Utility of Rescue Flap in the Reconstruction of Skull Base Defects Following Transnasal Endoscopic Excision of Sellar/Supra-sellar Lesions

Background: Naso-septal Rescue Flap(NSRF) technique involves the preservation of unilateral posterior septal artery pedicle without harvesting full Naso-Septal Flap (NSF). This enables usage of NSF flap when needed while allowing enough exposure to resect tumor completely. This also provides with added advantage of tailoring flap according to preference to cover the defect post tumor removal. This technique involves partial harvestation of only the most superior and posterior aspect of the flap to protect its pedicle, providing better instrumentation for the sphenoid sinus. At the end of the procedure, if there is unexpected CSF rhinorrhea or resultant bony defect is large then Nasoseptal flap is harvested from the rescue flap. As very few studies have been conducted for rescue flap technique in anterior skull base defect reconstruction following excision of sellar/supra-sellar lesions, the technique requires further validation, hence the present study is being undertaken. Objectives: To study the post-operative outcome of Nasal Septal Rescue Flap (NSRF) in terms of donor site morbidity and CSF leak. To study the post-operative outcome of posterior nasoseptal flap in terms of donor site morbidity and CSF leak. Methodology: A cross-sectional study will be conducted at Department of E.N.T, AVBRH, Sawangi Wardha, during a period of August 2020 to August 2021. A sample size of 20 within 18 -70 years of age with sellar/supra-sellar lesions will be included for the research. Results: The observations obtained will be analyzed statistically and will be discussed in light of literature available. Conclusion: This study will help in formulating the guidelines for the NSF harvest with the goal of preventing unnecessary harvest, thereby decreasing peri-operative and post-operative disadvantages as well as preserving the flap for reconstruction in patients requiring revision surgery.

Impact of the nutritional status of children with congenital heart diseases on the early post-operative outcome

Background Children with congenital heart disease (CHD) frequently become malnourished due to many factors including hypermetabolic state, inadequate caloric intake, malabsorption, and fluid restriction as part of the hemodynamic intervention. The abnormal nutritional status may affect early outcome after pediatric cardiac surgery; we aim to prove the importance of nutritional assessment and patient nutritional preparation before performing pediatric cardiac surgery. Results We conducted a prospective observational cohort study from March 2013 till January 2015. All children from birth until 14 years of age admitted to the pediatric cardiac intensive care unit (PCICU) after cardiac surgery. Nutritional status was assessed preoperatively and prognostic nutritional index (PNI) was calculated. All post-operative outcome parameters, PCICU and hospital length of stay (LOS), ventilation time, the rate of infection, and ICU mortality were recorded. Two hundred fifty-nine children were evaluated. At admission, 179 patients (69%) had intake less than 50% of the recommended daily allowance (RDA) of calories intake. There was a statistically significant relationship between pre-admission RDA and the infection rate (P value 0.018). Severely malnourished patients had significantly longer ICU length of stay (LOS) (P value = 0.049). Similarly, weight and height percentiles have a significant effect on ICU LOS (P value 0.009 and 0.045) respectively. There was a significant relation between PNI ≥ 55 and the ICU LOS (P < 0.05), and ventilation time (P = 0.036). Delay in feeding postoperatively was associated with a higher risk of infection (P = 0.005), and higher mortality (P = 0.03). Conclusions Children with CHD were significantly malnourished preoperatively and had further weight loss postoperatively. Preoperative nutritional status and delayed postoperative enteral feeding were associated with a higher infection rate and mortality.

Clinicopathologic Factors Related to Post-Operative Outcome of Pituitary Adenoma: a Meta-Analysis

Purpose: About 30% to 40% of patients with pituitary adenoma require surgery. About 25% to 40% of those who have had surgery will have an aggressive outcome. The purpose of this study was to see if certain clinicopathologic factors such as size, type/subtype, invasiveness, proliferative (ki-67, mitotic rate, and p53), and grade influenced the aggressiveness of postoperative pituitary adenomas. Methods: The factors mentioned in the research objectives were examined as independent variables. Ten studies out of 736 were chosen. The 10 studies had 2727 participants and 632 cases. The monitoring lasted 3-11 years. The studies' quality ranged from fair to excellent. Results: The results of the meta-analysis were: size ≥10mm OR 1,79 (1,29-2,48), corticotroph OR 1,91 (1,41-2,58), invasive OR 3,67 (1,95-6,90), proliferative OR 4,78(3,61-6,32), Ki-67 ≥ 3% OR 4,13 (2,94-5,81), mitotic rate > 2 OR 3,91 (2,74-5,57), p53 positive OR 1,92 (1,28-2,90), and grade 2b OR 4,56 (3,0-6,91). Conclusions: Size, type/subtype, invasiveness, proliferative (ki-67, mitotic rate, and p53), and grade of postoperative pituitary adenoma influenced the postoperative aggressiveness outcome.

Necrotizing descending mediastinitis by Acinetobacter Baumannii in an out-patient: a case report

Background Complicated cervico-facial cellulitis is an infectious disease which can have fatal prognosis. Necrotizing descending mediastinitis is a rare and fatal complication of cervico-thoracic cellulitis. This is the case of necrotizing descending mediastinitis complicating by a multi-resistant Acinetobacter Baumannii in a 27-year-old female, with early management of hemodynamic, respiratory and surgical emergencies, and very careful post-operative care, resulting in very satisfying outcome. Case presentation The patient presented was first treated with broad spectrum antibiotics for Ludwig’s angina for 10 days, then presented with a swelling of sub-mandibular, sub-mental, and cervical regions, a mild respiratory distress, with clinical enhancement of dyspnea in proclive position, tachycardia of 100 beats per minute, and arterial blood pressure of 10/5. Clinical exam showed a tight trismus, with oral opening inferior to 1 cm, no inflammatory signs in facial and cervical swollen areas, and a saturation of 95% in proclive position. Auscultation suspected a pericardial effusion. CT scan with and without injected contrast medium showed diffuse abscesses of sub-mental, sub-mandibular, retro-pharyngeal, para-pharyngeal regions, along with mediastinal abscesses and pericardial effusion. Trans-thoracic ultrasound showed 2 cm pericardial effusion, preserved function of myocardium, and without signs of tamponade. The diagnosis of necrotizing descending mediastinitis with pericardial effusion was established. The patient underwent a course of wide spectrum antibiotic therapy, low doses of cathecholamine, and a surgical drainage through cervical approach of all implicated zones. The surgical dissection was thorough and difficult due to diffuse fibrosis found in tissues of cervical regions. Two hundred milliliters of pus was evacuated, with a placement of surgical drains and Delbet blades. Bacteriological exam found an Acinetobacter Baumannii sensitive to colistin only. The post-operative outcome showed clinical and biological enhancement; however, a residual mediastinal collection appeared in control CT scan after 48 h, which indicated a surgical revision through mediastinoscopy. The post-operative outcome was satisfying with stabilized clinical, biological, and radiological aspects. Conclusions Necrotizing descending mediastinitis is an infectious disease correlated with a very elevated mortality rate, and management is based on airway control, antibiotic therapy, and surgical treatment, as well as the post-operative intensive unit care. Early diagnosis and appropriate management enhances outcome and decreases mortality significantly.

Demographic and Surgical Profile of the Patients Underwent Minimally Invasive Cardiac Surgery in a Rural Center of Bangladesh

Background: Ever Since its inception , minimally invasive cardiac surgery is growing rapidly for better convenience and superb post operative outcome. As newer instruments, surgical technique and operative exposure are increasing more and more patients are demanding minimally invasive cardiac surgery. Objective: The study was conducted to evaluate the various pre operative and peroperative factors in minimally invasive cardiac surgery. Materials and Methods: A retrospective observational study on the patients who underwent minimally invasive cardiac surgery in the department of cardiovascular and thoracic surgery, Khwaja Yunus Ali Medical College, Sirajganj, Bangladesh from January 2016 to December 2020. Results: A total of 40 cases were operated through minimally invasive cardiac surgery in our department. Maximum number of cases was Atrial septal defect(ASD), and minimally invasive direct coronary artery bypass (MIDCAB). About 62.50% were female, majority of patients were in the range of 11-15 years. Right anterolateral thoracotomy was done in 27 cases and left anterolateral thoracotomy in 10 cases. The maximum number of cannulation done in femoral artery and femoral vein, followed by direct superior vena caval cannulation and only a single percutaneous superior venacaval cannulation through internal jugular vein. In 14 cases the length of incision was in the range of 3-4 cm and 12 cases in 4-5cm. Conclusion: Minimally invasive cardiac surgery is now becoming more demanding. As more and more centers are opening the door to newer technology, common people are also becoming conscious about its excellent post operative outcome. KYAMC Journal.2021;12(02): 71-74

Comparative Evaluation of Extrusion of Apical Debris and Irrigant from Curved Root Canals Using Three Different Ni-Ti Instruments with Conventional Needle Irrigation Methods - An In Vitro Study

BACKGROUND Extrusion of debris, bacteria, and irrigant effect the inter-appointment flare ups and post-operative outcome of the endodontic treatment. So, it is necessary to make every effort to minimize such extrusion during cleaning and shaping of the canals. The present study was done to compare and evaluate debris and irrigant extrusion from curved root canals using different Ni-Ti systems. METHODS 30 mesial roots of mandibular molars were used in this study. Crown were decoronated, working length and initial apical diameter was established. 1.5 % agar gel model was used in this study. Samples were assigned randomly into 3 groups (n = 10 teeth per group). ProTaper Next, One Shape, FANTA AF BLUE F ONE files were used according to the manufacturer’s instructions for canal instrumentation. Apically extruded debris and irrigant was computed after the biomechanical preparation and their comparative analysis for each of the instruments and experimental models was performed. RESULTS Statistically significant difference was found between the three experimental groups. (P < .05). CONCLUSIONS All the instruments produced apically extruded debris and irrigant, but least was seen with FANTA AF BLUE F ONE and maximum with One Shape among the experimental groups. KEY WORDS Apical Debris, Irrigant, NiTi Files