Adult T-cell leukemia/lymphoma (ATLL) is a rare, human T-lymphotropic virus type 1 (HTLV-1)-driven neoplasm that is often underrecognized in low-endemic regions. We describe a 23-year-old man with an eight-year history of chronic dry cough who later developed weight loss, night sweats, odynophagia, and dyspnea. CT revealed cervical/supraclavicular lymphadenopathy with innumerable pulmonary micronodules, interlobular septal thickening, and ground-glass opacities; abdominal imaging showed hepatosplenomegaly, ascites, and extensive retroperitoneal/mesenteric adenopathy. HTLV-1 ELISA and confirmatory Western blot were positive. Excisional lymph node biopsy demonstrated diffuse architectural effacement by atypical T cells with a CD3+, CD4+, CD5+, CD25+, CD7-, granzyme B+ immunophenotype and a ~90% Ki-67 index, establishing lymphomatous-type ATLL with a cytotoxic profile. Despite rapid recognition, the patient deteriorated and died from respiratory failure 15 days after diagnosis, before chemotherapy could begin. This lung-predominant presentation in a young adult illustrates how ATLL can mimic chronic pulmonary disease and evade early detection outside endemic areas. Clinicians should prioritize early tissue acquisition and a minimal T-cell panel (CD3, CD4, CD25, CD7, Ki-67); a CD4+CD25+ phenotype with CD7 loss should prompt HTLV-1 testing irrespective of geography. Streamlined access to immunophenotyping and confirmatory HTLV-1 assays is essential to reduce diagnostic delays and improve outcomes.

Woody breast (WB) is a prominent growth-related defect affecting chicken meat quality and animal welfare and may contribute to economic loss through carcass condemnation. This study aimed to characterize truckload-level patterns involving WB-type condemnation during whole-bird inspection at a federally inspected abattoir in Alberta, Canada, and to further examine its associations with other rejection causes and potential contributing factors. Data from 13,849 truckloads representing 112 growers (April 2021-March 2024) were analyzed. Rejections due to dead-on-arrival (DOA) and condemnations recorded during postmortem inspection totaled 1.56% of broilers, with subcutaneous issues (0.77%), DOA (0.36%), WB-type condemnation (0.18%), ascites (0.11%), and dark-colored carcasses (0.08%) being the primary causes. Liver conditions (0.05%) and respiratory issues (0.03%) frequently co-occurred with WB-type condemnation, DOA, and ascites, with their within-load proportions often exceeded the respective medians when occurring together. These conditions were more common during cold seasons and in raised without antibiotics (RWA) systems, whereas subcutaneous issues were more prevalent during warm seasons and in systems not strictly limited to RWA. Higher average body weight and relatively younger age were associated with increased DOA, ascites, and WB-type condemnation even within the commercially targeted range. Greater within-load weight heterogeneity was also associated with condemnation causes, particularly respiratory and liver conditions. Clear-off loads showed higher proportions of WB-type condemnations and dark-colored carcasses, but lower rates of subcutaneous issues. These findings describe truckload-level patterns of association and may help inform management strategies to reduce condemnation burden, including WB-related defects.

Blunt abdominal trauma can be difficult to evaluate, especially when an unusual injury mimics a far more common one. We present a case of a 17-year-old boy who was struck in the abdomen by bicycle handlebars. His initial imaging suggested a possible bladder rupture because of the presence of both intraperitoneal and extraperitoneal fluid. A retrograde CT cystogram, however, ruled out any bladder injury. Because of his worsening condition, he underwent an urgent laparoscopy followed by exploratory laparotomy, which revealed a large volume of milky-white free fluid, suggestive of chyle, within the abdomen. Laboratory analysis of the aspirated fluid showed a high triglyceride level of 1,079 mg/dL, confirming the chylous nature of the fluid. There was an enlarged and engorged cisterna chyli in the retroperitoneum suggesting lymphatic injury. Treatment involved applying fibrin sealant in the region of the cisterna chyli, placing a peritoneal drain, and keeping a diet based on medium-chain triglycerides. The patient recovered well without any recurrence of chylous ascites. This case highlights the need to consider rare lymphatic injuries causing posttraumatic chylous ascites when evaluating blunt abdominal trauma with diffuse abdominal fluid collection, particularly when common injuries have been ruled out but the patient's clinical status continues to worsen.

Objective: To analyze the clinical characteristics and key points of diagnosis and treatment in patients with pseudomyxoma peritonei (PMP) presenting with external abdominal hernia as the initial manifestation. Methods: A descriptive case-series study was conducted. From May 2015 to September 2024, a total of 569 patients diagnosed with PMP and treated with cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) were admitted to Beijing Shijitan Hospital. Among them, 13 patients (2.3%) presented with external abdominal hernia as the initial clinical manifestation. Clinical data of these 13 patients were retrospectively analyzed, including the type of inguinal hernia, pathological diagnosis, peritoneal cancer index (PCI), interval from pathological diagnosis to first CRS+HIPEC, completeness of cytoreduction (CC) score, operation duration, and serious adverse events within 30 postoperative days and prognosis. Results: The median age of the 13 patients was 51 years (range 33-71 years), including 10 males. Twelve patients presented with inguinal hernia as the initial symptom: 6 with right inguinal hernia, 5 with left inguinal hernia, and 1 with bilateral inguinal hernia. The remaining 1 patient had an umbilical hernia. The hernia contents were tumor tissue and mucus in 11 patients, while 2 patients had complete spontaneous reduction of hernia contents. Pathological diagnosis showed low-grade in 10 cases, acellular mucus, high-grade, and high-grade with signet-ring cells in 1 case each. The median interval from pathological diagnosis to first standard CRS+HIPEC was 2.5 (range 0.6-11.6) months . Perioperative assessment showed that 7 patients had PCI < 20, 9 patients had CC score 0-1, median ascites volume was 800 (range 0-20 000) ml, median Karnofsky performance status score was 90 (range 80-100), and median operation duration was 655 (range 403-1018) minutes . Seven patients developed postoperative serious adverse events: 4 involving the respiratory system, 1 the circulatory system, 1 the digestive system, and 1 with infection. No deaths occurred within 30 postoperative days. The median follow-up was 61.2 months (95%CI: 36.3-86.1), the mean overall survival was 124.3 months (95%CI: 92.1-156.6), and 2 patients died. Conclusions: In PMP patients presenting with external abdominal hernia as the initial symptom, inguinal hernia is the most common type, and most hernia contents cannot be reduced spontaneously. If PMP is suspected during surgery for external abdominal hernia, prompt referral to a specialized peritoneal metastasis center for CRS+HIPEC is recommended.

Ovarian cancer (OC) is a leading cause of gynecological cancer-related mortality. Management remains challenging as the disease frequently presents with intra-abdominal metastases at diagnosis, standard therapies can be associated with severe complications and disease recurrence is common. While cellular immunotherapy is increasingly investigated as a promising approach, the most effective routes of administration need to be established. We have investigated NK cell therapeutics as a less toxic option and examined the permanent NK cell line, NK-92, as a suitable model. Here, we report two xenograft mouse models with the ovarian adenocarcinoma cell line, SKOV-3, representing early-stage OC and late-stage OC with ascites to comprehensively evaluate the anti-cancer efficacy of different routes of NK-92 administration. Bioluminescence imaging, cell tracking with the IVIS system and animal survival were used to evaluate outcomes. The cells were administered via intraperitoneal (IP), intravenous (IV), or a combination of IP and IV routes. We showed that NK-92 significantly increased animal survival when delivered IP (p = 0.009 and p = 0.018) or combined IP and IV (p = 0.05 and p = 0.017) in early and established OC xenografts, respectively, whereas intravenous delivery at similar doses had no effect on survival (p = 0.665 and p = 0.052) compared with untreated controls. These findings, and our novel models, have potential implications for enhancing the clinical benefit of NK therapy in patients with advanced OC.

Purpose Hepatocellular carcinoma (HCC) is the most common and highly morbid primary liver malignancy. In this retrospective study, we describe the clinical characteristics of patients with HCC, identify factors determining the type of delivered treatment, and evaluate the overall survival (OS).  Materials and methods Demographic and treatment details were collected for HCC patients diagnosed in Manitoba between January 2011 and December 2021. The cohort was divided according to the treatment that was delivered: curative, non-curative, and supportive care-only groups.  Results A total of 800 patients were identified. Complete staging information was not available for all patients. The mean age was 67 years, and men represented 72.5% of the cohort. One hundred ninety-five (24.4%) patients received curative treatment, 188 (23.5%) received non-curative treatment, and 417 (52.1%) received supportive care only. Alcoholic cirrhosis was the most common etiology of chronic liver disease (20.3%). Patients were less likely to receive curative treatment if they had portal hypertension or multifocal disease. Patients with ascites or distant metastasis were more likely to receive supportive care only. The one- and five-year OS rates for the full cohort were 50% and 23%, respectively. Between 2011 and 2021, the prevalence of non-curative therapies has increased. Trans-arterial chemoembolization (TACE) was the most common non-curative treatment with one- and three-year OS rates of 88% and 41%, respectively.  Conclusion The OS of patients with HCC in Manitoba improved between 2011 and 2021 and was temporally associated with increased utilization of non-curative local therapies, including TACE. However, given the retrospective nature of the study, these findings demonstrate association rather than causal effect.

Chyloascites is the presence of milky peritoneal fluid rich in triglycerides of lymphatic origin. The most common causes include postoperative lymphatic injury, lymphatic or solid neoplasia, and cirrhosis. The occurrence of chyloascites after hysterectomy is very rare. The pathophysiological mechanisms that cause lymph accumulation include obstruction of lymphatic flow due to neoplastic origin or thoracic duct injuries acquired through trauma or surgical procedures. We present the case of a 32-year-old woman with a history of cervical adenocarcinoma, treated surgically, who presented with abdominal distension. The diagnosis was chyloascites, confirmed by paracentesis. She received treatment with octotride with clinical improvement and favorable outcome.

Introduction Infections of sterile body fluids are caused by various bacterial agents and are usually associated with high morbidity and mortality. Timely microbiological culture and sensitivity testing of clinical specimens can identify the etiological agent, guide the targeted antibiotics, and reduce further complications. Knowledge of local antimicrobial susceptibility patterns is essential for selecting appropriate empirical therapy. The present study aimed to determine the profile of bacterial pathogens and their antimicrobial resistance patterns isolated from normally sterile body fluids at a tertiary care center in Odisha, India. Methods A retrospective laboratory-based observational study was carried out in the Department of Microbiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha. Culture and sensitivity records from the previous two years (January 2021 to December 2022) were retrieved and analyzed after getting approval by the Institutional Ethics Committee (KIIT/KIMS/IEC/1098/2023, date: January 1, 2023). A total of 2307 sterile body fluid samples (CSF, pleural, ascitic, and synovial fluids) were processed using standard microbiological procedures. Isolate identification and antimicrobial susceptibility testing were carried out using the VITEK-2 system and interpreted according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY). Results Out of 2307 samples, 291 yielded bacterial growth, giving an overall culture positivity rate of 12.6%. Pleural fluids showed the highest positivity rate (18.5%), followed by synovial fluid (16.4%). Gram-positive bacteria outnumbered (54%), with Staphylococcus aureus as the most common isolate (31.6%). Among Gram-negative isolates, Klebsiella pneumoniae (13.7%) was predominant. Enterobacterales showed higher susceptibility to aminoglycosides and carbapenems, with high resistance to ciprofloxacin. Pseudomonas spp. and Acinetobacter spp. exhibited limited susceptibility to the commonly used antibiotics. Multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) among Gram-negative bacilli (GNB) were 21.6%, 14.2%, and 3%, respectively. Methicillin-resistant Staphylococcus aureus (MRSA) constituted 48.9% of Staphylococcus aureus. Conclusion Sterile body fluid infections due to bacterial agents at our center were found to be 12.6% and showed a diverse bacterial profile with a substantial burden of antimicrobial resistance. The high prevalence of MDR GNB and MRSA underscores the importance of continuous local surveillance and antimicrobial stewardship to guide empirical therapy and improve patient outcomes.

Hepatorenal syndrome (HRS) is a multiorgan condition affecting the kidneys and the liver. It is a cause of acute kidney injury that can be seen in those with acute or chronic liver disease. The first association of renal failure in cirrhosis was observed in the late 1800s. In the mid to late 1900s, further research revealed that renal failure in liver cirrhosis was functional. This was demonstrated in patients with hepatorenal syndrome with normal kidney histology in addition to the absence of proteinuria. This was further demonstrated clinically when kidneys from patients with HRS were transplanted into those with chronic kidney disease as well as the improvement of renal function in liver cirrhosis patients who underwent a liver transplant. Further research investigating renal clearance established the association of renal vasoconstriction in HRS.

Background: This study aimed to evaluate the etiology, clinic and laboratory features of acute pancreatitis (AP) in children retrospectively. We also aimed to determine the effects of clinical, laboratory and radiological markers on length of hospital stay (LOS). Materials and methods: This study was conducted of 133 patients diagnosed with AP. Patients were divided into two groups based on LOS: ≤7 days and >7 days. Demographic, clinical, laboratory and radiological parameters, as well as time to initiation of feeding, were analyzed. Results: The mean age of patients was 11.2 ± 4.8 years, and 54.1% were male. The most common etiologies were obstructive (30.8%) and idiopathic (29.3%). Drug-induced and traumatic causes were significantly more prevalent in patients with a hospital stay of more than seven days (p = 0.001). Radiological findings other than pancreatic edema (peripancreatic fluid, pleural effusion, or ascites) were significantly associated with prolonged LOS (p = 0.002). A positive correlation was observed between LDH and LOS (r = 0.253, p = 0.031). LOS was significantly shorter in patients who initiated oral feeding within 48 h (p < 0.001). Conclusions: LOS in pediatric AP is influenced by laboratory parameters, radiological findings, and the timing of feeding initiation. Identifying early prognostic indicators, particularly in the pediatric patient group, may guide individualized management and improve clinical outcomes.