Study of serum bilirubin as a diagnostic method to predict acute perforated appendicitis

Background: Acute appendicitis is the commonest cause of ‘acute surgical abdomen’. Appendicectomy is the most frequently performed urgent abdominal operation and is often the first major procedure performed by a surgeon in training. The aim of the study was to whether hyperbilirubinemia might be used as a diagnostic tool to predict perforated appendicitis.Methods: This study comprised patients who presented with the condition of appendicitis and abnormal liver function tests on admission and had a laparoscopic or open appendectomy. The age information, duration of symptoms, temperature, white blood cell counts, bilirubin levels, and histology data were gathered. Peritoneal fluid was cultured and examined for sensitivity.Results: The average bilirubin level of all participating patients was 0.92 mg/dl (range, 0.1-4.3 mg/dl). The mean bilirubin levels were higher for patients with simple appendicitis compared to those with a non-inflamed appendix (0.7 mg/dl and 0.4 mg/dl, p<0.001). Hyperbilirubinaemia was reported to have a specificity of 89% and a positive predictive value of 90.02% for acute appendicitis. Patients with appendiceal perforation, however, had a mean bilirubin level of 1.7 mg/dl and were more likely to have hyperbilirubinaemia (p<0.001). The specificity of hyperbilirubinaemia for perforation or gangrene was 73%.Conclusions: Patients with hyperbilirubinemia with appendicitis condition should be screened for a greater risk of appendiceal perforation than those with normal bilirubin levels.

Primary Catheter-Directed Thrombolysis For Porto-Mesenteric Venous Thrombosis (PMVT) In Non-Cirrhotic Patients.

Purpose: To report our technique, treatment strategy and clinical outcomes for porto-mesenteric venous thrombosis (PMVT) in non-cirrhotic patients.Methods: 16 non-cirrhotic PMVT patients (mean age: 48.6 years) with imminent intestinal ischemia were enrolled from 2004-2020. 8 patients presented thrombus extension into the peripheral mesenteric vein, close to the venous arcade. Transhepatic catheter-directed thrombolysis (CDT) was performed by urokinase infusion (60,000-30,000 IU/hour concomitant with heparin 300-400 IU/hour), catheter aspiration and/or balloon dilation/stent placement. Additional intra-arterial mesenteric infusion of urokinase (30,000 IU/hour) was given in patients with the peripheral mesenteric venules involved. Transjugular intrahepatic porto-systemic shunt (TIPS) was created in patients with poor recanalization of the intrahepatic portal flow (PV). Results: The transhepatic route was adopted in all patients, with adjunct indirect mesenteric arterial thrombolytic infusion in 8 patients. A total of up to 20.4 million IU urokinase was infused for 1-30 days’ treatment duration. TIPS was created in 3 patients with recanalization failure of the intrahepatic PV. Technical success was achieved in 100% of patients with complete recanalization of 80% and partial recanalization of 20%. No major procedure-related complications were encountered. The 30-day mortality rate was 6.7%. The overall 1- and 2-year primary and secondary patency were both 74.0% and 84.6% respectively. Conclusions: CDT can be performed as a primary salvage treatment once the diagnosis is made. CDT via the transhepatic route with tailored thrombolytic regimen is safe and effective for both acute and chronic PMVT . TIPS creation can be preserved in non-cirrhotic PMVT patients if intrahepatic PV recanalization fails.

Bronchoskopische Thermoablation beim Lungenkarzinom: Ermutigende Daten eines experimentellen Verfahrens

<b>Background:</b> Bronchoscopic thermal vapour ablation (BTVA) is an established and approved modality for minimally invasive lung volume reduction in severe emphysema. Preclinical data suggest potential for BTVA in minimally invasive ablation of lung cancer lesions. <b>Objectives:</b> The objective of this study is to establish the safety, feasibility, and ablative efficacy of BTVA for minimally invasive ablation of lung cancers. <b>Methods:</b> Single arm treat-and-resect clinical feasibility study of patients with biopsy-confirmed lung cancer. A novel BTVA for lung cancer (BTVA-C) system for minimally invasive treatment of peripheral pulmonary tumours was used to deliver 330 Cal thermal vapour energy via bronchoscopy to target lesion. Patients underwent planned lobectomy to complete oncologic care. Pre-surgical CT chest and post-resection histologic analysis were performed to evaluate ablative efficacy. <b>Results:</b> Six patients underwent BTVA-C, and 5 progressed to planned lobectomy. Median procedure duration was 12 min. No major procedure-related complications occurred. All 5 resected lesions were part-solid lung adenocarcinomas with median solid component size 1.32 ± 0.36 cm. Large uniform ablation zones were seen in 4 patients where thermal dose exceeded 3 Cal/mL, with complete/near-complete necrosis of target lesions seen in 2 patients. Tumour positioned within ablation zones demonstrated necrosis in &#x3e;99% of cross-sectional area examined. <b>Conclusion:</b> BTVA of lung tumours is feasible and well tolerated, with preliminary evidence suggesting high potential for effective ablation of tumours. Thermal injury is well demarcated, and uniform tissue necrosis is observed within ablation zones receiving sufficient thermal dose per volume of lung. Treatment of smaller volumes and ensuring adequate thermal dose may be important for ablative efficacy.

Bronchoscopic Thermal Vapour Ablation for Localized Cancer Lesions of the Lung: A Clinical Feasibility Treat-and-Resect Study

Background: Bronchoscopic thermal vapour ablation (BTVA) is an established and approved modality for minimally invasive lung volume reduction in severe emphysema. Preclinical data suggest potential for BTVA in minimally invasive ablation of lung cancer lesions. Objectives: The objective of this study is to establish the safety, feasibility, and ablative efficacy of BTVA for minimally invasive ablation of lung cancers. Methods: Single arm treat-and-resect clinical feasibility study of patients with biopsy-confirmed lung cancer. A novel BTVA for lung cancer (BTVA-C) system for minimally invasive treatment of peripheral pulmonary tumours was used to deliver 330 Cal thermal vapour energy via bronchoscopy to target lesion. Patients underwent planned lobectomy to complete oncologic care. Pre-surgical CT chest and post-resection histologic analysis were performed to evaluate ablative efficacy. Results: Six patients underwent BTVA-C, and 5 progressed to planned lobectomy. Median procedure duration was 12 min. No major procedure-related complications occurred. All 5 resected lesions were part-solid lung adenocarcinomas with median solid component size 1.32±0.36 cm. Large uniform ablation zones were seen in 4 patients where thermal dose exceeded 3 Cal/mL, with complete/near-complete necrosis of target lesions seen in 2 patients. Tumour positioned within ablation zones demonstrated necrosis in >99% of cross-sectional area examined. Conclusion: BTVA of lung tumours is feasible and well tolerated, with preliminary evidence suggesting high potential for effective ablation of tumours. Thermal injury is well demarcated, and uniform tissue necrosis is observed within ablation zones receiving sufficient thermal dose per volume of lung. Treatment of smaller volumes and ensuring adequate thermal dose may be important for ablative efficacy.

Multidisciplinary assessment of patients with ischemic stroke, the structure of a stroke team, and first Egyptian experience in adults undergoing transcatheter PFO closure for PFO-related stroke

Background Patent foramen ovale closure in the setting of stroke was debatable until the recent data from the long-term follow-up of multiple randomized control trials. These recent data have led to increase the number of the procedure worldwide. To our knowledge, there was no previous formal structured program in Egypt between cardiologists and neurologists for investigation and management of patients with cryptogenic stroke. The first Egyptian-dedicated stroke team was created in two large tertiary centers with collaboration between cardiologists, dedicated cardiac imagers, and neurologists for investigation and management of patients with cryptogenic stroke. Results Sixty-three patients with cryptogenic stroke were identified from a total of 520 patients admitted to the stroke units between 2016 and 2019. Twenty-five patients had a proven PFO-related stroke. Three patients were referred for surgical closure, 19 patients underwent transcatheter PFO closure, and procedural success was met in 18 patients (94.7%). We did not experience any major procedure-related complication. Complete closure was achieved in 83.3% of patients at 6 months. One patient had a single attack TIA within the first 3 months after device closure; one patient had a device-related thrombosis; both were managed successfully. Conclusion Our initial experience in collaboration between cardiologist and neurologist with the establishment of a dedicated cryptogenic stroke team added significantly to the management of patients with stroke. The results of the first Egyptian cohort who underwent transcatheter PFO closure demonstrated procedural feasibility, safety, and efficacy with very low incidence of major complications. A nationwide program is needed to reduce the ischemic stroke disease burden and the risk of recurrence.

Paediatric lateral humeral condyle fractures managed by k-wire fixation, should the wires be buried or left exposed: a dilemma

<p><strong>Background:</strong> Fractures of the lateral condyle of the humerus in children are common injuries. If displaced or unstable they may require surgical reduction and fixation with Kirschner wires (K-wires). These may be passed through the skin and left exposed or buried subcutaneously.</p><p><strong>Methods:</strong> A prospective study was carried out in department of orthopaedics at my college from January 2019 to March 2020. A total number of 37 subjects were included in the study.</p><p><strong>Results:</strong> Patients were followed for a period of 3 months and results were drawn on basis of union, infection, carrying angle at the elbow, and range of motion (ROM) which was assessed by clinico-radiological means.</p><p><strong>Conclusions: </strong>Buried wire group has shown better union rate than exposed group, wires could be removed under local anaesthesia thereby avoiding any major procedure and also the risk of infection is low making this a better option than the exposed cohort.</p>

Predictors of major procedure-related complications in transvenous lead extraction

Background Transvenous lead extraction (TLE) has become the mainstay therapy for device-related infections. Though TLE procedures are associated with low complication and high success rates, risk factors for major procedure-related complications remain not well defined. Purpose To evaluate the safety and efficacy of TLE in a large single centre cohort and to identify risk factors for major complications. Methods All consecutive patients who had undergone TLE in our department between May 2012 and January 2020 were included in a prospective registry. Our protocol for TLE followed a stepwise approach according to lead dwell time and estimated complexity of the procedure: use of simple traction ± locking stylet (LS) ± mechanical and/or powered sheaths ± snare technique. In case of unsuccessful extraction from the venous entry site, femoral or jugular access was approached. Patient characteristics, procedural data and complications were gathered and analysed. Logistic regression analysis was applied to identify risk factors for major procedure-related complications. Results A total of 1717 leads (443 [25.9%] ICD leads) were targeted for TLE in 810 patients (67±15 years; 76% male). The mean lead dwell time was 83±60 months. The leading indication for TLE was cardiac device related infection (CDRI) in 527 patients (65.1%), of whom 273 (51.8%) had systemic and 254 (48.2%) localized infection. Two hundred eighty-three patients (34.9%) underwent TLE for non-CDRI causes. Leads were extracted by simple traction in 28.2%, traction with LS in 4.1%, dilator sheaths with LS in 50.1%, and additional use of powered mechanical sheaths in 13.0%. The snare technique was used in 4.6%. Venous access for TLE was exclusively from the entry site in 94.8%, combined from femoral in 4.0% and jugular in 1.2%. TLE was completely successful in 96.2%, partially successful in 2.1%, and failed in 1.7% of all attempted leads, which translated to a clinical success rate of 96.8%. Eighteen patients (2.2%) experienced minor and 12 patients (1.5%) had major procedure-related complications (cardiac tamponade/perforation) including one intraprocedural death (0.1%) from fulminant pulmonary embolism. Lead-years-per-patient (HR 1.064, 95% CI 1.032–1.096; p&lt;0.001), dwelling time of the oldest lead (HR 1.013, 95% CI 1.007–1.019; p&lt;0.001), and BMI (HR 0.877, 95% CI 0.772–0.997; p=0.020) were significant predictors for major complications in logistic regression analysis. Conclusion TLE is feasible, effective and safe in our large single centre experience. Overall complication and failure rates are low. Following our TLE protocol, dwelling time of the extracted leads and low BMI were associated with major procedure-related complications. Funding Acknowledgement Type of funding source: None

A review study of nasal endoscopy protocol during the COVID-19 pandemic

During ENT practice, we have to examine the nose and perform several nasal procedures in our clinics. Otolaryngologists are at a high risk of exposure to the COVID-19 virus. Nasal endoscopy is a major procedure for the diagnosis of the nasal and paranasal sinus diseases and introducing proper health services for our patients. In addition, the world is living the era of the COVID-19 pandemic, for which we have to protect ourselves, educate our medical staff, and work together against the spread of this severely contagious disease within our communities. The main purpose of this study is to review the protocol of nasal endoscopy in the ENT clinic and enhance the safest way to deal with patients during this pandemic.(1)

P1422Low incidence of major procedure-related adverse events of cryoballoon ablation in real practice: an interim analysis of the Russian national prospective cryoablation registry

OnBehalf On Behalf Of the National Cryoballoon Registry Investigators Background Cryoballoon ablation (CBA) is an effective strategy for atrial fibrillation (AF) management. The Russian Cryoballoon Atrial Fibrillation Ablation Registry (NCT03040037) is a prospective observational multicenter national registry that aims to provide real-world efficacy, safety and outcomes of this technology. Methods A specialized Web-based registry platform was developed for prospective data entry. The platform consists of 8 sections: AF ablation clinic experience and operator experience, patient characteristics, CBA procedure characteristics, periprocedural patient management (including drug therapy), 12-moths follow-up with scheduled and unscheduled visits, redo procedure characteristics, early and late procedure-related complications. Patient inclusion criteria were the following: indications for AF catheter ablation, planned CBA, a signed informed consent. Results To date thirty-one clinics have joined the Registry, and 830 patients (477 males, a mean age 65.4 ± 11.3 years) were included. The mean BMI was 33.2 ± 3.3 kg/m2. Paroxysmal AF was presented in 688 pts, persistent AF – 111 pts, long standing persistent AF – 31 pts. The main underlying diseases were hypertension (75%), coronary artery disease (11%), chronic heart failure (25%); less commonly - hypertrophic cardiomyopathy (1.4%) and dilated cardiomyopathy (0.7%). The mean LA diameter was 45.4 ± 10.2 mm, and LVEF was 65.4 ± 12.6%. Periprocedural anticoagulant therapy included uninterrupted NOACs (313 pts), bridge anticoagulation (327 pts), uninterrupted warfarin (45 pts), anticoagulation initated only after CBA (32 pts). The mean temperature of cryoablation was -44.6 ± 16.3 C. Transesophageal echo-guided CBA was performed in 92 cases , intracardiac echocardiography-guided - in 465 cases. There were 5 (0.6%) cases of hemopericardium, and pericardiocentesis was required in 1 (0.1%) case only. Periprocedural TIA was diagnosed in 1 (0.1%) patient with bridge anticoagulation, no stroke occurred. Transient phrenic nerve injury was detected in 18 (2.1%) patients, persistent palsy – in 1 (0.1%) patient. Two cases of esophageal injury were reported, no surgery was required and healing was reported in both patients. The data collection is ongoing. Conclusion We report early results of the ongoing national CBA Registry. There was a low number of major procedure-related adverse events in real clinical practice among centers with different AF ablation experience. Long-term follow up of the included patients will be reported in the future. Abstract Figure. Antithrombotic therapy and CBA