Surgical treatment of a newborn in critical condition with intrapericardiac teratoma: a case report

This article presents a clinical case of the successful surgical treatment of a newborn with intrapericardial teratoma, which was initially diagnosed in the postnatal period, complicated by multiple organ failure, including severe cardio-respiratory disorders and acute renal damage. The systematized results of clinical, electrophysiological, radiation, and morphological diagnostics during the initial examination and at the stages of supervision of the newborn are reported. On the nineteenth day of life, significant multidisciplinary cooperation was implemented to perform a radical surgical intervention to remove the intrapericardial teratoma in a patient in critical condition due to heart compression and intrathoracic tension syndrome, which determined the needed prosthetics for vital functions. Two months after the operation, the efficiency of the intervention and complex therapy was confirmed by the direct results and data of the infants examination. The organizational aspects provided newborns with emergency multidisciplinary specialized medical care.

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The Use of Eye Tracking to Discern the Threshold at Which Metopic Orbitofrontal Deformity Attracts Attention

The Cleft Palate-Craniofacial Journal ◽

10.1177/1055665620926014 ◽

2020 ◽

Vol 57 (12) ◽

pp. 1392-1401

Author(s):

Mark P. Pressler ◽

Emily L. Geisler ◽

Rami R. Hallac ◽

James R. Seaward ◽

Alex A. Kane

Keyword(s):

Surgical Treatment ◽

Graduate Students ◽

Eye Tracking ◽

Dwell Time ◽

Surgical Intervention ◽

Three Dimensional ◽

Average Dwell Time ◽

Eye Tracker ◽

Gaze Patterns ◽

Areas Of Interest

Introduction and Objectives: Surgical treatment for trigonocephaly aims to eliminate a stigmatizing deformity, yet the severity that captures unwanted attention is unknown. Surgeons intervene at different points of severity, eliciting controversy. This study used eye tracking to investigate when deformity is perceived. Material and Methods: Three-dimensional photogrammetric images of a normal child and a child with trigonocephaly were mathematically deformed, in 10% increments, to create a spectrum of 11 images. These images were shown to participants using an eye tracker. Participants’ gaze patterns were analyzed, and participants were asked if each image looked “normal” or “abnormal.” Results: Sixty-six graduate students were recruited. Average dwell time toward pathologic areas of interest (AOIs) increased proportionally, from 0.77 ± 0.33 seconds at 0% deformity to 1.08 ± 0.75 seconds at 100% deformity ( P < .0001). A majority of participants did not agree an image looked “abnormal” until 90% deformity from any angle. Conclusion: Eye tracking can be used as a proxy for attention threshold toward orbitofrontal deformity. The amount of attention toward orbitofrontal AOIs increased proportionally with severity. Participants did not generally agree there was “abnormality” until deformity was severe. This study supports the assertion that surgical intervention may be best reserved for more severe deformity.

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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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The development of complications of community-acquired pneumonia of a severe course against the background of parenteral poisoning with a mixture of narcotic substances

Vestnik of Russian military medical Academy ◽

10.17816/brmma62806 ◽

2020 ◽

Vol 22 (4) ◽

pp. 59-66

Author(s):

I. N. Gayvoronskiy ◽

Yu. Sh Khalimov ◽

S. V. Gayduk ◽

T. V. Lyanginen ◽

A. S. Partsernyak ◽

...

Keyword(s):

Young Patient ◽

Severe Pneumonia ◽

Modern Medicine ◽

Multiple Organ ◽

Community Acquired Pneumonia ◽

High Tech ◽

Antibacterial Drug ◽

Toxic Substances ◽

Military Medical Academy ◽

Vital Functions

Doctors of the clinic of military field therapy of the Military Medical Academy named after S.M. Kirov, the experience of successful treatment of community-acquired pneumonia of a severe course with the development of complications against the background of parenteral poisoning with a mixture of narcotic substances in a young patient was obtained. An important feature in the treatment tactics of this patient was the impossibility of antidote therapy with naloxone (a competitive opioid receptor antagonist) due to the presence of signs of respiratory failure, hypoxic and tissue hypoxia. As a result of the systemic treatment in the young patient, it was possible to arrest a significant septic process and multiple organ disorders of vital functions that arose due to severe endotoxic damage. An important factor in ensuring the survival of patients with severe pneumonia against a background of immune depression due to the use of toxic substances is the rational selection of an antibacterial drug or combinations of antibiotic therapy, constant monitoring of vital functions with prompt correction of emerging disorders, as well as the need to use modern high-tech treatment methods. This example clearly shows the need for urgent, systematic and complex intensive care in a number of manipulations performed in people with complications of community-acquired pneumonia, suffering from drug addiction. In addition, it is important to minimize the time from the detection of a poisoned person to the start of emergency measures, as well as their further evacuation to the stage of providing qualified and specialized medical care. Thus, modern medicine continues to face an extremely urgent problem of drug use by the population. A significant number of people with drug dependence syndrome do not seek medical help for various reasons, continuing to use illegal drugs.

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Medical Versus Surgical Treatment of Primary Vesicoureteral Reflux

PEDIATRICS ◽

10.1542/peds.67.3.392 ◽

1981 ◽

Vol 67 (3) ◽

pp. 392-400 ◽

Cited By ~ 6

Keyword(s):

Surgical Treatment ◽

Vesicoureteral Reflux ◽

Therapeutic Intervention ◽

Renal Damage ◽

Rational Basis ◽

Benefit Ratio ◽

International Trial ◽

Prospective Longitudinal ◽

Primary Vesicoureteral Reflux

The role of VUR in the development and progression of renal damage in children is universally acknowledged. The risk/benefit ratio of therapeutic intervention, whether medical or surgical, continues to be debated. This carefully controlled prospective, longitudinal, multispecialty, international trial aims to establish a rational basis for the treatment of VUR.

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Predictors of Surgical Intervention in Patients with Inflammatory Bowel Disease

QJM ◽

10.1093/qjmed/hcab100.017 ◽

2021 ◽

Vol 114 (Supplement_1) ◽

Author(s):

Khaled Hamdy Abd El Megeed ◽

Shereen Abou Bakr Saleh ◽

Christina Alphonse Anwar ◽

Ahmed Elkattary Mohamed Elkattary

Keyword(s):

Inflammatory Bowel Disease ◽

Surgical Treatment ◽

Bowel Disease ◽

Surgical Intervention ◽

High Sensitivity ◽

Medical Patients ◽

Mayo Score ◽

Calprotectin Level ◽

Inflammatory Bowel ◽

The Mean

Abstract Background Inflammatory bowel disease (IBD) is comprised of two major disorders: Ulcerative Colitis and Crohn’s disease. Ulcerative Colitis affects the colon, where as Crohn’s disease can involve any component of the gastrointestinal tract from the mouth to the perianal area. These disorders have somewhat different pathologic and clinical characteristics, but with substantial overlap; their pathogenesis remains poorly understood. Objective To determine & detect different predictors that help us to characterize patients with high probability of undergoing surgical intervention for inflammatory bowel diseases. Patients and Methods The present study was designed to detect & identify possible factors that can be used to predict surgical intervention in patients with IBD. The present study was a case control study that was conducted on 80 patients with inflammatory bowel disease (either controlled by medical treatment or needed surgical intervention as a part of disease control) who were recruited form Ain-Shams university hospitals and El Quabbary general hospital in Alexandria. In the present study, the mean age of the included patients was 36.67 ±8.5 years old and 50% of the patients were males. The mean age at the onset of the disease was 25.81 ±6.8 years old. Results In the present study, there were statistically significant differences between surgical and medical patients in terms of CDAI for CD (p < 0.001) and Mayo score for UC (p < 0.001). Surgical patients were more likely to have higher scores. CDAI and Mayo score were negative predictors of surgical treatment. CDAI score > 287 and Mayo score > 8.5 achieved high sensitivity and specificity for the detection of surgical treatment. In the present study, we found that there was statistically significant differences between surgical and medical patients in terms of Stool Calprotectin level. Surgical patients were more likely to have higher Stool Calprotectin level. Stool Calprotectin level was negative predictor of surgical treatment at a level of > 341.5 microgm/gm with high sensitivity and specificity. Conclusion Surgical treatment is a common outcome in IBD. Certain clinical features and the extent of disease are risk factors for surgical intervention. Our study indicates that smoking, Chron’s disease, perianal disease, granulomas, higher severity scores, higher stool Calprotectin level, CRP, and ESR were associated with higher risks of surgical intervention. In addition, smoking, peri-anal disease, CDAI, Mayo score, Stool Calprotectin level, and CRP level were predictors of surgical treatment. The findings of our analysis have implications for practice, particularly in the promotion of preoperative individualized risk prediction. The ability to predict which patients will need surgery and target more intensive, early treatment to that group would be invaluable. Further research through large prospective cohort studies is needed to confirm our findings and conclusions.

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Intestinal Perforation during the Stabilization Period in a Preterm Infant with Congenital Diaphragmatic Hernia

European Journal of Pediatric Surgery Reports ◽

10.1055/s-0037-1606288 ◽

2017 ◽

Vol 05 (01) ◽

pp. e51-e54

Author(s):

Zbyněk Straňák ◽

Karel Pýcha ◽

Simona Feyereislova ◽

Jaroslav Feyereisl ◽

Michal Rygl

Keyword(s):

Birth Weight ◽

Congenital Diaphragmatic Hernia ◽

Diaphragmatic Hernia ◽

Intestinal Perforation ◽

Surgical Repair ◽

Very Low Birth Weight ◽

Surgical Intervention ◽

Multiple Organ ◽

Stabilization Period ◽

Early Surgical Intervention

Background Delayed surgery after stabilization of infants with congenital diaphragmatic hernia (CDH) is an accepted strategy. However, the evidence favoring delayed versus immediate surgical repair is limited. We present an extremely rare case of a very low-birth-weight infant with prenatally diagnosed left-sided CDH and unexpected transmural bowel perforations developing within the postnatal stabilization period. Case Report A neonate born at 31st week of gestation with a birth weight of 1,470 g with antenatally diagnosed left-sided CDH presented with bowel dilation leading to transmural bowel perforations on the 2nd day of life. Meconium pleuroperitonitis resulted in severe systemic inflammatory response syndrome, pulmonary hypertension, multiple organ failure, and death. Conclusion In neonates with CDH deteriorating under standard postnatal management, intestinal perforation, and early surgical intervention should be considered.

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Pulmonary Valve Insufficiency as a Complication of Radical Surgical Treatment of Tetralogy of Fallot

Acta Facultatis Medicae Naissensis ◽

10.1515/afmnai-2017-0020 ◽

2017 ◽

Vol 34 (2) ◽

pp. 179-188

Author(s):

Milovan Stojanović ◽

Marina Deljanin-Ilić ◽

Aleksa Vuković ◽

Dejan Petrović

Keyword(s):

Surgical Treatment ◽

Tetralogy Of Fallot ◽

Pulmonary Valve ◽

Surgical Intervention ◽

Ultrasound Examination ◽

Clinical Signs ◽

Common Complication ◽

Pulmonary Valve Insufficiency ◽

Valve Insufficiency ◽

Additional Imaging

Summary Tetralogy of Fallot is the most common cyanogenic congenital heart defect. The diagnosis is based on clinical signs, ECG examination, ultrasound examination of the heart, additional imaging methods and invasive testing. The therapeutic approach to the patient with tetralogy is complex and based on conservative and radical methods. Patients who have not undergone a radical surgical intervention have a poor prognosis, whereas the prognosis is much better for patients who have been operated. The most common complication of the surgical treatment is the pulmonary valve insufficiency which usually requires reintervention, as was the case with our patient.

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Evolution of diagnosis and surgical treatment of intra-abdominal infiltrates, abscesses of primary and postoperative origin in patients

Paediatric Surgery Ukraine ◽

10.15574/ps.2021.72.15 ◽

2021 ◽

pp. 15-29

Author(s):

V.V. Skyba ◽

◽

V.F. Rybalchenko ◽

A.V. Ivanko ◽

R.М. Borys ◽

...

Keyword(s):

Duodenal Ulcer ◽

Gastric Ulcer ◽

Surgical Treatment ◽

Abdominal Cavity ◽

Postoperative Mortality ◽

Multiple Organ ◽

Long Term Results ◽

Control Group ◽

Study Group ◽

Perforated Gastric Ulcer

Purpose – to improve the results of surgical treatment of patients with intra-abdominal infiltrates and abscesses through the introduction of the latest imaging methods and surgical technologies. Materials and methods. In the clinic of the Department of Surgical Diseases No 1, on the basis of the Surgery Center of the Kyiv City Clinical Hospital No. 1 from 2006 to 2019 218 patients with primary and secondary intra-abdominal infiltrates, abscesses and fluid formations were treated. The patients’ age ranged from 16 to 85 years. There were 107 (49.08%) male patients, 111 (50.92%) female patients. Depending on the time of hospitalization (by years), the patients were divided into two groups: the control group (CG) (2006–2012) 117 (53.67%) patients and the study group (SG) (2013–2019) 101 (46.33%) patients. The SG used the latest imaging technologies and improved methods of surgical treatment. Results. The patients were divided into two groups: primary in 191 (87.61%) and secondary postoperative infiltrates and abscesses in 27 (12.39%). The causes of primary infiltrates and abscesses were: complicated forms of appendicitis in 74 (33.94%), perforated stomach and duodenal ulcer in 48 (22.02%), complicated forms of cholecystitis in 69 (31.65%). Postoperative infiltrates and abscesses were observed in 27 (12.39%) patients who underwent urgent surgery: adgeolysis of adhesive ileus in 14 (6.42%) and complicated hernias of various localization in 13 (5.97%). Postoperative complications were diagnosed in 43 (19.72%) patients, of whom 34 (15.59%) from the surgical wound and 29 (15.18%) of the abdominal cavity, who required relaparotomy or laparoscopy, with destructive appendicitis in 10 (13.51%), perforated gastric ulcer and 12 duodenal ulcer in 6 (12.5%), destructive cholecystitis in 9 (13.04%), adhesive intestinal obstruction in 13 (19.12%) and with strangulated and complicated hernias in 14 (17.28%) of the examined patients. During relaparotomy, incompetence of the intestinal wall and intestinal sutures was established in 11 out of 32 patients, an ileostomy was imposed in 7, and cecostomy in 1 patient. Actually, in the control group, 8 (6.84%) patients died on the background of ongoing peritonitis, thrombosis of mesenteric vessels and multiple organ failure and concomitant ailments and in the study group 4 (3.96%) patients died. Conclusions. Surgical treatment is individualized depending on the disease, so with destructive appendicitis from 74 (38.74%) laparotomic in 42 (21.99%), laparoscopic in 32 (16.75%), and in 12 (6.28%) with conversion; perforated gastric ulcer and duodenal ulcer in 48 (25.13%) open laparotomy; with cholecystitis of 69 (36.13%) patients, 48 (25.13%) had laparotomy and 21 (11.00%) had laparoscopic examination. The use of the latest imaging and treatment technologies: Doppler ultrasonography, hydrojet scalpel and laparoscopy in 64 (33.51%), allowed to have better near and long-term results and to reduce postoperative mortality from 6.84% to 3.96%, with an average of 5.5%. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare no conflicts of interests. Key words: destructive appendicitis, cholecystitis, perforated gastric ulcer and 12-duodenal ulcer, adhesive leakage, strangulated hernias, diagnosis and treatment.

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Prevention of pain syndrome and immediate postoperative complications in the surgical treatment of chronic hemorrhoids

Pacific Medical Journal ◽

10.34215/1609-1175-2020-1-68-71 ◽

2020 ◽

pp. 68-71

Author(s):

V. N. Ishchenko ◽

A. E. Krasnobaev ◽

A. A. Grigoryuk

Keyword(s):

Surgical Treatment ◽

Postoperative Complications ◽

Urinary Retention ◽

Acute Urinary Retention ◽

Surgical Intervention ◽

Pain Syndrome ◽

Modified Technique ◽

Postoperative Urinary Retention ◽

Clinical Comparison ◽

Suggested Technique

Objective: To assess the efficacy of hemorrhoidectomy with Milligan-Morgan technique in the author’s modification.Methods: Results of surgical treatment of 558 patients aged 21–72 years with complicated hemorrhoids of III–IV stage were analyzed. The group of clinical comparison (207 patients) was operated according to standard scheme, the main group (351 patients) – according to author’s technology with modified technique for treating the hemorrhoid bolus using betamethasone.Results: When using the author’s technique, a more significant decrease in postoperative pain syndrome severity was achieved: injection analgesics were not required already in a day, and after 6 days the pain syndrome was stopped in all cases. Only three patients (0.9%) demonstrated an acute urinary retention up to two days. The group of clinical comparison maintained a longterm (up to three months) pain syndrome; postoperative urinary retention was registered in 38 cases (18.4%); 9 patients (4.3%) developed blood loss in the area of surgical intervention.Conclusions: Suggested technique of surgical treatment for hemorrhoids is quite effective, simple and can be implemented in any surgical inpatient facility.

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Microsurgical Treatment of Epidermoids. Case Report and Literature Review

Acta biomedica scientifica ◽

10.29413/abs.2019-4.2.16 ◽

2019 ◽

Vol 4 (2) ◽

pp. 114-121

Author(s):

V. A. Byvaltsev ◽

A. A. Kalinin ◽

E. G. Belykh ◽

S. L. Antipina ◽

D. I. Badaguev

Keyword(s):

Surgical Treatment ◽

Literature Review ◽

Aseptic Meningitis ◽

Epidermoid Cyst ◽

Surgical Intervention ◽

Perioperative Complications ◽

Medical Knowledge ◽

Clinical Results ◽

Russian Science ◽

Russian Science Citation Index

The aim of the research: study the features of surgical treatment of epidermoids.Materials and methods. We present a literature review and the clinical case of surgical treatment of a patient with epidermoid. We have searched medical databases: Medline, Russian Science Citation Index, EMedicine, United Medical Knowledge Base. We considered the features of the clinic, diagnosis, and surgical intervention. The article presents a clinical example of successful surgical treatment of a patient with an epidermoid cyst of the posterior cranial fossa. The result of the literature review was the writing of a clinical lecture; the current state of the issue of etiopathogenesis, diagnosis and management of patients with epidermoids was studied.Results. The authors found that total microsurgical removal is the method of choice, and the operative technique should be aimed at preventing postoperative aseptic meningitis. Although it was not possible to establish the cause of the development of aseptic meningitis, the authors assume that the mechanism of its formation lies in the self-breaking of the capsule of the epidermoid cyst, probability of which was confirmed by a number of studies. Further study of this pathology is a promising direction in neurosurgery.Conclusion. Difficulties in the diagnosis and choice of surgical tactics point at the need for detailed preoperative planning of surgical intervention, performing a precise total removal of a lesion with compliance with preventive measures for aseptic meningitis to improve clinical results and reduce the incidence of perioperative complications.

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