Background/Objectives: The precise staging of non-small cell lung cancer (NSCLC) determines its initial treatment and provides more accurate prognostic information for patients. The aim of this cohort study was to determine pre- and post-operative mediastinal nodal staging agreement and its effect on 2-year survival. Methods: A retrospective multi-centre cohort study was performed, using prospectively collected and pre-defined data from weekly lung cancer multidisciplinary team (MDT) meetings in 11 hospitals. Consecutive patients who underwent surgical resection of NSCLC between 2015 and 2017 were eligible. Pre-operative under-staging was defined as a lower pre-operative than post-operative nodal stage, and pre-operative over-staging as a higher pre-operative than post-operative nodal stage. Disparities between pre-operative nodal staging established at MDT and post-surgical nodal staging were determined and associations with subsequent lung cancer-specific 2-year mortality were identified using univariate and multivariate regression. Results: A total of 973 patients fulfilled the eligibility criteria. Concordant pre- and post-operative nodal staging was observed in 783/973 (80%), 123/973 (13%) were under-staged pre-operatively and 67/973 (7%) were over-staged. In 173 patients with clinical N1 or N2 disease (in whom invasive mediastinal staging was indicated), staging EBUS was performed in 55/173 (32%). In these patients, younger age and use of staging EBUS were independent predictors of concordant pre- and post-operative staging. In all patients, pre-operative under-staging was independently associated with increased lung cancer-specific 2-year mortality. There was no increased mortality associated with pre-operative nodal over-staging. Conclusions: Invasive mediastinal staging with EBUS was independently associated with more accurate pre-operative staging. Pre-operative nodal under-staging was associated with increased lung cancer-specific mortality. Nodal staging accuracy in potentially curable NSCLC is of fundamental importance to ensure patients receive the correct first-line treatment and to improve survival.

Background

Endoscopic interventions are the mainstay treatment for choledocholithiasis. However, failure ofstone extraction could be encountered in some cases. Also, some patients may have recurrent stones after previousendoscopic duct clearance. Choledechoduodenostomy (CDD) may be a good option for these patients. Herein, wepresent our experience regarding the safety and efficacy of CDD in the management of such patients.

Patients and methods

We retrospectively reviewed the data of 30 consecutive patients who underwent theprevious procedure in our tertiary care setting. Our main outcome was the incidence of short- and intermediatetermcomplications. Patients were followed for a minimum of 18 months after the operation.

Results

Twenty-five patients were performed via the open approach, while the remaining five were performed bylaparoscopy. The majority of cases (93.3%) had a side-to-side anastomosis, while only two cases had an end-tosideanastomosis. Laparoscopy was superior to the open approach in blood loss and hospital stay. However, it wasassociated with a significantly prolonged operative time. Regarding postoperative complications, wound infectionwas the most common one (33.3%). Other early complications included abdominal collection (10%), bile leakage(6.7%), ileus (6.7%), and pulmonary embolism (3.3%). Late complications included cholangitis (6.7%), whichresponded to medical treatment. No patients with sump syndrome or anastomotic stenosis were encounteredthroughout the follow-up period.

Conclusion

Apart from high wound infection rates, CDD is a feasible and effective procedure for the …

Pityriasis lichenoides (PL) presents a spectrum of uncommon inflammatory skin diseases that includes acute and chronic variants. The hypopigmented PL is a rare variant that was reported in dark-skinned individuals. It was proved histologically to be a variant of PL chronica (PLC). To our best knowledge, we report the first case of a hypopigmented variant of PL that shows histopathological features of PLC and PL et varioliformis acuta.

Background:

Male infertility emerges as an important cause during the evaluation of infertile couples. Varicocele is a well-known cause of male infertility. The role of seminal lactoferrin, an iron-binding glycoprotein, in male fertility is unclear and needs further investigation. Recently, it has been linked to some sperm abnormalities and subfertility.

Aim:

This study aims to detect seminal lactoferrin levels in infertile men with varicocele and their relation to semen parameters and fertility status. We investigated a possible link between seminal lactoferrin and iron.

Settings and Design:

A cross-sectional study was conducted through the outpatient clinic.

Materials and Methods:

Seventy-five individuals were included in 3 groups (33 infertile men with varicocele, 25 infertile men without varicocele and 17 fertile participants without varicocele). Conventional semen analysis was conducted, and seminal plasma was obtained in all …

BACKGROUND

Periorbital hyperpigmentation (POH) is a therapeutic problem. Platelet-rich plasma (PRP) has been successfully used in some pigmentary disorders including POH. Proper evaluation of treatment in POH can be difficult.

OBJECTIVE

To assess the efficacy and safety of PRP injections for POH in skin phototypes III and IV by multiple clinical tools.

METHODS

A clinical trial included 30 patients with POH, skin phototypes III and IV. Three sessions of intradermal PRP injections were used in periorbital area every month. Treatment was assessed on different clinical levels 1 month after the last session by POH severity grading, blinded photographic assessment, and patient satisfaction. Adverse effects of PRP were evaluated.

RESULTS

A significant improvement in POH was documented by disease severity grading, patient satisfaction, and to a lesser extent by photographic evaluation. Grade II-POH showed the …