Candidates For Surgical Treatment Research Articles

Stereotactic Body Radiotherapy for Kidney Cancer: Ready for Prime Time?

The standard treatment for renal cell carcinoma (RCC) is surgery. However, a number of patients will not be candidates for surgical treatment or will reject this therapeutic approach. Therefore, alternative approaches are required. Historically, radiotherapy has been considered an ineffective treatment for RCC due to the radioresistance of renal tumour cells to conventional fractionation and the increased rate of toxicity. Stereotactic body radiotherapy (SBRT) is a radiotherapy technique that provides a non-invasive ablative treatment with remarkable rates of local control in both primary tumours and metastases in several locations, with a low associated morbidity due to the highly conformal dose and the use of image-guided techniques. Current evidence shows that a higher dose per fraction, achieving a higher biological effective dose, can overcome the radioresistance of RCC cells. Therefore, SBRT, as well as the combination of SBRT and new emerging immune therapies, has a potential role in the local treatment of primary RCC and oligometastatic RCC patients.

RF11 | PSAT274 A Dramatic Response of a Thyroid Lymphoma to R-CHOP Chemotherapy Reversing Mechanical Airway Obstruction and Respiratory failure, A Case Report

Abstract Introduction Primary thyroid lymphoma is extremely rare and accounts for <5% of all thyroid malignancies, with an estimated incidence of 2 per 1 million each year. It usually occurs in patients with preexisting Hashimoto thyroiditis and commonly presents between 60 to 70 years. Almost all thyroid lymphomas are non-Hodgkin's lymphoma of B-cell origin, with diffuse large B-cell lymphoma being the most common subtype. Chemotherapy and radiotherapy are the primary treatment of thyroid lymphomas. This case report shows a dramatic response to chemotherapy in a patient with mechanical airway obstruction due to large thyroid lymphoma, which facilitated her extubation. Case Presentation An 83-year-old woman with a past medical history significant for type 2 diabetes, coronary heart disease, and hypothyroidism controlled on L-thyroxine replacement therapy was presented with 3 months history of gradually progressive dysphagia. It was associated with left-sided neck pain with swallowing, choking on food, and shortness of breath. She denied fever, chills, or excessive sweats. Local examination of her neck revealed a large firm thyroid mass associated with left cervical lymphadenopathy. Her CT neck scan with intravenous contrast showed an enlarged, probably malignant thyroid gland with marked amount of adjacent pathologic lymph nodes and marked transverse narrowing of the trachea to approximately 8.6 mm with no retrosternal extension. Also, Her CT abdominal scan with intravenous contrast showed a 3.6 cm lesion of the medial right hepatic lobe (segment 8) concerning for metastases. The patient underwent an ultrasound-guided thyroid biopsy, and the results confirmed the diagnosis of diffuse large B cell lymphoma of the neck and thyroid. A few days later, the patient experienced respiratory distress and failure secondary to mechanical airway obstruction that required urgent intubation and mechanical ventilation. The discussion among different specialties, including general surgery, concluded that the patient was not a candidate for surgical intervention or tracheostomy, and recommendations were to proceed to palliative chemotherapy. She started R-CHOP chemotherapy (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisone), followed by a marked reduction in the thyroid size and relieving of the tracheal compression on the following CT neck scan. Her condition dramatically improved, and she was extubated after 5 days of receiving the first cycle of R-CHOP chemotherapy. Conclusion Our case report demonstrates dramatic reversal of mechanical airway obstruction caused by a thyroid lymphoma within a few days of initiation of R-CHOP chemotherapy. These cases are usually considered terminal and do not undergo aggressive surgical interventions. R-CHOP chemotherapy needs to be considered in these cases before considering hospice care. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m., Saturday, June 11, 2022 1:12 p.m. - 1:17 p.m.

Indicación, realización y resultado del cateterismo de venas adrenales en pacientes con hiperaldosteronismo primario

Primary hyperaldosteronism (PAH) is an important cause of secondary hypertension (HTN). The study of the same requires a high clinical suspicion in addition to a hormonal study that confirms hormonal hypersecretion. It is important to start the appropriate treatment once the diagnosis is confirmed, and for this is necessary to demonstrate whether the hormonal hypersecretion is unilateral (patients who could be candidates for surgical treatment) or bilateral (patients who are candidates for pharmacological treatment only).At the Hospital del Mar since 2016 there has been a multidisciplinary work team in which Nephrologists, Endocrinologists, Radiologists and Surgeons participate to evaluate cases with suspected hyperaldosteronism and agree on the best diagnostic-therapeutic approach for these patients, including the need for adrenal vein sampling, which is a technique that in recent years has become the gold standard for the study of PAH.In the present study we collect the experience of our center in performing adrenal vein catheterization and its usefulness for the management of these patients.

S2611 It Is so Complicated: Pancreatico-Spleno-Colonic Fistula Presenting as Gastrointestinal Bleeding

Introduction: Gastrointestinal bleeding is common in clinical practice with variable etiology, we present a rare case of pancreatic pseudocyst complicated by spleno-colonic fistula manifesting with brisk hematochezia. Case Description/Methods: A 50-year-old male with no significant past medical history presented with fever and acute encephalopathy. He subsequently had a prolonged and complicated hospital course with a new diagnosis of Human immunodeficiency virus/Acquired immunodeficiency syndrome, disseminated tuberculosis, and chronic pancreatitis with a pancreatic pseudocyst. During hospitalization, the patient suddenly developed passage of bright red blood per rectum over 48 hours with down-trending hemoglobin. Hemoglobin initially dropped from 9.6 g/dL to 5.0 g/dl (Normal: 12-16 g/dL) and he required multiple units of packed red cell, platelets, and fresh frozen plasma transfusion. The patient underwent a tagged Red blood cell scan with radiolabelled 28.4 mCi of Tc-99 m. Red blood cell tagged Tc 99 m gastrointestinal bleeding scan showed large brisk pooling of the radiotracer in the splenic flexure consistent with significant active hemorrhage in the region of the splenic flexure. There was a retrograde flow of the tracer into the transverse colon and antegrade flow into the descending colon. Retrospective evaluation of the prior CT tomography scans of the abdomen demonstrated possible communication between the pancreatic tail cyst, the spleen as well as the splenic flexure which was the likely source of the GI bleed. The patient had a total of 35 units of packed red blood cells transfused, 8 units of platelets, and 7 units of fresh frozen plasma during his hospital course. The patient failed multiple attempts at Interventional radiology arterial embolization and due to multiple co-morbidities, he was not a candidate for surgical intervention. He later died after 6 months of hospitalization (Figure 1). Discussion: There have been reported cases of pancreatico-colonic fistula and spleno-colonic fistula, arising from pancreatic pseudocysts and pseudoaneurysms associated with trauma, pancreatitis, and Crohn’s disease. Pancreatico-spleno-colonic fistula is a rare and complex entity usually presenting with massive gastrointestinal bleeding. The findings of acute or chronic pancreatitis and pseudocyst with gastrointestinal bleeding should raise the suspicion of possible pancreatico-colonic fistula. Prompt imaging is key to accurate diagnosis and management.Figure 1.: Tc-99 m RBC tagged showing radiotracer in the splenic flexure, transverse colon and the descending colon. Non-contrast (A) and contrast enhanced axial (B, C) and coronal (D, E) computerized tomographic scan of the abdomen showing cystic mass at the tail of pancreas (blue arrow) communicating with the spleen and splenic flexure of the colon(red arrow).

O037 / #247 MULTI TARGETING DEEP BRAIN STIMULATION FOR TREATMENT-RESISTANT DEPRESSION: A 22 MONTH FOLLOW UP CASE REPORT: TRACK 2: BRAIN STIMULATION FOR TREATMENT RESISTANT DEPRESSION, PAIN, AND PARKINSON'S DISEASE

According to WHO, there are more than 300,000,000 people worldwide suffering from depression. It is the world's leading cause of disability and contributes significantly to the overall global burden of disease. 30% of the patients are refractory, being possible candidates for surgical treatment by means of Deep Brain Stimulation (DBS). We present the follow up at 22 months of a patient with Treatment Refractory Depression (TRD) operated on with a new combination of targets.

SOULMATE: the Swedish study of liver transplantation for isolated colorectal cancer liver metastases not suitable for operation or ablation, compared to best established treatment—a randomized controlled multicenter trial

BackgroundAround one fourth of patients with colorectal cancer present themselves with distant metastases at the time of diagnosis, and one additional one fifth of the patients will develop distant metastases during the disease, most commonly in the liver.Surgical treatment such as liver resection or ablation, often combined with chemotherapy and targeted therapy, is the only treatment option with curative potential, but only about 20% of the patients with liver metastases are candidates for surgical intervention. Standard treatment for unresectable patients is palliative oncological therapy; however, less than 10% of these patients will achieve a 5-year survival.Non-randomized studies indicate that liver transplantation could be an option for selected patients with colorectal liver metastases (CRLM), which are not suitable for operation or ablation due to surgical technical reasons such as massive tumor burden and small future liver remnant, or oncological reasons, for example, early relapse after liver surgery. Since there is a shortage of donated liver grafts, it is important to select the patient group that benefit most from the treatment. Although some studies present positive results from liver transplantation of CRLM, the results must be validated in a randomized controlled trial before this new indication for liver transplantation can be introduced as a clinical routine.MethodsThe SOULMATE study is a randomized study evaluating if liver transplantation with liver grafts, primarily from extended criteria donors, increases overall survival in patients with CRLM, not suitable for resection or ablation, in comparison with best established treatment.Patients will be randomized to liver transplantation (LT)+ best established treatment (BET) or to best established treatment only.In the SOULMATE trial, we will evaluate the use of livers from extended criteria donors to decrease the risk of prolonging waiting time for patients on the waiting list for LT.DiscussionThe SOULMATE study has the possibility to confirm the positive results of previous studies in a randomized setting. The use of extended criteria donors will make the results transferable globally, as most countries are struggling with organ shortage.Trial registrationClinical Trial number: NCT04161092 registered 13 November 2019.

Predicting urine culture results in candidates for lithotripsy.

Urological guidelines assert that "urine culture should be obtained" before surgical management of ureteral or kidney stones. Thus, many surgeries are delayed by 1-3 days until the results of urine culture are available. During this time, the patient frequently experience pain and possible kidney damage. We investigated the hypothesis that it is possible to predict the results of urine culture in candidates for surgical intervention using parameters that are accessible immediately upon admission. A database of 1000 patients who underwent either percutaneous nephrolithotomy (PCNL) or ureteroscopy/retrograde intrarenal surgery was analyzed. Eleven parameters potentially related to urinary infections and accessible to the clinician at the emergency department were correlated with the preoperative urine culture results. Of the patients, 234 (23.4 %) had positive cultures. On multivariate analysis, only sex, hydronephrosis grade, and history of previous nephrolithotomy were significantly associated with a positive preoperative urine culture. The risk of a positive culture can be easily determined from a simple table or an Excel-based calculator. This risk could be as low as 0.45% for a man without a history of PCNL and no hydronephrosis (4% in a woman with similar parameters) or as high as 79.5% in a man with a history of PCNL and hydronephrosis (85% in a woman with similar parameters). The risk of preoperative positive urine culture can be predicted using 3 parameters that are accessible upon admission. In low-risk cases, prompt surgical treatment can be provided, eliminating the anticipation time for urine culture results.

The Effects of Underlying Comorbidities on Surgical Outcome in Patients With Spondylolisthesis Undergoing Surgical Treatment

Background and Aim: In patients with spondylolisthesis, both conservative and surgical approaches are considered based on the stage of the disease. However, in addition to the technical characteristics of the surgery and the stage of the disease, the underlying characteristics of the patients may also affect the therapeutic prognosis. In this regard, some studies have indicated that the surgical prognosis is worse in diabetic and hypertensive patients and also preoperative medical treatments, such as anticoagulants may be effective in the prognosis of the disease. The aim of this study was to evaluate the role of underlying risk factors, such as diabetes mellitus, hypertension, and anticoagulant conditions (such as aspirin) in worsening outcomes after surgery in patients with spondylolisthesis. Methods and Materials/Patients: This cross-sectional study was conducted on 130 patients suffering from spondylolisthesis and scheduled for surgery. According to baseline characteristics, 65 patients with a history of diabetes mellitus, hypertension, and receiving aspirin were categorized as the case group, and 65 sex- and age matched individuals without such comorbidities as the control group. Preoperative and postoperative radicular pain intensity, wound healing, and discharge from the surgical site were considered the study outcomes. Results: The two groups with and without comorbidities were matched for gender, mean age, mean body mass index, and time of operation. Preoperative pain intensity was similar in the groups, but those with comorbidities experienced higher radicular pain severity postoperatively. We showed no difference in the rate of surgical site discharging, but the lack of wound healing was significantly higher in those with comorbidities. Conclusion: In patients with spondylolisthesis and candidates for surgical treatment, a history of diabetes mellitus, hypertension, and aspirin can be associated with a worse prognosis, including no improvement in pain and lack of wound healing.

Sequential therapy for pancreatic cancer patients with synchronous oligo-hepatic metastatic lesions.

Treatments for patients suffering from pancreatic cancer with oligo-hepatic metastasis have always been a cause of certain controversy. Herein, we reported 15 pancreatic cancer patients with oligo-hepatic metastasis who accepted sequential therapy of chemotherapy, radiofrequency ablation (RFA), and radical resection of the primary tumor. A total of 87 pancreatic cancer patients with synchronous oligo-metastatic hepatic lesions who received treatments in the 2nd Affiliated Hospital of Zhejiang University between January 2017 and July 2020 were enrolled. The chemotherapy regimens included modified folfirinox (54/87) and gemcitabine plus nab-paclitaxel (33/87). Test of blood tumor markers and contrast-enhanced computed tomography (CT) or magnetic resonance (MR) scan was performed at diagnosis and after eight weeks of chemotherapy. Thirty-five patients received just chemotherapy because of poor reaction to the first round of chemotherapy(Overall survival (OS), 6.47±1.80 months); 15 patients reassessed as stable disease (SD)/partial response (PR) continued chemotherapy (OS, 10.35±3.15); nine patients reassessed as progressive disease (PD) after RFA and continued chemotherapy (OS, 10.90±2.60). The primary tumors in 13 patients were unresectable after chemotherapy and RFA (OS, 12.92±2.47), while 15 patients completed the sequential therapy of chemotherapy, radio-frequency ablation, and radical resection (OS, 16.76±6.55). Sequential chemotherapy and RFA is a good treatment strategy to select the best candidates for surgical treatment among patients with pancreatic cancer with oligo-hepatic metastasis.

A Novel Construct to Treat Destructive Osteomyelitis of the Lumbar Spine in a Patient With Pre-existing Paraplegia

Treatment for vertebral osteomyelitis varies depending on the extent of pathology and includes both medical and surgical approaches. Pathogen-directed antibiotic therapy is often the first-line treatment, however, refractory cases or those with sepsis, segmental instability, or epidural abscess may be candidates for surgical treatment. Patients with extensive bony destruction often require a corpectomy with the placement of a cage for anterior column reconstruction. In this case report, we describe a patient with a complex past medical history, including paraplegia secondary to a spinal cord infarct, chronic urinary tract infections (UTIs), acute myeloid leukemia (AML), and decubitus ulcers who presented with increasing back pain and imaging demonstrating vertebral osteomyelitis and diskitis with associated epidural abscess extending from L1-L4 vertebral bodies and significant osseous destruction of the L3 and L5 vertebral bodies. A multistage surgical approach was performed involving an initial laminectomy, wound wash-out, and bony debridement followed by an additional wound wash-out and then a posterior approach for corpectomy and graft placement accomplished by tying off the thecal sac. In rare cases where patients present with complete neurologic injury and extensive destructive osteomyelitis, a posterior approach for corpectomy and stabilization may be an option.

Límites y desafíos de la cirugía urooncológica en el paciente anciano: Una visión crítica sobre el manejo del cáncer de próstata, vejiga y riñón

Due to the increase in life expectancy, challenging scenarios in oncogeriatrics are becoming more common in clinical practice. The outcomes of curative cancer treatments, which have shown benefits in the general population, are not always studied in elderly patients. Chronological age alone may not accurately correlate with the risk of complications or the potential benefit in survival, in contrast to the increasingly used frailty scores. Therefore, an adequate preoperative comprehensive geriatric assessment is essential. This review addresses the challenge of decision-making regarding surgical treatment of the most frequent urological cancers in elderly patients. Prostate cancer in elderly patients implies a complex scenario; life expectancy represents a determining factor given its often indolent behavior, in order to avoid overtreatment. It is crucial to face this challenge focusing on cancer screening primarily. In the literature, there are heterogeneous data regarding survival, although a similar rate of surgical complications and worse functional outcomes than younger patients have been reported. Muscle-invasive bladder cancer in the elderly also represents a challenge, because of the high rate of complications of radical cystectomy and the evidence of lower overall and cancer-specific survival in this group of patients. Finally, the key elements in the management of kidney cancer in elderly patients who are candidates for surgical treatment are the need to preserve renal function (considering nephron-sparing surgery) and the limited data regarding benefit in overall survival. For this reason, active surveillance of small renal masses can be a useful strategy.

Hiatal hernia types and their radiological diagnostics in patients with gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal pathology. In more than 80–90 % of patients, GERD is caused by the presence of hiatal hernia, leading to the failure of the lower esophageal sphincter. Therefore, experts increasingly agree that GERD can be effectively treated surgically in this case with a detailed diagnosis and assessment of hiatal hernia types. One of the most common methods for diagnosing hiatal hernia is radiological. But the results of the data interpretation obtained during preparation for surgical treatment are contradictory. This situation requires work continuation in this direction. The aim of the study was to improve radiological diagnosis and conduct a detailed analysis of the hiatal hernia types in GERD patients. Materials and methods. The examination results of 120 patients with GERD were analyzed. The mean age was 55.1 ± 10.7, there were 34 (28.3 %) men, 73 (71.7 %) women. In all patients, polypositional radiological examination (“Opera T 90cex”, “General Medical Merate S.p.A.”, Italy) of the esophagus, stomach with a water-soluble contrast agent (barium), photographic fixation, video recording and video analysis was performed. An internationally accepted classification was used to assess the hiatal hernia types. All patients were candidates for surgical treatment by laparoscopic cruroraphy and Nissen or Toupet fundoplication. The results of the preoperative examination were specified intraoperatively. Statistical processing of the obtained results was performed using the Statistica for Windows 13.0 software package (StatSoft Inc., USA). Results. In all patients, hiatal hernias were diagnosed. Type I hernias – in 94 (78.3 %) patients, type II hernias – in 3 (2.5 %), type III hernias – in 15 (12.5 %), type IV was detected in 8 (6.7 %) patients. The features of radiological diagnostic of hiatal hernia types were analyzed in detail, and steps to improve it were proposed. The issues of large and giant hernias diagnosis and definition were addressed. All results were illustrated with our own photographic material. A quantitative and qualitative assessment of the obtained results was carried out. Conclusions. The leading role of various hiatal hernia types in the development of GERD has been suggested. Type I hiatal hernia has been presented as the most common among such patients. Detailed X-ray diagnostics with the use of photographic fixation, video recording and video analysis has been shown to be the important and effective method for determining the anatomical features of hiatal hernia types as the main factors of the esophagogastric junction disruption and, consequently, the development of GERD.

Palatopharyngeal Muscle Suspension Suture Technique for Obstructive Sleep Apnea

Various treatment modalities for obstructive sleep apnea (OSA) patients were introduced including continuous positive airway pressure (CPAP), lifestyle modification, and surgery. Numerous factors such as compliance, treatment failure, and preference should be considered when deciding the treatment. In general, patients for whom CPAP or other conservative treatment modalities failed become candidates for surgical treatments. Uvulopalatopharyngoplasty is one of the most generally performed surgeries, of which success rate is relatively low. Recently, numerous techniques that can correct lateral pharyngeal obstruction for OSA patients were introduced. However, some of them are technically difficult and aggressive. In this article, we introduce a novel surgical method for OSA called palatopharyngeal muscle suspension suture technique.

A comparative study between Holmium Laser Enucleation of Prostate (HoLEP) and Transurethral resection of the prostate (TURP) in the treatment of benign prostatic hyperplasia

Background: Benign Prostatic Hyperplasia (BPH) is one of the most frequent diseases in men. The laser treatment for BPH has challenged TURP due to advances in laser technology, a better understanding of tissue-laser interactions, and rowing clinical experience.1 The objective of this work is to evaluate the safety and efficacy of Holmium Laser Enucleation of Prostate (HoLEP) and compare it to Bipolar Transurethral resection of the prostate (TURP). Methods: This is a prospective study to evaluate the outcomes in BPH patients undergoing surgery by HoLEP and Bipolar TURP done between January 2018 to December 2019. A total of 80 Patients were enrolled, forty undergoing HoLEP and the other forty went for Bipolar TURP for BPH. All patients with symptomatic BPH and who were candidates for surgical treatment were included. Patients with previous prostate surgery, urethral surgery, history of prostate cancer, or neurogenic bladder were excluded.1,2Results: Baseline parameters were almost similar between both groups in terms of age (years), International Prostatic Symptom Score (IPSS), Quality of life (QOL), Q max(ml/s), Post Void Residue (PVR), and gland size(grams) [Table 1]. Operative time and resected gland weight were more in HoLEP arm (p < 0.001). Catheter time and Hospitalization period were significantly lower in the HoLEP group (p < 0.0001). Haemoglobin drop was not significant between the two groups (p = 0.148). IPSS at three months was similar in both groups (p = 0.608). Qmax improved significantly in both groups, with 18.87 in TURP and 17.87 in HoLEP with a p-value of 0.261. PVR and QOL were similar between the two groups (P = 0.914 and P = 0.781) [Table 2]. Conclusion: Both Bipolar TURP and HoLEP were effective in relieving bladder outlet obstruction (BOO). HoLEP has equal efficacy compared to conventional bipolar TURP, with decreased hospital stay and catheter indwelling time.

Scintigraphic Imaging of Inflammation in the Aortic Wall Using 99mTc-Pyrophosphate.

The aim of this study was to develop and test a technique for scintigraphic examination of the thoracic aorta, which allows for visualizing foci of inflammation.Materials and MethodsThe study included 15 patients (median age — 61 [47; 73] years) with aortic dilatation more than 45 mm and thoracic aortic aneurysm who were candidates for surgical treatment. All patients underwent a chest scintigraphy with 99mTc-pyrophosphate 48 h before surgery to identify foci of inflammation in the aortic wall. The new technique included intravenous administration of 370 MBq of a radiopharmaceutical (RP), registration of scintigrams at 3 and 6 h after injection of RP in a tomographic mode combined with X-ray computed tomography. After the image reconstruction, subtraction of the later scintigrams from the early ones was performed, followed by analysis of the final images. The results of scintigraphy were compared with the histological data obtained from intraoperative samples of resected aorta.ResultsAccording to the results of this novel scintigraphic technique, artifacts from the radioactivity of the vascular blood pool were eliminated and pathological RP uptake was identified in 5 (33.3±1.5%) out of 15 examined patients. The “focus/vessel lumen” ratio averaged at 1.47 [1.30; 1.48]. Histological examination of resected aorta samples confirmed the presence of chronic inflammation in 4 (26.7±1.3%) out of 15 patients. Parameters of diagnostic efficiency were: sensitivity — 100%, specificity — 91%, diagnostic accuracy — 93%.ConclusionThe method of scintigraphic diagnostics of inflammatory processes in the aorta using 99mTc-pyrophosphate, supplemented by subtraction of the late from the early images, makes it possible to eliminate artifacts from the radioactivity of the aortic blood pool and to reveal the pathological RP accumulation indicating the areas of inflammation in the aortic wall.

Posterior Lumbar Decompression:Variations and Pitfalls

Lumbar canal stenosis is the most common pathological condition causing spinal degeneration. Symptomatic patients who fail conservative treatment are considered candidates for surgical treatment. Many types of minimally invasive procedures for lumbar decompression have been proposed, most of which are effective and have shown good long-term results. However, in special cases, a second operation may be needed for spondylolisthesis caused by degeneration of the same segment. Two major minimally invasive approaches are available for bilateral decompression of lumbar canal stenosis: unilateral approach and midline approach. The unilateral approach is used to preserve midline structures, the contralateral facet joint, and the contralateral paravertebral muscle. The midline approach is used to preserve the left and right facet joints and the enthesis of the paravertebral muscle. These two approaches are suitable for specific situations based on their own concepts. Nevertheless, it is important to understand the advantages and disadvantages of each procedure. In this article, the varieties of lumbar decompressive methods and the pitfalls of decompression procedures will be discussed.

Acute heart failure in congenital heart disease in adults: a single-institution study in Latin-America

Abstract Background Heart failure in the adult with adult congenital heart disease (ACHD) is a current topic due to its association with high morbidity and mortality and has been implicated as the leading cause of death in these kinds of patients. Purpose This study reports experience of patients with ACHD and Acute Heart Failure (AHF) hospitalized at a teaching center specialized in cardiovascular disease in Latin America. Methods A retrospective cohort study of patients with AHF who were hospitalized in the coronary care unit of a Latin-American teaching hospital from January 2006 to December 2018. Patients with ACHD were identified and their clinical characteristics and in-hospital evolution were analyzed. Results During the study period, of 7,759 patients admitted with AHF, 181 (2.3%) had ACHD. Their median age was 34 years and 53.6% were men. Patients were grouped as follows: (Group I) left to right shunt 51.4%, (Group II) left ventricular outflow tract obstruction 17.7%, (Group III) outflow tract obstruction of the right ventricle 7.2%, (Group IV) conotronchal anomalies 3.9% and (Group V) miscellaneous group 19.9%. In general, history of previous surgery was in 28.2%, the frequency was higher in Group I and Group III (38.5% and 31.3%, respectively). Overall, all-cause in-hospital mortality was higher among patients with AHF- ACHD compared with patients without ACHD with AHF (23.2% vs. 17.8%; p=0.05). Unadjusted in-hospital mortality was not significant different across the five groups (21.5%, 28.1%, 7.7%, 42.9% and 25.0% for Group I, Group II, Group III, Group IV and Group V, respectively; p=0.41) (Figure 1). Conclusions Adult patients with congenital heart disease and acute heart failure are a challenge in clinical and surgical management that entails a high in-hospital mortality. A high percentage of these patients are candidates for surgical treatment. Funding Acknowledgement Type of funding sources: None. Figure 1

PH Roundtable: Conundrums and Controversies in PH-ILD: To Treat or Not to Treat—Identifying Optimal Treatment Candidates

PH Roundtable: Conundrums and Controversies in PH-ILD: To Treat or Not to Treat—Identifying Optimal Treatment Candidates

The Risk of Perioperative Bleeding in Patients with Dual Antiplatelet Therapy

Background. Patients with dual antiplatelet therapy have high risk of perioperative bleeding. In this article we evaluated the risk of bleeding in patients whose antiplatelet therapy had not been canceled before coronary artery bypass grafting (CABG).
 The aim. To investigate and evaluate the risk of intra- and postoperative bleeding in patients who underwent CABG during antiplatelet therapy.
 Materials and methods. In the study, 47 case reports of patients with coronary heart disease who underwent CABG were evaluated. The patients were divided into 2 groups. The first group included 26 patients who discontinued antiplatelet therapy less than 5 days before the operation. The second group included 21 patients who discontinued antiplatelet therapy more than 5 days before the operation. Stratification of the risk of bleeding was performed using HAS-BLED Score for Major Bleeding Risk online calculator.
 Results and discussion. The major bleeding risk was 5.1 ± 1.4% and 4.4 ± 1.6% in the first and in the second group, respectively. In spite of higher risk of bleeding in the first group, there was no significant difference in intra- and postoperative bleeding complications.
 Conclusions. Candidates for surgical intervention who receive dual antiplatelet therapy have high risk of intra- and postoperative bleeding complications. In urgent cases when timely discontinuation of dual antiplatelet therapy is impossible and there is urgent need in the intervention, the latter must be performed. For patients who were prepared for CABG and discontinued dual antiplatelet therapy less than 5 days before the operation, sufficient volume of blood for transfusion must be provided.

Case Report: Giant Meningohydroencephalocele

BACKGROUND: Encephaloceles are a rare congenital anomaly, affecting 1 in 5 000 live births.A meningohydroencephalocele is the herniation of the meninges, ventricles, and part of the brain through a congenital defect in the skull. The prognosis of newborns depends on several factors. The young age and the associated congenital anomalies in these patients contribute to the diagnostic and treatment challenge. CASE REPORT: Male newborn, born at 37 weeks of gestation, by emergency C-section due to latent labor, presenting a large mass over the parieto-occipital region, with lobed, irregular edges, partially covered by the scalp, and in other areas a purplish red tone. The newborn was no very reactive, had decreased tone, absent crying. EVOLUTION: After specialist’s evaluation, due to the significant defect in the cranial shell and the structural brain abnormalities, the patient was not a candidate for surgical treatment. The newborn was discharged with a reduced life expectancy, to receive care at home. CONCLUSION: giant meningohydroencephalocele is a rare neural tube defect. The management of encephaloceles can be complicated and must be individualized, and will depend on the anatomical structures involved. Although in this case the prognosis was bad, multidisciplinary work is always necessary for proper management.