New Surgical Technique to Induce Reversible Liver Fibrosis by Surgical Closure of Major Duodenal Orifice in Dogs

This study was conducted to induce and evaluate reversible liver fibrosis in dogs by surgical closure of the major duodenal orifice. The study was performed on six healthy local adult dogs. Reversible liver fibrosis was surgically induced in all animals by surgical closure of major duodenal papilla using absorbable suture material for 60 days. Induced liver fibrosis was assessed by clinical, ultrasonographical examination, laboratory and histological methods. The clinical manifestation of the jaundiced dogs showed reduced food intake, pale-yellowish mucus membrane, inflammatory signs of the wound site and severe postoperative pain. Biochemically, there was significantly increased values of the aspartate aminotransferase, alkaline phosphatase, alanine aminotransferase, indirect bilirubin, direct bilirubin and total bilirubin especially during the first two days after surgery followed by a gradual decrease of these values until the end of the but still higher than normal values. Ultrasonographic examinations showed abnormal changes in the liver tissue such as an increase in both size and wall thickness of the gall bladder and mottled heterogeneous appearance of the liver during the first two weeks following the surgical induction of the hepatic fibrosis. Histological evaluation of liver samples revealed showed necrosis of hepatocytes and deposition of eosinophilic material, infiltration of inflammatory cells, recent thrombus in the hepatic vein, fatty change. Slight clinical, biochemical, ultrasonographic improvement was observed at 30th post-operative day. In conclusion, surgical induction of reversible liver fibrosis in dogs was an easy technique by surgical closure of major duodenal papilla and the results were confirmed by the clinical, ultrasonographical, laboratory and histological examination.

Spontaneous alveolo-pleural fistula in a case of COVID-19 pneumonia-challenges and solutions: case report

COVID-19 pneumonia has demonstrated a wide spectrum of clinical presentations that have yet to be completely uncovered. As this pandemic progresses, uncommon presentations of this disease have come into light. Development of broncho/alveolo-pleural fistula in a patient with COVID-19 pneumonia is a rare phenomenon with only 4 cases reported in literature till date. A 61-year-old gentleman presented to the emergency department with fever, cough, and shortness of breath. His initial chest X-ray was suggestive of a viral pneumonia that was later confirmed to be due to COVID-19. The patient was put on non-invasive ventilator support and treated with empirical antibiotics, glucocorticoids, anti-viral medications and convalescent plasma therapy. Four weeks into the patient’s hospital course, his vital parameters suddenly deteriorated with a subsequent chest X-ray showing a tension pneumothorax, for which a chest tube insertion was done. However, when the air leak did not resolve by the 3rd day, a chest computed tomography (CT) was planned which showed a spontaneous alveolo-pleural fistula (APF). The patient was managed with conservative treatment using negative suction applied to an underwater seal, had his chest tube removed 10 days later and was discharged subsequently. Spontaneous fistulisation between broncho-alveolar tree and pleura can occur rarely in patients with COVID-19 pneumonia and can be managed using underwater seal with negative suction, insertion of endobronchial valves or surgical closure, and needs to be individualised.

Clinical and Sonographic Analysis of Biometric Indicators of Cheek Thickness and Cheek Fat Body in Patients with Different Face Types

The purpose of the study was to conduct a scientific and practical analysis of clinical sonographic results of examination of patients with different face types in the process of planning the reconstruction of facial soft tissues with the involvement of buccal fat pad. Materials and methods. The study was conducted on 28 patients of different age groups (from 20 to 45 years old) with defects and deformities of the tissues of the dental system. Instrumental sonographic analysis of the thickness of the buccal fat body was performed using an ultrasound scanner GE Logiq E (USA), transducer frequency 7.5-12 MHz. The types of buccal fat pad of correct (oval) or irregular (“hourglass”) shapes were determined, as well as its localization in relation to the median axial location of the crown of the first upper molars and the average value of the buccal fat pad thickness with an accuracy of 0.01 mm. Results and discussion. The results of a clinical study of the average value of the thickness of the cheek of patients with mesofacial type of face allowed to establish that on the left its value is 8.94±0.89 mm, on the right side – 9.05±0.82 mm. In patients with brachyfacial type of face on the left the value of the thickness of the cheek is 12.33±1.63 mm, and on the right side – 12.44±1.54 mm. In patients with dolichofacial type of face on the left, the index of the thickness of the cheek reaches the value of 7.53±0.61 mm, on the right side – 8.58±1.093 mm. Statistical significance was determined in comparison with data from the group of patients with mesofacial facial type. The obtained statistical results show mediocre values of buccal fat pad thickness in patients with mesofacial type of face, which are 1.117 times larger than in dolichofacials and 0.73 times smaller than in brachyfacials, which should be taken into account when conducting sonographic studies. Differences in the quantitative values of buccal fat pad thickness, which are established by clinical and sonographic studies conducted in patients with different types of faces is recommended to take into account when choosing surgical approaches during surgical closure of tissue defects of the alveolar processes of the jaws with autologous buccal fat pad. Conclusion. Buccal fat pad has morphological advantages associated with its saturation with cell complexes that have significant degree of vascularization, pliable texture, plasticity and direct participation in the implementation of the basic functions of the maxillofacial area

Preoperative Left Ventricle End Diastolic Volume Index as a Predictor for Low Cardiac Output Syndrome After Surgical Closure of Secundum Atrial Septal Defect With Small-Sized Left Ventricle

Introduction: Low cardiac output syndrome is one of the postoperative complications that are associated with significant morbidity and mortality after surgical closure of atrial septal defect (ASD) with small-sized left ventricle (LV). This study investigated whether preoperative left ventricular end-diastolic volume index (LVEDVi) could accurately predict low cardiac output syndrome (LCOS) after surgical closure of ASD with small-sized LV.Method: This retrospective cohort study involved adult ASD patients with small-sized LV from January 2018 to December 2019 in National Cardiovascular Center Harapan Kita. Preoperative MRI data to assess the left and right ventricle volume were collected. A bivariate analysis using independent Student's t-test was done. Diagnostic test using receiver operating characteristic (ROC) curve was also done to obtain the area under the curve (AUC) value. The best cutoff point was determined by Youden's index.Result: Fifty-seven subjects were involved in this study [age (mean ± SD) 32.56 ± 13.15 years; weight (mean ± SD) 48.82 ± 12.15 kg]. Subjects who had post-operative LCOS (n = 30) have significantly lower LVEDVi (45.0 ± 7.42 ml/m2 vs. 64.15 ± 13.37 ml/m2; p < 0.001), LVEDV (64.6 ± 16.0 ml vs. 85.9 ± 20.7 ml; p < 0.001), LVSV (38.97 ± 11.5 ml vs. 53.13 ± 7.5 ml; p < 0.001), and LVSVi (27.28 ± 8.55 ml/m2 vs. 37.42 ± 5.35 ml/m2; p < 0.001) compared to subjects who did not have post-operative LCOS (n = 27). ROC analysis showed that the best AUC was found on LVEDVi (AUC 95.3%; 95% confidence interval: 90.6–100%). The best cutoff value for LVEDVi to predict the occurrence of LCOS after surgical closure of ASD was 53.3 ml/m2 with a sensitivity of 86.7% and a specificity of 85.2%.Conclusion: This study showed that preoperative LVEDVi could predict LCOS after surgical closure of ASD with small-sized LV with a well-defined cutoff. The best cutoff value of LVEDVi to predict the occurrence of LCOS after surgical ASD closure was 53.5 ml/m2.

Vitrectomy With Peeling the Internal Limiting Membrane for the Treatment of Macular Hole Following Ruptured Retinal Arterial Macroaneurysm: A Case Report

Background: This study aimed to report a case of vitrectomy with peeling the internal limiting membrane for the treatment of macular hole (MH) following ruptured retinal arterial macroaneurysm (RAMA).Case Presentation: A 65-year-old woman noticed a sudden decrease in vision in the left eye. She had no other ocular problems apart from a mild cataract in both eyes before. Her best-corrected visual acuity (BCVA) was 20/33 in the right eye, and 6/100 in the left eye. Fluorescein angiography (FFA) showed a retinal arterial macroaneurysm with telangiectatic retinal vascular changes in the inferior temporal macular region. Optical coherence tomography (OCT) examination demonstrated the presence of subretinal hemorrhage extending into the foveal area and incomplete posterior vitreous detachment. Because of the presence of submacular hemorrhage, some medicine was administrated and the patient was followed up. Then, 5 months later, the hemorrhage was absorbed. OCT examination exhibited a full-thickness MH with a macular epiretinal membrane. The size of the MH was 722 μm in diameter. She was then given a standard three-port pars plana vitrectomy (PPV), along with peeling of the internal limiting membrane (ILM) and filling the vitreous cavity with air. Anatomic closure of the MH was achieved after 4 weeks of the surgery by the examination of OCT. The BCVA was improved to 15/100.Conclusions: This case expanded our knowledge of the association of MH secondary to ruptured RAMA. We reported a case with successful surgical closure of the MH and improvement of BCVA.

SCENARIOS OF THE COURSE OF BRONCHOPULMONARY DYSPLASIA IN PREMATURE INFANTS WITH PATENT DUCTUS ARTERIOSUS IN FOLLOW-UP TO 3 YEARS

Summary. Bronchopulmonary dysplasia (BPD) is one of the most common long-term complications associated with preterm birth. The severity of BPD is associated with immaturity of a child's body, perinatal infections, and patent ductus arteriosus (PDA).The aim of the study was to identify the features of BPD in the 1st year of life of a child and in the follow- up to 3 years, depending on the condition of the ductus arteriosus.Material and methods. The observations of 146 premature infants with BPD, who were divided into groups depending on the state of the ductus arteriosus, were analyzed: Group I consisted of 58 children with BPD whose ductus arteriosus closed spontaneously in the early neonatal period; II group – 60 children with hemodynamically insignificant PDA, which remained open for 6-12 months; III group – 28 children with hemodynamically significant (HS) PDA, which required surgical closure during the stay of a child in the perinatal center. Results. There were significantly more cases of severe BPD among children of group II compared to group I: 23.3 vs. 8.6 % (p <0.01) and, accordingly, fewer cases of moderate course: 41.7 vs. 58.6 % (p <0.05) at the stage of children treatment in the perinatal center. At the age of 3 years, there were significantly more healthy children who underwent BPD in group I compared to group III: 62.5 vs. 25.9 % (p <0.01), and severe course was significantly more common in both groups II and III compared to group I: 6.8 and 7.4 % vs. 0 % (p <0.01). No significant differences in the severity of BPD at the age of 2-3 months and in the follow-up to 1 year from the date of surgical closure of HS PDA were detected. Conclusions. Sexual dimorphism was found, namely the prevalence of males among preterm infants with delayed closure of the ductus arteriosus. The presence of hemodynamic disorders connected with PDA is associated with a more severe course of BPD at the age of 3 years compared to children whose ductus arteriosus closed on its own in the early neonatal period. At the average term of surgical closure of PDA 21.5 ± 1.6 days of life, significant differences in the severity of BPD from the term of surgical closure of PDA weren`t detected.

Surgical Management of Lymphatic Leakage

Lymphatics are found in almost every organ in the body, and they produce a variety of waste products that must be eliminated. lymphatic leakage is a typical occurrence. It can cause immunodeficiency as well as nutritional issues. Furthermore, it has a significant morbidity and death rate, depending on the existence of an underlying illness. Lymphatic leakage can be congenital, traumatic, or cancerous, and occurs when the lymphatic system is disrupted. It might take the following forms: Chylothorax, Lymphatic Fistula, Chylous Ascites. treatment of lymph leaks includes: reduction of lymphatic flow through physiological or pharmacological manipulation; replacement of fluid and electrolytes, as well as interventional procedure and/or direct surgical closure. In this review we’ll be discussing lymphatic system anatomy, its leakage and its management.

Anatomical Classification and Posttreatment Remodeling Characteristics to Guide Management and Follow-Up of Neonates and Infants With Coronary Artery Fistula: A Multicenter Study From the Coronary Artery Fistula Registry

Background: Coronary artery fistulas (CAFs) presenting in infancy are rare, and data regarding postclosure sequelae and follow-up are limited. Methods: A retrospective review of all the neonates and infants (<1 year) was conducted from the CAF registry for CAF treatment. The CAF type (proximal or distal), size, treatment method, and follow-up angiography were reviewed to assess outcomes and coronary remodeling. Results: Forty-eight patients were included from 20 centers. Of these, 30 were proximal and 18 had distal CAF; 39 were large, 7 medium, and 2 had small CAF. The median age and weight was 0.16 years (0.01–1) and 4.2 kg (1.7–10.6). Heart failure was noted in 28 of 48 (58%) patients. Transcatheter closure was performed in 24, surgical closure in 18, and 6 were observed medically. Procedural success was 92% and 94 % for transcatheter closure and surgical closure, respectively. Follow-up data were obtained in 34 of 48 (70%) at a median of 2.9 (0.1–18) years. Angiography to assess remodeling was available in 20 of 48 (41%). I. Optimal remodeling (n=10, 7 proximal and 3 distal CAF). II. Suboptimal remodeling (n=7) included (A) symptomatic coronary thrombosis (n=2, distal CAF), (B) asymptomatic coronary thrombosis (n=3, 1 proximal and 2 distal CAF), and (C) partial thrombosis with residual cul-de-sac (n=1, proximal CAF) and vessel irregularity with stenosis (n=1, distal CAF). Finally, (III) persistent coronary artery dilation (n=4). Antiplatelets and anticoagulation were used in 31 and 7 patients post-closure, respectively. Overall, 7 of 10 (70%) with proximal CAF had optimal remodeling, but 5 of 11 (45%) with distal CAF had suboptimal remodeling. Only 1 of 7 patients with suboptimal remodeling were on anticoagulation. Conclusions: Neonates/infants with hemodynamically significant CAF can be treated by transcatheter or surgical closure with excellent procedural success. Patients with distal CAF are at higher risk for suboptimal remodeling. Postclosure anticoagulation and follow-up coronary anatomic evaluation are warranted.