postoperative course
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Author(s):  
Salvatore Paiella ◽  
Matteo De Pastena ◽  
Alessandro Esposito ◽  
Erica Secchettin ◽  
Luca Casetti ◽  
...  

Abstract Background To compare the postoperative course of elderly patients (≥70 years) submitted to minimally invasive (MIDP) versus open distal pancreatectomy (ODP) and to evaluate if the modified Frailty Index (mFI) predicts the surgical course of elderly patients submitted to DP. Methods Data of patients aged ≥70 who underwent DP at a single institution between March 2011 and December 2019 were retrospectively retrieved. A 2:1 propensity score matching (PSM) was used to correct for differences in baseline characteristics. Then, postoperative complications were compared between the two groups (MIDP vs. ODP). Additionally, the entire cohort of DP elderly patients was stratified according to the mFI into three groups: non-frail (mFI = 0), mildly frail (mFI = 1/2), or severely frail (mFI = 3) and then compared. Results A total of 204 patients were analyzed. After PSM, 40 MIDP and 80 ODP patients were identified. The complications considered stratified homogenously between the two groups, with no statistically significant differences. The severity of the postoperative course increased as mFI did among the three groups regarding any complication (p = 0.022), abdominal collection (p = 0.014), pulmonary complication (p = 0.001), postoperative confusion (p = 0.047), Clavien-Dindo severity ≥3 events (p = 0.036), and length of stay (p = 0.018). Conclusions Elderly patients can be safely submitted to MIDP. The mFI identifies frail elderly patients more prone to develop surgical and non-surgical complications after DP.


Author(s):  
Ciara E. Hutchison ◽  
Virginia O. Shaffer ◽  
Terrah J. Paul Olson ◽  
Srinivas Emani ◽  
Joe Sharma ◽  
...  

2021 ◽  
Vol 23 (6) ◽  
pp. 433-443
Author(s):  
Wojciech Koniec

Most trochanteric fractures of the femur are classified as low-energy fractures as they are seen in people with decreased mechanical properties of bone tissue. The treatment is assumed to provide biomechanical fixation with the possibility of dynamization between bony fragments to stimulate the biological processes of bone union. The aim of the study was to analyze a complication presenting as migration of the cervical screw of an intra­medullary nail towards the hip joint acetabulum and present the therapeutic management of this complication. The case report concerned a 74-year-old patient with an AO/OTA type 31 A2.2 fracture of the trochanteric massif of the right femur treated with the Gamma3 intramedullary nail. An assessment of changes over time of the radiological appearances on A-P images after the surgery showed migration of the cervical screw towards the acetabulum and displacement of the major trochanter fracture. Extensive destruction of the acetabular fossa made biologic restorative treatment impossible. A total hip joint prosthesis with a modular stem and MDM articulation was implan­ted and the trochanter was fixed with a "hook" plate with a "cable system". The postoperative course was uneventful. Failure to perform axial radiographs in the preoperative and postoperative period made it impossible to objectively determine the type of fracture and the quality of screw insertion into the femoral neck, and assessment limited to A-P images turned out to be deceptive. The wandering of the screw towards the acetabulum led to extensive destruction of the acetabular fossa. The decision to stop biological treatment, which, if properly performed, stimulates bone union, and perform the mechanical procedure of endoprosthesoplasty was fully prognostically justified. The early and late postoperative course was not complicated.


2021 ◽  
Vol 27 (2) ◽  
pp. 114-117
Author(s):  
In Cho

The spleen is an organ located in the upper left portion of the abdomen. Wandering spleen is defined as the location of the spleen is the shift to other parts of the abdomen rather than the left upper quadrant. Wandering spleen is a rare clinical condition and can lead to hilar torsion and subsequent infarction requiring emergency surgery. The author presents a case of torsion of a wandering spleen in a 34-year-old female presenting with abdominal pain. The patients underwent emergent laparoscopic splenectomy. She had an uncomplicated postoperative course and recovered well.


2021 ◽  

A 58-year-old man came to our hospital with numbness of the left arm, fatigue, and fever. A huge solid mass with necrotic changes located in the left upper lobe was noted on the computed tomography scan. The tumor directly invaded the extrathoracic wall, the left main pulmonary artery, and the superior segment of the lower lobe. To avoid pneumonectomy, a combination of an extended double sleeve lobectomy and thoracic wall resection was performed. The postoperative course was uneventful. The patient has survived without any recurrence for 6 months postoperatively.


2021 ◽  
pp. 39-43
Author(s):  
O. V. Galimov ◽  
V. O. Khanov ◽  
R. O. Venediktov ◽  
D. M. Rudakov

Aim of the study is to present a clinical case of epiploic appendagitis as a rare acute abdominal pathology.Methods. This case demonstrates the prevalence of acute appendicitis symptoms in the clinical picture of the disease. During the operation was identified a necrotic changes in epiploic appendage of the ileocecal region with presence of secondary appendicitis.Result. The histological examination of the removed epiploic appendagitis gives a picture of tissues infarct with adipose necrosis and the presence of simple catarrhal appendicitis. It was received a normal postoperative course and a patient was discharged from hospital on the 8th day.Conclusion Epiploic appendagitis, due to the absence of pathognomonic symptoms, is an extremely difficult pathology for diagnosis. To establish the correct diagnosis, it is necessary to take into account a complex of data, including clinical and anamnestic, laboratory and instrumental diagnostic methods.


2021 ◽  
pp. 000313482110562
Author(s):  
Parvez M. U. Din Dar ◽  
Supreet Kaur ◽  
Vivek Kumar ◽  
Soumya Ghoshal ◽  
Junaid Alam ◽  
...  

Isolated innominate artery injury is very rare and accounts for less than 3% of recognized arterial injuries. Surgical exploration of the artery, especially at the origin of the artery from the arch of the aorta, is surgically challenging. Due to its rarity, any 1 surgeon’s experience in dealing with innominate artery injury is bound to be limited. We report 2 cases of innominate artery injury post-blunt chest trauma. Both patients underwent thoracotomy and innominate artery Dacron graft repair and both had an uneventful postoperative course.


2021 ◽  
Vol 36 (1) ◽  
Author(s):  
Simone Ulivieri ◽  
Davide Luglietto ◽  
Matteo Ulivieri ◽  
Antonio Giorgio

Abstract Background Cavernous hemangiomas are benign vascular malformations, probably representing the most common intraorbital and intraconal tumors in the adult population. Case presentation We report the case of a 49-year-old female with two intra-conal lesions. We performed a total resection using Ulivieri's extended lateral approach. The postoperative course was uneventful and the patient was discharged three days after surgery. Conclusions To the best of our knowledge, we report here the first case in the literature of a double intra-conal lesion.


Medicina ◽  
2021 ◽  
Vol 57 (12) ◽  
pp. 1302
Author(s):  
Chi-Hao Liao ◽  
Chu-Chun Liang ◽  
Tzong-Shiun Li ◽  
Ying-Chieh Liao ◽  
Ying-Cheng Chen

Herein, we describe the rare anatomy of an abnormal shunt from the left atrium to the coronary sinus, which ruptured during a percutaneous ablation for atrial fibrillation. The iatrogenic lesion was successfully repaired after emergent extracorporeal membrane oxygenation set up followed by surgical exploration. The patient’s postoperative course was uneventful, and she was regularly followed up without any complications.


Author(s):  
Hideaki Ono ◽  
Seiei Torazawa ◽  
Takeo Tanishima ◽  
Akira Tamura ◽  
Isamu Saito

AbstractWe present a 52-year-old male case of right trigeminal neurinoma at lateral cavernous sinus. The tumor was 40 mm in maximum diameter, obviously compressed temporal lobe and encased internal carotid artery. Extradural middle fossa and transcavernous approach was applied and the tumor was resected via Parkinson's triangle. This approach enabled safe and effective tumor resection, sufficient visualization, and operative field (Figs. 1 and 2). We performed dissection of the tumor from trigeminal nerve, tentorium, and middle fossa and resect the tumor around internal carotid artery sufficiently. Postoperative course was good without any new neurological deficit. This surgical method is considered safe and effective for the resection of the tumor at lateral cavernous sinus.The link to the video can be found at: https://youtu.be/2ekuILIgEuo.


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