Search Results (122)

Endoscopic dacryocystorhinostomy (DCR) is a widely recognized and highly effective procedure. This surgical procedure is performed globally, with minimal modifications across different regions. Background/Objectives: The fundamental goal of DCR is to marsupialize the lacrimal sac into the nasal cavity, which helps eliminate epiphora (excessive tearing) and recurrent dacryocystitis (inflammation of the tear sac). With advancements in technology, new instruments are being developed to minimize risks and maximize efficacy, ultimately improving surgeon convenience, patient safety, and quality of life. One such innovation is piezosurgery, a method of bone cutting that utilizes ultrasound vibrations. Originally prevalent in oral and maxillofacial surgery, piezosurgery is now being applied in many clinical applications. Its primary advantages include the preservation of soft tissues, precise bone cutting, and the ability to work effectively in narrow spaces. Methods: This article outlines the standard technique used at our facility for performing endoscopic dacryocystorhinostomy (DCR) with a piezoelectric system. We describe the preoperative evaluation, intraoperative techniques, and postoperative care to present what we consider the standard procedure in our clinic. Results and Conclusions: Piezosurgery’s selective cutting prevents damage to surrounding soft tissues, making it theoretically advantageous in DCR by preserving tissue integrity. Additional case–control and multicenter studies are necessary to compare its outcomes with those of traditional osteotomy, particularly in relation to the potential increase in operative time. Full article

Background: Migration of the peritoneal end of the ventriculoperitoneal shunt (VPS) into the scrotum is a rare but recognized complication. Inguinoscrotal migration typically occurs as a result of increased intra-abdominal pressure combined with a patent processus vaginalis. A 14-month-old pediatric patient presented to the emergency department with abdominal pain, vomiting, and swelling of the right scrotum that had persisted for two days. The patient had a history of a head injury that had resulted in a large secondary arachnoid cyst for which a VPS had been placed at eight months of age. Examination of the inguinoscrotal region revealed a swollen and painful right side of the scrotum with a hydrocele and a palpable distal portion of the ventriculoperitoneal catheter in the right groin extending to the scrotum. After a brief preoperative preparation, the patient underwent laparoscopic abdominal emergency exploration, during which shunt repositioning and laparoscopic closure of the patent processus vaginalis were performed. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: A total of 30 case reports and six case series were included, analyzing 52 pediatric patients with scrotal migration of the VPS. The median age at presentation was 24 months (range: 1–169 months). The indication for VPS placement was hydrocephalus. Migration of the VPS catheter occurred on the right side in 34 cases. The median interval from VPS placement to the onset of symptoms was 9.0 months (range: 1 day–72 months). The most frequently reported symptoms were scrotal/inguinoscrotal swelling (n = 50), vomiting (n = 7), and fever (n = 3). Diagnostic methods included abdominal X-ray (n = 43), ultrasound (n = 5), scrotal transillumination test (n = 5), and computed tomography (n = 1). Regarding treatment, surgical repositioning of the VPS catheter into the peritoneal cavity was performed in 47 patients (90.4%), with no intraoperative or postoperative complications reported. Conclusions: Laparoscopic repositioning of the VPS into the peritoneal cavity, combined with closure of the processus vaginalis, appears to be a safe and effective treatment option for scrotal migration of the VPS. However, further well-designed studies are warranted to provide more comprehensive, generalizable, and unbiased evidence regarding this complication in the pediatric population. Full article

Endometriosis is a chronic inflammatory disease characterized by the presence of ectopic endometrial tissue, mainly in the pelvic cavity. It primarily affects women of reproductive age and is associated with significant morbidity, particularly chronic pelvic pain and infertility. Despite its high prevalence, diagnosis is often delayed, contributing to prolonged suffering and increased healthcare burden. This review examines the management of endometriosis in Primary Care, focusing on clinical presentation, risk factors, diagnostic approaches, and therapeutic options. A comprehensive bibliographic search was conducted using PubMed, Scopus, and Uptodate, including evidence-based clinical guidelines and literature up to January 2025. Women diagnosed with endometriosis in Primary Care are typically of reproductive age, with symptoms including dysmenorrhea, dyspareunia, and abnormal uterine bleeding. Risk factors include early menarche, low birth weight, short menstrual cycles, and family history. Transvaginal ultrasound is the recommended first-line imaging tool. Treatment includes analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), and hormonal therapies such as combined oral contraceptives or progestins. Non-pharmacological interventions, including dietary modifications and psychological support, are also relevant. Early identification in Primary Care is key to improving out-comes. Enhancing awareness among healthcare providers and promoting multidisciplinary management are essential to optimize care and reduce diagnostic delays. Full article

Endometriosis is a clinical entity affecting up to 10% of women of reproductive age, characterized by ectopic endometrial tissue outside the uterine cavity. While extrapelvic endometriosis has been documented, pancreatic endometriosis remains extremely rare and poses significant diagnostic challenges due to its similarity to other pancreatic diseases. At the same time, splenic mesothelial cysts are also rare and typically benign. This report presents a unique case of pancreatic endometriosis coexisting with a splenic mesothelial cyst in a 31-year-old woman. The patient presented to the emergency department with complaints of persistent epigastric and low back pain. She noted having similar symptoms approximately a year prior. Her past medical history was otherwise unremarkable, and there was no known family history of pancreatic disease or neoplasms. Initial imaging revealed a 3.8 cm cystic lesion in the pancreatic tail, with features suggestive of mucinous cystadenoma. Following clinical evaluation and confirmation of the cyst’s nature through endoscopic ultrasound-guided biopsy, the patient subsequently underwent laparoscopic distal pancreatectomy and splenectomy due to worsening symptoms. Gross examination revealed a multilocular pancreatic cyst with a smooth, hemorrhagic wall. Microscopic analysis showed the cyst to be lined by cuboidal to columnar epithelium, consistent with pancreatic endometriosis, confirmed by immunohistochemical staining. The spleen showed cystic formations, diagnosed as a multifaceted mesothelial cyst. In conclusion, this report is the first to document the coexistence of pancreatic endometriosis and splenic mesothelial cysts, highlighting the importance of accurate imaging and pathologic evaluation in the diagnosis of these rare conditions. Early diagnosis and surgical intervention lead to favorable outcomes, reinforcing the importance of comprehensive diagnostic strategies. Full article

A five-month-old female mixed-breed dog presented with a two-week history of polyuria, polydipsia, and vomiting. Clinical examination revealed poor body condition, growth retardation, pale oral mucous membranes, weak pulse, and prolonged capillary refill time. Laboratory findings included neutrophilic leukocytosis with a regenerative left shift, fasting hyperglycemia, elevated fructosamine, glycated hemoglobin, and β-hydroxybutyrate concentrations, while the acid–base balance remained normal. Canine-specific pancreatic lipase and trypsin-like immunoreactivity concentrations ruled out an underlying pancreatitis or exocrine pancreatic insufficiency, respectively. Urinalysis showed glycosuria and ketonuria. Supportive care included antibiotics and regular insulin administration. Abdominal ultrasonography identified a pancreatic cavity with a thick wall and mixed echogenic fluid. Ultrasound-guided drainage was performed without complications. Cytology confirmed a pancreatic abscess with pyogranulomatous inflammation, though the culture results were negative. The dog was discharged with intermediate-acting lente insulin. Follow-up ultrasonographic evaluations at 7, 14, and 21 days and 5 months post-drainage showed no recurrence. The diabetes remained well-controlled one year post-discharge. This case report describes the successful management of a dog with juvenile diabetes mellitus complicated by a pancreatic abscess, highlighting the effectiveness of percutaneous ultrasound-guided drainage combined with medical therapy. Full article

Current therapeutic approaches for prostatic cysts and abscesses involve surgical methods like reduction and omentalization. This retrospective study evaluates the effectiveness and safety of ultrasound-guided percutaneous drainage combined with alcoholization as a minimally invasive treatment for prostatic cysts and abscesses in dogs. Forty-three male dogs with a single prostatic cavity (1–6 cm) were enrolled and categorized into two groups: group A (twenty-two dogs with prostatic abscesses treated via alcoholization) and group B (twenty-one dogs with BPH-associated cysts). Group B was further subdivided into three subgroups: B1 (finasteride only), B2 (alcoholization only), and B3 (combined finasteride and alcoholization). Alcoholization involved sedation, drainage of the cavity, and two ethanol instillations (first: 1/3–1/4 of aspirated volume; second: 1/10 after 25 min). Ultrasound evaluations were performed at scheduled intervals of up to 150 days. In group A, 76.19% of abscesses were resolved within 30 days, with complete resolution in all dogs by day 150. In group B, the combined treatment (group B3) showed superior outcomes, with significant cyst diameter reduction observed in all dogs within 30 days and complete resolution in 62.5% by day 150. These findings support alcoholization as an effective, low-complication alternative to surgery for selected prostatic lesions in dogs. Full article

Spent coffee grounds (SCG) are produced in large quantities during coffee brewing, contributing to environmental concerns. Additionally, cationic dyes from textile, paper, and leather wastewater pose a major pollution issue. This study explores SCG as an adsorbent for methylene blue (MB) dye. A novel comparison of SCG cleaning methods with warm water, accelerated solvent extraction (ASE), supercritical fluid extraction (SFE), and ultrasound-induced cavitation (US) is presented. In addition, the chemical modifications of SCG using acetylation, acid (HNO₃), and base (KOH) treatment that have not been reported before are presented. ATR-FTIR confirmed the inclusion of functional groups, for example, the nitro group in SCG treated with HNO₃, and an increase in carboxylic groups in the samples treated with KOH and HNO₃. SEM analysis revealed a consistent porous texture across samples, with SCG-SFE, SCG-US, and SCG-HNO₃ showing smaller pores, and SCG-ASE displaying elongated cavities. Adsorption isotherm tests followed the Freundlich and Langmuir models, indicating favorable adsorption. The Langmuir maximum adsorption capacity (q_max) varied among cleaning methods from 65.69 mg/g (warm water) to 93.32 mg/g (SFE). In contrast, in base- and acid-treated SCG, a three- to four-fold increase in adsorption capacity was observed, with q_max values of 171.60 mg/g and 270.64 mg/g, respectively. These findings demonstrate that SCG washed with warm water and chemically treated achieves adsorption capacities comparable to other biosorbents reported in the literature. Therefore, SCG represents a promising, low-cost, and sustainable material for removing cationic dyes from wastewater, contributing to waste valorization and environmental protection. Full article

Background/Objectives: Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of the minor salivary glands, often affecting the hard palate. Preoperative diagnosis and surgical planning are challenging due to anatomical complexity and limitations in sampling, generally obtained by fine-needle aspiration (FNA). This study retrospectively evaluated the diagnostic and therapeutic performance of a high-definition ultrasound (HDUS)-guided fine-needle aspiration cytology/biopsy (FNAC/FNAB) protocol in diagnosing intraoral MEC, based on the Milan System for Reporting Salivary Gland Cytopathology (MSRSGC), with the relative clinical outcomes. Methods: A cohort of 64 patients with histologically confirmed MEC of the minor salivary glands, treated between 2000 and 2022, was retrospectively analyzed. All patients underwent HDUS-guided FNAC/FNAB, imaging (CT, MRI, and panoramic X-ray), and subsequent surgical treatment. The cytological specimens were classified using the MSRSGC. Surgical margins, histopathological findings, lymph node status, and follow-up outcomes were recorded. Results: Of 64 MECs, 42 cases were finally diagnosed as low-grade (LG)/intermediate grade (IG) and 22 as high-grade (HG) carcinomas, using a two-tier histological classification system. HDUS accurately delineated the lesion size, infiltration depth, and bone proximity, with excellent correlation with surgical specimens (difference ≤ 0.6 mm). MSRSGC classification distributed the cases across all categories, with 28 classified as malignant (category VI). Repeat FNAC improved the diagnostic yield in non-diagnostic and atypical cases. FNAB confirmed the cytological findings in all cases, with immunohistochemistry investigation with Ki-67 supporting tumor grading. Surgical margins were clear in all resections. Lymph node metastases were identified in all patients who underwent neck dissection (n = 18), all with HG-MEC. No recurrences occurred among the LG/IG-MEC patients during a median 2-year follow-up. Conclusions: The combined use of HDUS and FNAC/FNAB, interpreted through the MSRSGC framework, offers a highly accurate, minimally invasive approach for preoperative diagnosis and surgical planning in intraoral MEC. HDUS-guided cytology significantly improves diagnostic reliability, particularly in LG/IG and cystic variants, facilitating tailored surgical management. Also, the clinical outcomes may support the possibility of using a simplified grading classification for two histopathological types. Full article

Ferritin, an emerging protein resource, has garnered significant attention in scientific research due to its biocompatibility and unique cavity structure capable of encapsulating bioactive compounds. This study aimed to optimize ultrasound-assisted extraction (UAE) for enhancing ferritin yield from northern pike liver byproducts and evaluate its potential as a nanocarrier for chlorogenic acid (CA). Through response surface methodology (RSM), the optimal UAE parameters were established as 200 W ultrasonic power, 1:3 solid–liquid ratio, and 25 min extraction time. Under these conditions, the ferritin extraction yield reached 139.46 mg/kg, representing a 4.02-fold increase compared to conventional methods (34.65 mg/mL). Electrophoretic analysis confirmed the electrophoretic purity of the extracted liver ferritin. Comprehensive characterization using UV-vis spectroscopy, FTIR, and fluorescence spectroscopy revealed preserved structural integrity of UAE-extracted ferritin. Homology modeling provided molecular insights into the ferritin architecture. Successful encapsulation of CA was achieved with an encapsulation efficiency of 13.25%, as quantified by HPLC. Analysis by DLS and ζ potential as well as TG and DSC showed that not only the thermal stability of CA was enhanced after ferritin encapsulation, but also that the ferritin remained stable with a cage-like structure. This investigation establishes UAE as an effective strategy for valorizing fish processing byproducts through high-yield ferritin extraction while demonstrating the protein’s functional capacity as a nanocarrier for bioactive compound delivery. The findings highlight the dual advantage of sustainable resource utilization and advanced delivery system development through this biotechnological approach. Full article

Background: Ectopic pregnancy (EP) is defined as the implantation of an embryo outside the uterine cavity, which can lead to high morbidity and mortality if not diagnosed and treated promptly. A rare form of EP is myomectomy scar pregnancy (MSP), where the embryo implants in a scar from a prior myomectomy. Due to its rarity, MSP presents unique diagnostic and therapeutic challenges. This scoping review aims to map the existing literature on MSP to better understand the diagnostic strategies, management options, and clinical outcomes associated with this condition, and to identify gaps in current research. Methods: We conducted a scoping review by searching databases such as PubMed, Scopus, Web of Science, and MEDLINE for studies published between 2003 and 2023. Keywords used in combination included “myomectomy scar pregnancy”, “scar pregnancy”, “leiomyoma”, “uterine myomectomy”, “PAS disorders”, “placenta previa”, and “placenta accreta”. Studies were screened for relevance and eligibility by two independent reviewers. Data were extracted from case reports, retrospective studies, and reviews discussing MSP. Results: From an initial set of 111 studies, 28 papers met the inclusion criteria, comprising 4 retrospective studies and 24 case reports. A total of 44 cases of MSP were analyzed. The majority of diagnoses were made through ultrasound, with magnetic resonance imaging (MRI) used in more complex cases. Surgical interventions, primarily cesarean sections and myometrial repairs, were the most common treatments, while medical therapy with methotrexate was less frequently applied. Conclusions: This scoping review highlights the challenges of diagnosing and managing MSP due to its rarity. Although surgical management remains the primary approach, there is a lack of consensus on the optimal treatment for different clinical scenarios. Further research is needed to establish standardized diagnostic and therapeutic protocols for MSP and to evaluate the long-term outcomes of affected patients. Full article

The aim of this study is to examine the behavior of subharmonics in a one-dimensional cavity filled with a bubbly liquid, leveraging the nonlinear softening phenomenon of the medium at high amplitudes to enhance subharmonic generation. To this purpose, we use a numerical model developed previously that solves a coupled differential system formed by the wave equation and a Taylor-expanded Rayleigh–Plesset equation. This system describes the nonlinear mutual interaction between ultrasound and bubble vibrations. We carry out several different simulations to measure the response of the subharmonic component $f/2$ and the acoustic source frequency signal f when the cavity is excited over a range around the linear resonance frequency of the cavity (the resonance value obtained at low pressure amplitudes). Different source amplitudes in three different kinds of medium are used. Our results reveal several new characteristics of subharmonics as follows: their generation is predominant compared to the source frequency; their generation is affected by the softening of the bubbly medium when acoustic pressure amplitudes are raised; this specific behavior is solely an acoustically-related phenomenon; their behavior may indicate that the bubbly liquid medium is undergoing a softening process. Full article

Endometriosis, a prevalent gynecological condition affecting 10–15% of reproductive-age women, involves the growth of endometrial-like tissue outside the uterine cavity. This chronic inflammatory disease can significantly impact fertility by disrupting ovulation, tubal transport, and implantation. Clinical manifestations vary widely, ranging from asymptomatic cases to severe pelvic pain, dysmenorrhea, and dyspareunia. Accurate diagnosis remains challenging, often requiring a combination of patient history, clinical examination, and imaging studies. This paper will discuss the clinical approach to endometriosis during a first-line gynecological appointment, focusing on patient history, including detailed assessment of menstrual, pelvic, and bowel symptoms, and clinical examination; thorough gynecological examination, including abdominal and pelvic palpation, speculum examination, and bimanual examination; imaging evaluation (particularly of the role of ultrasound in identifying and characterizing endometriotic lesions, including the use of the #ENZIAN classification for deep infiltrating endometriosis and evaluation of fertility impact); and discussion of the Endometriosis Fertility Index (EFI) as a tool for assessing fertility potential. This comprehensive approach aims to guide clinicians in identifying and managing endometriosis effectively, improving patient outcomes and optimizing fertility management strategies. Methods: A literature search for suitable articles published from January 1974 to 2024 in the English language was performed using PubMed. Results: Endometriosis is associated with infertility rates ranging from 20% to 68%, with mechanisms including pelvic adhesions, chronic inflammation, and immune dysregulation. The revised American Society for Reproductive Medicine (rASRM) classification and #ENZIAN classification were identified as essential tools for staging and characterizing the disease. Transvaginal ultrasound (TVS) demonstrated high diagnostic accuracy for deep infiltrating endometriosis, with a sensitivity of up to 96% and specificity of 99%. EFI emerged as a valuable predictor of natural conception post-surgery. Additionally, the review underscores the frequent co-occurrence of adenomyosis in women with endometriosis, which may further compromise fertility. Despite advancements in imaging techniques and classification systems, the variability in symptom presentation and disease progression continues to challenge early diagnosis and effective management. Conclusions: Endometriosis is a prevalent gynecological condition affecting women of reproductive age and is associated with infertility. This paper describes the diagnostic approach to endometriosis during a first-line gynecological appointment, focusing on clinical history, physical examination, and the role of imaging, particularly ultrasound, in identifying and characterizing endometriosis lesions. The adoption of standardized classification systems such as #ENZIAN and EFI enhances disease staging and fertility prognosis, allowing for tailored treatment strategies. Despite improvements in non-invasive diagnostic methods, challenges persist in correlating symptom severity with disease extent, necessitating continued research into biomarkers and novel imaging techniques. Additionally, the frequent coexistence of adenomyosis further complicates fertility outcomes, underscoring the need for comprehensive management strategies. Further research is needed to enhance early detection strategies and optimize fertility preservation techniques for affected women. Full article

Optical fiber-based acoustic detectors for ultrasound imaging in medical field feature plano-concave Fabry–Perot cavities integrated on fiber tips, realized via dip-coating. This technique imposes constraints on sensor geometry, potentially limiting performance. Lab-on-Fiber technology enables complex three-dimensional structures with precise control over geometric parameters, such as the curvature radius. A careful investigation of the optical and mechanical aspects involved in the sensors’ performances is crucial for determining the design rules of such probes. In this study, we numerically analyzed the impact of curvature on the optical and acoustic properties of a plano-concave cavity using the Finite Element Method. Performance metrics, including sensitivity, bandwidth, and directivity, were compared to planar Fabry–Perot configurations. The results suggest that introducing curvature significantly enhances sensitivity by improving light confinement, especially for cavity thicknesses exceeding half the Rayleigh zone (∼45 μm), reaching an enhancement of 2.5 a L = 60 μm compared to planar designs. The curved structure maintains high spectral quality (FOM) despite 2% fabrication perturbations. A mechanical analysis confirms no disadvantages in acoustic response and bandwidth (∼40 MHz). These findings establish curved plano-concave structures as robust and reliable for high-sensitivity polymeric lab-on-fiber ultrasound detectors, offering improved performance and fabrication tolerance for MHz-scale bandwidth applications. Full article

Background: The purpose of this article is to overview the clinical significance of left supraclavicular adenopathy and review the etiology of inferior vena cava (IVC) thrombosis, starting from a presentation of a rare case of renal cell carcinoma (RCCs) with Xp11.2 translocation involving TFE3 gene fusion. This article also aims to review the literature to understand the characteristics of this rare type of renal tumor. Renal cell carcinoma (RCC) associated with Xp11.2 translocation/gene fusion TFE3 is a rare subtype of kidney cancer that was classified in 2016 as belonging to the family of renal carcinomas with MiT gene translocation (microphthalmia-associated transcription factor). The prognosis for these kidney cancers is poorer compared to other types. Methods: We present a case of a 66-year-old man with Virchow–Troisier adenopathy during physical examination, which raises the suspicion of infra-diaphragmatic tumor. The echocardiography highlighted a heterogeneous mass in the right cardiac cavities, and the abdominal ultrasound exam revealed a solid mass at the upper pole of the left kidney. Results: Following computed tomography, magnetic resonance imaging, PET-CT, and histopathological and immunohistochemical examinations, the patient was diagnosed with renal carcinoma with Xp11.2 translocation and TFE3 gene fusion. Conclusions: IVC thrombosis is often associated with neoplastic disease due to the procoagulant state of these patients, the most common malignancies related to IVC thrombosis being represented by RCCs (38%), genitourinary cancers (25%), bronchus and lung cancers, retroperitoneal leiomyosarcoma, and adrenal cortical carcinoma. Imaging methods play a crucial role in differential diagnosis, allowing for the localization of the primary tumor and assessment of its characteristics. Full article

An eight-year-old spayed female Abyssinian cat presented with lameness. Palpation revealed swelling, heat, and a reduced range of motion in the stifle and tarsal joints in both hind limbs. A radiographic examination of both hind limbs revealed periosteal proliferation from the distal tibia to the tarsal and metatarsal bones, which suggested hypertrophic osteopathy. Thorax and abdominal radiographic examinations were performed to identify the primary disease. Complete blood count and routine serum biochemistry tests revealed no abnormalities. No obvious anomalies were evident in the thoracic radiograph; however, a mass was observed near the left kidney on an abdominal radiograph. An abdominal ultrasound was performed, which revealed a hypoechoic renal mass located in the caudal pole of the left kidney. The left nephrectomy was performed after exploration of the abdominal cavity confirmed an abnormality in the left kidney. A histopathological examination revealed renal cell carcinoma. The cat was subsequently fed on a renal prescription diet but received no additional treatment. The periosteal lesion in the distal tibia regressed over time, but the lesions remained in the talus and metatarsal bones. At 1670 days following surgery, blood tests indicated that urea nitrogen and creatinine were above the normal range. In addition, urinalysis revealed an isosthenuria. However, the cat survived over 4500 days following surgery. Full article