A Right Thalamo-Choroidal Arterio-Venous Malformation and Associated Vein of Galen Aneurysm in a Female Adult

Vein of Galen aneurysm (VGAM) is a rare vascular malformation accounting for less than 1% of all intracranial abnormalities. In this case report, we performed computed tomography (CT) and magnetic resonance imaging (MRI) examinations for a 26-year-old female patient who presented with a severe headache. On these images, a right thalamo-choroidal arterio-venous malformation (AVM) with secondary aneurysmal dilatation of the vein of Galen was suspected, and a CT angiography was performed for further evaluation, which confirmed the diagnosis. The patient refused digital subtraction angiography (DSA) and probable endovascular treatment. Although it is rarely seen in the adult population, CT and MRI have a tremendous impact on the diagnosis of these patients. We should also emphasize the role of CT angiography in the diagnosis and further evaluation of these vascular malformations. Endovascular therapy is regarded as an effective and safe technique in the treatment of these patients.

Sclerobanding (Combined Rubber Band Ligation with 3% Polidocanol Foam Sclerotherapy) for the Treatment of Second- and Third-Degree Hemorrhoidal Disease: Feasibility and Short-Term Outcomes

Background: Sclerobanding is a novel technique combining rubber band ligation with 3% polidocanol foam sclerotherapy for the treatment of hemorrhoidal disease (HD). The aim of this study is to evaluate the feasibility, safety and short-term outcomes of sclerobanding in the treatment of second- and third-degree HD. Methods: A retrospective analysis of second- and third-degree HD cases from November 2017 to August 2021 was performed. Patients on anticoagulants or with other HD degrees were excluded. Follow-up was conducted at 1 month, 3 months, 6 months, 1 year and then every 12 months. Results: 97 patients with second- (20 pts; 20.6%) and third-degree (77 pts; 79.4%) HD with a mean age of 52 years (20–84; SD ± 15.5) were included. Fifty-six patients were men (57.7%) and forty-one women (42.3%). Median follow-up was 13 months (1–26 months). No intraoperative adverse events or drug-related side effects occurred. Minor complications occurred in four patients (4.1%) in the first 30 postoperative days and all resolved after conservative treatment at the 3-month follow-up visit. No mortality or readmissions were observed. Conclusions: Sclerobanding is a safe technique with a low rate of minor postoperative complications. Further studies on larger samples are necessary to establish the effectiveness and long-term outcomes of the technique.

Spot Stenting Combined With False Lumen Endovascular Occlusive Repair for Post-dissection Abdominal Aortic Aneurysm

Purpose: To introduce a new spot stenting, combined with a false lumen endovascular occlusive repair (SS-FLEVOR) technique for treating post-dissection abdominal aortic aneurysms. Technique: This technique is demonstrated in a 74-year-old man who received an initial thoracic endovascular aortic repair 7 years ago and suffered from distal aortic expansion during the follow-up session. All the tears located more than 15 mm away from the orifice of visceral arteries were excluded by spot stenting in the aortic true lumen. Then, a compliant stent-graft was implanted in the false lumen to seal the tears near the visceral arteries orifice from the outside. In addition, coils were deployed to block the potential backflow from the intercostal arteries and to induce false lumen thrombosis. Moreover, visceral arteries originated from false lumen were repaired by covered-stents implanted from the true lumen. The distal iliac arteries were sealed either with iliac extensions or cover-stents. This new technique has been applied in 5 patients, resulting in 100% technical success and encouraging intermediate outcomes. Conclusion: SS-FLEVOR is a feasible and safe technique to promote false lumen thrombosis in selected cases.

The Evolution of Blood Flow Restricted Exercise

The use of blood flow restricted (BFR) exercise has become an accepted alternative approach to improve skeletal muscle mass and function and improve cardiovascular function in individuals that are not able to or do not wish to use traditional exercise protocols that rely on heavy loads and high training volumes. BFR exercise involves the reduction of blood flow to working skeletal muscle by applying a flexible cuff to the most proximal portions of a person’s arms or legs that results in decreased arterial flow to the exercising muscle and occluded venous return back to the central circulation. Safety concerns, especially related to the cardiovascular system, have not been consistently reported with a few exceptions; however, most researchers agree that BFR exercise can be a relatively safe technique for most people that are free from serious cardiovascular disease, as well as those with coronary artery disease, and also for people suffering from chronic conditions, such as multiple sclerosis, Parkinson’s, and osteoarthritis. Potential mechanisms to explain the benefits of BFR exercise are still mostly speculative and may require more invasive studies or the use of animal models to fully explore mechanisms of adaptation. The setting of absolute resistive pressures has evolved, from being based on an individual’s systolic blood pressure to a relative measure that is based on various percentages of the pressures needed to totally occlude blood flow in the exercising limb. However, since several other issues remain unresolved, such as the actual external loads used in combination with BFR, the type of cuff used to induce the blood flow restriction, and whether the restriction is continuous or intermittent, this paper will attempt to address these additional concerns.

Resection of small acoustic neuroma using the transcanal transvestibular endoscopic approach

We evaluated the outcomes of resection of small acoustic neuromas using the transcanal transvestibular endoscopic approach. Two patients with a small acoustic neuroma were treated using this approach. The sizes of the tumors were 11 × 6 mm and 12 × 10 mm. Both tumors were removed completely without residual tumor tissue, and damage to the facial nerve and cochlear nerve was avoided. No patients developed postoperative vertigo, aggravation of postoperative facial paralysis, severe pain, or permanent postoperative complications. The patients were followed up for 6 months, and none developed recurrence. Resection of small acoustic neuromas by the transcanal transvestibular endoscopic approach is a simple and safe technique that achieves excellent functional results.

Case Report: 3D Printing Guided Cardiac Autotransplantation for Treatment of a Giant Complex Primary Left Atrial Tumor

Primary cardiac tumors are rare and complete surgical resection is the optimal treatment. However, it is a great challenge to resect some malignant or complex benign left-sided cardiac tumors situated on the posterior aspect of the heart using conventional surgical resection techniques. Previous studies reported that cardiac autotransplantation is a feasible and safe technique for resection of such cardiac tumors. We report a successful case of cardiac autotransplantation with 3-dimensional (3D) printing technique for complete resection of a giant complex primary left atrial tumor.

Mandibular Reconstruction with Bridging Customized Plate after Ablative Surgery for ONJ: A Multi-Centric Case Series

Purpose: Computer-aided methods for mandibular reconstruction have improved both functional and morphological results in patients who underwent segmental mandibular resection. The purpose of this study is to evaluate the overlaying of virtual planning in terms of measures of the Computer Assisted Design/Computer Assisted Manufacturing CAD/CAM plate for mandibular reconstruction in patients who are ineligible for the insertion of reconstructing the titanium plate supported by fibular free flap, due to their poor health status, or in the presence of specific contraindications to autologous bone flap harvest. Materials and methods: The retrospective study performed analyzed the results of nine patients. The patients were treated at the Maxillofacial Surgery Unit of Policlinico S. Orsola of Bologna, Italy, and Policlinico San Marco, Catania, Italy, from April 2016 to June 2021. Superimposition between planning and post operative Computed Tomography CT scan was performed to assess the accuracy. Results: All reconstructive procedures were carried out successfully. No microsurgery-related complications occurred. In two cases, we had plate misplacement, and in one case, plate exposure that led to plate removal. The average accuracy of the series assessed after CT superimposition, as previously described, was 0.95 mm. Conclusions: Considering that microvascular bone transfer is a high-risk procedure in BRONJ patients, we can conclude that the positioning of a customized bridging mandibular prosthesis (CBMP), whether or not it is associated with a microvascular soft tissue transfer, is a safe technique in terms of surgical outcome and feasibility.

The Effect of Therapeutic Hypothermia after Cardiac Arrest on the Neurological Outcome and Survival—A Systematic Review of RCTs Published between 2016 and 2020

Therapeutic hypothermia is a treatment used for patients who have suffered cardiorespiratory arrest and remain conscious after the recovery of spontaneous circulation. However, its effectiveness is controversial. The objective of this systematic review is to summarize the scientific evidence available about the effect of therapeutic hypothermia on neurological status and survival in this type of patients. Methodology: A primary search in CINAHL, CUIDEN, Pubmed, Web of Science, and Scopus databases was carried out. Randomized clinical trials (RCT) published from 2016 to 2020 were selected. Results: 17 studies were selected for inclusion and most relevant data were extracted. Methodological quality was assessed by the RoB tool. Conclusions: Although therapeutic hypothermia is a safe technique with few adverse and manageable effects, it has not shown to improve survival rate and neurological status of adult nor pediatric patients. It is possible that its positive effect on neuroprotection could be achieved only by preventing hyperthermia although further investigation is needed.

P122 LAPAROSCOPIC APPROACH TO THE ABDOMINAL WALL WITH CLOSURE OF THE DEFECT, OUR INITIAL RESULTS

Aim The aim of the study is to evaluate the closure of the defect in postoperative pain, seroma and recurrence. Material and Methods Inclusion criteria were; defect width of 2 - 4 cm and body mass index ≤ 35 kg / m2, or previous intraperitoneal surgery. A prospective database of perioperative variables have been collected. We consider postoperative pain as a value ≥5 on the Visual Analogue Scale, seroma types III and IV of the Morales-Conde classification. Results 32 patients were operated with laparoscopic closure of the defect (LCD) between 2018 and 2020. The mean age was 59 years and body mass index was 31 kg / m2. 14 patients had incisional hernia. 90% of the cases were M2-3 with a mean defect diameter of 2.7 cm. In 5 cases, a preperitoneal mesh was placed without takers, the mean size of the mesh was 15 cm. The mean duration of the procedures was 96.1 min. Seven (22%) patients presented postoperative pain, of which 5 had 24 h limited and in two cases it lasted up to 48 h. No patient presented pain at the 30-day evaluation. The mean length of stay was 1.8 days. The mean follow-up was 23 months, one seroma (3.1%) and three (9.4%) recurrences were diagnosed. Conclusions In our initial experience, we considered LCD a safe technique with benefits for selected patients.

Functional Outcomes in Suprapatellar Intramedullary Nailing for the Treatment of Tibial Shaft Fractures

Introduction: The purpose of this study was to evaluate the functional outcomes of suprapatellar intramedullary nailing for the treatment of tibial shaft fractures.Material and Methods: The present retrospective study included 10 cases aged more than 20 years, who were operated for tibial shaft fractures over last 3 years with suprapatellar tibial nailing. Patients were retrospectively followed up with all their previous surgical records and radiographs.Results: The mean age was 41.57±16.51 with a range of 20-72 years. Mean operating time was 81±10.15 minutes. Mean blood loss was 110±20.5 ml. Mean time for union was 15.15±1.35 weeks. No deep infection was noted. 1 patient had anterior knee pain. The mean Lysholm knee score was 87.91 ± 5.75.Conclusion: The suprapatellar approach is good and safe technique for nailing in the tibial fractures.