Adnexal masses in pregnancy are not commonly encountered. The majority of these masses are discovered incidentally during routine follow-up. However, some of these masses become symptomatic due to their size, location, and impingement of adjacent structures. Several diagnostic modalities can be utilized for the detection of adnexal masses with different sensitivity and specificity rates. The differential diagnosis of adnexal masses discovered during pregnancy is broad and includes both benign and malignant lesions. The management of such lesions has been a subject of debate for years with no consensus regarding the best management plan. Tumor size, site, and the trimester of mass detection are all crucial in management. In this account, we review adnexal masses discovered in pregnancy, the diagnostic modalities utilized for detecting these lesions, their differential diagnosis, and management strategies.

Background: Recent reports have raised various concerns about the risk of vessel wall injury while withdrawing current laser-cut stent retrievers during active strut apposition to the vessel walls. The development of braided thrombectomy assist devices in conjunction with aspiration systems may be gentler on the fragile brain vessels and more optimized with regard to the radial force (RF) for vessel diameters of proximal (M1) and distal (M2) large vessel occlusions (LVOs). Methods: Mechanical bench testing of the RF was performed using a radial compression station mounted on a tensile testing machine. The total RF in newtons (N) generated in vessels with diameters ranging from 2.25 to 3 mm as seen in proximal LVOs (∼M1), and in vessel diameters ranging from 1.5 to 2.24 mm as seen in distal LVOs (∼M2), was measured. The outer diameter of each stent was recorded, and an RF ≤1 N was grouped as “low,” while an RF >1 N was grouped as “high” for this analysis. Results: The total RFs of all laser-cut stent retrievers were all higher in the simulated M2 vessels (>1 N) than in the M1 vessels (<1 N), whereas the total RFs of the braided thrombectomy assist devices were uniformly low in both the simulated M1 and the simulated M2 vessels. Conclusions: Novel braided thrombectomy assist devices in conjunction with aspiration systems have lower RFs than existing laser-cut stent retrievers in M1 and M2 vessel diameters. Further in vivo studies are needed to delineate the impact of lowering the RF on vessel wall integrity.

Background Exposing patients with metastatic colorectal cancer (mcrc) to all three active chemotherapeutic agents (oxaliplatin, irinotecan, fluorouracil) has improved survival. The benefit of second-line chemotherapy after a first-line triplet is not clearly defined. We evaluated the efficacy of second-line chemotherapy in patients who had received first-line triplet therapy.Methods The medical records of patients treated on a prospective trial of first-line triplet therapy were reviewed for second-line treatment. Univariate and multivariate analyses were performed to establish factors of prognostic significance.Results Of the 53 patients who received first-line triplet therapy, 28 (53%) received second-line chemotherapy [13 men; 8 with a colon primary; mutant KRAS in 10, wild-type in 15, and unknown status in 3; Eastern Cooperative Oncology Group performance status (ps) of 1 in 16 patients, ps 2 in 3, ps 3 in 2, and unknown in 7; involved organs: liver in 17 patients, lung in 16, and peritoneum in 8]. Second-line chemotherapy consisted of xelox or folfox in 13 patients, xeliri or folfiri in 12, and single-agent irinotecan in 3. Concurrent bevacizumab was given in 16 patients (57%), and cetuximab, in 2 (7%). Median survival was 28.0 months [95% confidence interval (ci): 22.8 months to 33.2 months] for patients receiving second-line therapy and 23.0 months (95% ci: 13.2 months to 32.8 months) for those not receiving it. Best response was partial in 6 patients (21%), stable disease in 11 (39%), and progressive disease in 11 (39%). Median progression-free survival was 4.8 months (95% ci: 2.4 months to 9.6 months), and overall survival was 15 months (95% ci: 9.6 months to 20.4 months).Conclusions Second-line chemotherapy after first-line triplet therapy in mcrc is feasible and suggests efficacy comparable to that reported for second-line therapy after a doublet, regardless of the agent used.by research evidence.

Introduction : Obtaining serial head computed tomography (CTH) imaging for patients with spontaneous intracerebral hemorrhage (sICH) is commonly utilized to monitor for hematoma expansion (HE), defined as an increase in ICH volume by 33%. Obtaining recurrent CTH in the ICU setting may burden nursing and transport staff, expose patients to radiation, and inflate healthcare costs. It remains unclear whether utilizing scheduled CTH for sICH patients is more advantageous than targeted CTH, which is prompted by a decline in neurological status. We reviewed clinical factors and imaging studies in patients with and without HE. Methods : This retrospective cohort study conducted over two years identified 171 sICH patients. Patient demographics, clinical and neuroimaging data were recorded (including the reason for repeat imaging). These variables were then compared and analyzed in relation to HE using SPSS version 26, chi‐square tests for categorical variables, and independent‐samples t‐tests were used for continuous variables. Results : Patients were predominantly male (65%), with a mean age of 65±14 years, a median GCS of 14, a median ICH score of 1, and a median ICH volume of 12.1 ccs. Repeat CTH was obtained within 14 hours after the initial imaging on average. Admission blood pressure (BP), BP‐lowering interventions, pre‐admission use of anticoagulant and antiplatelet therapy, GCS on admission, ICH volume, ICH score, and presence of spot signs were similar between the two groups. 15% of total patients (26/171) had HE. In the group that underwent scheduled repeat CTH, only 7% (9 patients) had HE, while the remaining 93% (119 patients) did not. Patients who underwent a second scan following a change in the neurologic assessment included 39% (17 patients) who had HE, compared to 61% (26 patients) that did not. HE detection was significantly lower in patients that underwent scheduled CTH (p < 0.0001). Conclusions : In patients with a stable exam, scheduled head CT only showed HE in 6% of patients; thus, the excess burden, radiation, and costs may not be necessary for these patients. Hematoma expansion is significantly lower in patients who underwent scheduled imaging than those prompted by a decline in neurologic status. However, our sample size is small and additional studies with larger population sizes are required to validate our findings.

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Background: The efficacy of second line therapy after first line triplet in advanced colorectal cancer has not been extensively explored. Methods: Medical records of patients (pts) with ACRC treated on prospective phase I-II study with the combination of oxaliplatin, irinotecan, capecitabine and bevacizumab were retrospectively reviewed. The following data were recorded: Demographics, response to first line chemotherapy, organs involved, type of second line chemotherapy, response to second line chemotherapy, progression free survival (PFS), overall survival (OS), K-ras status, and baseline lab results at second line chemotherapy. Results: Fifty three pts received first line triplets, out of which 28 (52%) received second line chemotherapy. Median survival for pts who received second line vs no second line was 28.0 months (95% CI 22.8-33.2) vs 23.0 months (95% CI 13.2-32.8) (Log-rank P ¼ 0.693). Of the 28 pts who received second line chemotherapy, 13 were male, 8 had colon primary, 10 had mutant K-tas with 3 unknown, ECOG performance status 1/2/3/ unknown was in 16/3/2/7 pts, organs involved: liver/lung/peritoneum: in 17/16/8 pts. Second line chemotherapy was Xelox/FOLFOX in 13, Xeliri/FOLFIRI in 12 and irinotecan þ cetuximab in 3 pts. Best response was partial in 6 (21.43%), stable disease in 11 (39.29%) and progressive disease in 11 (39.29). Median PFS and OS was 4.8 mo (95% CI 2.4-9.6) and 15 mo (95% CI 9.6-20.4). Univariate analysis of above prognostic factors for survival including type of chemotherapy showed no significance except for elevated CEA (Log-rank P ¼ 0.0074) Conclusions: Second line chemotherapy following first line triplet in ACRC shows equal efficacy compared to reported results following doublets, regardless of the agent used. Elevated CEA at second line chemotherapy confer poor prognosis.