Dhanushan Gnanendran

Background: Pancreatic pseudocyst fistulation into the portal venous system is rare. This may cause portal-vein thrombosis, portal hypertension, and biliary obstruction, complicating diagnosis and treatment. Case: A 45-year-old man with alcohol-induced necrotizing pancreatitis developed jaundice, pain, and abnormal liver tests. Imaging revealed a 6-cm pancreatic head pseudocyst connected to the portal confluence and thrombosed portal and splenic veins. CT showed cavernous transformation and bile duct compression. Pancreatic pseudocyst–portal vein fistula (PPVF) with portal hypertension–related biliary obstruction was diagnosed. The bile duct stricture was stented endoscopically; anticoagulation was withheld due to variceal risk. Symptoms and labs normalized within a week. At 3 months, the pseudocyst regressed, and the bile duct remained patent. Conclusion: PPVF should be considered when portal-vein thrombosis and pancreatic pseudocyst coexist. Characteristic imaging can often obviate invasive confirmation. Early multidisciplinary management, prioritizing endoscopic or percutaneous drainage and selective anticoagulation, allows for safe, effective treatment while avoiding high-risk surgery.

Purpose: Primary gastrointestinal lymphoma (PGIL) is a rare cancer, with diffuse large B‐cell lymphoma (DLBCL) as the most common subtype. PGIL can be acute, requiring emergency surgery, or non‐acute, allowing elective management. This article evaluates the clinical presentation, treatments, and survival outcomes of PGIL by comparing emergency and elective cases. Methods: A retrospective cohort study from January 2013 to December 2019 included patients with histologically confirmed PGIL, excluding secondary GI involvement. Survival distributions were performed using SPSS v.20 and Kaplan–Meier analysis. Results: Among 33 patients, 54.5% were male, with a mean age of 69. The most common site of lymphoma was the small bowel (54.5%), with DLBCL being the predominant subtype (66.7%). Emergency cases comprised 57.6% of the cohort. Poorer survival was noted in emergency cases, with significant differences in survival by age ( p = 0.036) and lymphoma site ( p = 0.038). Surgical excision was the main diagnostic method in emergency cases (54.5%), while endoscopic biopsy was more common in elective cases (39.4%) ( p < 0.001). Chemotherapy was given to 69.7%, with R‐CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone) (65.2%) being the most used regimen. Median survival was 17 months (interquartile range, IQR: 10–44.5). Survival differences were significant by age ( p = 0.036) and lymphoma site ( p = 0.038). Conclusion: Emergency surgery is often needed for PGIL, especially with small bowel lymphomas, which have poorer outcomes. Early diagnosis and elective care may improve prognosis. Further research should explore prognostic markers and standardize treatment.

We present a case of a girl in her early childhood with a background of chromosomal deletion 10q21.2, hypothyroidism, second-degree atrioventricular block, developmental delay, gastroesophageal reflux disease, constipation and recurrent fevers. She had subcutaneous nodules, which represented panniculitis. Diagnosis of fever of unknown origin (FUO) associated with panniculitis was very challenging despite the involvement of geneticist, dermatologist, rheumatologist and paediatrician. To detect possible malignant cases and start treatment plans promptly, the case emphasises the need for a comprehensive diagnostic examination, which includes an early biopsy of nodular lesions. To maximise patient outcomes in complicated paediatric presentations, it emphasises the need for continual multidisciplinary teamwork and close monitoring. This case adds to the body of knowledge on the treatment of panniculitis and FUO in paediatric patients, highlighting the need of a comprehensive approach to treatment.

Background Propofol has been the gold standard for anesthesia induction and maintenance due to its rapid onset and favourable pharmacokinetic properties. However, the search for alternative agents with improved safety and efficacy has led to the emergence of ciprofol (HSK3486), a structural analog of propofol. This systematic review and meta-analysis aims to comprehensively assess the safety and efficacy of ciprofol compared to propofol for anaesthesia induction and maintenance in adult patients undergoing surgical procedures. Methods This study included only double-arm RCTs in which participants were aged eighteen or older undergoing surgery. For the statistical analysis of the extracted data, we employed RevMan 5.4.1. Results Ciprofol demonstrated a promising trend of higher anesthesiologists’ satisfaction during the induction phase (MD: 0.14, 95%, CI: -0.28 to 0.56, p = 0.51), whereas Propofol was favored during maintenance. Propofol also exhibited advantages with a shorter time to successful anesthesia induction (MD: 0.08 minutes, 95% CI: 0.00 to 0.15, p = 0.04). and quicker attainment of full alertness (MD: 0.11 minutes, 95% CI: -1.29 to 1.52, p = 0.87), suggesting its efficiency in clinical practice. Importantly, there were no significant disparities in the success rate of anesthesia. Conclusion Both ciprofol and propofol demonstrate comparable efficacy and safety for anesthesia induction and maintenance in adult patients undergoing surgery. While propofol provides a faster onset of induction, ciprofol exhibits advantages in terms of pain management. Clinicians should consider these findings when selecting anesthetic agents, tailoring choices to individual patient needs and clinical scenarios.