2024–December 2025 was done. Lipomas were stratified by maximum diameter: small-intermediate (<5 cm) and large (≥5 cm). MOQIF used a one-quarter incision of the lipoma’s long axis determined by preoperative ultrasound measurement and palpation with four steps: hydro dissection preserving superficial subcutaneous tissue, superficial dissection, staged deep dissection with selective cautery of fibrovascular septa, and intact mass delivery. Outcomes included excision length, postoperative complications, Vancouver Scar Scale (VSS) scores, recurrence, and subjective treatment satisfaction of patients. Results: Mean lipoma size was 6.8 ± 2.0 cm (75.6% ≥5 cm). All lipomas were completely excised through 1.69 ± 0.49 cm incisions (ratio 0.25). Complications were low: seroma 10.98% (16.7% vs. 9.4%, p = 0.404), hematoma 7.3% (11.1% vs. 6.3%, p = 0.608), with no infections, nerve injuries, or recurrences at a mean 8.9-month follow-up. VSS scores were equivalent between groups (0.83 vs. 1.06; p = 0.438) and overall patient satisfaction was high (3.54 ± 0.53 (2–4)). Conclusions: MOQIF achieves complete lipoma excision through one-quarter incisions with safety and cosmetic outcomes across lipoma sizes, demonstrating feasibility through standardized technique refinement and careful case selection. Full article

Fascioloidosis is a parasitic disease caused by allochthonous parasite Fascioloides magna. In Europe, three types of final hosts are recognised: definitive, aberrant, and dead end. Several countries have launched disease control programmes using medicated feed, with different drugs, to control F. magna infections. In this study, we used corn treated with Albix^® 10 in a total dose of 60 mg/kg of body weight for five consecutive days (12 mg/kg per day). Following successful treatment, a destroyed pseudocyst with different amounts of degrading material and decaying flukes was detected. A total of 136 livers was examined. The average number of pseudocysts per positive liver was seven (min. 1–max. 45), while the average number of adult flukes was 14.17 (2–70). On average, 1.34 juvenile flukes in the migratory phase were detected per infected liver. The average number of pseudocysts was 7.07 per liver in total. Degrading pseudocysts were either absent or present to a maximum of 120 per liver, with an average of 7.99 per liver. Some livers had multifocal to confluent nodules bulging from the liver parenchyma, which were up to 7 cm in diameter. Histologically, these areas showed disruption, containing bands of fibrous connective tissue, dividing parenchyma into pseudolobules of varying size and shape. These septa contained dark brown to black pigment (iron porphyrin), along with remnants of elliptical, operculated, mainly empty trematode eggs. Nodules were surrounded with fibrous tissue and disorganised hyperplastic hepatocytes arranged in irregular trabeculae supported by fibrous bands occasionally containing blood vessels. This study shows the potential of liver regeneration in the case of acute and chronic liver injury, as well as in cases of fatty liver disease. Full article

Background: Floating barbed threads are commonly used for minimally invasive midface lifting and rely on mobile subcutaneous tissue for support, which may limit stability. Fixation is primarily achieved by barb engagement within the subcutaneous fat and fibrous septa of the retinacula cutis. Objectives: To describe an anatomically guided modification of the APTOS Excellence Visage Soft (PLLA/PCL) thread technique, positioning the terminal segment posterior to the zygomatic retaining ligament line with the aim to enhancing mechanical stability. This technical report presents the anatomical rationale, procedural steps, and illustrative clinical cases demonstrating feasibility. Methods: The modified technique uses a single-entry point at the superior zygomatic margin, with five threads per hemiface. After linear insertion, the cannula is rotated laterally and inferiorly to position the terminal barbs posterior to the zygomatic retaining ligament line, thereby transferring tensile load toward a more fixed anatomical structure. Representative cases were documented and are presented. Results: Illustrative cases showed immediate midface elevation with improved malar projection and softening of the nasolabial and mentolabial folds. Standardized 3D imaging and vector analysis demonstrated a superolateral pattern of soft tissue displacement along the intended vectors, consistent with the proposed fixed-anchorage concept. The procedure was well tolerated, with only mild and transient local effects observed. One illustrative case included photographic follow-up at 12 months, in which preservation of midface contour and malar projection was visually appreciable. Conclusions: Redirecting the terminal thread segment posterior to the zygomatic retaining ligament line is a feasible modification that may contribute to improved vector stability by engaging a fixed fascial structure. Observations—including one case with 12-month follow-up—support the anatomical plausibility of the approach, although controlled studies with objective endpoints are necessary to confirm long-term efficacy and reproducibility. Full article

Background/Objectives: To evaluate and characterize anatomical variations in the sphenoid sinus in the Saudi population using computed tomography (CT). Methods: This retrospective cross-sectional study included patients aged ≥18 years who underwent multi-detector CT (MDCT) of the paranasal sinuses at King Fahd University Hospital between July 2018 and 2023 for different indications. Radiological variables analyzed included sphenoid sinus pneumatization type, presence and number of inter-sphenoid septa, and deviation or attachment to adjacent structures. Results: The data of 2433 patients were analyzed (44.5% males, 55.5% females; mean age 40 ± 15 years). The mean sphenoid sinus volume was 20.4 ± 8.7 cm³, significantly larger in males (p < 0.001). The most common sinus shape was quadrilateral (33%), whereas the predominant pneumatization pattern was post-sellar (57.1%), followed by sellar (32.1%), pre-sellar (9.2%), and conchal (1.6%). Adjacent-structure pneumatization was frequent, most notably in the greater wing of the sphenoid (47.4%) and pterygoid (39%) processes. Optic-canal protrusion and dehiscence were observed in 13.9% and 4.1%, respectively, whereas carotid canal protrusion occurred in 22.2% and dehiscence in 3.2%. Intra-sinus septation was identified in 97.7% of assessable cases, most commonly as a single septum (59.6%). Several variants showed significant sex-related associations, including sinus volume, anterior clinoid process/posterior clinoid process pneumatization, and dehiscence patterns. Conclusions: CT imaging revealed considerable diversity in the sphenoid-sinus anatomy among the Saudi population. Awareness of these variations, particularly their relationship with critical neurovascular structures, is crucial for radiologists and surgeons to ensure accurate diagnosis and safe surgical planning. Full article

Mycobacterium abscessus exhibits intrinsic resistance to conventional antibiotics, significantly limiting treatment options. Our previous studies established that MAB_2362 (SteA) is a key regulator of cell division that contributes to intrinsic resistance and virulence. Considering that SteA-like proteins often act alongside SteB counterparts, we hypothesized that the adjacent gene MAB_2363 encodes the corresponding SteB-like division regulator. In this study, we found that deletion of MAB_2363 significantly increased susceptibility to multiple antibiotics and disrupted cell wall permeability. Microscopy revealed pronounced cell division defects in the mutant, including elongated cell morphology and multiple septa. Subcellular localization of a GFP-MAB_2363 fusion protein demonstrated its enrichment at division septa, confirming its direct involvement in cell division. Furthermore, deletion of MAB_2363 led to attenuated virulence, as evidenced by reduced bacterial survival in macrophages and murine infection models. To assess its functional relation with MAB_2362, we compared the single-deletion mutant of MAB_2363 with the single-deletion mutant of MAB_2362 and the double-deletion mutant of MAB_2362-MAB_2363. Notably, the phenotypes of the MAB_2363 mutant, including cell division defects, antibiotic susceptibility, and virulence, were markedly milder than those of the other two mutants. Collectively, these findings indicate that MAB_2363 functions as a secondary but essential division-associated factor that operates during cell division, thereby influencing intrinsic resistance and virulence in M. abscessus. Full article

Tsunami hazards pose persistent threats to low-lying coastal settlements in Indonesia, where physical exposure and social vulnerability often intersect. This study integrates tsunami inundation modelling using the Cornell Multi-grid Coupled Tsunami (COMCOT) model with a community preparedness assessment to develop a comprehensive understanding of tsunami risk in Tanjung Benoa, Bali, Indonesia. The COMCOT simulation, based on a potential Mw 8.5 earthquake scenario south of Bali, indicates a maximum inundation depth of up to 14 m, where the tsunami waves are projected to traverse the Tanjung Benoa peninsula, with the first tsunami arrival being expected within 24 min after rupture. A social survey involving 327 household heads across six neighborhoods was conducted using the Tsunami Ready Community framework (UNESCO–IOC) to evaluate awareness, preparedness, and response capacities. The overall Preparedness Index (PI) reached 78, categorized as “Ready”, indicating moderate readiness but uneven distribution across neighborhoods. This integrated approach highlights that physical modelling alone is insufficient to capture real tsunami risk without incorporating social preparedness dimensions. The study provides actionable insights for local disaster management authorities and supports the strengthening of the UNESCO–IOC Tsunami Ready Community indicators in Tanjung Benoa. The framework demonstrated here can serve as a replicable model for other coastal communities pursuing sustainable and data-driven tsunami resilience strategies. Full article