Rejected

Sclerosing extramedullary hematopoietic tumor (SEMHT) is a rare disease that was originally named fibrous hematopoietic tumor or myelosclerosis. The process typically occurs in patients with a history of chronic myeloproliferative disorders and may afflict the skin, lung, breast, gastrointestinal tract, breast, kidney, lymph node, and thyroid gland. In this article, we report the case of a 37-year-old female with more than 5 years history of acute B-cell lymphoblastic leukemia who presented with right upper quadrant pain and tenderness. Computed tomography scan showed multiple new ring-enhancing low-density lesions within the right and left hepatic lobes. A computed tomography-guided liver core biopsy was performed on one of the new liver lesions and showed extramedullary hematopoiesis with atypical megakaryocytes and sinusoidal capillarization with associated fibroblastic proliferation. Numerous atypical megakaryocytes were scattered in the background of haphazard collagen deposition. No significant blasts or a leukemic process were identified. Bone marrow aspiration and biopsy showed extensive reticulin fibrosis (MF-3), trilineage dysplasia, increased blasts (10% to 19%), and hypercellularity (close to 100%), which was consistent with MDS-EB-2. Cytogenetics was reported as follows: 44~46,XX,-3,add(3)(p13),-5,-6,-7,17,del(17)(p12),+1~5mar[cp9]/46,XX. Molecular analysis was negative for both JAK2 V617F and CALR exon 9 activating mutations. In summary, we contributed a new case of SEMHT diagnosis in a synchronous presentation with poor clinical evolution associated chromosome 7 deletion and intact JAK2 and CALR exon 9. Care should be taken when diagnosing intraabdominal and retroperitoneal soft tissue masses with the history of hematological disorders.

Total pancreatectomy with islet autotransplantation (TPIAT) is a promising treatment for refractory chronic pancreatitis (CP). Pathological features of CP include progressive fibrosis in pancreas parenchyma, atrophy, and/or ductal occlusion. Complete acinar atrophy (CAA) caused by chronic fibrosis and necroinflammation results in exocrine sufficiency and may influence islet isolation characteristics during TPIAT. In this analysis of patients who underwent TPIAT at our center, we compared transplant outcomes among those with CAA ( = 5) vs non-acinar atrophy (NAA; matching controls, = 36). Data were analyzed using one-way analysis of variance with Bonferroni post hoc test or Student's test. Pancreas digestion was longer in CAA than in NAA cases (18.6 vs 14.6 min) despite a lower pancreas weight (55.2 vs 91.2 g). Obtained tissue volume was 1.0 ml in the CAA group and 12.1 ml in the NAA group. Both groups had similar islet viability (96%) and islet dose (CAA, 3,391 IEQ/kg; NAA, 4141.1 IEQ/kg). During islet infusion, serum cytokine (IL-6, IL-8, and MCP-1) levels and plasma hsa-miR-375 levels were lower in the CAA group than in the NAA group, but not significantly. Serum tumor necrosis factor α levels at 3 h after infusion were significantly higher in CAA group than in NAA group. After TPIAT, the metabolic outcomes of the CAA group were comparable with that of the NAA group. Narcotics usage decreased significantly over 24 months in both groups, with the CAA group reporting being pain free at 12 months. Complete atrophy of acinar cells of pancreas did not significantly impact islet yield or endocrine function after TPIAT.

Posterior spinal fusion for idiopathic scoliosis is extremely painful, with no superior single analgesic modality. We introduced a methadone-based multimodal analgesia protocol, aiming to decrease the length of hospital stay (LOS), improve pain control, and decrease the need for additional opioids.

We present a rare case of extraskeletal para-articular osteochondroma (ESPAOC) in the ankle of a 9-year-old boy, which was causing pain and limiting the range of motion of the ankle joint. The lesion might have also contributed to the deformity of the medial aspect of the talus. Total resection resolved all of the symptoms, with no recurrence at 1-year postoperatively.

Despite its importance, no study from the Middle East has assessed the neonatal pain knowledge of health-care providers in neonatal intensive care units (NICUs).

The overarching goal of video games is to amuse the end-users by means of interactive systems that are now existent across numerous platforms such as personal computer, mobile phones, tablets and game consoles. Player Unknown's Battlegrounds (PUBG) is a multiplayer online game. The addiction of PUBG is soaring worldwide and it has thick user-base. It is suggested that inhuman attitudes such as lack of empathy and war-related sentiments are likely to emerge among children who play aggressive and violent games like PUBG. In 2018, World Health Organisation (WHO) acknowledged online gaming compulsion as a grave mental health problem. Some of the well-known repercussions of playing PUBG video game are eyes strain, exhaustion, headache, obesity, poor quality of sleep, insomnia, withdrawal symptoms (rage and irritability) and even drug abuse owing to compulsive disorder. This game craze is unfortunately triggering world's young population to invest their valuable time, money and effort in a no-return business, and therefore needs urgent measures.

Optic neuritis is an inflammatory demyelinating disorder of the central nervous system. Anti-NMDA receptor (NMDAR) antibodies encephalitis is also mediated by the inappropriate immunological response. We report a girl who was readmitted because of unilateral eye pain and vision impairment in the remission period of anti-NMDAR encephalitis. Based on the limited available literature on the treatment of optic neuritis associated with anti-NMDA receptor antibody, she was treated with a combination of corticosteroids and intravenous immunoglobulin with clinical improvement. Optic neuritis in the remission phase of anti-N-methyl-D-aspartate receptor encephalitis remains relatively uncommon. It is important to document and follow these patients to understand the pathogenesis of optic neuritis in the setting of anti-NMDAR encephalitis and formulate effective therapeutic strategies.

Using narcotics for pain management is an integral part of orthopaedic surgery, especially after traumatic injuries such as ankle fractures. Although narcotics are often necessary for adequate pain control, prolonged duration of opioid treatment is becoming more common, and the detrimental effects of opioid use are well known. To treat this epidemic, we need to better understand the factors that put patients at risk for increased narcotic requirements and potential opioid misuse after orthopaedic injuries. The purpose of this study was to retrospectively compare opioid use among ankle fracture patients in smokers versus nonsmokers to better elucidate whether tobacco use is a risk factor for increased opioid consumption. A retrospective review was conducted for all patients who presented with an ankle fracture (Weber A to C) to any of 8 institutions in a large mid-Atlantic regional hospital system and subsequently underwent surgery between the November 2013 and January 2017. Exclusion criteria included patients age <18 years, a diagnosis of a pilon fracture, polytrauma, history of substance abuse, chronic pain syndromes, and osteoporosis. This yielded a total of 130 patients (96 nonsmokers and 34 smokers). A repeated-measures analysis of variance was conducted to compare opioid consumption between the 2 groups. Model analysis demonstrated no difference between the 2 groups (p = .782). There was no difference in opioid consumption at 1 month (p = .838), 2 months (p = .569), or 3 months (p = .656) between smokers and nonsmokers. Our study revealed no significant difference in opioid consumption among smokers compared with nonsmokers in patients treated for ankle fractures.

Hip arthroplasty is a widely used and successful orthopedic procedure for the treatment of degenerative, inflammatory, or traumatic joint disease. The procedure promotes significant pain relief, as well as recovery of limb function, reduction of disability, and better quality of life. However, there are related complications, which have characteristic imaging aspects. In the present study, we review the literature and exemplify such complications using images obtained at our facility, illustrating the main radiological aspects of complications such as heterotopic ossification, periprosthetic fractures, osteolysis, infection, wear, and dislocation.

The evolution of skull base approaches associated with individualization of surgical corridor and minimizing the collateral damage. Achieving the radical removal of tumor and preserving the neurological status of the patient is possible, both with the traditional approaches and keyhole approaches. Our work presents experience using the transpalpebral approach (TPA) for microsurgical removal of tuberculum sellae meningioma (TSM).