Analysis on Influencing Factors of Recurrence after Indirect Inguinal Hernia Laparoscopic Surgery

This paper aims to analyze the recurrence of indirect inguinal hernia in children after laparoscopic surgery and investigate the influencing factors that may lead to recurrence so as to guide the prevention and treatment of postoperative recurrence of this kind of disease in the future. The data of 260 children with indirect inguinal hernia treated by laparoscopic surgery and followed up in our hospital from July 2019 to July 2021 were selected. A self-designed questionnaire was used to collect the basic data. The recurrence was analyzed, and the influencing factors of recurrence were analyzed by univariate analysis and multivariate analysis. Among 400 children after indirect inguinal hernia laparoscopic surgery, an occurrence was observed in 15 children, and the recurrence rate was 5.77%. Univariate analysis showed that the age and course of disease were not correlated with recurrence after indirect inguinal hernia laparoscopic surgery ( P > 0.05 ). Being male, bilateral lesions, exact high ligation, loose hernia back wall peritoneum, deciduous ligature, incorrect ligation of the fascia of musculus obliquus externus abdominis, large inguinal hernia, circumferential wiring, and too early off-bed activity were the influencing factors of recurrence after indirect inguinal hernia laparoscopic surgery ( P < 0.05 ). Logistic multivariate regression analysis showed that being male, bilateral lesions, loose hernia back wall peritoneum, deciduous ligature, incorrect ligation of the fascia of musculus obliquus externus abdominis, large inguinal hernia, and too early off-bed activity were the influencing factors of recurrence after indirect inguinal hernia laparoscopic surgery (OR>1, P < 0.05 ). Exact high ligation and circumferential wiring were protective factors of recurrence after indirect inguinal hernia laparoscopic surgery (OR>1, P < 0.05 ). After indirect inguinal hernia laparoscopic surgery, recurrences were affected by many factors, such as gender, site of pathological changes, and loose hernia back wall peritoneum. For these children with risk factors, reasonable intervention should be taken to reduce recurrence; exact high ligation and circumferential wiring are the protective factors. If permitted, the children meeting related indications can be treated by high ligation or circumferential wiring to reduce the risk of recurrence after indirect inguinal hernia laparoscopic surgery.

A Multicenter Assessment of Anatomic Suitability for Iliac Branched Devices in Eastern Asian Patients With Unilateral and Bilateral Aortoiliac Aneurysms

Objective: This study aims to assess the suitability of four types of commercial iliac branch device systems to treat Eastern Asian abdominal aortic aneurysm (AAA) patients with bilateral or unilateral common iliac artery aneurysms (CIAAs).Methods: Patients with a coexisting AAA and a unilateral or bilateral CIAAs who underwent endovascular aneurysm repair (EVAR) at two tertiary centers in China from 2015 to 2017 were reviewed. Morphology of lesions was measured and the anatomic suitability for Cook iliac branch device (IBD), Gore iliac branch endoprosthesis (IBE), Lifetech iliac branch stent graft (IBSG), and Jotec IBD was evaluated according to the latest instructions for use.Results: Seventy-six patients with AAA were enrolled, including 35 bilateral CIAAs, 41 unilateral CIAAs. A hundred and eleven lesions were investigated aggregately: 16.2, 28.8, 21.6, and 19.8% met the criteria for Cook IBD, Gore IBE, Lifetech IBSG, and Jotec IBD, respectively. A total of 34 (44.7%) patients could be treated for at least one lateral lesion. The diameter of the internal iliac artery (IIA) was the most common restriction for IBD application. Additionally, the IIA diameter of lesions in the bilateral group was significantly larger compared with the unilateral group (P &lt; 0.001). Based on the anatomical characteristics alone, it is likely that IBDs will be more suitable for unilateral lesions than bilateral ones (P &lt; 0.05). However, there was no difference between the suitability for patients with unilateral or bilateral CIAAs (P &gt; 0.05).Conclusions: Less than half of Eastern Asian patients with aortoiliac aneurysms were eligible for IBD application. This was primarily due to the IIA diameter failing to meet the criteria. And thus, the suitability of lesions in bilateral group was significantly lower than that in the unilateral group. Aiming to expand the indications and optimize the design of the iliac branch devices, IIA diameter and the anatomical characteristics of the bilateral lesions should be considered deliberately.

Corpus Callosotomy for Controlling Epileptic Spasms: A Proposal for Surgical Selection

In 1940, van Wagenen and Herren first proposed the corpus callosotomy (CC) as a surgical procedure for epilepsy. CC has been mainly used to treat drop attacks, which are classified as generalized tonic or atonic seizures. Epileptic spasms (ESs) are a type of epileptic seizure characterized as brief muscle contractions with ictal polyphasic slow waves on an electroencephalogram and a main feature of West syndrome. Resection surgeries, including frontal/posterior disconnections and hemispherotomy, have been established for the treatment of medically intractable ES in patients with unilaterally localized epileptogenic regions. However, CC has also been adopted for ES treatment, with studies involving CC to treat ES having increased since 2010. In those studies, patients without lesions observed on magnetic resonance imaging or equally bilateral lesions predominated, in contrast to studies on resection surgeries. Here, we present a review of relevant literature concerning CC and relevant adaptations. We discuss history and adaptations of CC, and patient selection for epilepsy surgeries due to medically intractable ES, and compared resection surgeries with CC. We propose a surgical selection flow involving resection surgery or CC as first-line treatment for patients with ES who have been assessed as suitable candidates for surgery.

Reconstruction of congenital microtia after ear canaloplasty using V-Y advancement of a temporal triangular flap

Background Reconstruction of congenital microtia remains challenging, particularly in patients with a history of ear canaloplasty due to insufficient regional soft tissue. The insertion of a tissue expander prior to implantation of the cartilage framework has traditionally been employed. However, this procedure could induce additional morbidity. Herein, we present a method using V-Y advancement of a temporal triangular flap to gain additional soft tissue in these challenging cases.Methods Congenital microtia patients with a history of ear canaloplasty who underwent auricular reconstruction using the Nagata technique between 2016 and 2020 were reviewed. To obtain additional soft tissue, V-Y advancement of a temporal triangular flap was performed concurrently with implantation of the costal cartilage framework, without prior insertion of a tissue expander. The outcomes of these patients with respect to postoperative complications and esthetics were evaluated.Results Eight patients with bilateral lesions were included. No specific complications developed after the first-stage surgery. However, one patient experienced complications after the second stage (auricular elevation). An analysis of the esthetic results showed most patients had excellent outcomes, achieving a satisfactory convolution. The median number of operations needed to complete reconstruction was 2, which was fewer than required using the conventional method with prior insertion of a tissue expander.Conclusions In patients with a history of previous canaloplasty, V-Y advancement of a temporal triangular flap could serve as an alternative to tissue expansion for microtia reconstruction. This technique provided reliable and satisfactory results with a reduced number of surgical stages.

Stroke-Associated Cortical Deafness: A Systematic Review of Clinical and Radiological Characteristics

Background: Stroke is the leading cause of cortical deafness (CD), the most severe form of central hearing impairment. CD remains poorly characterized and perhaps underdiagnosed. We perform a systematic review to describe the clinical and radiological features of stroke-associated CD. Methods: PubMed and the Web of Science databases were used to identify relevant publications up to 30 June 2021 using the MeSH terms: “deafness” and “stroke”, or “hearing loss” and “stroke” or “auditory agnosia” and “stroke”. Results: We found 46 cases, caused by bilateral lesions within the central auditory pathway, mostly located within or surrounding the superior temporal lobe gyri and/or the Heschl’s gyri (30/81%). In five (13.51%) patients, CD was caused by the subcortical hemispheric and in two (0.05%) in brainstem lesions. Sensorineural hearing loss was universal. Occasionally, a misdiagnosis by peripheral or psychiatric disorders occurred. A few (20%) had clinical improvement, with a regained oral conversation or evolution to pure word deafness (36.6%). A persistent inability of oral communication occurred in 43.3%. A full recovery of conversation was restricted to patients with subcortical lesions. Conclusions: Stroke-associated CD is rare, severe and results from combinations of cortical and subcortical lesions within the central auditory pathway. The recovery of functional hearing occurs, essentially, when caused by subcortical lesions.

Hypoxic-Ischemic Injury of Basal Ganglia Associated with the COVID-19 Infection: Case Report

There is emerging evidence of a broad spectrum of neurological manifestations in COVID-19 patients. We report a case of a patient diagnosed with COVID-19 who presented bilateral lesions of the basal ganglia related to a severe acute respiratory distress syndrome. This observation allows expanding the neurological spectrum of COVID-19 particularly in patients with a more severe clinical course.

Native Kidney Hydronephrosis Is Associated with Upper Urinary Tract Urothelial Carcinoma in Post-Kidney Transplantation Patients

Background: Upper urinary tract urothelial carcinoma (UTUC) is the most common malignancy occurring after kidney transplantation (KT) in Taiwan. The aim of this study was to investigate the association between native kidney hydronephrosis and UTUC in post-KT patients. Methods: From 2003 to 2018, we conducted a retrospective cohort study that enrolled 1005 post-KT patients, 67 of whom were subsequently diagnosed with UTUC. We divided patients into two groups based on whether or not they had UTUC. Multivariate analysis and Kaplan-Meier plot were used to evaluate if native kidney hydronephrosis was associated with post-KT UTUC. Results: The total cohort consisted of 612 men (60.9%) and 393 women (39.1%) with a mean age of 48.2 ± 12.0 at KT. The mean follow-up time was 118.6 ± 70.2 months, and mean time from KT to UTUC was 7.53 years. There was a significant gender difference with a female predominance among the UTUC patients (73.1% versus 26.9%, p < 0.001). Native kidney hydronephrosis occurred more frequently in the UTUC group (68.7% versus 4.8%, p < 0.001). Multivariate analysis showed that native kidney hydronephrosis and female gender were significantly associated with UTUC with odds ratios of 35.32 (95% CI, 17.99–69.36; p < 0.001) and 3.37 (95% CI, 1.55–7.29; p = 0.002), respectively. UTUC in the post-KT patients also showed aggressive pathological characteristics and a tendency toward bilateral lesions (41.8%). Conclusions: Native kidney hydronephrosis is significantly associated with post-KT UTUC patients in Taiwan. Native kidney hydronephrosis may be a deciding factor for standard nephroureterectomy and bladder cuff excision in selected patients. Nevertheless, almost half of the patients with kidney hydronephrosis do not present with UTUC at the end of our study.

COVID-19 and Tuberculosis Coinfection: An Overview of Case Reports/Case Series and Meta-Analysis

Background: Coronavirus disease 2019 (COVID-19) and tuberculosis (TB) are two major infectious diseases posing significant public health threats, and their coinfection (aptly abbreviated COVID-TB) makes the situation worse. This study aimed to investigate the clinical features and prognosis of COVID-TB cases.Methods: The PubMed, Embase, Cochrane, CNKI, and Wanfang databases were searched for relevant studies published through December 18, 2020. An overview of COVID-TB case reports/case series was prepared that described their clinical characteristics and differences between survivors and deceased patients. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) for death or severe COVID-19 were calculated. The quality of outcomes was assessed using GRADEpro.Results: Thirty-six studies were included. Of 89 COVID-TB patients, 19 (23.46%) died, and 72 (80.90%) were male. The median age of non-survivors (53.95 ± 19.78 years) was greater than that of survivors (37.76 ± 15.54 years) (p &lt; 0.001). Non-survivors were more likely to have hypertension (47.06 vs. 17.95%) or symptoms of dyspnea (72.73% vs. 30%) or bilateral lesions (73.68 vs. 47.14%), infiltrates (57.89 vs. 24.29%), tree in bud (10.53% vs. 0%), or a higher leucocyte count (12.9 [10.5–16.73] vs. 8.015 [4.8–8.97] × 109/L) than survivors (p &lt; 0.05). In terms of treatment, 88.52% received anti-TB therapy, 50.82% received antibiotics, 22.95% received antiviral therapy, 26.23% received hydroxychloroquine, and 11.48% received corticosteroids. The pooled ORs of death or severe disease in the COVID-TB group and the non-TB group were 2.21 (95% CI: 1.80, 2.70) and 2.77 (95% CI: 1.33, 5.74) (P &lt; 0.01), respectively.Conclusion: In summary, there appear to be some predictors of worse prognosis among COVID-TB cases. A moderate level of evidence suggests that COVID-TB patients are more likely to suffer severe disease or death than COVID-19 patients. Finally, routine screening for TB may be recommended among suspected or confirmed cases of COVID-19 in countries with high TB burden.

The Histopathological Analysis of 122 Cases of Ovarian Lesions

Aim: To outline various histopathological types of ovarian cysts received in our teaching hospital along with their prevalence and mode of presentation and to assess the proportion of physiologic versus pathological cysts and benign versus malignant ovarian cysts. Duration of study: From Jan 2019 to March 2021. Methods: Histopathology Department of Bakhtawar Amin Medical & Dental College & Hospital, Multan. A retrospective review of 122 ovarian lesions including physiological/functional cysts, pathological non neoplastic cysts as well as benign, borderline and malignant neoplasm. Histopathology reports of all ovarian specimens were reviewed and counted. Details like age, marital status, parity, presenting complaints, procedure opted, laterality, size, gross and microscopic details and final histological diagnosis etc were recorded. H&E stained slides of all cases were reviewed. In difficult suspicious cases, immunohistochemistry was also carried out. Percentage and proportions were calculated for all the variables. Relevant tables and charts were computed. Results: A total of 122 ovarian specimens with some lesion were segregated in histopathology department of Bakhtawar Amin Hospital from 117 patients with 5 patients having bilateral lesions. The mean age was 33.2 years (ranging from 13-71 years). Most ladies presented between 25-45 years of age. Out of these 117 patients, 18 ladies were unmarried. Out of the 99 married, 12 were nulliparous. Sixty four ladies (54.7%) found to have cysts/neoplasm in right sided ovary, forty eight (41%) presented with left sided ovarian involvement and 5 (4.3 %) presented with bilateral ovarian lesions. Conclusion: Non neoplastic ovarian cysts are more frequent as compared to neoplastic masses. Histopathological diagnosis is mandatory for final confirmatory diagnosis. Keywords: Ovarian lesions, reproductive cells, cyst

Chest CT and Clinical Features of COVID-19 Patients in the Early Stage of the Epidemic: An Observational Study from China

Background: COVID-19 had caused more than 2.8 million deaths globally, and the epidemic will persist for an extended period of time. We analyzed clinical features of patients in the early stage of the epidemic, so as to deepen the understanding of the disease.Methods: In this retrospective study, we included 84 confirmed cases of COVID-19 during February 1, 2020 and March 31, 2020. Baseline data were used to classify patients as moderate (57%) or severe/critical based on Chinese protocol. We focused on analyzing the differences in chest computed tomography (CT) between the two groups. Results: Of the 84 cases, 50 were male and the median age was 69 years. 55 (65%) patients had comorbidities at admission, more in the severe/critical group (P=0.040). 94% patients had bilateral lesions on CT, up to 68% had lesions involving all lobes. Ground glass opacification (GGO) (96%), consolidation (44%), Linear opacities (50%) and Air bronchogram (23%) were the mainly lesions. The lesion was gradually absorbed over time, but imaging abnormalities can persist for a long time. Compared with moderate cases, the severe/critical group had more pulmonary consolidation changes (P=0.044) and significantly higher CT severity Score (CTSS) (P=0.040). Lymphocyte counts were significantly lower (P=0.011) and NLR were higher (P=0.029) in severe/critical cases. Conclusions: Chest CT showed bilateral and multiple GGO and consolidation mainly. After treatment, pulmonary lesions were gradually absorbed over time, and imaging abnormalities can be persistent for a long time. Lung consolidation, CTSS, comorbidity, lymphocyte counts, and NLR may be predictors of severe COVID-19.