Search Results (96)

Objectives: Venous malformations (VMs) that infiltrate the muscular layer, involve or are closely adjacent to critical nerves or vessels, or are located deep within or very close to major organs in the thoracic or abdominal cavities are challenging to access during sclerotherapy, which we defined as inaccessible VMs. This study proposed an integrated real-time stereotactic MRI-guided sclerotherapy with bleomycin-polidocanol foam (RSMS-BPF) for the treatment of inaccessible VMs, focusing on its clinical feasibility, efficacy, and safety. Methods: A retrospective study was conducted involving patients treated with RSMS-BPF between 2019 and 2021. During the sclerotherapy, the intraoperative magnetic resonance imaging (MRI) was combined with an optical navigation system to guide precise needle placement and track BPF, a foam sclerosant optimized for MRI visibility. Radiological response was assessed by lesion volume, while clinical improvement was evaluated through patients’ description of their symptoms. Rigorous follow-up and documentation of complications were conducted. Results: A total of 42 patients (mean age 23.6 ± 1.6 years; 18 males) were treated in 64 sclerotherapy sessions. The treatment achieved an overall response rate of 89.5%. Imaging analysis revealed an average lesion volume reduction of 59.6%. 57.9% of patients achieved good or excellent radiological responses. After a median follow-up of 12.25 months, 60.53% of patients reported complete or significant relief. Lesion depth did not affect treatment efficacy (p = 0.43). Minor complications included skin hyperpigmentation (5.3%, 2/38) and blisters (2.6%, 1/38), with no major complications observed. Conclusions: RSMS-BPF demonstrated satisfactory efficacy and safety in VMs treatment, particularly for inaccessible VM lesions. It enables authentic real-time dynamic tracking during sclerotherapy, achieving unparalleled precision targeting while minimizing procedural risks. These findings strongly support routine integration of RSMS-BPF as first-line therapy for complex vascular malformations with critical anatomical constraints. Full article

Background: Endometriosis is a chronic disease defined by the presence of endometrial-like tissue outside the uterine cavity. While typically confined to the pelvis, extrapelvic manifestations—including thoracic endometriosis—can occur. Although rare, thoracic endometriosis is the most common extragenital form. In clinical practice, this presentation is often described as thoracic endometriosis syndrome (TES), a constellation of cyclic thoracic symptoms temporally associated with menstruation but not always histologically confirmed. Its atypical symptoms and limited clinical awareness frequently lead to delayed diagnosis, mismanagement and increased patient burden. Methods: In accordance with the CARE guidelines, we present a case report of a female patient with thoracic endometriosis syndrome, emphasizing the prolonged interval between symptom onset and final diagnosis. Case Report: We describe a 42-year-old woman with a longstanding history of dysmenorrhea and menorrhagia, who developed cyclical chest pain and dyspnea in 2019. Despite multiple thoracoscopic procedures, her symptoms persisted and were repeatedly misattributed to anxiety or infection. Thoracic endometriosis syndrome (TES) was suspected in 2022, and although histopathological confirmation was lacking, intraoperative visualization revealed diaphragmatic fenestrations. In 2025, a second laparoscopic intervention targeting the abdominal surface of the diaphragm resulted in significant symptom relief. The patient is currently continuing hormonal therapy with Dienogest and has reported a marked improvement in quality of life. Nevertheless, the protracted diagnostic and therapeutic process—marked by chronic pain and repeated hospitalizations—had a profound psychosocial impact, culminating in a suicide attempt. Conclusions: This case illustrates the substantial burden associated with the delayed recognition of thoracic endometriosis syndrome and the consequences of fragmented care. The patient’s experience underscores the urgent need for coordinated, multidisciplinary management and psychological support, particularly for patients with extrapelvic manifestations. Early multidisciplinary evaluation, with readiness to consider surgical intervention alongside individualized hormonal therapy, may support improved outcomes, provided they are reinforced by increased clinical awareness and systemic improvement in diagnostic pathways. Full article

Background and Clinical Significance: Spinal arachnoid cysts are rare lesions that may become symptomatic through progressive spinal cord compression. We present a complex case of a thoracic extradural SAC in a 17-year-old male, managed through a stepwise, multidisciplinary approach. Case Presentation: The patient presented with progressive lower limb weakness, right knee paresthesia, and urinary hesitancy following physical exertion. MRI revealed a large posterior extradural SAC extending from T2–T3 to T8, with associated spinal cord compression. Initial management involved T8 laminectomy and cyst fenestration under intraoperative neurophysiological monitoring, with partial clinical improvement. However, early recurrence with pseudomeningocele formation prompted a second surgery, including external CSF drainage. Persistent cerebrospinal fluid (CSF) leakage led to targeted epidural blood patching, followed by temporary stabilization. Due to continued cyst enlargement and spinal cord compression, definitive surgical repair was undertaken: fistula clipping at T3 and embolization with platinum coils inside the cystic cavity, combined with a new blood patch. This novel technique resulted in radiological improvement and clinical stabilization. Conclusions: This case highlights the diagnostic and therapeutic challenges of managing symptomatic extradural SACs, particularly in young patients. Our experience underscores the utility of a staged approach involving surgical decompression, neuroimaging-guided interventions, and definitive dural repair. The combination of fistula clipping and coil embolization may offer a promising strategy for refractory cases, potentially reducing recurrence and preserving neurological function. Full article

Laminosioptes cysticola (Vizioli, 1870), a tissue-dwelling mite responsible for nodular acariasis in birds, was identified from two hens reared in a rural backyard flock in Umbria, Italy. Adult mites were found in the subcutaneous tissue and on the serosal surface of various internal organs. Larval and first- and second-stage nymphal forms were observed beneath the skin and near the trachea and esophageal serosa. By comparing the existing literature with that reported in the present study, we propose a hypothetical reconstruction of the parasite’s life cycle. It is postulated that the entry of L. cysticola occurs through the cervical skin, where adults mate and larviparous females give birth to larvae. These larvae migrate into the loose connective tissues surrounding the trachea and esophagus, where they develop into nymphs. The immature forms then progress along the esophagus and trachea to reach the thoracic and abdominal cavities, colonizing the serosal surfaces of visceral organs. It remains unclear whether, or how, the mites return to the subcutaneous tissues to complete their maturation. Senescent specimens degenerate within the subcutis, where they are encased by a granulomatous inflammatory reaction that leads to the formation of characteristic calcified nodules. Full article

Background/Objectives: The primary objective of PE repair is to relieve compression exerted on the cardiac and pulmonary structures and enhance the thoracic cavity volume. However, the number of volumetric studies of the thoracic cavity, including the heart and lung volumes, is scarce. This study seeks to systematically evaluate the volumetric changes in these structures to assess the physiological impact obtained by PE repair. Methods: A retrospective analysis was conducted on 63 patients who underwent PE repair using the XI bar technique from April 2023 to February 2024. Volumetric changes were measured preoperatively and postoperatively using SYNAPSE 3D imaging software (Version 4.6, Fujifilm, Tokyo, Japan). Cardiac and pulmonary volumes were quantified, and CT indexes (Haller index, Depression index) were assessed. Complication rates, reoperation rates, and length of hospital stay were also analyzed. Results: The mean cardiac volume increased significantly from 458.25 mL preoperatively to 499.13 mL postoperatively (p = 0.018), showing an 8.9% increase. Pulmonary volumes, however, showed no statistically significant change, remaining stable at approximately 4371.31 mL preoperatively and 4266.87 mL postoperatively (p = 0.57). Conclusions: Repairing PE markedly enhances cardiac volume, emphasizing its importance in relieving mediastinal compression. Pulmonary volumes remain largely unaffected, suggesting that PE primarily impacts cardiac structures. Our approach to the volumetric measurements provides valuable insights into the physiological outcomes of chest wall remodeling and is considered to be a good modality for future studies to enhance our understanding of the functional benefits of PE repair. Full article

Pressurized intra-thoracic aerosol chemotherapy (PITAC) is a novel and promising strategy for the treatment of malignant pleural effusion (MPE). PITAC enables effective pleurodesis while potentially exerting an antineoplastic effect by delivering chemotherapeutic agents as a therapeutic aerosol into the thoracic cavity via a nebulizer. Our preliminary study involved nine patients with unresectable pleural mesothelioma (PM) treated with PITAC. Among them, one case was particularly emblematic for demonstrating notable oncological improvements in addition to well-known palliative benefits. This patient underwent two PITAC procedures, one year apart, without perioperative complications. Redo pleural biopsies from both previous and new sites revealed only fibrous tissue and inflammatory cells, with no evidence of malignancy. Beyond achieving pleurodesis, PITAC—by combining cytotoxic and sclerosing effects—may offer effective local antineoplastic control and represent a promising avenue for enhancing loco-regional therapy in PM. Full article

A 6-month-old neutered male Belgian Malinois dog living in a kennel was presented to a veterinary emergency service for the management of severe respiratory distress that had developed within the past 24 h. Thoracic radiographs performed by a referring veterinarian showed abnormalities identified as a pneumothorax. Upon admission to the emergency service, the striking anomalies turned out to be a large intrathoracic air-filled cavity and countless smaller ones causing mechanical compression of the adjacent pulmonary parenchyma and mimicking tension pneumothorax. Emergency management included thoracocentesis followed by placement of a thoracostomy tube. The dog exhibited rapid clinical improvement and recovered completely within a few days, without requiring surgical intervention. Serial follow-up radiographs showed progressive and complete resolution of all lesions. Based on the complete resolution without resection, the main lesion—initially interpreted as a giant pulmonary bulla—was ultimately considered consistent with an acquired pneumatocele. To the authors’ knowledge, this is the first report in veterinary medicine of a vanishing lung syndrome presentation in a dog. Full article

Congenital diaphragmatic hernia (CDH) is a complex disorder whereby improper formation of the diaphragm allows herniation of the internal organs into the thoracic cavity, resulting in pulmonary hypoplasia among other complications. Although epithelial dysfunction is central to CDH pathology, relatively little attention has been paid to the underlying mechanisms orchestrating epithelial malfunction. Proinflammatory signaling downstream of impaired mechanotransduction due to in utero lung compression has been elucidated to drive epithelial cell phenotypes. This has been illustrated by a reduction in nuclear YAP and the upregulation of NF-kB in CDH models. In this review, we draw from recent findings using emerging technologies to examine epithelial cell mechanisms in CDH and discuss the role of compression as a central and, crucially, sufficient driver of CDH phenotypes. In recognition of the limitations of using genetic knockout models to recapitulate such a heterogenic and etiologically complicated disease, we discuss alternative models such as the established nitrofen rat model, air–liquid interface (ALI) cultures, organoids and ex vivo lung explants. Throughout, we acknowledge the importance of involving mechanical compression in the modeling of CDH in order to faithfully recapitulate the disease. Finally, we explore novel therapeutic strategies from stem cell and regenerative therapies to precision medicine and the importance of defining CDH endotypes in order to guide treatments. Full article

Background. Thoracic endometriosis is thought to be the most common form of endometriosis occurring outside of the pelvis. We aimed to characterize thoracic symptoms of endometriosis in a population of patients not necessarily suffering from catamenial pneumothorax, which is most commonly identified as a symptom of thoracic endometriosis. Material and methods. We used a web-based survey addressed to users of two Polish endometriosis patient advocate organizations. The factor that qualified patients for the study was the presence of symptoms in the chest related to the menstrual cycle. Results. A total of 92 respondents were questioned. In this group, 96% (88/92) of patients were previously diagnosed with pelvic endometriosis, 20% (18/92) with thoracic endometriosis, and 18% (17/92) with diaphragmatic endometriosis. The percentage of patients diagnosed with both thoracic and diaphragmatic endometriosis was 15% (14/92). Ninety-eight percent of patients suffered from pain. The four most common symptoms reported by patients were chest pain, dyspnea, cough, and stunned limb, occurring in 96%, 67%, 52%, and 33%, respectively. The feeling of a stunned, weakened limb occurs in older women at 38.4 vs. 35.5 years of age (p = 0.021). There is a trend that women who suffer pain (36.7 vs. 31.3 years of age p = 0.053) and hemoptysis (41.0 vs. 36.2 years of age p = 0.059) are older than women without these symptoms. We identified two unique symptoms of thoracic endometriosis—pouring liquid sensation (13%) and popping sensation (12%)—which can be related to a small amount of gas and fluid in the pleural cavity. Conclusions. Patients who have endometriosis suffer from a constellation of thoracic symptoms related to menses. Full article

This report examines the successful recovery of a feline that presented with multiple complex fractures and dislocations involving the facial and cranial structures resulting from a traffic accident. Diagnostic CT imaging identified significant injuries, including luxation of the left temporomandibular joint (TMJ), a mandibular symphyseal fracture, a hard palate fracture, and a left orbital fracture accompanied by severe exudate within the nasal cavity, compressing the left orbit and nasal passages. Importantly, no additional injuries were detected in the thoracic or abdominal regions, facilitating a more targeted treatment plan. The management of this case required extensive surgical intervention, including open reduction of the TMJ, stabilization of the mandibular symphysis, repair of the bony palate, and partial maxillectomy. After 20 days of ICU hospitalization, the feline fully recovered. This outcome is particularly noteworthy as the combination of severe injuries observed in this case is unprecedented in the veterinary literature. Consequently, it offers critical insights into both surgical techniques and postoperative management strategies applicable to similarly complex trauma cases. The feline’s full recovery, characterized by the restoration of normal daily functions, highlights the clinical significance of pursuing multiple, complex surgical procedures in cases of severe trauma. It serves as a valuable reference for advancing the understanding and management of severe facial trauma in veterinary practice. Full article

Background: Approximately 50% of all oncological patients undergo radiation therapy, where personalized planning of treatment relies on gross tumor volume (GTV) delineation. Manual delineation of GTV is time-consuming, operator-dependent, and prone to variability. An increasing number of studies apply artificial intelligence (AI) techniques to automate such delineation processes. Methods: To perform a systematic review comparing the performance of AI models in tumor delineations within the body (thoracic cavity, esophagus, abdomen, and pelvis, or soft tissue and bone). A retrospective search of five electronic databases was performed between January 2017 and February 2025. Original research studies developing and/or validating algorithms delineating GTV in CT, MRI, and/or PET were included. The Checklist for Artificial Intelligence in Medical Imaging (CLAIM) and Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis statement and checklist (TRIPOD) were used to assess the risk, bias, and reporting adherence. Results: After screening 2430 articles, 48 were included. The pooled diagnostic performance from the use of AI algorithms across different tumors and topological areas ranged 0.62–0.92 in dice similarity coefficient (DSC) and 1.33–47.10 mm in Hausdorff distance (HD). The algorithms with the highest DSC deployed an encoder–decoder architecture. Conclusions: AI algorithms demonstrate a high level of concordance with clinicians in GTV delineation. Translation to clinical settings requires the building of trust, improvement in performance and robustness of results, and testing in prospective studies and randomized controlled trials. Full article

The practical application of flexible sensors in sound detection is significantly hindered by challenges such as information isolation, fragmentation, and low fidelity. To address these challenges, this work developed a composite hydrogel via a one-pot method, employing polyvinyl alcohol (PVA) as the first network, polyacrylic acid (PAA) as the second network, and two-dimensional nanomaterials—reduced graphene oxide (rGO)—generated through the redox reaction of polydopamine (PDA) and graphene oxide (GO) as conductive fillers. The uniformly distributed rGO within the hydrogel forms an efficient conductive network, endowing the material with high sensitivity (GF = 0.64), excellent conductivity (8.15 S m⁻¹), rapid response time (350 ms), and outstanding stability. The synergistic interaction between PDA and PAA modulates the hydrogel’s adhesion (0.89 kPa), enabling conformal attachment to skin surfaces. The designed rGO@PVA-PAA hydrogel-based flexible sensor effectively monitors vibrations across diverse frequencies originating from five vocal cavities (head, nasal, oral, laryngeal, and thoracic cavities) during singing. Integrated with multi-position synchronization and Bluetooth wireless sensing technologies, the system achieves coordinated and efficient monitoring of multiple vocal cavities. Furthermore, the hydrogel sensor demonstrates versatility in detecting physiological signals, including electrocardiograms, subtle vibrations, and multi-scale body movements, highlighting its broad applicability in biomedical and motion-sensing applications. Full article

Pheochromocytomas and paragangliomas (PPGLs) are infrequent neuroendocrine hypervascular neoplasms arising within different sites of the paraganglion system. They are divided into sympathetic (including pheochromocytomas and extraadrenal paragangliomas) and parasympathetic extraadrenal tumors. These tumors are usually not malignant and grow slowly; about 90% of them are found in the adrenal paraganglia (pheochromocytomas). Extraadrenal tumors are most frequently located in the abdominal cavity (85%), followed by the thoracic cavity (12%), and head and neck (3%). About 25% of PPGLs are related to germline mutations, which are risk factors for multifocal and metastatic disease. In PPGL diagnostics, laboratory, biochemical, and imaging (anatomical and functional) examinations are used. Surgery is the standard management choice for locoregional disease. For patients who are not candidates for surgery and who have stable, not-growing, or slow-growing tumors, active observation or other less invasive techniques (i.e., stereotactic surgery, hypofractionated stereotactic radiotherapy) are considered. In metastatic disease, systemic therapies (tyrosine kinase inhibitors [TKIs], mTORC1 inhibitor everolimus, immunotherapy, cold somatostatin analogs [biotherapy], and radioligand therapy) are used. The prognosis for PPGLs is quite good, and the 5-year survival rate is >90%. The goal of this paper is to review knowledge on the etiopathogenesis, current diagnostics, and therapy for PPGL patients. Our paper is particularly focused on the current management of PPGLs. Full article

Coronary heart disease, a leading global cause of mortality, has witnessed significant advancement through robotic coronary artery bypass grafting (CABG), with the internal mammary artery (IMA) emerging as the preferred “golden conduit” for its exceptional long-term patency. Despite these advances, robotic-assisted IMA harvesting remains challenging due to the absence of force feedback, complex surgical maneuvers, and proximity to the beating heart. This study introduces a novel virtual simulation platform for robotic IMA harvesting that integrates dynamic anatomical modeling and real-time haptic feedback. By incorporating a dynamic cardiac model into the surgical scene, our system precisely simulates the impact of cardiac pulsation on thoracic cavity operations. The platform features high-fidelity representations of thoracic anatomy and soft tissue deformation, underpinned by a comprehensive biomechanical framework encompassing fascia, adipose tissue, and vascular structures. Our key innovations include a topology-preserving cutting algorithm, a bidirectional tissue coupling mechanism, and dual-channel haptic feedback for electrocautery simulation. Quantitative assessment using our newly proposed Spatial Asymmetry Index (SAI) demonstrated significant behavioral adaptations to cardiac motion, with dynamic scenarios yielding superior SAI values compared to static conditions. These results validate the platform’s potential as an anatomically accurate, interactive, and computationally efficient solution for enhancing surgical skill acquisition in complex cardiac procedures. Full article