Method of spleen reduction in laparoscopic splenectomy in children with hereditary autoimmune hemolytic anemia

Purpose. This study aimed to improve the results of surgical treatment of children with hereditary autoimmune hemolytic anemia by laparoscopic splenectomy. Materials and methods. In the period from 1991 to 2020, a total 47 patients with hereditary autoimmune hemolytic anemia were treated in the surgical department of the Republican Childrens Clinical Hospital of Syktyvkar. Splenectomy was performed by the open method in 25 children, and laparoscopic method in 22 patients. Since 2019, the method of spleen reduction during laparoscopic splenectomy has been used in 3 patients when the large size of the mobilized spleen does not correspond to the size of the endoscopic container. Results. On average, surgical intervention using the above-described method of spleen reduction lasted for 19 2 min lesser than with laparoscopic splenectomy without the above method, due to the possibility of removing a significantly smaller volume of spleen tissue from the endoscopic sac outside the abdominal cavity. However, the most important achievement was the almost complete elimination of the risk of getting free fragments of a pathologically altered spleen with its possible replantation and recurrence of the clinic of autoimmune hemolytic anemia. The postoperative period was smooth, and all patients were discharged at their place of residence 7 days after the laparoscopic splenectomy. Intra-abdominal complications and relapses of the disease associated with the above-described method of operation did not occur in any patient within 612 months postoperative. Conclusion. The proposed method of spleen reduction during laparoscopic splenectomy made it possible to avoid relapses of the disease, reduce the operation time, as a result, improved the results of surgical treatment in children with hereditary autoimmune hemolytic anemia.

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MEAN 6 YEAR CLINICAL OUTCOMES, SURVIVORSHIP, AND RETURN TO SPORTS AFTER ARTHROSCOPIC CAPSULAR REPAIR WITH SUTURE ANCHORS FOR ADOLESCENT MULTIDIRECTIONAL SHOULDER INSTABILITY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00021 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0002

Author(s):

Brendon C. Mitchell ◽

Matthew Y. Siow ◽

Alyssa Carrol ◽

Andrew T. Pennock ◽

Eric W. Edmonds

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Shoulder Instability ◽

Surgical Intervention ◽

Operation Time ◽

Demographic Variables ◽

Return To Sports ◽

Suture Anchors ◽

Surgical Failure

Background: Multidirectional shoulder instability (MDI) refractory to rehabilitation can be treated with arthroscopic capsulolabral reconstruction with suture anchors. No studies have reported on outcomes or examined the risk factors that may contribute to poor outcomes in adolescent athletes. Hypothesis/Purpose: To identify risk factors for surgical failure by comparing anatomic, clinical, and demographic variables in adolescents who underwent surgical intervention for MDI. Methods: All patients undergoing arthroscopic shoulder surgery at one institution between January 2009 and April 2017 were reviewed. Patients >20 years old at presentation were excluded. Multidirectional instability was defined by positive drive-through sign on arthroscopy plus positive sulcus sign and/or multidirectional laxity on anterior and posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for reporting purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Results: Eighty adolescents (88 shoulders) were identified for having undergone surgical treatment of MDI. Of these 80 patients, 42 (50 shoulders; 31 female, 19 male) were available at a minimum of 2-year follow-up. Mean follow-up was 6.3 years (range, 2.8-10.2 years). Thirteen (26.0%) shoulders experienced surgical failure defined by recurrence of subluxation and instability, all of which underwent re-operation. Time to re-operation occurred at a mean of 1.9 years (range, 0.8-3.2). Our cohort had an overall survivorship of 96% at 1 year after surgery and 76% at 3 years. None of the anatomic, clinical, or demographic variables tested, or the presence of generalized ligamentous laxity, were correlated with subjective outcomes or re-operation. Number of anchors used was not different between those that failed and those that did not fail. Patients reported a mean SANE score of 83.3, PASS score of 85.0, and QuickDASH score of 6.8. Return to prior level of sport (RTS) occurred in 56% of patients. Conclusion: Multidirectional shoulder instability is a complex disorder that can be challenging to treat. Adolescent MDI that is refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability. In patients who do experience failure of capsulorraphy, we show that failure will most likely occur within 3 years of the index surgical treatment. [Table: see text][Figure: see text]

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Laparoscopic splenectomy for autoimmune hemolytic anemia in patients with chronic lymphocytic leukemia: A case series and review of the literature

American Journal of Hematology ◽

10.1002/ajh.10472 ◽

2004 ◽

Vol 75 (3) ◽

pp. 134-138 ◽

Cited By ~ 15

Author(s):

John Hill ◽

R. Matthew Walsh ◽

Scott McHam ◽

Fred Brody ◽

Matt Kalaycio

Keyword(s):

Chronic Lymphocytic Leukemia ◽

Hemolytic Anemia ◽

Autoimmune Hemolytic Anemia ◽

Laparoscopic Splenectomy ◽

Case Series ◽

Lymphocytic Leukemia ◽

Review Of The Literature

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Surgical treatment and operation time in HIV-negative cryptococcal meningitis

10.21203/rs.2.10492/v1 ◽

2019 ◽

Author(s):

Xiang Zhao ◽

Jie Zhao ◽

Shaobo Yang ◽

Wenyang Li ◽

Ying Liu ◽

...

Keyword(s):

Surgical Treatment ◽

Cryptococcal Meningitis ◽

Surgical Intervention ◽

Operation Time ◽

Loss Of Consciousness ◽

Progressive Loss ◽

Male Patients ◽

Central South ◽

Hiv Negative

Abstract Background: There are still no unified guidelines of surgical treatment and timing for HIV-negative patients with cryptococcal meningitis (CM). Methods: The clinical data and follow-up data were collected from HIV-negative CM patients in Xiangya Hospital of Central South University from January 2009 to November 2018, and 42 patients who were treated with surgical intervention were enrolled in the present study. These 42 patients were divided into ventriculoatrial (VA) group, ventriculoperitoneal (VP) group, external ventricle drainage (EVD) group, hydrocephalus (HYC) group, non-HYC group, EVD group and non-EVD group (VA/VP) according to different surgical procedures. Statistical analyses were conducted using SPSS (version 19.0, Chicago, IL, USA). Results: Signs of headache, fever and loss of consciousness in the VA group were significantly improved compared with the EVD group at 1 week after operation (P<0.05). The mortality rate of the VA group was significantly lower than that of the EVD group (P<0.05). Moreover, male patients were more prone to have HYC (P<0.05). Younger patients tended to develop HYC (P<0.05). Cerebrospinal fluid (CSF) sugar in the non-HYC group was significantly lower compared with the HYC group (P<0.05). Time of CM-to-operation in the non-HYC group was markedly shorter compared with the HYC group (P<0.01). Conclusions: VA procedure could be one of the first choices for the treatment of uncontrollable intracranial hypertension caused by CM. Severe uncontrollable headache, loss of consciousness and cerebral hernia were indications of emergency surgery. Repeated headache, hearing impairment, and especially progressive loss of vision were indications of early surgery to avoid permanent damage to nerve functions of HIV-negative CM patients.

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Autoimmune hemolytic anemia associated with mesenteric teratoma

Terapevticheskii arkhiv ◽

10.17116/terarkh201789178-81 ◽

2017 ◽

Vol 89 (1) ◽

pp. 78-81

Author(s):

K I Ntanishyan ◽

K R Sabirov ◽

O V Shcherbakova ◽

D E Vybornykh ◽

I A Shupletsova ◽

...

Keyword(s):

Hemolytic Anemia ◽

Corticosteroid Therapy ◽

Autoimmune Hemolytic Anemia ◽

Laparoscopic Splenectomy ◽

Hypertensive Crisis ◽

Hemoglobin Level ◽

Sustained Remission ◽

Hematological Response ◽

Mesenteric Root ◽

Temporary Response

The paper describes a case of autoimmune hemolytic anemia (AIHA) in a 27-year-old woman whose examination revealed mesenteric teratoma. AIHA was characterized by a hypertensive crisis and a temporary response to corticosteroid therapy that was complicated by the development of somatogenic psychosis and discontinued. A relapse of hemolysis developed 6 months later. The patient underwent laparoscopic splenectomy and removal of mesenteric root teratoma. Immediately after surgery, a hematological response was obtained as relief of hemolysis and restoration of a normal hemoglobin level. There is a sustained remission of AIHA for the next 16 months.

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TREATMENT OF CHILDREN WITH PERFORATED ULCERS OF THE STOMACH AND DUODENUM IN TASHKENT

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2020-24-1-53-56 ◽

2020 ◽

Vol 24 (1) ◽

pp. 53-56

Author(s):

H. A. Akilov ◽

Nozim T. Urmanov ◽

N. R. Khodjayarov

Keyword(s):

Surgical Treatment ◽

Acute Abdomen ◽

Surgical Intervention ◽

Abdominal Cavity ◽

Laparoscopic Suturing ◽

Free Gas

The authors have analyzed outcomes of examination and surgical treatment of 68 children aged 6 - 18 with perforated ulcers of the stomach and duodenum who were treated in hospitals in 2005-2018. The authors concluded that children with the picture of acute abdomen and no free gas (radiographically) in their abdominal cavity, especially children of puberty period, are recommended to have esophago-gastro-duodenoscopy (EGDS). The choice of surgical intervention is laparoscopic suturing.

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PROBLEMS OF ACUTE APPENDICITIS DIAGNOSTICS AND SURGICAL TREATMENT

Art of Medicine ◽

10.21802/artm.2021.3.19.95 ◽

2021 ◽

pp. 95-99

Author(s):

V. K. Churpiy ◽

K. L. Churpiy

Keyword(s):

Surgical Treatment ◽

Acute Appendicitis ◽

Sigmoid Colon ◽

Abdominal Cavity ◽

Fish Bone ◽

Preoperative Period ◽

Terminal Ileitis ◽

Acute Calculous Cholecystitis ◽

Surgical Department ◽

Suspected Acute Appendicitis

Acute appendicitis is a "chameleon disease" that requires in many cases a complex differential diagnosis. Inflammation of the appendix is one of the most common surgical diseases. Difficulties in the verification of acute appendicitis, the severity of complications associated with late diagnosis indicate that the problems of diagnosis and treatment of this pathology has not lost its relevance. The most difficult question for the surgeon is to diagnose acute appendicitis in time and carry out surgical treatment, prevent all possible complications and minimize the frequency of removal of the unaltered appendix. The aim of the study to determine and systematize the causes of difficulties in diagnosing acute appendicitis at the preoperative stage. A retrospective analysis of 586 medical records of inpatients who were treated in the surgical department was performed. Among the operated 511 (87.2%) patients, the diagnosis of acute appendicitis before and after surgery coincided, which was confirmed morphologically. In 75 cases, which is 12.8%, the diagnosis of acute appendicitis had atypical symptoms or was masked by the clinic of another pathology. Observations of atypical cases of acute appendicitis in combination with other pathologies were the following diseases that occurred under the clinic signs, or combined with them: perforation of the small intestine with fish bone - 4 cases; perforation of Meckel's diverticulum - 2. In one case perforation by a fish bone, in another inflammation with its perforation. - terminal ileitis - 1; torsion and necrosis of the fatty suspension of the elongated sigmoid colon - 2; perforation of the diverticulum of the elongated sigmoid colon - 1, rupture of the ovarian cyst - 9 cases, including two children 13 and 17 years; piosalpinx - 2, 1 case of combination of acute calculous cholecystitis with gangrenous appendicitis, which was detected during the audit of the abdominal cavity; inflammatory infiltrate of the omentum - 3; torsion and gangrene of the omentum - 2, a combination of acute appendicitis with omentitis - 8 cases; combination of acute appendicitis with mesoadenitis - 39 cases; rupture of the spleen - 1. Conclusions: Under the clinic of acute appendicitis or in combination with it other acute diseases of the abdominal cavity can mask, up to 12.8%, which are difficult or in some cases impossible to diagnose in the preoperative period. One of the reasons for the difficulties of diagnosis is the omission by patients of anamnesis data regarding the onset and course of the disease, as well as alcohol consumption. Difficulties in diagnosis occur in children, especially young people, which is 61.3% of cases. The combination of acute appendicitis with mesoadenitis was observed in 6.6%. Among these patients, acetonemic syndrome was observed in 87.2% of cases. This group of patients is dominated by children. Gynecological diseases are disguised under the clinic of acute appendicitis in 1.9%, which requires a joint examination by a surgeon and obstetrician-gynecologist of patients with suspected acute appendicitis in the preoperative period. Deciding on surgical treatment for suspected acute appendicitis is a clinic of acute peritonitis, which was observed in 63.3%, requires proper clinical thinking of the surgeon combined with experience, laboratory and instrumental examination.

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Results of surgical treatment of gastric and duodenal ulcers

Kazan medical journal ◽

10.17816/kazmj63935 ◽

1937 ◽

Vol 33 (3) ◽

pp. 317-322

Author(s):

G. I. Mukhamedyarov ◽

V. I. Mikhailov

Keyword(s):

Surgical Treatment ◽

Surgical Intervention ◽

Abdominal Cavity ◽

Gastric Ulcers ◽

Malignant Degeneration ◽

Duodenal Ulcers

The question of indications for surgical treatment of gastric ulcers and duodenal ulcers cannot be considered fully resolved until now, as well as the question of the nature of the surgical intervention itself. The readings are divided into absolute and relative. The first include: a) perforation of the ulcer into the free abdominal cavity, b) its malignant degeneration, c) cicatricial narrowing of the pylorus. Chronic gastric and duodenal ulcers are considered relative indications. There is no disagreement about absolute indications among surgeons and therapists, which is not the case for relative indications.

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