Cyst fluid CEA concentration provides a highly accurate test for the diagnosis of a mucinous cyst, but does not distinguish benign from malignant cysts. Cytology is the most accurate test for the diagnosis of a malignant cyst.

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Importance: Measurement of delirium severity has been recognized as highly important for tracking prognosis, monitoring response to treatment, and estimating burden of care both during and after hospitalization. Rather than simply rating delirium as present or absent, the ability to quantify its severity will enable development and monitoring of more effective treatment approaches for delirium. Objective: This study had 3 major goals: to present a comprehensive review of delirium severity instruments; to conduct a methodologic quality rating of the original validation study of the most commonly used instruments; and to select a group of top-rated instruments. Evidence Review: Using key words, subject headings, and full text approaches, we conducted a systematic review of the following databases,

Natural orifice translumenal endoscopic surgery (NOTES) for rectosigmoid resection using TEM with or without transgastric endoscopic assistance is feasible and associated with low morbidity in a porcine survival model. Transgastric assistance significantly prolongs the operative time but extends the length of the rectosigmoid mobilized transanally, with a nonsignificant increase in complication rates related to gastrotomy creation.

Background Cognitive impairment is a well-recognized risk factor for delirium. Our goal was to determine if the level of cognitive performance across the non-demented cognitive ability spectrum is correlated with delirium risk, and to gauge the importance of cognition relative to other known risk factors for delirium. Methods The SAGES (Successful Aging after Elective Surgery) study enrolled 566 adults age ≥ 70 years scheduled for major surgery. Patients were assessed preoperatively and daily during hospitalization for the occurrence of delirium using the Confusion Assessment Method. Cognitive function was assessed preoperatively with an 11-test neuropsychological battery combined into a composite score for general cognitive performance (GCP). We examined the risk for delirium attributable to GCP, as well as demographic factors, vocabulary ability, and informant-rated cognitive decline, and compared the strength of association to risk factors identified in a previously published delirium prediction rule for delirium. Results Delirium occurred in 135 (24%) patients. Lower GCP score was strongly and linearly predictive of delirium risk (RR = 2.0 per each half standard deviation difference in GCP score, 95% confidence interval, 1.5, 2.5). This effect was not attenuated by statistical adjustment for demographics, vocabulary ability, and informant-rated cognitive decline. The effect was stronger than, and largely independent from, both standard delirium risk factors and comorbidity. Conclusions Risk of delirium is linearly and strongly related to presurgical cognitive performance level even at levels above the population median, which would be considered unimpaired.

Anomalies of the inferior vena cava (IVC) have been recognized as one of the predisposing factors for deep vein thrombosis. Rarely, thrombosis of an anomalous retroperitoneal vein may resemble a soft tissue mass. Awareness of this fact helps preventing unnecessary interventions. We report a case of thrombosis of retroaortic left renal vein and interrupted IVC that mimicked a retroperitoneal neoplasm.

We evaluated the role of cognitive and brain reserve markers in modifying risk for postoperative delirium associated with a pathophysiologic marker. The Successful Aging after Elective Surgery (SAGES) study enrolled 556 adults age ≥ 70 years without dementia scheduled for major surgery. Patients were assessed preoperatively and daily during hospitalization for delirium. We used C-reactive protein (CRP) as a pathophysiologic marker of inflammation, previously associated with delirium. Markers of reserve included vocabulary knowledge, education, cognitive activities, occupation type and complexity, head circumference, intracranial volume, and leisure activities. Vocabulary knowledge, cognitive activities, and education significantly modified the association of CRP and postoperative delirium (p < .01). However, effect sizes -- when statistically significant -- were small in magnitude. The strongest effect modification was observed for vocabulary knowledge: high scores were generally protective, but not at high levels of CRP. Select reserve markers attenuate the risk of delirium associated with lower grade inflammatory processes, supporting the role of reserve in delirium.