Approaches to Female Congenital Genital Tract Anomalies and Complications

Objective: Female congenital genital tract anomalies may appear with quite confusing and deceptive complications. This study aims to evaluate the difficulties in diagnosis and treatment of female congenital genital tract anomalies that frequently present with complications. Summary: During a 10-year period, we evaluated 20 female patients with congenital genital tract anomalies aged between 3 days and 16 years. All patients were retrospectively analyzed in terms of the results of diagnostic studies, surgical intervention, and treatment. Methods: Ultrasonography and magnetic resonance imaging revealed hydromucocolpos or hematocolpometra, imperforate hymen, distal vaginal atresia, didelphys uterus, an obstructed right hemivagina, uterovaginal atresia, a unicornuate uterus with a noncommunicating rudimentary horn, a vesicovaginal fistula, a utero-rectal fistula, intraabdominal collection, and a vaginal calculus. Results: Two patients had Mayer-Rokitansky-Küster-Hauser syndrome and 6 patients had obstructed hemivagina and ipsilateral renal anomaly syndrome. Definitive surgical interventions were hymenotomy, vaginal pull-through, vaginovaginostomy, and vesicovaginal fistula repair using a transvesical approach. In conclusion, female congenital genital tract anomalies may appear with a wide range of complications. Conclusions: There is a potential to do significant harm, if the patient's anatomic problems are not understood using detailed imaging. Revealing the anatomy completely and defining the complications that have already developed are critical to tailor the optimal treatment strategies and surgical approaches.

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PSEUDOEXPHOLIATIVE SYNDROME

RUDN Journal of Medicine ◽

10.22363/2313-0245-2019-23-1-54-61 ◽

2019 ◽

Vol 23 (1) ◽

pp. 54-61

Author(s):

B. B. Bekmirova ◽

M. A. Frolov

Keyword(s):

Early Stage ◽

Low Vision ◽

Cataract Extraction ◽

Surgical Approaches ◽

Surgical Interventions ◽

Wide Range ◽

Common Causes ◽

Before And After ◽

Initial Appearance ◽

Modern Level

Today, the clouding of the lens is one of the common pathology of the organ of vision. The clouding of the lens-cataract is one of the most common causes of blindness and low vision in children and adults. According to most authors, the main method of cataract treatment is surgical. In modern cataract surgery, the leading place is occupied by the most common cataract extraction method, phacoemulsification. The modern level of phacoemulsification technology made it possible to perform operations less traumatic, gave a full restoration of visual functions. It makes no sense to talk about the indications of IOL implantation, since Currently, there is a wide range of IOL models that can be implanted for all types of complicated cataracts. It is advisable to talk about contraindications, in this case, the surgeon makes a decision based on the material capabilities, experience, and perfection of the surgical technique. There are various associated syndromes in the development of cataracts. One of the syndromes that occurs in cataracts is the pseudo-excoliation syndrome. This review addresses the unresolved issues of pseudoexfoliation syndrome. The results of studies of some scientists, data analysis, clinical cases and ways to solve this problem are considered. In particular, a number of questions remain about the tactics of patient administration before and after surgical interventions. This syndrome, as far as we know, affects the development and outcome of the disease. It is sometimes difficult to diagnose pseudo-excoliation syndrome at an early stage, sometimes contradictory statements about the initial appearance of the syndrome are encountered. The issues of prevention of postoperative complications, less traumatic surgical approaches at various stages of PES remain open.

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Congenital anomalies causing hemato/hydrocolpos: imaging findings, treatments, and outcomes

Japanese Journal of Radiology ◽

10.1007/s11604-021-01115-7 ◽

2021 ◽

Author(s):

Keizo Tanitame ◽

Nobuko Tanitame ◽

Saiko Urayama ◽

Kazuhiro Ohtsu

Keyword(s):

Correct Diagnosis ◽

Late Complications ◽

Diagnosis And Treatment ◽

Imaging Findings ◽

Vaginal Septum ◽

Renal Anomaly ◽

Imperforate Hymen ◽

Adequate Knowledge ◽

Transverse Vaginal Septum ◽

Urogenital Anomalies

AbstractHemato/hydrocolpos due to congenital urogenital anomalies are rare conditions discovered in neonatal, infant, and adolescent girls. Diagnosis is often missed or delayed owing to its rare incidence and nonspecific symptoms. If early correct diagnosis and treatment cannot be performed, late complications such as tubal adhesion, pelvic endometriosis, and infertility may develop. Congenital urogenital anomalies causing hemato/hydrocolpos are mainly of four types: imperforate hymen, distal vaginal agenesis, transverse vaginal septum, and obstructed hemivagina and ipsilateral renal anomaly, and clinicians should have adequate knowledge about these anomalies. This article aimed to review the diagnosis and treatment of these urogenital anomalies by describing embryology, clinical presentation, imaging findings, surgical management, and postoperative outcomes.

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Inappropriate surgery in a patient with misdiagnosed Robert’s uterus

BMC Women s Health ◽

10.1186/s12905-021-01404-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Iori Kisu ◽

Kanako Nakamura ◽

Tetsuro Shiraishi ◽

Tomoko Iijima ◽

Moito Iijima ◽

...

Keyword(s):

Quality Of Life ◽

Uterine Wall ◽

Septate Uterus ◽

Case Presentation ◽

Surgical Interventions ◽

Unicornuate Uterus ◽

Uterine Malformation ◽

Mullerian Anomaly ◽

Future Pregnancy

Abstract Background Robert’s uterus is a rare Mullerian anomaly, which can be described as an asymmetric, septate uterus with a non-communicating hemicavity. Herein, we present the case of a misdiagnosed Robert’s uterus, resulting in an invasive and disadvantageous surgery. Case presentation A 16-year-old woman was referred to our department because of dysmenorrhea and suspicion of uterine malformation. We misdiagnosed Robert’s uterus as a unicornuate uterus with a non-communicating rudimentary horn and hematometra, and performed laparoscopic hemi-hysterectomy. Although the patient’s symptoms were relieved, our surgical procedure left the lateral uterine wall weak, making the patient’s uterus susceptible to uterine rupture in any future pregnancy. Conclusions Although the early diagnosis of Robert’s uterus is challenging, it is important in order to determine appropriate surgical interventions and management for maintaining the quality of life and ensuring safety in future pregnancies.

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Advances and Applications of Water Phytoremediation: A Potential Biotechnological Approach for the Treatment of Heavy Metals from Contaminated Water

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105215 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5215

Author(s):

Cristián Raziel Delgado-González ◽

Alfredo Madariaga-Navarrete ◽

José Miguel Fernández-Cortés ◽

Margarita Islas-Pelcastre ◽

Goldie Oza ◽

...

Keyword(s):

Water Quality ◽

Plant Species ◽

Treatment Strategies ◽

Pollution Sources ◽

Water Contaminants ◽

Biotechnological Approach ◽

Wide Range ◽

Great Relevance ◽

Multidisciplinary Perspective ◽

Viable Method

Potable and good-quality drinking water availability is a serious global concern, since several pollution sources significantly contribute to low water quality. Amongst these pollution sources, several are releasing an array of hazardous agents into various environmental and water matrices. Unfortunately, there are not very many ecologically friendly systems available to treat the contaminated environment exclusively. Consequently, heavy metal water contamination leads to many diseases in humans, such as cardiopulmonary diseases and cytotoxicity, among others. To solve this problem, there are a plethora of emerging technologies that play an important role in defining treatment strategies. Phytoremediation, the usage of plants to remove contaminants, is a technology that has been widely used to remediate pollution in soils, with particular reference to toxic elements. Thus, hydroponic systems coupled with bioremediation for the removal of water contaminants have shown great relevance. In this review, we addressed several studies that support the development of phytoremediation systems in water. We cover the importance of applied science and environmental engineering to generate sustainable strategies to improve water quality. In this context, the phytoremediation capabilities of different plant species and possible obstacles that phytoremediation systems may encounter are discussed with suitable examples by comparing different mechanistic processes. According to the presented data, there are a wide range of plant species with water phytoremediation potential that need to be studied from a multidisciplinary perspective to make water phytoremediation a viable method.

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Prevalence of Hand Malformations in Patients With Moebius Syndrome and Their Management

Hand ◽

10.1177/1558944721994265 ◽

2021 ◽

pp. 155894472199426

Author(s):

Jose E. Telich-Tarriba ◽

David F. Navarro-Barquin ◽

Karol Verdezoto-Gaibor ◽

Alexander Cardenas-Mejia

Keyword(s):

Upper Extremity ◽

Treatment Strategies ◽

Abducens Nerve ◽

Poland Syndrome ◽

Statistical Association ◽

Moebius Syndrome ◽

Cross Sectional ◽

Reconstructive Procedures ◽

Nerve Paralysis ◽

Wide Range

Background: Moebius syndrome is a disorder characterized by facial and abducens nerve paralysis. Patients can present a wide range of upper extremity malformations. Literature focused on orthopedic manifestations of Moebius syndrome shows variability in the prevalence and clinical presentation of upper extremity anomalies. The aim of this work is to evaluate the prevalence of upper extremity malformations in patients with Moebius syndrome, clarify its various clinical presentations, and present treatment strategies for their management. Methods: This is a retrospective, cross-sectional study including patients with Moebius syndrome and upper extremity malformations between 2012 and 2019. Data include demographic characteristics, Moebius syndrome subtype, type of malformation, affected extremity, and surgical procedures underwent. Quantitative data were recorded as mean (standard deviation [SD]), and qualitative data were expressed in terms of totals and percentages. Statistical association between Moebius syndrome subtype and development of upper extremity anomalies was evaluated using binary logistic regression. Results: Twenty-five out of 153 patients (16.3%) presented upper extremity malformations (48% male). Mean age of presentation was 9.08 ± 9.43 years. Sixty-eight percent of the malformations were unilateral. The most common presentations included Poland syndrome and simple syndactyly with 8 cases each (32%), followed by 5 cases of brachysyndactyly (20%), 3 cases of amniotic band syndrome (12%), and 1 case of cleft hand (4%). No statistical association was found between Moebius syndrome subtype and odds ratio for development of upper extremity anomalies. Thirteen patients (52%) underwent reconstructive procedures. Conclusion: Poland syndrome and syndactyly are the most common anomalies in patients with Moebius syndrome. Patients may present with a wide range of hand malformations, each patient should be carefully evaluated in order to determine whether surgical treatment is needed and to optimize rehabilitation protocols.

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Infectious and inflammatory complications after endoscopic hernioplasty in patients with postoperative ventral hernias: features of diagnosis and treatment strategies

Vestnik of Russian military medical Academy ◽

10.17816/brmma75485 ◽

2021 ◽

Vol 23 (3) ◽

pp. 157-164

Author(s):

Valery V. Semenov ◽

Sofya А. Prudyeva ◽

Alexander A. Kurygin

Keyword(s):

Negative Pressure ◽

Negative Pressure Wound Therapy ◽

Treatment Strategies ◽

Repeated Administration ◽

Early Postoperative Period ◽

Diagnosis And Treatment ◽

Wound Therapy ◽

Active Growth ◽

Surgical Interventions ◽

Ventral Hernias

An algorithm for the diagnosis and treatment of infectious and inflammatory complications after endovideosurgical hernioplasty in patients with postoperative ventral hernias using traditional and minimally invasive methods of therapy was proposed. The study was based on the treatment results of 177 patients who underwent endovideosurgery for postoperative ventral hernias. Despite the perioperative antibiotic prophylaxis according to the accepted at the S.M. Kirov Military Medical Academy, according to the protocol scheme (first-generation cephalosporin at a dose of 1 g once parenterally 30 min before the operation, followed by repeated administration in case of operation duration of 3 h), course of the early postoperative period on days 35 in 8 (4,5%) patients after endovideosurgical hernioplasty was complicated by suppuration in the intervention area. When analyzing the causes of infectious and inflammatory complications, in both the main and control groups of observations, all suppuration in the area of surgical interventions was diagnosed in patients with metabolic syndrome (stages IIIII obesity and type 2 diabetes mellitus). The use of the negative pressure wound therapy resulted in wound cleansing for 4.1 2.5 days (p 0.05) and was comparable with the traditional method of treatment, but more active growth of granulation tissue prevailed in the wound, which contributed to its accelerated healing. The negative pressure wound therapy is effective in the systemic infectious and inflammatory process, especially after prosthetic hernioplasty of large W3-postoperative hernias. Drainage of abscesses under ultrasound navigation is possible with small (S 10 cm2) delimited purulent processes in the area of the polypropylene implant with the preservation of the latter.

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How to Perfuse: Concepts of Cerebral Protection during Arch Replacement

BioMed Research International ◽

10.1155/2015/981813 ◽

2015 ◽

Vol 2015 ◽

pp. 1-10 ◽

Cited By ~ 1

Author(s):

Andreas Habertheuer ◽

Dominik Wiedemann ◽

Alfred Kocher ◽

Guenther Laufer ◽

Prashanth Vallabhajosyula

Keyword(s):

Cerebral Perfusion ◽

Circulatory Arrest ◽

Cerebral Protection ◽

Surgical Approaches ◽

Optimal Method ◽

Surgical Interventions ◽

Emergent Strategy ◽

Thoracic Aneurysms ◽

Arch Reconstruction ◽

Aortic Pathologies

Arch surgery remains undoubtedly among the most technically and strategically challenging endeavors in cardiovascular surgery. Surgical interventions of thoracic aneurysms involving the aortic arch require complete circulatory arrest in deep hypothermia (DHCA) or elaborate cerebral perfusion strategies with varying degrees of hypothermia to achieve satisfactory protection of the brain from ischemic insults, that is, unilateral/bilateral antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP). Despite sophisticated and increasingly individualized surgical approaches for complex aortic pathologies, there remains a lack of consensus regarding the optimal method of cerebral protection and circulatory management during the time of arch exclusion. Many recent studies argue in favor of ACP with various degrees of hypothermic arrest during arch reconstruction and its advantages have been widely demonstrated. In fact ACP with more moderate degrees of hypothermia represents a paradigm shift in the cardiac surgery community and is widely adopted as an emergent strategy; however, many centers continue to report good results using other perfusion strategies. Amidst this important discussion we review currently available surgical strategies of cerebral protection management and compare the results of recent European multicenter and single-center data.

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Tailoring surgical interventions to treat obstructive sleep apnoea: one size does not fit all

Breathe ◽

10.1183/20734735.020118 ◽

2018 ◽

Vol 14 (3) ◽

pp. e84-e93 ◽

Cited By ~ 4

Author(s):

Priya Sethukumar ◽

Bhik Kotecha

Keyword(s):

Obstructive Sleep Apnoea ◽

Evidence Base ◽

Sleep Apnoea ◽

Good Effect ◽

Surgical Approaches ◽

List Type ◽

Drug Induced ◽

Surgical Interventions ◽

Obstructive Sleep ◽

New Treatments

While continuous positive airway pressure (CPAP) remains the gold standard treatment of choice in patients with moderate or severe obstructive sleep apnoea (OSA), surgery has been established as a means to improve compliance and facilitate the use of CPAP, both of which are potential pitfalls in the efficacy of this treatment modality. In a minority of cases, with obvious oropharyngeal anatomical obstruction, corrective surgery may completely alleviate the need for CPAP treatment. In this review, we summarise clinical assessment, surgical options, discuss potential new treatments, and outline the importance of investigating and addressing the multiple anatomical levels that can contribute to OSA. Research into effectiveness of these procedures is rapidly accumulating, and surgery can be an effective treatment. However, given the myriad of options available and multiple levels of anatomical pathology that can present, it is imperative that correctly selected patients are matched with the most appropriate treatment for the best outcomes.Key pointsOSA is an increasingly prevalent disorder which has significant systemic effects if left untreated.Anatomical abnormalities can be corrected surgically to good effect with a growing and robust evidence base.Drug-induced sleep endoscopy is a key tool in the otolaryngologist's armamentarium to tailor specific surgery to address specific anatomical concerns, and to facilitate appropriate patient selection.Multilevel surgical approaches are often indicated instead of a “one size fits all” model.Educational aimsTo discuss how to assess patients presenting with OSA in clinic, from an otorhinolaryngology perspective.To discuss the indications for intervention.To provide an overview of nonsurgical interventions for treating OSA, with evidence.To discuss the different surgical modalities available for treatment of OSA, with evidence.

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The enigmatic immunoglobulin G4-related disease and its varied cardiovascular manifestations

Heart ◽

10.1136/heartjnl-2020-318041 ◽

2021 ◽

pp. heartjnl-2020-318041

Author(s):

Aamina Shakir ◽

Yurong Wheeler ◽

Guha Krishnaswamy

Keyword(s):

Aortic Aneurysm ◽

Cardiovascular System ◽

Surgical Approaches ◽

Pulmonary Vascular Disease ◽

Obliterative Phlebitis ◽

Immunoglobulin G4 ◽

Surgical Interventions ◽

Related Disease ◽

Disease Modifying ◽

Disease Modifying Agents

Immunoglobulin G4-related disease (IgG4-RD) is a systemic fibroinflammatory disease characterised by multiorgan lymphoplasmacytic infiltration, obliterative phlebitis and storiform fibrosis. It can be associated with cardiovascular pathology. The objective of this narrative review is to summarise the published literature on cardiovascular manifestations of IgG4-RD and to provide a basis for diagnosis and management of the condition by the practising cardiologist.We propose the following categorisations of cardiovascular IgG4-RD: aortitis, medium-vessel arteritis, pulmonary vascular disease, phlebitis, valvulopathy, pericarditis, myocardial disease and antineutrophilic cytoplasmic antibody-associated vasculitis. We also review herein developments in radiological diagnosis and reported medical and surgical therapies. Cardiovascular lesions frequently require procedural and/or surgical interventions, such as aortic aneurysm repair and valve replacement. IgG4-RD of the cardiovascular system results in serious complications that can be missed if not evaluated aggressively. These are likely underdiagnosed, as clinical presentations frequently mimic cardiovascular disease due to more common aetiologies (myocardial infarction, abdominal aortic aneurysm and so on). While systemic corticosteroids are the mainstay of IgG4-RD treatment, biological and disease-modifying agents are becoming more widely used. Cardiologists should be aware of cardiovascular IgG4-RD as a differential diagnosis, and understand the roles of corticosteroids, disease-modifying agents and biologicals, as well as their integration with surgical approaches. There are several knowledge gaps, including diagnosis, risk factors, pathogenesis and appropriate management in Ig4-RD of the cardiovascular system. Areas lacking well-conducted randomized trials include safety of steroids in the setting of vascular aneurysms and the role of disease-modifying drugs and biological agents in patients with established cardiovascular complications of this multifaceted enigmatic disease.

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Anatomic Sphenoid Cell Variants: Introduction of the Retrosphenoid Cell and Relevance in the Presentation and Management of Sinus Disease

American Journal of Rhinology and Allergy ◽

10.1177/1945892419881837 ◽

2019 ◽

Vol 34 (2) ◽

pp. 170-175

Author(s):

Anali Dadgostar ◽

Aneela Hashmi ◽

Judy Fan ◽

Amin R. Javer

Keyword(s):

Sphenoid Sinus ◽

Internal Carotid ◽

Treatment Strategies ◽

Ct Scans ◽

Preoperative Imaging ◽

Surgical Approaches ◽

Anatomic Variations ◽

Sinus Disease ◽

Anatomic Variants ◽

Air Cells

Background Despite the well-appreciated variability in sphenoid sinus anatomy, there are no documented cases of retrosphenoid cells in the literature to date. Objective This study defines and determines the prevalence of retrosphenoid cells as identified on computed tomography (CT) imaging and intraoperative endoscopy and reviews the prevalence of other related anatomical variants of the sphenoid sinus. Methods Retrospective study of 300 random noncontrast sinus CT scans of patients with chronic rhinosinusitis presenting to a tertiary rhinology center. All identifiable anatomic variations and any presence of retrosphenoid cells and their pneumatization patterns were recorded. The prevalence of various anatomic variations of the sphenoid sinus was also calculated. Results A total of 300 sinus CT scans were included in the study. Protrusion of both the internal carotid artery (42.6%) and optic nerve (19.7%) into the sinus was more prevalent than the dehiscence of either one. A retrosphenoid cell was identified in 2% of CT scans. Other anatomic variants were less prevalent. Conclusion Meticulous review of preoperative imaging is key in identifying rare and complex sphenoid cell variations in planning surgical approaches and potential treatment strategies for the unusually pneumatized sphenoid air cells. Various manifestations of sinus disease can be localized to this area, and suspicion of a retrosphenoid cell should be raised in patients presenting with recalcitrant headache.

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