Open surgical approach to management of rhino-orbito-cerebral mucormycosis

<p class="abstract"><strong>Background: </strong>Since December 2019, when novel corona virus (COVID 19) was reported, it has spread widely to cause a pandemic. Rhino-orbito-cerebral Mucormycosis (ROCM), an opportunistic fungal infection caused by the order Mucorales and class Zygomycetes has led to an epidemic in our country.</p><p class="abstract"><strong>Methods: </strong>This prospective cross sectional study was conducted at a 1200 bed tertiary care teaching hospital in Mysore. All patients of ROCM who presented to us for treatment were selected for the study after informed consent. Only those patients who were operated via open approach were included.</p><p class="abstract"><strong>Results:</strong> Median age of the patients was 50 years (SD±10). 49 were male patients (67.1%). Diabetes mellitus was the most common underlying co-morbidity seen in 71 patients (97.3%). Facial pain (100%) and facial swelling (90.4%) were the most common presenting complaint. KOH positivity from nasal swab for Mucormycosis was positive in only 37 patients (50.7%). Traditional inaccessible areas to endoscope like the premaxilla, lateral orbit cavity, infra temporal fossa and hard palate were tackled by the open surgical approach route. Advantages of open surgical approach being the access to areas which are traditionally difficult to approach via the endoscope, aggressive debridement is possible which might be challenging endoscopically. Complications like wound dehiscence, oro-antral fistula, osteomyelitis and abscess were noted in our study.</p><p class="abstract"><strong>Conclusions: </strong>Open surgical approach offers a very viable, affordable and a very effective means for aggressive surgical debridement of infection and reduce mortality associated with ROCM.</p><p> </p>

Blunt aortic injury: Surgical treatment of the ascending and descending aorta

Traumatic aortic injury is potentially fatal. Although uncommon, involvement of the aortic arch and the ascending aorta can occur. This case shows concomitant dissection of the ascending and descending sections of the aorta after blunt chest trauma where the open surgical approach was successfully performed to treat both aortic injuries.

Complications and their management

This chapter reviews the complications that can occur after minimally invasive surgical fusion of the sacroiliac joint, focusing on infection and neurovascular injuries and their prevention and treatment. The sacroiliac joint has been identified as a potential pain generator in 15% to 30% of chronic low back pain and post-laminectomy syndrome patients. Minimally invasive sacroiliac joint fusion via the lateral approach is effective and better tolerated than the open surgical approach. Most of the current studies have focused on efficacy and patient satisfaction as opposed to the safety profile of the procedure. There is a dearth of literature regarding the safety of minimally invasive sacroiliac joint fusion. Over the past few years, a novel posterior approach to sacroiliac joint fusion has become more common that theoretically is safer and potentially as efficacious as the lateral approach.

Minimally invasive techniques in thymic surgery (review of literature)

We carried out the systematic review of the domestic and foreign literature focusing on surgical treatment of patients with thymic pathology. Special attention was paid to the discussion of the advantages of minimally invasive surgery, particularly, video endoscopic thymectomy from subxiphoid access. Pubmed, Medline and E-library databases were searched for retrospective and prospective randomized trials. Based on the analysis of literature sources, we presented the data on tumor and non-tumor pathology of the thymus gland, clarified indications for surgical treatment in different types of thymic pathology. Variants of thymectomy were described, a brief historical review of the use of the surgical method in patients with thymus gland pathology was conducted. The technique of surgeries, advantages and weak points of various surgical approaches were described. We focused our attention on minimally invasive interventions, listed its advantages in comparison with the standard “open” surgical approach. The contemporary trends in surgical approaches in thymus pathology were discussed. Minimally invasive thymectomy is modern, safe and feasible variant of surgical treatment of patients with tumor and non-tumor pathology of the thymus gland. The subxiphoid approach allows to reduce postoperative pain, provides an excellent view of mediastinal structures and both pleural cavities, which improves the safety of operation with satisfactory cosmetic results.

Retained Pacemaker Lead Fragment-Induced Fibrosis, Resulting in Impaired Tricuspid Valve Function, Managed with a Valve-Sparing Open Surgical Approach

Retained pacemaker lead fragments can induce fibrosis which can affect valve function. In this case, a female patient in her fifties had undergone pacemaker insertion in her teens for symptomatic bradycardia. Due to pacemaker pocket erosion, she had undergone a lead extraction where lead fragments were left in-situ. Over time, she gradually developed symptomatic tricuspid dysfunction. Due to the severe impact on her quality of life, the patient opted for an open surgical approach. Intraoperatively, electrocautery was used to debride the fibrotic tissue inhibiting the leaflets of the tricuspid valve. This resulted in marked improvement of valve function and additional repair/replacement was not necessary. To our knowledge, such a case has not been previously described.

Quiste de colédoco Todani Iva. Reporte de caso y revisión de la literatura

Biliary tree dilations are unusual congenital malformations that may involve the entire bile circulation and, they are common during the first life decade. Most cases initiate with jaundice and chronic abdominal pain which localizes in right upper quadrant. High clinical suspicion accompanied by imaging studies are essential for diagnosisHigh suggestive clinic associated with imaging studies are essential for diagnosis. Treatment has evolved until today complete cyst resection has become the treatment of choice, since it presents a good response, although without being free from long-term complicationsTreatment has been evolving being at the present time cyst complete resection the gold standard in treatment although without being exempt from long-term complications. We present the case of a 27-year-old male patient with a history of 3 months onset epigastric abdominal pain diagnosed as Todani IVa common bile duct choledochal cyst by magnetic resonance imaging. It is performed Open surgical management was performed with total resection of the cyst and biliodigestive Roux-en-Y diversiona total cyst resection with Roux-en-Y biliodigestive bypass by open surgical approach without any complications. He was discharged 7 days post-op. A review of the literatura focused on the surgical approach and management of similar cases was carried out. We carry out bibliography review focused on surgical approach and management of similar cases. Keywords: Bile duct dilation; choledochal cyst; Todani IVa; jaundice.

A perfect storm: Open surgical approach to iatrogenic abdominal aortic injury developed during percutaneous nephrostomy

Percutaneous nephrostomy catheter insertion allows the diagnosis and treatment of many pathologies from kidney failure to infection and obstruction. Vascular injuries are considered one of the complications of percutaneous interventions and are rarely seen after percutaneous nephrostomy catheter insertion. Herein, we report the first case of the successful surgical treatment of iatrogenic abdominal aortic injury after percutaneous nephrostomy catheter insertion in a 78-year-old female patient who developed hydroureteronephrosis and acute renal failure due to obstructive ureteral stone in the right proximal ureter.

Video-assisted pulmonary metastectomy is equivalent to thoracotomy regarding resection status and survival

Background Surgical resection of pulmonary metastases leads to prolonged survival if strictly indicated. Usually, thoracotomy with manual palpation of the entire lung with lymph node dissection or sampling is performed. The aim of this study was to evaluate the role of video-assisted thoracoscopic surgery (VATS) in pulmonary metastectomy with curative intent. Methods In this study, all patients with suspected pulmonary metastasis (n = 483) who visited the Center for Thoracic Surgery in Regensburg, between January 2009 and December 2017 were analysed retrospectively. Results A total of 251 patients underwent metastectomy with curative intent. VATS was performed in 63 (25.1%) patients, 54 (85.7%) of whom had a solitary metastasis. Wedge resection was the most performed procedure in patients treated with VATS (82.5%, n = 52) and thoracotomy (72.3%, n = 136). Postoperative revisions were necessary in nine patients (4.8%), and one patient died of pulmonary embolism after thoracotomy (0.5%). Patients were discharged significantly faster after VATS than after thoracotomy (p < 0.001). Complete (R0) resection was achieved in 89% of patients. The median recurrence-free survival was 11 months (95% confidence interval 7.9–14.1). During follow-up, eight (12.7%) patients in the VATS group and 42 (22.3%) patients in the thoracotomy group experienced recurrence (p = 0.98). The median overall survival was 61 months (95% confidence interval 46.1–75.9), and there was no significant difference with regard to the surgical method used (p = 0.34). Conclusions VATS metastasectomy can be considered in patients with a solitary lung metastasis. An open surgical approach with palpation of the lung showed no advantage in terms of surgical outcome or survival.

Emergent Hybrid Treatment of a Ruptured Scalp Arteriovenous Fistula with Eyelid involvement: Technical Note

Background Scalp arteriovenous fistulas (AVFs) are a rare vascular disease usually presenting as a progressively increasing pulsating mass in the scalp. These lesions can be associated with mild to severe complications, including congestive heart failure. If ruptures, this pathology constitutes a life-threatening medical emergency because of its potential to cause severe bleeding and acute anemia. Methods We describe the case of a young woman with a ruptured Yokouchi type C scalp AVF with eyelid involvement. Results The patient presented with hypovolemic shock and acute anemia due to severe bleeding from the lesion. Emergent treatment through a combined endovascular and open surgical approach was required to stop bleeding and stabilize the patient. Conclusions Emergent and effective treatment is required to stop bleeding when a scalp AVF ruptures. A combination of endovascular embolization and microsurgical excision of the shunt is a treatment option.