Treatment of Umbilical Granuloma in Infants With Topical Application of Common Salt: A Scoping Review

BackgroundCommon salt is a safe, effective and cheap home-made remedy for umbilical granuloma. The aim of this scoping review is to identify and summarize the available evidence and examine the research conducted on salt treatment for umbilical granuloma.MethodsA literature search was performed in the second week of September, 2022 using Google scholar, PubMed, MEDLINE and EMBASE databases using the keywords ‘umbilical granuloma’ and ‘salt treatment’ to identify all English articles pertaining to salt treatment for umbilical granuloma. Tables were made to summarize the methodological characteristics, results and the dosage regimens of salt used by different authors. The Cochrane Collaboration's tool was used for assessing risk of bias in RCTs. The indexing statuses of the journals publishing these studies were also noted. The overall efficacy with the use of common salt was calculated by adding the success rates mentioned in each study.ResultsTwenty-four articles (2 systematic reviews, 6 Randomized Controlled Trials, 11 prospective cohort studies, 1 case control study, 3 retrospective case series and 1 case report) were included. An overall 93.91% success rate (1033/1100) was seen with common salt application, without any reports of complications/recurrences.ConclusionTopical application of common salt for umbilical granulomas is simple, effective and inexpensive. This scoping review provides a broader outlook at the existing level of evidence and may help in planning interventional comparative studies, so that recommendations can be formulated. It also highlights a lack of properly designed randomized controlled trials on this topic.Level of EvidenceI.     

Phase 0 Study of Vandetanib-Eluting Radiopaque Embolics as a Preoperative Embolization Treatment in Patients with Resectable Liver Malignancies

PurposeTo assess the safety and tolerability of a vandetanib-eluting radiopaque embolic (BTG-002814) for transarterial chemoembolization (TACE) in patients with resectable liver malignancies.Materials and MethodsThe VEROnA clinical trial was a first-in-human, phase 0, single-arm, window-of-opportunity study. Eligible patients were aged ≥18 years and had resectable hepatocellular carcinoma (HCC) (Child-Pugh A) or metastatic colorectal cancer (mCRC). Patients received 1 mL of BTG-002814 transarterially (containing 100 mg of vandetanib) 7–21 days prior to surgery. The primary objectives were to establish the safety and tolerability of BTG-002814 and determine the concentrations of vandetanib and the N-desmethyl vandetanib metabolite in the plasma and resected liver after treatment. Biomarker studies included circulating proangiogenic factors, perfusion computed tomography, and dynamic contrast-enhanced magnetic resonance imaging.ResultsEight patients were enrolled: 2 with HCC and 6 with mCRC. There was 1 grade 3 adverse event (AE) before surgery and 18 after surgery; 6 AEs were deemed to be related to BTG-002814. Surgical resection was not delayed. Vandetanib was present in the plasma of all patients 12 days after treatment, with a mean maximum concentration of 24.3 ng/mL (standard deviation ± 13.94 ng/mL), and in resected liver tissue up to 32 days after treatment (441–404,000 ng/g). The median percentage of tumor necrosis was 92.5% (range, 5%–100%). There were no significant changes in perfusion imaging parameters after TACE.ConclusionsBTG-002814 has an acceptable safety profile in patients before surgery. The presence of vandetanib in the tumor specimens up to 32 days after treatment suggests sustained anticancer activity, while the low vandetanib levels in the plasma suggest minimal release into the systemic circulation. Further evaluation of this TACE combination is warranted in dose-finding and efficacy studies.     

Risk prediction of common bile duct stone recurrence based on new common bile duct morphological subtypes

Stones in the common bile duct (CBD) are reported worldwide, and this condition is majorly managed through endoscopic retrograde cholangiopancreatography (ERCP). CBD stone recurrence is an important issue after endoscopic stone removal. Therefore, it is essential to identify its risk factors to determine the necessity of regular follow-up in patients who underwent endoscopic removal of CBD stones. The authors identified that the S and polyline morphological subtypes of CBD were associated with increased stone recurrence. New morphological subtypes of CBD presented by the authors can be important risk predictors of recurrence after endoscopic stone removal. Furthermore, the new morphological subtypes of CBD may predict the risk of residual CBD stones or technical difficulty in CBD stone removal. Further studies with a large sample size and longer follow-up durations are warranted to examine the usefulness of the newly identified morphological subtypes of CBD in predicting the outcomes of ERCP for CBD stone removal.     

Percutaneous thermal ablation of sacral metastases: Assessment of pain relief and local tumor control

PurposeTo retrospectively report on safety, pain relief and local tumor control achieved with percutaneous ablation of sacral bone metastases.Materials and methodsFrom February 2009 to June 2020, 23 consecutive patients (12 women and 11 men; mean age, 60 ± 8 [SD] years; median, 60; range: 48-80 years) with 23 sacral metastases underwent radiofrequency (RFA) or cryo-ablation (CA), with palliative or curative intent at our institution. Patients’ demographics and data pertaining to treated metastases, procedure-related variables, safety, and clinical evolution following ablation were collected and analyzed. Pain was assessed with numerical pain rating scale (NPRS).ResultsSixteen (70%) patients were treated with palliative and 7 (30%) with curative intent. Mean tumor diameter was 38 ± 19 (SD) mm (median, 36; range: 11-76). External radiation therapy had been performed on five metastases (5/23; 22%) prior to ablation. RFA was used in 9 (39%) metastases and CA in the remaining 14 (61%). Thermo-protective measures and adjuvant bone consolidation were used whilst treating 20 (87%) and 8 (35%) metastases, respectively. Five (22%) minor complications were recorded. At mean 31 ± 21 (SD) (median, 32; range: 2-70) months follow-up mean NPRS was 2 ± 2 (SD) (median, 1; range: 0–6) vs. 5 ± 1 (median, 5; range: 4–8; P < 0.001) at the baseline. Three metastases out of 7 (43%) undergoing curative ablation showed local progression at mean 4 ± 4 (SD) (median, 2; range: 1-8) months follow-up.ConclusionPercutaneous ablation of sacral metastases is safe and results in significant long-lasting pain relief. Local tumor control seems sub-optimal; however, further investigations are needed to confirm these findings due to paucity of data.     

Neuraxial anesthesia in a parturient with common variable immunodeficiency: a case report

Choosing whether or not to initiate neuraxial anesthesia in pregnant women with immune system defects may be challenging. Anesthesiologists have the responsibility of making the best decision in terms of anesthesia management for both mother and baby during the labor and delivery process. Whether neuraxial anesthesia is associated with an increased risk of central nervous system infection in immunocompromised compared with healthy patients is unknown. It is also unclear if maternal immune modulation required for fetal tolerance makes pregnant women susceptible to pathogens and causes an altered immune response. Infection-related complications of neuraxial anesthesia are rare but may be severe, especially in immunocompromised parturients. There are no guidelines regarding the indications and limitations of regional anesthesia procedures in these patients. Immunocompromised patients are now seen more commonly, and it is essential to adopt a multidisciplinary approach to their care while tailoring anesthetic plans to the individual. We present the case of a 37-year-old parturient who had a congenital immune deficiency and who developed aseptic meningitis after receiving spinal anesthesia for cesarean delivery.     

Predictors of Survival after Yttrium-90 Radioembolization of Chemotherapy-Refractory Hepatic Metastases from Breast Cancer

PurposeTo determine predictors of survival after transarterial radioembolization of hepatic metastases from breast cancer.Materials and MethodsTwenty-four patients with chemotherapy-refractory hepatic metastases from breast cancer who underwent radioembolization from 2013 to 2018 were evaluated based on various demographic and clinical factors before and after treatment. Overall survival (OS) was estimated by Kaplan–Meier method. Log-rank analysis was performed to determine predictors of prolonged OS from the time of first radioembolization and first hepatic metastasis diagnosis.ResultsMedian OS times were 35.4 and 48.6 months from first radioembolization and time of hepatic metastasis diagnosis, respectively. Radioembolization within 6 months of hepatic metastasis diagnosis was a positive predictor of survival from first radioembolization, with median OS of 38.9 months vs 22.1 months for others (P = .033). Estrogen receptor (ER)–positive status predicted prolonged survival (38.6 months for ER⁺ vs 5.4 months for ER⁻; P = .005). The presence of abdominal pain predicted poor median OS: 12.8 months vs 38.6 months for others (P < .001). The presence of ascites was also a negative predictor of OS (1.7 months vs 35.4 months for others; P = .037), as was treatment-related grade ≥ 2 toxicity at 3 months (5.4 months vs 38.6 months for others; P = .017).ConclusionsIn patients with metastatic breast cancer, radioembolization within 6 months of hepatic metastasis diagnosis and ER⁺ status appear to be positive predictors of prolonged survival. Conversely, baseline abdominal pain, baseline ascites, and treatment-related grade ≥ 2 toxicity at 3 months after treatment appear to be negative predictors of OS.     

类似胆总管囊肿的胆总管横纹肌肉瘤：阻塞性黄疸的罕见原因

肝外胆道肿瘤罕见，其中以横纹肌肉瘤最常见。横纹肌肉瘤是一种软组织恶性肌肉骨骼肿瘤，是儿童非常罕见的一种胆总管恶性肿瘤。它通常表现为阻塞性黄疸和/或瘙痒。如果肿瘤没有局部浸润邻近组织，其影像学表现则类似胆总管囊肿。因此，确诊通常是在手术时或术前通过活检。早期诊断、与胆总管囊肿鉴别、尽早开始治疗对延长患者生存时间有重要意义。该文报道1例10岁男童，反复阻塞性黄疸和发热，术前诊断为胆总管囊肿，术后确诊为胆总管胚胎性横纹肌肉瘤。经手术切除、术后化疗，该患儿预后良好。故必须了解这种罕见的肿瘤可以类似先天性胆总管囊肿，并且在儿童阻塞性黄疸的鉴别诊断时应加以考虑。