Successful Treatment of Rhabdomyolysis-Associated Acute Kidney Injury with Haemoadsorption and Continuous Renal Replacement Therapy

We report two children with rhabdomyolysis-associated acute kidney injury who were successfully treated with a haemoadsorption column CytoSorb® in addition to continuous renal replacement therapy (CRRT). A 14-year-old girl with multiorgan failure requiring extracorporeal membrane oxygenation developed rhabdomyolysis due to reperfusion injury. Her creatine kinase (CK) and lactate levels continued to escalate despite high-dose CRRT. A haemoadsorption column was therefore added post-CRRT filter, which brought down the CK level from 264,500 IU/L to 97,436 IU/L after 8 hours of therapy. Another 4-year-old boy with epilepsy and cerebral palsy who was admitted for gastroenteritis with dehydration developed acute kidney injury and rhabdomyolysis with a peak CK level of 946,060 IU/L. He was initially treated with CRRT for 40 hours, which reduced his CK level to 147,580 IU/L. Two sessions of haemoadsorption were then performed in addition to the CRRT, which further lowered his CK level to 32,306 IU/L in 48 hours. Both patients demonstrated enhanced reduction of CK levels when the haemoadsorption column was used in addition to the CRRT, and no specific complication related to the haemoadsorption therapy was reported. Our cases showed that haemoadsorption can be considered as an adjunctive therapy for children with severe rhabdomyolysis-associated acute kidney injury.

Lateral ventricular stenting as a method of preventing trapped temporal horn following resection of lateral ventricular trigone tumor. Case report and review of literature

Resection of lateral ventricular trigone tumor can lead the development of specific complication like a trapped temporal horn. Secretion of cerebrospinal fluid from the choroid plexus in closed space leads to progressive enlargement of the temporal horn. The enlargement of the temporal horn leads to lateral transtentorial herniation with brain steam compression, which manifested by disorders of consciousness, hemiparesis, memory impairment and loss of visual fields. The proposed stenting technique allows to prevent the development of extended temporal horn and excludes the requirement its treatment in the long-term period. Over the past year, intraoperative stenting have been performed in five cases. In the long-term period none of the patients have had trapped temporal horn. There was no case of stent dysfunction.The article presents a clinical case of ventricular stenting following resection of lateral ventricular trigone tumor.

420 Accuracy of Documenting Complications When Consenting Patients for Laparoscopic Appendectomy

Background Appropriately performed informed consent acts as a shield against false complaints or claims of malpractice against the doctors. Laparoscopic Appendectomy accounts for a significant portion of general surgical workload hence shows a difference in the patient consenting. Method A proforma was devised which included recognised complications of Laparoscopic Appendectomy and grade of the consenting medical professional. The proforma containing 10 standard complications was then cross-referenced with the consent forms of 38 patients and the documented risks in each form was noted. Result The result showed a wide variation in the documentation of complications based on the grades of the medical professional. Out of 38 consent forms, 32/38 ( 84.21 %) were completed by Junior Grade Doctors out of which 15/32 by FY2 and 17/32 by Core Surgical Trainees (CST) and 6/38 (15.78 %) by Specialist Registrars (SpR). Of the set standard 10 complications, FY2 documented an average of 4.2, CST documented 6.2 and SpR documented 8.16 complications. Conclusions The study showed a need of improvement in the documentation of complications especially among Junior Doctors. Procedure specific complication stickers was developed for a standardised list of complications which will act as a source of information for the patient and prompt doctors to discuss the risks.

Mediastinal Emphysema as a Specific Complication of COVID-19 (Case Report)

During the care of patients with novel coronavirus infection at the Lomonosov MSU Medical Research and Education Center from April 21 to June 13, 2020, we observed cases of spontaneous mediastinal emphysema (spontaneous pneumomediastinum) as a manifestation or a probable complication of COVID-19.The aim of the paper. To provide clinical case descriptions and approaches to the management of patients with spontaneous pneumomediastinum in COVID-19 associated pneumonia, as they are not addressed in the current clinical guidelines, and therefore are worthy of special attention.Among 224 patients with laboratory-confirmed diagnosis of the novel coronavirus infection COVID-19, five cases of pneumomediastinum without pneumothorax were identified. Of these, in two cases the pneumomediastinum developed during noninvasive lung ventilation (NLV) (one case) and invasive lung ventilation (one case). In three cases, spontaneous mediastinal emphysema was not associated with lung ventilation. By the time of publication, one case of pneumomediastinum was completed, and four patients remained hospitalized. All five patients were males aged from 52 to 84 years.This paper presents in depth the description of two cases of mediastinal and subcutaneous emphysema in patients with COVID-19.

Outcomes of Application Two-Piece Microkeratome-Assisted Mushroom Keratoplasty

Purpose: to evaluate outcomes and to expose possible specific complications of two-piece mushroom keratoplasty.Patients and methods. A total of 9 patients (9 eyes) with corneal perforations and deep stromal opacities involving the Descemet membrane were undergone surgery. In all cases, preserved hypothermic corneoscleral buttons (in Borzenok– Moroz medium) for up to 5 days were used as donor material. The two-piece mushroom keratoplasty was performed using a microkeratome and vacuum trephines set in the variant proposed by M. Busin.Results. Success survival was obtained in 78 % of patients (7 out of 9 cases). Best spectaclecorrected visual acuity (BSCVA) 1 year after surgery averaged 0.54 ± 0.20. The average of corneal astigmatism was 3.41 ± 1.89 D. Endothelial cell density in 6 months after surgery was on average 2364 ± 236/mm2, and in 1 year — 2082 ± 228/mm2. A false chamber formation between separate parts of the graft as a specific complication was detected in 2 patients on 1 day after surgery. In one case it was eliminated by air re-injecting into the ocular anterior chamber. The second patient underwent conventional PKP due to the lack of graft adaptation. In addition, 1 patient also underwent conventional PKP as a result of postoperative crystalline infectious keratopathy, which is the non-specific complication of mushroom keratoplasty.Conclusion. The two-piece microkeratome-assisted mushroom keratoplasty is an effective method of surgical treatment of corneal perforations and deep stromal opacities involving the Descemet membrane.

Albumin Difference as a New Predictor of Postoperative Complications following Pancreatectomy

<b><i>Background:</i></b> Postoperative complications after pancreatectomy are a challenging problem due to their high incidence and serious consequences. The majority of studies have focused on a specific complication, but data on predictors of overall postoperative complications (OPCs) are limited. <b><i>Methods:</i></b> The data of patients who underwent pancreatectomy at a single institute between 2017 and 2019 were analyzed retrospectively. Univariate and multivariate logistic regression were used to investigate predictors of the outcomes of interest. The Clavien-Dindo classification and comprehensive complication index (CCI) were used to assess postoperative complications and the severity of postoperative complications. The relationship between predictors and the CCI was evaluated by linear regression. <b><i>Results:</i></b> A total of 490 patients were divided into a training group (<i>n</i> = 339) and a validation group (<i>n</i> = 151). The rate of OPCs was 44.25%. Fluid transfusion and albumin difference (AD) were predictors of OPCs. AD showed a good discrimination (AUC = 0.70) and good calibration in the validation cohort. AD was associated with complications, including pancreatic fistula, intra-abdominal hemorrhage, intra-abdominal infection, delayed gastric emptying, and re-intervention, and was positively correlated with complication severity. Intraoperative blood loss and preoperative albumin were independent predictors of AD. <b><i>Conclusions:</i></b> AD, a variable that reflects dynamic physiological changes is a new and accessible predictor of OPCs following pancreatectomy.

Activity Tracking After Surgery: Does It Correlate With Postoperative Complications?

Background Postoperative ambulation is an important tenet in enhanced recovery programs. We quantitatively assessed the correlation of decreased postoperative ambulation with postoperative complications and delays in gastrointestinal function. Methods Patients undergoing major abdominal surgery were fitted with digital ankle pedometers yielding continuous measurements of their ambulation. Primary endpoints were the overall and system-specific complication rates, with secondary endpoints being the time to first passage of flatus and stool, the length of hospital stay, and the rate of readmission. Results 100 patients were enrolled. We found a significant, independent inverse correlation between the number of steps on the first and second postoperative days (POD1/2) and the incidence of complications as well as the recovery of GI function and the likelihood of readmission ( P < .05). POD2 step count was an independent risk factor for severe complications ( P = .026). Discussion Digitally quantified ambulation data may be a prognostic biomarker for the likelihood of severe postoperative complications.

Twin anemia polycythemia sequence – modern approaches to diagnosis and antenatal correction

Twin anemia polycythemia sequence (TAPS) is a specific complication of the monochorionic multiple birth, which is based on chronic feto-fetal blood transfusion over placental vascular anastomoses, and the main clinical symptom is discordant fetal hemoglobin level in the absence amniotic fluid imbalance. Currently, there is no generally recognized consensus on the optimal treatment tactics. Dynamic observation, labor, intrauterine blood transfusion, selective fetocide, fetoscopic laser coagulation of placental vascular anastomoses are applied, although the latter is recognized by the majority of researchers as the most promising method for treating TAPS. There are disagreements in estimating the frequency of perinatal morbidity and mortality during pregnancy, complicated by the development of TAPS, and their real value has not yet been completely defined. Key words: intrauterine transfusion, Solomon method, monochorionic twins, twin anemia polycythemia sequence, fetoscopic laser coagulation

An unusual presentation of a giant pancreatic pseudocyst extending through the lateral abdominothoracic wall into the subcutaneous plane

Pancreatic pseudocysts are a common complication of pancreatitis affecting up to 40% of chronic cases. Typically, they are located within or abutting the pancreas and are self-limiting with the majority been smaller than 6cm, asymptomatic and resolving with conservative management. Here we present an unusual multiloculated giant pancreatic pseudocyst that originated at the pancreatic tail and extended through the lateral thoracoabdominal walls into the subcutaneous plane in a male with chronic alcohol pancreatitis. A literature search revealed no previous documented cases of this specific complication.