Pancreatic schwannomas are extremely rare and their variable imaging features on computed tomography (CT) and magnetic resonance imaging (MRI) make preoperative diagnosis challenging. A 73 year-old man was incidentally found to have a 13 mm hypoechoic mass in the pancreatic body on transabdominal ultrasonography. CT showed delayed enhancement, and MRI demonstrated hypointensity on T1, slight hyperintensity on T2, and hyperintensity on diffusion-weighted imaging (DWI). On endoscopic ultrasonography (EUS), the lesion appeared as a 13 mm hypoechoic mass, and contrast-enhanced EUS revealed gradual isoenhancement beginning 17 s after contrast injection. Another 6 mm hypoechoic lesion was identified in the pancreatic tail on EUS, and contrast-enhanced EUS showed rapid hyperenhancement beginning 12 s after contrast injection. EUS-guided fine-needle aspiration (EUS-FNA) was performed for both lesions, which were diagnosed as schwannoma and Grade 1 neuroendocrine tumor, respectively. A strategy of observation was adopted for both tumors. This is a rare case of concomitant pancreatic schwannoma and NET. EUS contributed to the detection of a small NET, while contrast-enhanced EUS revealed different vascular patterns between the two lesions, leading to a decision to perform EUS-FNA for both tumors.
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Hallux valgus is a common forefoot deformity. Sensory complications after correction can result from iatrogenic injury to the medial branch of the medial dorsal cutaneous nerve (MDCNm), lateral dorsal cutaneous nerve (LDCN), medial plantar cutaneous nerve (MPCN), and lateral plantar cutaneous nerve (LPCN). We synthesized evidence and landmarks to aid nerve identification and reduce injury. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, PubMed, Embase, and Cochrane were searched to February 2025 using 'nerve anatomy', 'hallux valgus' and 'bunion'. English/French studies describing course, measurements or localization of hallux sensory nerves from the first tarsometatarsal to interphalangeal joints were included. From 863 records, 13 studies were included comprising cadaveric, imaging, and clinical series with both normal and hallux valgus feet. Evidence was most robust for MDCNm localization. Palpation during resisted hallux extension and targeted ultrasonography were reported as low-cost methods to define the MDCNm in relation to the extensor hallucis longus (EHL). Palpation showed 100% sensitivity (positive predictive value [PPV] 99%), whereas novice ultrasonography achieved 75% sensitivity (PPV 100%) in cadaveric feet before dissection. At the metatarsophalangeal (MTP) level, a transverse 'clock-face' reference (EHL at 12 o'clock) typically locates the MDCNm between 10 and 12 o'clock for a right foot. A communicating dorsoplantar 'sentinel' vein crosses the MDCNm about 2 cm proximal to MTP, with the nerve running deep to the vein. Limited data place the LDCN at 11-12, LPCN at 5-6 and MPCN at 7-8 o'clock. Most maps were derived from non-deformed feet. Hallux valgus severity shifts the MDCNm-EHL intersection proximally and may widen the medial danger zone to ~19 mm. Ultrasonography suggests MPCN lies within 3 to 4 mm of the metatarsal head and medial sesamoid, helping define capsulotomy limits; data for LPCN remain still limited. Combining palpation, ultrasonography and vein-based landmarks with awareness of axial danger zones may reduce sensory nerve injury during hallux valgus surgery; clinical validation in deformed feet remains necessary.
Osteoarthritis (OA) is a degenerative joint disease that frequently affects the knee, particularly in older adults. Asymptomatic atherosclerosis (AS) in femoral and popliteal arteries may complicate surgical outcomes in patients undergoing total knee arthroplasty (TKA). (A narrative review. Arthroplasty, 4(1), 11). This study aimed to assess the prevalence of AS in advanced knee OA and evaluate the role of Doppler ultrasonography in preoperative vascular risk assessment. This cross-sectional study included 121 patients over 40 years of age with Kellgren-Lawrence grade III and IV knee OA. Bilateral Doppler ultrasonography was performed to measure peak systolic velocity (PSV) in the common femoral and popliteal arteries. Thresholds of 120 cm/sec (femoral) and 80 cm/sec (popliteal) were considered significant for stenosis. Correlation analyses were performed between Doppler parameters and clinical factors including BMI, symptom duration, and comorbidities. The prevalence of asymptomatic AS was 34.7% in the femoral artery and 36.6% in the popliteal artery. Abnormal waveforms were observed in 22.7% of femoral and 13.6% of popliteal arteries. PSV values correlated significantly with KL grade (femoral r = 0.513, popliteal r = 0.468, p 0.001) and with clinical risk factors such as higher BMI, longer symptom duration, hypertension, and smoking. ROC analysis showed high discriminatory power of PSV values for predicting OA severity. A high prevalence of asymptomatic AS was observed in patients with advanced knee OA. Doppler ultrasonography proved effective in identifying vascular risk factors, suggesting its value in preoperative planning for TKA. Incorporating vascular screening, particularly in patients with high BMI, smoking, or hypertension, may reduce postoperative complications. Further studies with gold goldstandard imaging validation are recommended.
A duplicated cystic duct draining a single gall bladder is an exceedingly rare congenital biliary anomaly. Fewer than 25 cases have been described in published literature, and the condition is almost never diagnosed before surgery. We report a 19-year-old male who presented with recurrent right upper quadrant pain. Abdominal ultrasonography confirmed cholelithiasis but revealed no biliary ductal abnormality. During elective laparoscopic cholecystectomy, meticulous dissection of Calot's triangle unexpectedly identified two separate cystic ducts, both draining a single gall bladder. Each duct was individually traced to confirm its distal course, then clipped and divided under direct vision after establishing the critical view of safety. The procedure was completed laparoscopically without complication. The patient was discharged on the post-operative day 2 and remained well at the follow-up. This case underscores that standard pre-operative imaging does not guarantee normal biliary anatomy and that systematic, unhurried dissection with a critical view of safety remains the only reliable safeguard against inadvertent bile duct injury.
The significant cross-reactivity between bovine, ovine, and caprine pregnancy-associated glycoproteins (PAGs) enables the adaptation of bovine-specific diagnostics for use in other ruminants; consequently, the Alertys OnFarm Pregnancy Test (AOFPT)-a blood-based lateral flow assay-provides a rapid and practical solution for pregnancy detection directly at the animal's head under field conditions. This study evaluated to assess and validate the performance of AOFPT in goats at days 21 and 28 post-mating, by comparing the results with serum progesterone (P4) analysis and using transabdominal ultrasonography (TAUS) as the gold standard. The study involved 85 Kilis goats, five months post-partum. Estrus was synchronized using an 11-day progestagen device, d-cloprostenol, and PMSG. Whole blood and serum samples were collected on Days 21 and 28 post-mating. AOFPT was performed on-farm immediately after collection. For validation, serum progesterone concentrations were measured via electrochemiluminescence immunoassay, and TAUS was performed on Days 35 and 42, with Day 42 findings serving as the gold standard. Results indicated that on Day 21, AOFPT sensitivity, specificity, positive predictive value, and negative predictive value were 79.4%, 93.8%, 98.2%, and 51.7%, respectively. By Day 28, these metrics reached 100%, 81.3%, 95.8%, and 100%. Statistical agreement between AOFPT and the reference method was K = 0.55 (82.14%) on Day 21 and K = 0.87 (96.43%) on Day 28 (p <0.001). Median ± interquartile range (IQR) of P4 concentrations were 5.95±2.60 ng/mL on day 21 and 6.92 ± 2.93 ng/mL on Day 28. AOFPT-identified pregnant goats exhibited significantly higher P4 levels (p < 0.001) than non-pregnant goats on Day 21 (5.98 ± 3.21 vs. 4.05 ± 5.46) and Day 28 (6.84 ± 3.06 vs. 0.75 ± 5.96). AOFPT demonstrated accuracy and reliability closely matching P4 measurements and the reference method. This test provides a practical tool for early on-farm pregnancy diagnosis in goats, potentially enhancing reproductive management and productivity in dairy goat farms and large herds.
Acute appendicitis during pregnancy is the most common indication for non-obstetric emergency surgery. However, physiological changes associated with pregnancy can reduce the sensitivity of its clinical signs and symptoms. This study aimed to compare the diagnostic performance of the Alvarado, Appendicitis Inflammatory Response (AIR), Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA), and Tzanakis scoring systems in pregnant patients, as well as to evaluate surgical outcomes. A total of 39 pregnant patients who underwent surgery for acute appendicitis between January 2017 and January 2025 were retrospectively analyzed. Demographic characteristics, gestational age, clinical presentation, laboratory parameters (white blood cell count [WBC], C-reactive protein [CRP]), ultrasonography findings, surgical approach (open vs. laparoscopic), histopathological results, and maternal and fetal outcomes were recorded. Alvarado, AIR, RIPASA, and Tzanakis scores were calculated for each patient. Patients were stratified into risk categories based on established cut-off values from the literature, and diagnostic performance was assessed against histopathological findings. The mean age was 26.0±5.3 years, and the mean gestational age was 19.6±7.9 weeks; 53.8% of patients were in the second trimester. Open appendectomy was performed in 61.5% of cases, while 38.5% underwent laparoscopic appendectomy. High-risk classification rates were 66.7% for Alvarado, 69.2% for AIR, and 79.5% for both RIPASA and Tzanakis scores. Histopathology confirmed acute appendicitis in 66.7% of patients, perforated appendicitis in 15.4%, and a normal appendix in 17.9%. WBC and CRP levels were significantly higher in patients with confirmed appendicitis (p<0.05). The highest sensitivity and specificity were observed with the RIPASA (93.7% and 85.7%, respectively) and Tzanakis (90.6% and 71.4%) scoring systems. Laparoscopic surgery was associated with a shorter hospital stay compared to open surgery (p<0.001), with comparable maternal and fetal safety outcomes. Clinical scoring systems are effective and reliable tools for diagnosing acute appendicitis in pregnant patients, with the RIPASA score demonstrating the highest diagnostic accuracy. Elevated CRP levels and leukocytosis may further support diagnosis. Laparoscopic appendectomy is a safe option associated with a shorter hospital stay compared with open surgery. These findings support the safe use of both clinical scoring systems and laparoscopic surgery in pregnant patients.
Acute appendicitis is one of the most common emergency surgical conditions and may progress to perforation, sepsis, and mortality if not treated promptly. This study aimed to evaluate the effectiveness of the Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) score and the Modified Alvarado Scoring System (MASS) in identifying perforated acute appendicitis. This study included 164 patients admitted to the General Surgery Department between June 2023 and December 2023 with a preliminary diagnosis of acute appendicitis. MASS and RIPASA scores, along with demographic data, were obtained from the Hospital Information Management System (HIMS) at the time of diagnosis. A total of 153 patients were included in the final analysis. The mean age was 35.2±14.1 years (range: 18-82 years). Perforation was identified in 15.8% of cases evaluated by ultrasonography (USG) and 6.1% of those assessed by computed tomography (CT). A RIPASA score >7 demonstrated a sensitivity of 71.1% and a specificity of 54.7% for detecting perforation. Patients with perforation had significantly higher RIPASA and MASS scores (both p<0.001) and longer hospital stays (p<0.001). Compared with the MASS scoring system, the RIPASA score demonstrates higher sensitivity and specificity and is associated with greater inflammation when elevated. Its incorporation into routine clinical practice may facilitate faster, more efficient, and cost-effective management in emergency and general surgical settings.
Placenta accreta spectrum represents a group of abnormal placental implantation disorders characterized by partial or complete adherence of the placenta to the uterine wall, with invasion into the myometrium or beyond. It is a major cause of severe obstetric hemorrhage and is associated with significant maternal morbidity and mortality. The rising incidence of placenta accreta spectrum parallels the increasing rate of cesarean deliveries, making early diagnosis and planned multidisciplinary management crucial in modern obstetric practice. The objective of this study is to describe the clinical presentation, antenatal diagnosis, intraoperative findings, management strategies, and maternal outcomes of placenta accreta spectrum cases encountered in a tertiary care obstetric setting. This case series included five women diagnosed with placenta accreta spectrum and managed at a tertiary care teaching hospital over 1-year study period from January 2024 to December 2025. The clinical details, including obstetric history, risk factors, antenatal imaging findings, intraoperative diagnosis, surgical management, blood transfusion requirements, and maternal outcomes, were documented and analyzed. Diagnosis was based on antenatal ultrasonography and/or intraoperative findings consistent with placenta accreta spectrum. All cases had identifiable risk factors, with previous cesarean section being the most common. Placenta accreta spectrum was suspected antenatally in most cases, allowing planned delivery with multidisciplinary preparedness. Surgical management included cesarean hysterectomy in selected cases, while conservative approaches were attempted in carefully chosen patients. Significant blood loss was observed; however, timely intervention and availability of blood products resulted in favorable maternal outcomes in all cases. Placenta accreta spectrum remains a serious obstetric condition with the potential for life-threatening hemorrhage. Antenatal suspicion, early diagnosis, planned delivery, and a multidisciplinary approach are essential to reduce maternal morbidity and improve the outcomes. Résumé Contexte:Le spectre du placenta accreta représente un groupe de troubles d’implantation placentaire anormale caractérisés par une adhérence partielle ou complète du placenta à la paroi utérine, avec une invasion du myomètre ou au-delà. Il constitue une cause majeure d’hémorragie obstétricale sévère et est associé à une morbidité et une mortalité maternelles importantes. L’augmentation de l’incidence du spectre du placenta accreta suit la hausse du taux des césariennes, rendant le diagnostic précoce et une prise en charge multidisciplinaire planifiée essentiels dans la pratique obstétricale moderne.Objectifs:L’objectif de cette étude est de décrire la présentation clinique, le diagnostic anténatal, les constatations peropératoires, les stratégies de prise en charge et les issues maternelles des cas de spectre du placenta accreta rencontrés dans un centre obstétrical tertiaire.Matériels et méthodes:Cette série de cas comprenait cinq femmes diagnostiquées avec un spectre du placenta accreta et prises en charge dans un hôpital universitaire tertiaire sur une période d’un an, de janvier 2024 à décembre 2025. Les données cliniques, incluant les antécédents obstétricaux, les facteurs de risque, les résultats de l’imagerie anténatale, le diagnostic peropératoire, la prise en charge chirurgicale, les besoins transfusionnels et les issues maternelles, ont été recueillies et analysées. Le diagnostic reposait sur l’échographie anténatale et/ou sur des constatations peropératoires compatibles avec un spectre du placenta accreta.Résultats:Toutes les patientes présentaient des facteurs de risque identifiables, la césarienne antérieure étant le plus fréquent. Le spectre du placenta accreta a été suspecté en période anténatale dans la majorité des cas, permettant une planification de l’accouchement avec une préparation multidisciplinaire. La prise en charge chirurgicale comprenait une hystérectomie césarienne dans certains cas, tandis que des approches conservatrices ont été tentées chez des patientes soigneusement sélectionnées. Une perte sanguine importante a été observée ; toutefois, grâce à une intervention rapide et à la disponibilité des produits sanguins, toutes les patientes ont eu une évolution maternelle favorable.Conclusion:Le spectre du placenta accreta demeure une affection obstétricale grave avec un risque potentiel d’hémorragie mettant en jeu le pronostic vital. La suspicion anténatale, le diagnostic précoce, la planification de l’accouchement et une approche multidisciplinaire sont essentiels pour réduire la morbidité maternelle et améliorer les résultats.
To explore the clinical significance of key pelvic floor ultrasound indicators in the treatment of pelvic organ prolapse (POP). This study aims to address the limitations of the subjective POP-Q system and the costly static MRI, optimize objective evaluation metrics, and construct an effective POP risk prediction model. A retrospective analysis was conducted on 110 patients with POP or lower urinary tract symptoms. All participants underwent POP-Q assessment and 3D pelvic floor ultrasonography. Following 1:1 age-matched propensity score matching (PSM), Lasso regression was employed to screen variables and establish the POP\u index model. Model efficacy was validated through area under the curve (AUC), sensitivity, specificity, and decision curve analysis. Eighty-four participants were included after matching. In the POP group, the levator hiatus area was significantly larger, and both bladder neck mobility and rectal prolapse rate were higher (both p<0.001). Seven core ultrasound indicators were identified. The POP\U index demonstrated excellent diagnostic efficiency, with an AUC of 0.94, and both sensitivity and specificity at 0.88, yielding an ideal clinical net benefit. Pelvic floor ultrasound, combined with PSM and machine learning, enables accurate POP assessment. The prediction model and ultrasound indicators provide an objective basis for clinical diagnosis and risk stratification, facilitating individualized intervention and primary-level POP screening.
Malignant Triton tumor (MTT) is a rare, aggressive variant of malignant peripheral nerve sheath tumor (MPNST) featuring divergent rhabdomyoblastic differentiation. Comprising less than 5% of MPNST cases, MTT is associated with a poor prognosis, exhibiting a five-year survival rate of only 27.5%. Its occurrence in the pediatric retroperitoneum is exceedingly rare and frequently mimics more common malignancies, such as Wilms tumor. A 6-year-old female presented with a four-month history of a painful right flank mass and lower limb functional impairment, without clinical stigmata of neurofibromatosis type 1 (NF1). Ultrasonography revealed a 349 mL vascularized retroperitoneal mass, leading to a provisional diagnosis of Wilms tumor. Exploratory laparotomy identified a tumor adherent to the vertebral column, necessitating intracapsular excision. Histopathological and immunohistochemical analysis confirmed MTT with rhabdomyoblastic differentiation and an immunoprofile suggestive of NF1 association. Despite palliative chemotherapy (cyclophosphamide and vincristine), the patient experienced rapid tumor recurrence and progressive clinical deterioration, culminating in death three weeks post-intervention. This case highlights the diagnostic complexity of pediatric retroperitoneal MTT, which can be clinically and radiologically indistinguishable from nephroblastoma. In resource-limited settings, where advanced molecular diagnostics are scarce, maintaining a high index of clinical suspicion and ensuring multidisciplinary management are paramount. Early histopathological confirmation is critical to addressing the rapid progression and therapeutic resistance characteristic of this malignancy.
New, more effective therapies are needed for patients with liver tumors who are ineligible for surgical resection, transplantation, or local ablation. Noble metal nanoparticles (NPs) exhibit substantial biological reactivity toward liver cancer cells, yet their unpredictable nanotoxicity highlights the need for a deeper understanding of NP-cell interactions. The present study examined the in vitro toxicological properties of gold (Au), palladium (Pd), and Pd-Au NPs in three hepatocellular carcinoma cell lines (HepG2, Hep3B, and Huh7D-12). The cytotoxicity of noble-metal-based NPs was assessed using Alamar Blue and MTT colorimetric assays. Reactive oxygen species generation and oxidative stress markers were quantified by fluorometric, luminometric, and flow cytometry methods. Confocal microscopy combined with fluorescence readouts were used to evaluate mitochondrial homeostasis and programmed cell death pathways. Molecular markers of NP-induced cellular stress were further confirmed using qRT-PCR. Distinct cellular differences were observed among the three NPs, particularly in terms of cytotoxicity and death modalities. Au NPs caused mild mitochondrial perturbations without significant cytotoxicity. Pd NPs induced necroptosis, primarily at high concentrations. In contrast, Pd-Au NPs induced oxidative stress, lipid peroxidation, glutathione depletion, and transcriptional changes in the genes regulating glutathione synthesis and metabolism. Pd-Au NPs also activated ferroptosis, which is a regulated cell death pathway increasingly recognized as a promising anticancer strategy. Among the tested formulations, Pd-Au NPs exhibited the strongest cytotoxic and antiproliferative effects that were driven by mitochondrial disruption and ferroptosis induction. These in vitro findings provided a mechanistic reason for advancing Pd-Au NP research efforts into in vivo studies and patient-derived preclinical models for hepatocellular carcinoma.
To review the applications of contrast‑enhanced ultrasound (CEUS) in the evaluation of retinal and choroidal disease, and to present a series of illustrative cases highlighting its clinical utility. A comprehensive search of PubMed, Ovid MEDLINE, EMBASE, Cochrane library, and Google Scholar was conducted in August 2025 to identify studies describing or differentiating CEUS features in retinal and choroidal pathology. Studies were included if CEUS findings were correlated with clinical, multimodal imaging, or histopathological diagnoses. Additionally, we present a prospective case series of posterior segment pathologies utilising B-mode US, colour Doppler ultrasound (CDUS), and CEUS (Definity®) to descriptively analyse imaging characteristics. In choroidal lesions, CEUS can differentiate hemangioma (slow centripetal homogenous, prolonged late enhancement) from melanoma (rapid peripheral enhancement with early washout) and metastasis (rapid wash-in with variable wash-out). Choroidal detachment shows rapid, homogenous enhancement with clear distinction from non-enhancing subchoroidal haemorrhage. In retinal disease, CEUS improves the sensitivity for retinal detachment detection compared with B-mode/CDUS and provides an imaging option for eyes with media opacity. CEUS can distinguish RD from benign vitreoretinal conditions such as degenerative retinoschisis and posterior vitreous detachment due to the presence of contrast enhancement. Acute RD generally shows significant contrast uptake, whereas chronic RD may show variable findings. In peripheral exudative haemorrhagic chorioretinopathy, CEUS reveals a peripherally enhancing lesion surrounding a central region of hypoenhancing haemorrhagic core. CEUS enables real-time assessment of the retinal and choroidal microcirculation, improving diagnostic accuracy and radiological characterisation across several posterior segment pathologies. Larger prospective studies are warranted to better define the role of CEUS in clinical practice.
Appendiceal neoplasms (ANs) may mimic acute appendicitis (AA), making preoperative recognition difficult in emergency settings. We aimed to derive and externally validate a simple non-contrast CT criterion combining appendiceal diameter and fecalith obstruction status for differentiating AN from AA. This multicenter retrospective case-control study included adults who underwent appendectomy at four tertiary hospitals from January 2013 to June 2025. Histopathology after centralized re-review served as the reference standard. In the derivation cohort, receiver operating characteristic analysis was used to determine the optimal cutoff for maximum appendiceal diameter. A locked criterion of significantly enlarged appendiceal diameter (SEAD) without fecalith obstruction was then applied unchanged to the validation cohorts and reader-based validation subsets. Its diagnostic performance was also compared with that of the original CT reports. The final analytic cohort included 292 patients with ANs and 876 controls with AA. A cutoff of 12.48 mm defined SEAD. In the derivation cohort, SEAD without fecalith obstruction yielded an AUC of 0.76 (95% CI, 0.71-0.80), with 64.1% sensitivity and 87.0% specificity. In Center 2, the AUC was 0.82 (95% CI, 0.77-0.87), and in the pooled Centers 3 and 4 cohort it was 0.73 (95% CI, 0.66-0.81), without significant differences versus the derivation cohort (p = 0.051 and p = 0.598). Reader-based AUCs were 0.80, 0.76, and 0.72, without significant between-reader differences (all p > 0.05). Compared with original CT reports, the criterion substantially improved preoperative AN detection across cohorts (all p < 0.001). A predefined non-contrast CT criterion of SEAD without fecalith obstruction may facilitate preoperative identification of AN in patients with presumed AA.
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Lineage-based cell identification in C. elegans typically requires intensive live imaging and tracking. Recent methods attempt to automate cell identification on the basis of spatiotemporal atlases. We present EmbAlign, an automated 3D registration framework that determines lineage identities from single embryo snapshots. EmbAlign retrieves reference templates from a spatiotemporal atlas and refines assignments using an iterative Sinkhorn alignment procedure, robustly handling positional variability and arbitrary orientations in uncompressed embryos. EmbAlign achieves 96.9% accuracy up to the 190-cell stage and includes a diagnostic layer for continuous scoring (AUPRC = 0.546), converting raw spatial data into lineage aware datasets.
Giant bullous disease (GBD) frequently complicates the diagnosis of acute pulmonary embolism (PE) by creating radiographic ambiguity that mimics pneumothorax. In settings where advanced imaging is not immediately available, clinical examination is the primary tool for risk stratification. A 65-year-old female presented with subjective dyspnea. Despite a profound oxygen saturation of 80%, she exhibited a normal respiratory rate and minimal distress, a state known as silent hypoxia. Initial chest X-rays showed a hyperlucent left hemithorax. While this suggested a pneumothorax, the lack of hyper-resonance on percussion pointed toward GBD. Bedside echocardiography confirmed right ventricular strain and a thrombus. Due to the lack of on-site resources, the patient was transferred to a private facility for CT pulmonary angiography (CTPA), confirming a massive PE and a 15-cm giant bulla. This case illustrates how silent hypoxia serves as a physiological red flag for vascular obstruction. By using percussion to rule out pneumothorax, we avoided a potentially fatal chest tube insertion into the bulla. Bedside ultrasound provided the clinical justification for a costly, off-site transfer. Clinical acumen remains the most effective safeguard against iatrogenic injury and diagnostic delay in complex cardiopulmonary cases.
To evaluate differences in the presentation patterns of Type 3 macular neovascularization (T3 MNV) secondary to age-related macular degeneration in Caucasian and Asian populations. This retrospective, multicenter, comparative case series included treatment-naïve T3 MNV patients from Switzerland, Italy, and South Korea. All patients underwent comprehensive multimodal imaging. The topography of T3 MNV foci was mapped relative to the Early Treatment Diabetic Retinopathy Study(ETDRS) grid. Demographic and clinical variables were analyzed with respect to ethnicity, and discriminant score performance was assessed for differentiating Caucasian and Asian populations. A total of 301 eyes (181 European and 120 Korean) from 248 patients were included. Asian patients were significantly younger at presentation(76.1±6.9 vs. 81.1±6.1 years, p<0.001), with T3 MNV lesions located closer to the foveal center (mean distance: 810.7±329.0 vs. 1061.4±300.8 μm, p<0.001). Central ETDRS circle involvement was observed in Asians (17.5% vs 4.4%; p<0.001). Subfoveal choroidal thickness was similar between groups (154.1±72.1 vs. 153.3±71.0 μm, p=0.904). The prevalence of reticular pseudodrusen was higher in Caucasians than in Asians(89.0% vs. 74.2%; p=0.001). Multivariable analysis demonstrated that age(β=0.128, p<0.001), mean foveal distance (β=0.003, p<0.001) and RPD (β=1.150, p=0.003) had the strongest associations with ethnicity. In the discriminant model analysis, age and foveal distance emerged as significant discriminant features (Δ-C-index decreases=0.03 and 0.04, respectively). The presentation patterns of T3 MNV in the Caucasian and Asian populations demonstrated both shared and distinct characteristics. These findings suggest that while T3 MNV may involve common pathophysiological mechanisms across ethnicities, certain contributing factors may vary between populations.
Turner syndrome (TS) is associated with delayed puberty, abnormal breast development, and increased risk of certain diseases. The purpose of this article is to present the current state of breast development assessment in TS patients, focusing on the use of ultrasound (US), mammography, and MRI, regarding their utility in monitoring changes in women with TS. A comprehensive literature review was conducted using databases like PubMed and Medline. There are currently no specific recommendations for breast US in TS patients, and because no conclusive US classification of breast development with distinctive sonographic features in the breast has been established, breast US in women with TS remains a diagnostic challenge. Proposed US scales for breast development in adolescent girls and fibroglandular tissue evaluation in men with gynecomastia are suggested as potential tools for monitoring breast development in women with Turner syndrome. Further research is highlighted as crucial to improving diagnostic and therapeutic approaches.