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Percutaneous treatments, including thoracic duct embolization (TDE) and thoracic duct disruption (TDD), are reportedly effective and safe alternatives to surgical thoracic duct ligation for refractory chylothorax. When catheterization of the thoracic duct is impossible, TDD can be performed as long as the thoracic duct can be opacified by lymphangiography. However, no report has described percutaneous treatment when the thoracic duct cannot be visualized. In this case, TDE was not feasible because intranodal lymphangiography failed to opacify the thoracic duct: cannulation was not achieved. Therefore, we aimed to disrupt the thoracic duct by puncturing the retrocrural area where it was anatomically suspected to be located. Chylothorax improved thereafter. In cases without lymphangiographic thoracic duct visualization, TDD by puncturing the retrocrural space might improve refractory chylothorax.

Objective: To examine the changes in total kidney volume (TKV) and total liver volume (TLV) before and after dialysis initiation in patients with autosomal dominant polycystic kidney disease. Patients and Methods: This was a retrospective, single-center cohort study to investigate the changes in TKV and TLV before and after dialysis initiation, along with influencing factors, using linear mixed models. We enrolled 95 patients with autosomal dominant polycystic kidney disease (85 receiving hemodialysis [HD] and 10 receiving peritoneal dialysis [PD]) who began receiving dialysis at Toranomon Hospital from January 1, 2008, to December 31, 2020. Results: The least squares mean TKV ratio (TKV at each time point/TKV at dialysis initiation) was 63.8% (95% confidence interval [CI], 54.7%-72.9%) at 6 years before dialysis initiation and 95.5% (95% CI, 82.9%-108.2%) at 6 years after dialysis initiation (P

Anomalous retro-psoas artery is an extremely rare congenital anomaly of the iliac arteries reported in the English-language literature. Using contrast-enhanced computed tomography, we incidentally diagnosed an anomalous retro-psoas artery in a 60-year-old male patient with right renal cancer. Although anomalous retro-psoas artery is extremely rare and mostly asymptomatic, knowledge of it is needed to avoid severe vascular complications in the event of vascular intervention and surgery.

Objective:. We hypothesized that preoperatively planned portal vein resection (PVR), which prevents from approaching tumors, improves survival in patients with resectable pancreatic head cancer adjacent to the portal vein (PhC-PV). Summary:. The decision to perform PVR is difficult in patients with resectable PhC-PV. Methods:. This is a retrospective, bi-institutional study of patients undergoing pancreatoduodenectomy (PD) for resectable PhC-PV from 2009 to 2018. We compared clinical data of patients who underwent PD with preoperatively planned PVR (planned PVR group) and those who underwent conventional PD (cPD) in which decision to perform PVR was made intraoperatively (cPD group). Results:. Among the study population of 176 patients, 53 patients (30.1%) underwent PD with planned PVR. The remaining 123 patients (69.9%) underwent cPD. Tumor characteristics were similar between the 2 groups. Operation time and major complication rates did not differ between the 2 groups. The local recurrence rate of patients in the planned PVR group (28.3%) was lower than that of the cPD group (44.7%; P = 0.041). Median overall survival (OS) was longer in the planned PVR group than in the cPD group (32 vs 27 months; P = 0.011). Multivariate analysis revealed that having undergone planned PVR was an independent factor for favorable OS (hazard ratio = 1.65; 95% confidence interval = 1.08–2.61; P = 0.021). Conclusions:. The preoperative decision to perform PVR improves survival by enhancing local control of resectable PhC-PV.

Vertebral hemangiomas are the most common benign tumor of the spine. Although usually asymptomatic, there is a higher risk of severe neurological deficits when hemangiomas afflict the thoracic spine. The management of vertebral hemangioma patients with extraosseous extension causing neurological dysfunction has not yet been established. We described the effectiveness of surgical and radiation therapy in a case of recurrent hemangioma in the thoracic spine with extraosseous extension causing progressive paraparesis. We retrospectively reviewed a case of vertebral recurrent hemangioma treated by posterior spinal decompression and fusion and subsequent radiation therapy.A 61-year-old woman suffered from neurological deficits caused by a hemangioma in the thoracic spine. Despite initial treatment by posterior decompression, subtotal transpedicular tumor resection, and posterior spinal fusion, her neurological symptoms due to tumor compression recurred 5 years later. Posterior-approach anterior spinal cord decompression by subtotal transpedicular tumor resection was attempted next but her paraparesis continued to worsen. Radiotherapy of a total of 32 Gy in 16 fractions restored mobility and lesion size was markedly reduced 7 months later. Even 14 months after surgery, she has been able to walk although she has slightly paralysis of the lower extremity remaining.Subtotal transpedicular tumor resection, and especially additional radiation therapy, was effective in reducing tumor volume and improving neurological dysfunction caused by a thoracic spine recurrent hemangioma. Keywords: Recurrent vertebral hemangioma, Subtotal transpedicular tumor resection, Radiation therapy

Spinal deformity is a characteristic feature of mucopolysaccharidosis (MPS), for which surgical correction is indicated when the deformity is progressive to avoid neurological deficits and respiratory impairment. However, there exist few reports on the surgical treatment of spinal deformity in MPS and no treatment standard has been established. We herein describe the clinical and radiological outcomes of a patient with MPS-I receiving surgery for severe thoracolumbar (TL) kyphoscoliosis. The patient was a 12-year-old girl with MPS-I who underwent posterior spinal fusion with an all pedicle screw construct from T9 to L4 for a preoperative TL curve Cobb angle of 50° and TL kyphotic angle of 71°. Postoperative Cobb angle of the TL curve and TL kyphotic angle improved to 5 and 12°, respectively. Although her lumbar lordosis decreased slightly due to mild back-out of the pedicle screws in L4, bony union was achieved 3 years after surgery without perioperative complications. Based on the present case, posterior spinal fusion represents a strong treatment option for severe spinal deformity in MPS. Keywords: Posterior spinal fusion, Pedicle screw, Thoracolumbar kyphoscoliosis, Radiological findings, Mucopolysaccharidosis

Dear Editor, Pilonidal cyst disease is a common, acquired, inflammatory disease predominantly affecting the natal clefts of the buttocks (1,2). The disease has a predilection for men, with a male-to-female ratio of 3-4:1. Patients are generally young, towards the end of second decade of life. Lesions are initially asymptomatic, while the development of complications such as abscess formation is associated with pain and discharge (1). Patients with pilonidal cyst disease may present to dermatology outpatient clinics, especially when the disease is asymptomatic. Herein we report the dermoscopic features of four cases of pilonidal cyst disease encountered in our dermatology outpatient clinic. Four patients who presented to our dermatology outpatient department for evaluation of a solitary lesion on buttocks were diagnosed with pilonidal cyst disease based on clinical and histopathological examination. All patients were young men and presented with solitary, firm, pink, nodular lesions in the region in proximity to the gluteal cleft (Figure 1, a, c, e). Dermoscopy of the first patient revealed a red structureless area in the central part of the lesion, consistent with ulceration. Additionally, white lines reticular as well as glomerular vessels were present at the periphery on the pink homogenous background (Figure 1, b). In the second patient, a yellow structureless central ulcerated area was surrounded by linearly arranged multiple dotted vessels at the periphery on a homogenous pink background (Figure 1, d). In the third patient, dermoscopy revealed a central yellowish structureless area with peripherally arranged hairpin and glomerular vessels (Figure 1, f). Lastly, similar to the third case, dermoscopic examination of the fourth patient showed a pink homogenous background with yellow and white structureless areas and peripherally arranged hairpin and glomerular vessels (Figure 2). Demographics and clinical features of the four patients are summarized in Table 1. Histopathology of all our cases revealed epidermal invagination and sinus formation, free hair shafts, and chronic inflammation with multinuclear giant cells. Histopathological slides of the first case can be seen in Figure 3 (a-b). All patients were referred to general surgery for treatment. The current knowledge pertaining to dermoscopy of pilonidal cyst disease is scarce in the dermatologic literature, and was previously evaluated in only two cases. Similar to our cases, the authors reported the presence of a pink-colored background, radial white lines, central ulceration, and multiple peripherally arranged dotted vessels (3). The dermoscopic features of pilonidal cysts differ from other epithelial cysts and sinuses. As for epidermal cysts, the presence of punctum and an ivory-white background color have been reported as characteristic dermoscopic findings (4,5). In addition, unruptured epidermal cysts reveal arborizing telangiectasia, while the ruptured epidermal cysts show peripheral linear branched vessels (4,5). A peripheral brown rim, linear vessels, and yellow homogenous background of the entire lesion have been reported as dermoscopic features of steatocystoma multiplex as well as milias (5). Of note, other cystic lesions mentioned above are typified by linear vessels, whereas pilonidal cysts present dotted, glomerular, and hairpin vessels. Pilonidal cyst disease must also be considered in the differential diagnosis of pink nodular lesions, along with amelanotic melanoma, basal cell carcinoma, squamous cell carcinoma, pyogenic granuloma, lymphoma, and pseudolymphoma (3). Based on our cases and the two cases in the literature, pink background, central ulceration, peripherally arranged dotted vessels, and white lines seem to be common dermoscopic features of pilonidal cyst disease. Our observations demonstrate that central yellowish structureless areas along with peripheral hairpin and glomerular vessels are also among the dermoscopic features of pilonidal cyst disease. In conclusion, pilonidal cysts can be easily differentiated from other skin tumors by the aforementioned dermoscopic features, and the diagnosis in patients clinically suspected of having pilonidal cyst can be supported by dermoscopy. However, there is need for further studies in order to better characterize typical dermoscopic features of this disease and their frequency.

The purpose of this investigation was to acknowledge and to analyze death according to the social representation of health professionals. The research was carried out with professionals that renders assistance to the women in the gestation-puerperal period. The technique of content analysis was chosen, but data analysis was also anchored in social representations. From the narratives of the subjects interviewed, death emerged as an empirical category with a social representation denominated as "terrible". Death, as it enters the scene, both in hospital or ambulatory settings, is apprehended in different ways by health professionals: as a terrible phase of life that is difficult to be accepted, as a conflict over the purpose of one's profession, as a way of seeking for mistakes in the procedure carried out in order to justify it, and, at this moment, professionals experience feelings of insecurity, incapacity, embarrassment, guilt, anguish, suffering and pain.

This study aims at learning about and identifying the causes leading to maternal death. Data were obtained from the Ribeirão Preto Committee for Studies and Prevention of Maternal Death and from obituaries. It is an exploratory study in which 72 maternal deaths occurring in Ribeirão Preto were analyzed from 1991 to 1995. In 1995, the maternal death rate was 60.3 in 100,000 births, with the predominance of avoidable causes, such as hemorrhage (33.3%), other causes (26.4%), hypertension (15.3%), abortion (11.1%), infection (8.3%) and puerperium (5.6%). Maternal death is a public health problem which must be faced by government authorities.

The present article presents the sociological analysis of the nursing profession, focussing the specificities of the profession on the basis of the component elements of a profession, according to the theoretical system of the sociology of professions. At the end of the 20th century and the beginning of the new millennium, nursing faces crucial questions for the profession, which bring back the need to restructure the strategic considerations that make up the political agenda of the nursing profession. Specific knowledge, professional qualification, particularities of the work process, monopoly of the professional exercise, and the configuration of the hierarchy of the nursing team are some of the items dealt within this article. As one of the essential professions in the health area, nursing needs to reach the next century with a new perspective, knowing how and in which conditions it will develop in a context of paradigmatic changes. Considering this new context, a political agenda for nursing professionals will have to contemplate the several aspects that make up a profession, that is, specific knowledge, exclusive labor market, form of organization, among others.