Hydroperitoneum: A complication of mini PCNL in pediatric age group? -A case report

Renal stones constitute 40% of renal disorders in Pakistan with silent stones constituting up to 3%. Nephrolithotomy and Pyelolithotomy were the only surgical options available for the treatment of large renal stones, with high rate of complications. Percutaneous nephrolithotomy (PCNL) has now become the mainstay of treatment for large renal stones over the past 30 years. Recent advances in equipment and technology has made PCNL the gold standard for this disease, resulting in removal of stones with shorter recovery time and decreased morbidity and mortality, and with few complications Case Discussion A boy aged 13 years, underwent mini PCNL for treatment of left side renal stone causing hydronephrosis, previously evaluated by KUB X-Rray and non contrast CT scan. His retrograde-percutanous access to the collecting system was done under fluoroscopic guidance. At the end of procedure, patient revealed taut and distended abdomen. Aspiration revealed presence of intraperitoneal fluid. Patient was effectively treated with immediate placement of abdominal drain with improvement of clinical presentation Conclusion Hydroperitoneum is a rare complication of conventional PCNL. Based on our experience and review of published literature, our case of hydroperitoneum after mini PCNL, is the first of its kind. A high degree of sensitivity and knowledge of this complication during PCNL in children would help identify and manage this complication in future. We recommend examination of abdomen post-PCNL in every child before he/she is brought out of anesthesia.

The challenging airway: Tracheal agenesis in the newborn

A preterm female presented with severe respiratory distress in the delivery room and was found to have tracheal agenesis with a tracheoesophageal fistula and a congenital heart defect. Tracheal agenesis is uncommon and is often associated with other congenital abnormalities. Although there are surgical options for repair, mortality remains high.

Sphenoid sinus mucocele with unilateral blindness – a case report

Mucocele of the paranasal sinuses are benign cystic lesions filled with mucus. They occur in the sphenoid sinus in 1–2% of all paranasal sinuses, most often in the fourth decade of life. Clinical manifestations are non-specific, caused by pressure expansion into anatomical structures immediately adjacent to the sphenoid sinus. They are manifested by headaches, dropped eyelids, impaired movement of the globe, and impaired vision. In the differential dia­gnosis, it is necessary to distinguish them from tumour processes and processes propagating from the intracranium. Computed tomography (CT) and Magnetic Resonance Imaging (MRI) play an important role in the dia­gnosis, the definitive dia­gnosis is determined by perioperative findings and histological examination. Curative surgical options include endoscopic transnasal sphenoidotomy with marsupialization. In this article, we present a case of a patient with a mucocele of the sphenoid sinus, which was the cause of unilateral blindness. Keywords: marsupialization – mucocele – sphenoid sinus – endoscopic transnasal sphenoidotomy

Chronic Rhinosinusitis’s with Nasal Polyps

Chronic Rhinosinusitis is a chronic disease that negatively affects the quality of life. When associated with nasal polyps, there is worsening of the condition, and it becomes harder to treat due to the high rates of recurrence and the increased morbidity rates. Though having a set treatment method, the condition still has unknown etiology and pathophysiology, which makes it extremely hard to diagnose and evaluate. Due to these unknown factors, treatment is still not as precise and effective; we still rely on systemic drugs like corticosteroids which most often do not resolve the disease, and we then present surgical options, though effective still do not pose as an effective cure, which may be a factor in the high rate of recurrences. However, there have been giant leaps in the specialized research of this particular topic, leading to classification through biomarkers allowing us to study and consolidate data on the disease pathology and all of the different options causing recurrences, which further enhances our understanding of how this disease affects a diverse population. The majority of the treatment given in this disease is not evidence-based but instead based on clinical observation and experience. Therefore, with CRSwNP, we are confronted with more questions than answers, which is problematic as the disease can often be associated with comorbidities leading to a further decrease in quality of life. Hence, this review article aims to aggregate and compile this valuable research and highlight the strides which have already been made while promoting additional research so that the disease can become more manageable without any recurrence.

Clinical Practice in Spine Surgery: An International Survey

Background The availability of diverse and sophisticated surgical options to treat spine conditions is compounded by the scarcity of high-level evidence to guide decision-making. Although studies on discrete treatments are frequently published, little information is available regarding real-world surgical practice. We intended to survey spine surgeons to assess clinical management of common spine diagnosis in day-to-day settings. Methods An online survey was distributed among neurosurgeons and orthopaedic surgeons worldwide. The obtained assessment of common surgical practice is contextualized in a review of the best available evidence. Results The survey was answered by more than 310 members of several European, Australasian, and South African professional societies. The submitted responses translate a surgical practice generally grounded on evidence, favoring well-tried techniques, providing comprehensive treatment for the most severe diagnoses. Such practice comes mostly from neurosurgeons focused on spine surgery, practicing in teaching hospitals. Conclusion We believe that the pragmatic, day-to-day approach to spine conditions captured in the present survey offers an informative insight to involved surgeons.

Surgical Management for a Rare Pedunculated Left Ventricular Apical Lipoma: A Case Report and Review of Literature

Cardiac lipomas, though extremely rare, are encapsulated tumors composed primarily of mature fat cells. Despite their benign character, cardiac lipomas can cause life-threatening complications by rapid growth. Cardiac lipomas, which are frequently located in the left ventricle (LV) or right atrium, can originate either from the subendocardium, subpericardium, or the myocardium. They are usually asymptomatic and carry a good prognosis during long-term follow-up; however, published reports show that untreated cardiac lipomas may be fatal when they cause arrhythmic or obstructive symptoms. In addition, several surgical options have been reported to obtain an appropriate operative view following poor visualization, primarily when tumors are located in the LV. Herein, we present a case of a pedunculated LV apical lipoma in a symptomatic patient successfully managed by surgical resection. We also discuss diagnostic modalities in surgical planning and the choice of surgical approach.

The Surgical Management of Peptic Ulcer Disease

The treatment of peptic ulcer disease has evolved substantially through the decades since the discovery of acid-reducing agents and helicobacter pylori bacteria. With the success of medical treatment, surgical therapy continues to play a less prominent role in the care of this disease. Operative candidates include the naive patient treated with over-the-counter NSAIDs who are often those with undiagnosed Helicobacter pylori, requiring less complicated initial surgery. With more surgeons graduating with less experience operating on PUD with evolving operative techniques, the question arises as to what constitutes the optimal surgical approach, especially in the elective vs. emergent settings. Recent literature discussing GI bleeding associated with COVID-19 also merits discussion of surgical options in this chapter. Future surgical options may include minimally invasive endoscopic surgeries akin to per-oral endoscopic myotomy of the pylorus; however, this has not yet been described in this disease.

The Application of Different Surgical Methods in Endometrial Cancer

Endometrial cancer is a common gynecological malignancy in women, which accounts for the second in malignant tumor of female reproductive system. Obesity, high blood pressure and diabetes are risk factors for endometrial cancer. At present, the treatments of endometrial cancer focus on surgical treatment, followed by radiotherapy, chemotherapy and endocrine therapy. The progress of surgical method is transferring from traditional laparotomy, laparoscopy, single port laparoscope to Da Vinci robotic surgery system. Different surgical options should be personalized according to the patient’s situation. We compared the pros and cons of different surgical methods and introduced the clinical value of the Sentinel lymph node mapping in hope of giving some information for clinic.

Retrograde tibial nailing of far distal tibia fractures: a biomechanical evaluation of double- versus triple-distal interlocking

Objectives Retrograde tibial nailing using the Distal Tibia Nail (DTN) is a novel surgical option in the treatment of distal tibial fracture. Its unique retrograde insertion increases the range of surgical options in far distal fractures of the tibia beyond the use of plating. The aim of this study was to assess the feasibility of the DTN for far distal tibia fractures where only double rather than triple-distal locking is possible due to fracture localisation and morphology. Methods Six Sawbones® were instrumented with a DTN and an AO/OTA 43-A3 fracture simulated. Samples were tested in two configurations: first with distal triple locking, second with double locking by removing one distal screw. Samples were subjected to compressive (350 N, 600 N) and torsional (± 8 Nm) loads. Stiffness construct and interfragmentary movement were quantified and compared between double and triple-locking configurations. Results The removal of one distal screw resulted in a 60–70% preservation of compressive stiffness, and 90% preservation of torsional stiffness for double locking compared to triple locking. Interfragmentary movement remained minimal for both compressive and torsional loading. Conclusions The DTN with a distal double locking can, therefore, be considered for far distal tibia fractures where nailing would be preferred over plating.