Retrospective Case Series Analysis Research Articles

Overview and Prevention of Complications During Biportal Endoscopic Cervical Spine Surgery

Purpose: Biportal endoscopic spine surgery is becoming popular for various spinal pathologies, including cervical and thoracic spine diseases. However, the safety of biportal endoscopic cervical spine surgery (BECSS) has not been fully investigated, and inexperienced surgeons can cause serious complications. The study aimed to evaluate the complications of BECSS and identify tips for preventing them through a literature review and retrospective analysis of case series. Methods: Articles on BECSS were electronically retrieved from multiple databases, with inclusion criteria including controlled and case series designs, detailed reporting of complications and/or reoperations, and the use of BECSS. The study excluded simple review articles and case reports. The clinical data of 45 patients who underwent BECSS at our institution were collected, and information was extracted on demographic features, surgery type, surgical level, surgery-related complications, and reoperations and their reasons.Results: The study retrieved a total of 67 studies from 5 databases, of which 6 were included after screening. In total, 227 cases of BECSS were identified, and the overall complication rate was 0%–14.3%. Complications included dura tearing, symptom recurrence, incomplete decompression, postoperative epidural hematoma, and transient paralysis. Reoperation was performed in 3 cases.Conclusion: BECSS has similar complication rates to those of other surgical techniques. It is important to provide extensive education, share knowledge and experience, and conduct further research to minimize complications and improve outcomes for patients, as is the case with other spinal surgical procedures.

Carbon-Ion Radiotherapy Combined with Concurrent Chemotherapy for Locally Advanced Pancreatic Cancer: A Retrospective Case Series Analysis

Systemic chemotherapy has significantly improved in recent years. In this study. the clinical impact of carbon-ion radiotherapy (CIRT) with concurrent chemotherapy for locally advanced unresectable pancreatic cancer (URPC) was evaluated. Methods: Patients with URPC who were treated with CIRT between January 2016 and December 2020 were prospectively registered and analyzed. The major criteria for registration were (1) diagnosed as URPC on imaging; (2) pathologically diagnosed adenocarcinoma; (3) no distant metastasis; (4) Eastern Cooperative Oncology Group performance status of 0–2; (5) tumors without gastrointestinal tract invasion; and (6) available for concurrent chemotherapy. Patients who received neoadjuvant chemotherapy (NAC) for more than one year prior to CIRT were excluded. Results: Forty-four patients met the inclusion criteria, and thirty-seven received NAC before CIRT. The median follow-up period of living patients was 26.0 (6.0–68.6) months after CIRT. The estimated two-year overall survival, local control, and progression-free survival rates after CIRT were 56.6%, 76.1%, and 29.0%, respectively. The median survival time of all patients was 29.6 months after CIRT and 34.5 months after the initial NAC. Conclusion: CIRT showed survival benefits for URPC even in the multiagent chemotherapy era.

Prognostic Factors in Staged Bilateral Total Knee Arthroplasty-A Retrospective Case Series Analysis.

Bilateral osteoarthritis of the knee is an indication for a bilateral total knee replacement (TKR) procedure. The goal of our study was to assess the sizes of the implants used during the first and second stages of TKR procedures in order to compare their size and identify the prognostic factors for the second procedure. We evaluated 44 patients who underwent staged bilateral TKR procedures. We assess the following prognostic factors from the first and second surgery: duration of anesthesia, femoral component size, tibial component size, duration of hospital stay, tibial polyethylene insert size, and the number of complications. All assessed prognostic factors did not differ statistically between the first and second TKR. A strong correlation was found between the size of femoral components and the size of tibial components used during the first and second total knee arthroplasty. The mean duration of the hospital stay associated with the first TKR surgery was 6.43 days, whereas the mean duration of the second hospital stay was 5.5 days (p = 0.211). The mean sizes of the femoral components used during the first and second procedures were 5.43 and 5.2, respectively (p = 0.54). The mean sizes of the tibial components used during the first and second TKR procedures were 5.36 and 5.25, respectively (p = 0.382). The mean sizes of the tibial polyethylene inserts used during the first and second procedures were 9.45 and 9.34 (p = 0.422), respectively. The mean duration of anesthesia during the first and second knee arthroplasty was 117.04 min and 118.06 min, respectively (p = 0.457). The mean rates of recorded complications associated with the first and second TKR procedures were 0.13 and 0.06 per patient (p = 0.371). We observed no differences between the two stages of treatment in terms of all analyzed parameters. We observed a strong correlation between the size of femoral components used during the first and second total knee arthroplasty. We noted a strong correlation between the size of tibial components used during the first and second procedure. Slightly weaker prognostic factors include the number of complications, duration of anesthesia and tibial polyethylene insert size.

Reconstruction of Myelomeningocele by Lumbar Artery Perforator plus flap: Retrospective Analysis of case series

Reconstruction of Myelomeningocele by Lumbar Artery Perforator plus flap: Retrospective Analysis of case series

Role of pre-existing incomplete intestinal metaplasia in gastric adenocarcinoma: A retrospective case series analysis.

Risk stratification for patients with gastric precancerous lesions for endoscopic surveillance remains controversial. To analysis of patients having developed gastric adenocarcinoma during the period of follow-up. We conducted a retrospective study on patients having undergone upper endoscopy prior to the development of gastric adenocarcinoma. The presence and stage of precancerous lesions as well as subtype of intestinal metaplasia at the baseline endoscopy got evaluated. Literature mini-review was performed. Out of 1681 subjects in the Biobank, gastric adenocarcinoma was detected in five cases in whom previous endoscopy data with biopsies either from the corpus or antral part were available. All of the patients had incomplete intestinal metaplasia during the baseline endoscopy; all three subjects in whom intestinal metaplasia subtyping was performed according to Filipe et al, had Type III intestinal metaplasia. Two of the five cases had low Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis Intestinal Metaplasia Assessment (OLGIM) stages (I-II) at the baseline. The presence of incomplete intestinal metaplasia, in particular, that of Type III is a better predictor for gastric adenocarcinoma development than OLGA/OLGIM staging system. Subtyping of intestinal metaplasia have an important role in the risk stratification for surveillance decisions.

Haemophagocytic lymphohistiocytosis in pregnancy and the postpartum period: A retrospective case series analysis.

Haemophagocytic lymphohistiocytosis (HLH) is an extremely rare condition characterised by excessive immune activation leading to haemophagocytic activity and has seldom been reported in pregnancy. HLH manifests as relapsing fevers with features of multi- organ failure and has a high mortality. A retrospective case series analysis using national data from MBRRACE-UK maternal death reports (n=5) and case notes from patients diagnosed with HLH during pregnancy at New Cross Hospital, Wolverhampton (n=2) between 2012 and 2021. A total of seven cases were included. Cases uniformly presented with fever and experienced prodromal illnesses consisting of lymphadenopathy, fevers, and malaise. Gestation at presentation ranged from 9/40 to 11 months postpartum. All patients had multiple cytopaenias. Other common features included elevated liver enzymes (n=5), hyperferritinaemia (n=5), splenomegaly (n=4), hypofibrinogenemia (n=4) and elevated soluble interleukin-2 receptor α (CD25) levels (n=3). Underlying causes were identified in four cases. Median time from presentation to diagnosis was 35 days. Bone marrow biopsy was diagnostic in a majority of cases. Corticosteroids and ciclosporin were the most frequently used treatments. In some cases early delivery by caesarean section or termination of pregnancy was necessary to permit maternal treatment. Progression to multi-organ failure resulting in maternal death occurred in five cases: two cases survived. Pregnancy outcomes were: livebirth at term (n=2), preterm livebirth (n=3), termination of pregnancy (n=1), and miscarriage (n=1). Of the surviving infants, one had bone marrow suppression with anaemia at birth and sensorineural deafness. Due to the rarity of the condition, diagnosis is often delayed. In view of the high mortality, clinicians should consider HLH early when reviewing pregnant patients with unexplained pyrexia and multi-organ dysfunction. Early involvement of haematology should be sought, as prompt diagnosis is crucial for meaningful attempts at curative therapy. Important treatment considerations include fetal viability, maternal condition and treatment toxicity.

In-hospital clinical course, outcome and complications among patients vaccinated against COVID-19

This retrospective case-series analysis evaluated 403 fully vaccinated with Vero Cell or Sputnik V vaccines patients hospitalized in the 6th City Clinical Hospital of Minsk in the period between January 01 and February 28, 2022 with the main diagnosis of “coronavirus infection (COVID-19)”. The diagnosis was confirmed by PCR or SARS-CoV-2 virus antigen tests, as well as chest computed tomography data.The study revealed higher prevalence of older patients (over 65 years) infected with the SARS-CoV-2 virus and hospitalized in early 2022, at the height of the wave of the pandemic due to the spread of the Omicron variant. Most patients (91.8 %) had moderate symptoms. More than half of them received oxygen support. A relatively small number of inpatient, only 8 persons (1.9 %), were hospitalized in the intensive care unit (ICU) and four of them needed mechanical ventilation. Comorbid conditions and high incidence of mortality (63.5 %) were common in ICU patients. Hypertension and obesity prevailed in the structure of comorbid pathology of all inpatient persons (74.2 and 24.3 %, respectively). Patients of therapeutic departments had relatively short length of stay in the hospital, as well as low in-hospital mortality (0.5 %) and low incidence of complications (5.3 %).

The potential impact of coagulation factor XIII in trauma-induced coagulopathy – a retrospective case series analysis

BackgroundThe role of factor XIII (FXIII) in trauma-induced coagulopathy (TIC) is not fully understood.MethodsWe evaluated FXIII supplementation in severely injured patients with persistent bleeding. This was a retrospective case series analysis.ResultsTwenty-four patients received FXIII concentrate within 24 h of admission for bleeding that continued after transfusion of > 6 U red blood cells (RBCs); control patients (n = 27) did not receive FXIII concentrate. Both study groups were similar regarding injury severity score and global coagulation tests, but FXIII activity levels were significantly higher and lactate levels significantly lower in the control group, respectively. The differences in FXIII activity between the groups could be attributed to a more severe trauma-induced coagulopathy in FXIII-deficient patients, as demonstrated by lower fibrinogen and higher lactate levels. The median dose of FXIII concentrate within 24 h of admission was 2500 IU (IQR: 1250–4375). Median 24-h transfusion of RBCs (primary study endpoint) was significantly higher in the FXIII group versus controls (10.0 U, IQR 5–14 U vs. 2, IQR 0–6 U; p < 0.01). Subsequently, while patients were in the intensive care unit, there was no statistically significant difference regarding RBC transfusion anymore and the overall clinical outcomes were similar in both patient groups.ConclusionsThe substitution of FXIII in patients who were more seriously compromised due to higher lactate levels and who presented with initially more severe bleedings than patients in the control group, resulted in a comparable transfusion necessity after 24 h. Thus, we guess that the substitution of FXIII in severely injured patients with ongoing bleeding might have an impact on their clinical outcome.

Discussion on the Clinical Course of Adverse Effects after COVID-19 Vaccination: A Retrospective Analysis of Case Series in an Outpatient Department.

A total of 8,303 individuals (4.3%) with adverse reactions (n=191,860) after vaccination developed serious conditions or died. Such health developments could cause people not vaccinated yet or waiting for a booster shot to become fearful of the vaccination. The 3-month (July-September 2021) clinical data of 41 patients from the family medicine department of a single medical center were analyzed retrospectively to determine risk factors and to investigate the clinical course to identify the cause of symptoms in detail. A significant number of older adults aged over 50 years reported experiencing general weakness (P=0.026) but fewer incidences of fever than patients aged 50 years or younger (P=0.011). Eighteen of the 41 patients were requested to visit more than twice or consult a specialist. In 14 patients, the symptoms were explained by other medical causes. The primary physician has a pivotal role in thoroughly evaluating patients who complain of adverse effects after vaccination, considering the broad multitude of symptoms and medical conditions presented. To thoroughly evaluate and appropriately advise patients with adverse reactions to their chosen vaccine, taking detailed medical history and nutritional counseling are required to identify possible underlying causes, resolve symptoms, and educate them on self-care and regarding vaccines.

An Outbreak of Fungal Endophthalmitis After Cataract Surgery in South Korea

Fungal endophthalmitis caused by contaminated medical products is extremely rare; it follows an intractable clinical course with a poor visual prognosis. To report the epidemiologic and clinical features and treatment outcomes of a nationwide fungal endophthalmitis outbreak after cataract surgery as a result of contaminated viscoelastic agents in South Korea. This was a retrospective case series analysis of clinical data from multiple institutions in South Korea conducted from September 1, 2020, to October 31, 2021. Data were collected through nationwide surveys in May and October 2021 from the 100 members of the Korean Retinal Society. Patients were diagnosed with fungal endophthalmitis resulting from the use of the viscoelastic material sodium hyaluronate (Unial [Unimed Pharmaceutical Inc]). Data were analyzed from November 1, 2021, to May 30, 2022. The clinical features and causative species were identified, and treatment outcomes were analyzed for patients who underwent 6 months of follow-up. The fungal endophthalmitis outbreak developed between September 1, 2020, and June 30, 2021, and peaked in November 2020. An official investigation by the Korea Disease Control and Prevention Agency confirmed contamination of viscoelastic material. All 281 eyes of 265 patients (mean [SD] age, 65.4 [10.8] years; 153 female individuals [57.7%]) were diagnosed with fungal endophthalmitis, based on clinical examinations and supportive culture results. The mean (SD) time period between cataract surgery and diagnosis was 24.7 (17.3) days. Patients exhibited characteristic clinical features of fungal endophthalmitis, including vitreous opacity (212 of 281 [75.4%]), infiltration into the intraocular lens (143 of 281 [50.9%]), and ciliary infiltration (55 of 281 [19.6%]). Cultures were performed in 260 eyes, and fungal presence was confirmed in 103 eyes (39.6%). Among them, Fusarium species were identified in 89 eyes (86.4%). Among the 228 eyes included in the treatment outcome analysis, the mean (SD) best-corrected visual acuity improved from 0.78 (0.74) logMAR (Snellen equivalent, 20/120 [7.3 lines]) to 0.36 (0.49) logMAR (Snellen equivalent, 20/45 [4.9 lines]) at 6 months. Furthermore, disease remission with no signs of fungal endophthalmitis (or cells in the anterior chamber milder than grade 1) was noted in 214 eyes (93.9%). This was a retrospectively reviewed case series of a fungal endophthalmitis outbreak resulting from contaminated viscoelastic material. Findings of this case series study support the potential benefit of prompt, aggressive surgical intervention that may reduce treatment burden and improve prognosis of fungal endophthalmitis caused by contaminated medical products.

Factors related to mortality in patients with stage 5 chronic kidney disease on dialysis with COVID-19: An exploratory case series analysis.

Different studies describe the clinical profile and factors that could explain the evolution and outcome of patients with chronic kidney disease and COVID-19. This study aims to evaluate the factors related to the mortality of patients with stage-5 chronic kidney disease on chronic dialysis hospitalized for COVID-19 at the Hospital Nacional Arzobispo Loayza from April to December 2020. Retrospective case series and exploratory analysis were performed. Patients with stage-5 chronic kidney disease on dialysis, older than 18 years, and hospitalized for COVID-19 disease were included. Hospital medical records were the primary data source. A total of 105 medical records were reviewed. 57 were male (54.3%), with a mean age of 58.6 years (standard deviation: 14.3). Eighty-four patients survived (80%), and 21 died (20%). The main cause of hospital admission, present in 80 patients (76.2%), was respiratory failure; the mean hospital stay was of 11.8 days (SD: 7.8). In the bivariate analysis: patients with moderate to severe COVID-19, overweight and obesity, increased levels of leukocytes, D-dimer, ferritin, C-reactive protein, lactate dehydrogenase, as well as, decreased levels of lymphocytes, bicarbonate and arterial oxygen pressure/inspired oxygen fraction were related to mortality risk. In multivariate analysis, only severe COVID-19 disease (OR 1.48; 95% CI 2.24 to 7.77), C-reactive protein > 10 mg/dL (OR: 9.72; 95% CI: 1.41 to 18.58), and arterial oxygen pressure/inspired oxygen fraction ≤ 150 millimeters of mercury (OR: 10.23; 95% CI: 5.87 to 36.06) were factors associated with poor survival. In patients with stage-5 chronic kidney disease hospitalized for COVID-19, severe COVID-19 disease, C-protein reactive levels > 10 milligrams per deciliter, arterial oxygen pressure / inspired oxygen fraction ≤ 150 millimeters of mercury and severe COVID-19 disease were the main factors related to mortality.

Cocaine-induced granulomatosis with polyangiitis-an under-recognized condition.

Cocaine and cocaine mixed with levamisole are increasingly used in the UK and result in significant direct nasal damage in addition to promoting vasculitis. Our aims were as follows: (1) to identify the main symptoms and presentation of cocaine-induced vasculitis; (2) to provide evidence regarding the best practice for the investigation and diagnosis of cocaine-induced vasculitis; and (3) to analyse the clinical outcomes of patients in order to understand the optimal management for the condition. We performed a retrospective case series analysis of patients presenting with cocaine-induced midline destructive lesions or vasculitis compatible with granulomatosis with polyangiitis (GPA) from two large tertiary vasculitis clinics between 2016 and 2021. Forty-two patients (29 Birmingham, 13 London) with cocaine-induced midline lesions or systemic disease were identified. The median age was 41 years (range 23-66 years). Current cocaine use was common, and 20 of 23 samples provided were positive when routine urine toxicology was performed; 9 patients who denied ever using cocaine were identified as using cocaine based on urine toxicology analysis, and 11 who stated they were ex-users still tested positive. There was a high incidence of septal perforation (75%) and oronasal fistula (15%). Systemic manifestations were less common (27%), and only one patient had acute kidney injury. Fifty-six per cent of our patients were PR3-ANCA positive, with none testing positive for MPO-ANCA. Symptom remission required cocaine discontinuation even when immunosuppression was administered. Patients with destructive nasal lesions, especially young patients, should have urine toxicology performed for cocaine before diagnosing GPA and considering immunosuppressive therapy. The ANCA pattern is not specific for cocaine-induced midline destructive lesions. Treatment should be focused on cocaine cessation and conservative management in the first instance in the absence of organ-threatening disease.

Clinical Outcomes of Soft Tissue Sarcoma around the Elbow Joint: A Retrospective Single Institution Study.

We report a retrospective case series analysis of clinical outcomes of patients with soft tissue sarcoma around the elbow. Twenty-two patients underwent surgical tumor excision between January 1999 and May 2017, with a mean follow-up of 85.2 months. Six tumors were localized in the upper arm, nine in the elbow, and seven in the forearm. Sixteen tumors were deep-seated, and six were superficially located. Fifteen patients underwent wide excision, including one amputation, and 18 achieved (81.8%) negative margins histologically. Two local recurrences and four distant metastases developed. The mean Musculoskeletal Tumor Society score was 92.0% (range, 33.3-100). The 5-year local recurrence-free survival rate, metastasis-free survival rate, and overall survival rate were 90.0%, 77.0%, and 79.7%, respectively. Local control and limb function can have favorable outcomes when the tumor excised has a histologically negative margin without sacrificing the major structure.

The Short-Term Outcome of Middle Meningeal Artery Embolization for Chronic Subdural Hematoma with Mild Symptom: Case Series

A few reports have demonstrated the efficacy of middle meningeal artery embolization (MMAE) alone for mildly symptomatic chronic subdural hematoma (CSDH); however, the clinical course in the early posttreatment period remains unclear. The purpose of this study was to analyze the short-term outcomes of this technique at our center. This study was based on a retrospective analysis of a single-center consecutive case series. Patients with mildly symptomatic CSDH treated with MMAE alone between July 2020 and June 2022 were examined. Neurological examinations and head computed tomography scans were performed before treatment and 1, 7, 14, and 28days after treatment. The clinical course of the patients was analyzed. In particular, symptom improvement within 1week from treatment or rescue evacuation and the factors associated were evaluated. Fifteen patients were included in this study. No procedure-related complications occurred. Partial or complete recovery within the first week from treatment was observed in 10 cases (66.7%), and the symptoms resolved completely in a median of 26 (6.5-33.5) days. Rescue evacuation was needed in 3 cases (20.0%). The hematoma volume and midline shift gradually decreased from baseline, with a significant improvement within the first week (P= 0.030 and 0.0032, respectively). MMAE alone provides relatively early improvement in cases of mildly symptomatic CSDH and may be a potential alternative to surgical evacuation or medical therapy.

Development and Validation of the Chronic Subdural HematOma Referral oUtcome Prediction Using Statistics (CHORUS) Score: A Retrospective Study at a National Tertiary Center

Chronic subdural hematoma (CSDH) is a common neurosurgical condition with an increasing rate of patient referrals. CSDH referral decision-making is a subjective clinical process, and our aim was to develop a simple scoring system capable of acting as a decision support tool aiding referral triage. A single tertiary center retrospective case series analysis of all CSDH patient referrals from 2015 to 2020 was conducted. Ten independent variables used in the referral process were analyzed to predict the binary outcome of either accepting or rejecting the CSDH referral. Following feature selection analysis, a multivariable scoring system was developed and evaluated. 1500 patient referrals were included. Stepwise multivariable logistic and least absolute shrinkage and selection operator regression identified age <85years, the presence of headaches, dementia, motor weakness, radiological midline shift, a reasonable premorbid quality of life, and a large sized hematoma to be statistically significant predictors of CSDH referral acceptance (P<0.04). These variables derived a scoring system ranging from -9 to 6 with an optimal cut-off for referral acceptance at any score >1 (P<0.0001). This scoring system demonstrated optimal calibration (brier score loss=0.0552), with a score >1 predicting referral acceptance with an area under the curve of 0.899 (0.876-0.922), a sensitivity of 83.838% (76.587-91.089), and a specificity of 96.000% (94.080-97.920). Certain patient specific clinical and radiological characteristics can predict the acceptance or rejection of a CSDH referral. Considering the precision of this scoring system, it has the potential for effectively triaging CSDH referrals.

Clinical and functional outcomes of displaced proximal humerus fractures treated with PHILOS plate system and autologous bone graft.

This retrospective case series analyses the clinical and radiological outcomes of displaced proximal humerus fractures treated with PHILOS plate system and iliac crest bone autograft. Twenty-six patients with displaced fractures of proximal humerus, who were treated with PHILOS plate and autologous iliac crest bone grafts from January 2015 to September 2020, were included in this study. The inclusion criteria were proximal humerus fractures with displacement of more than 1cm and angulation of more than 45 degrees. The functional outcomes were evaluated using DASH and constant score. Radiological outcomes were measured by calculating the fracture union. The average age of the cohort was 47.28±13.69 years. Over all, the mean DASH score was 10.25 and constant score was 77.65 at three-year follow-up. The PHILOS plate with iliac crest bone autologous graft provides good radiological and functional outcomes, especially for the cases with bone defects and poor-bone stock.

8890 Robotic Hysterectomies with Mini-Laparotomies for Enlarged Uteri

<h3>Study Objective</h3> Robotic surgical system assistance in hysterectomies has gained significant popularity amongst gynecologists for its ease of employment, improved visualization and minimally invasive approach in attempts to decrease intra-/post-operative complications and improve clinical outcomes. Assessment of clinical outcomes, specifically length of hospitalization and postoperative complication rates, of patients undergoing robotic hysterectomy with the addition of mini-laparotomy and in bag manual morcellation for extraction of enlarged uteri specimen was analyzed. <h3>Design</h3> Retrospective case series analysis of patients who received the treatment in question pooled from a private practice Obstetrics and Gynecology group. <h3>Setting</h3> N/A. <h3>Patients or Participants</h3> Surgical database of this private practice was reviewed and analyzed between 2015 and 2021 for patients undergoing this procedure for benign indications with enlarged uteri (namely uterine fibroids) yielding 52 eligible participants. <h3>Interventions</h3> After completion of a robotic-assisted laparoscopic hysterectomy of an enlarged uterus using the standard technique, the resulting specimen which could not easily be delivered vaginally, was placed into a surgical bag, brought through a mini-laparotomy (≤5cm) and manually morcellated to facilitate specimen extraction. <h3>Measurements and Main Results</h3> A total of 52 patients were included in the retrospective analysis revealing a 90.4% (47/52) same day discharges with 5 post-operative admissions; one for uncontrolled blood glucose and four for post-operative pain. The minimum uterine size requiring mini-laparotomy for extraction was found to be 12cm with at least a 366g weight. The average uterine size and weight requiring said intervention were found to be 18cm and 853g, respectively. Complications were also found to be rare with seven total reports of post-operative fever of which 5 pelvic collections were found and three microbiologically confirmed as pelvic abscesses necessitating drainage and parenteral antibiotics. <h3>Conclusion</h3> Mini-laparotomy within bag manual morcellation for enlarged uteri is a beneficial adjunct technique to robotic-assisted laparoscopic hysterectomies allowing the preservation of the benefits of minimally invasive surgery while also maintaining low complication rates.

Point-of-Care Ultrasound for the Diagnosis of Pediatric Testicular Torsion: A Retrospective Case Series Analysis.

Acute testicular torsion is a surgical emergency that warrants prompt treatment. The diagnosis is typically confirmed by ultrasonography interpreted by a radiologist (RADUS); however, in this study, we describe the clinical course of 23 patients for whom point-of-care ultrasound (POCUS) was performed by pediatric emergency medicine physicians during the initial assessment for testicular torsion in the pediatric emergency department (PED). A retrospective case series analysis of patients aged 0 to 18 years who were diagnosed with acute testicular torsion after undergoing scrotal POCUS through our PED. Between June 2015 and December 2020, 155 boys received an International Classification of Diseases-9 code of Torsion of Testis after presenting to our PED. Seventy-three patients were imaged preoperatively, of which 50 (68.5%) were diagnosed via RADUS alone. Twenty-three patients (31.5%) underwent POCUS (median age 14.1 years [interquartile range {IQR}: 11.4-15.9 years]), of which 14 (60.9%) were imaged by POCUS alone, whereas the remaining 9 patients (39.1%) underwent POCUS before RADUS. Thirteen of the 23 patients (56.5%) who underwent POCUS had intraoperative findings consistent with acute testicular torsion, whereas another 3 patients (13.0%) required manual detorsion in the PED before orchiopexy. Six patients required orchiectomy. All patients for which POCUS findings were suggestive of acute testicular torsion were correctly classified.The median length of stay from time to admission to orchiopexy for those who received RADUS only versus POCUS only was 184 minutes (IQR: 136-255), and 121 minutes (IQR: 80-202), respectively ( P = 0.036). Among the patients who experienced POCUS, the median length of stay for those who underwent RADUS in addition to POCUS compared with those who underwent POCUS alone was 202 minutes (IQR: 136-338.4) ( P = 0.031). Point-of-care ultrasound performed by pediatric emergency medicine physicians can be used to expedite surgical management and streamline the management of pediatric patients suspected of acute testicular torsion.

Sugammadex to Facilitate Neurologic Assessment in Severely Brain-Injured Patients: A Retrospective Analysis and Practical Guidance.

Background Widely used in anesthetic management, sugammadex is increasingly employed in the reversal of neuromuscular blocking agents (NMBAs) in the emergency department and critical care arena, where little evaluative data currently exists. This study explored the utility and safety of using sugammadex to facilitate neurologic assessmentsin critically ill, NMBA-exposed patients. Methods We pursued a retrospective case series and single-arm cohort analysis of all brain-injured patientsreceiving sugammadex to facilitate neurologic evaluation during one year at a high-volume Level 1 trauma center. The primary outcome was the qualitative impact of sugammadex administration on neurosurgeon decision-making. Secondary outcomes included the change to Glasgow Coma Scale (GCS) and hemodynamic parameters compared before and after sugammadex administration.Sugammadex dosing was also assessed across various weight scalars to explore dose-response trends and generate preliminary guidance for use in this setting. Results Our study criteria yielded 12 sugammadex administrations across 11 patients, the majorityof whom had sustained a traumatic brain injury.All sugammadex administrations were adjudicated as beneficial to neurosurgeon decision-making and 50% were associated with a change to prognosis and plan. Sugammadex was associated with an increase in the GCSof 1-8 points among the 67% of patients who responded. Mean arterial pressure decreased significantly after sugammadex administration (median 94 vs. 104 mmHg, p=0.0215, median change of -8 mmHg [95%CI -25-3 mmHg]). No apparent dose-response trends were observed for changes to GCS or hemodynamic parameters. Conclusions The use of sugammadex to facilitate neurologic assessment after NMBA exposure in brain-injured patients was frequently associated with clinically meaningful changes to the neurologic exam and treatment plan. The risks of hemodynamic compromise and care complexity should be collaboratively weighed before pursuing this modality.An empiric sugammadex dose of 200 mg appears reasonable for this purpose, but further evaluation of NMBA reversal in the neurocritically ill outside of procedural settings is warranted.

Combined use of minimal screw synthesis and external articulated fixation is effective for the management of supra-intercondyloid humeral fractures in the elderly? A retrospective study

BackgroundFractures of the distal humerus are relatively rare and can be a source of disabling outcomes especially if not properly treated. Therefore, the objective of the treatment must be to obtain a stable synthesis that allows early mobilization, avoiding complications such as muscular hypotonotrophy, joint rigidity or delays in consolidation that may be due to prolonged immobilization of this joint. Although ORIF treatment of these fractures may intuitively appear to be the gold standard, there is still no consensus in the literature on which type of treatment is most suitable. Patients and methodWe report in this retrospective case series analysis our experience on 31 elder patients (more than 65 years old), affected by a supra-intercondyloid humerus fracture, treated using a minimal internal fixation with cannulated screws combined with the use of an external articulated elbow fixator. This methodology is less invasive but allows a stable synthesis and an early mobilization.Clinical and radiographic examinations were performed for each patient at 1, 2, 3 and 6 months after surgery. At 6 months the residual joint excursion was evaluated and the data were collected. In addition, at 6 months, each patient underwent three different functional capacity assessment questionnaires: MAYO Elbow Performance score, The Disability of the ARM, Shoulder and Hand Score (QuickDASH) and Oxford Elbow Score. ResultsThe healing rate was 100% with no cases of non-union, despite the old age of our patients. The average range of motions obtained at 6 months from the surgery was 111° in flexion-extension and 157° in pronation-supination for the patient with an extra-articular fracture, 88° in flexion-extension and 153° in pronation-supination for the patients with a partial articular fracture and 85° in flexion-extension and 149° in pronation-supination for the patients with a complete articular fracture. Our results in the recovery of an arc of motion in flexion-extension are slightly less performing than the results obtained with an ORIF treatment. Indeed, according to literature the mean postoperative flexion arc in an ORIF treatment of distal humerus fractures in adults is 110°.The functional results obtained were satisfactory, with an average score at 6 months from the surgery of 95/100 (Mayo score) for the patients with an extra-articular fracture, 83.3/100 for the patients with a partial articular fracture and 79/100 for the patients with a complete articular fracture. ConclusionThe results obtained, in terms of range of motions, function, pain and healing and complications rate lead us to affirm that, in selected patients, this technique can represent a valid treatment and therefore a valid option that could be considered.