Clinical Case Of Surgical Treatment Research Articles

Metastatic brainstem medulloblastoma: a clinical case report

Medulloblastoma (MB) is one of the most common tumors of the central nervous system (CNS) of embryonic origin. MB is a malignancy that is quite common in pediatric patients; it represents a small proportion of brain tumors in young people, with an incidence of 0.6 per million per year. The peak age of diagnosis among the pediatric population is 3-6 years, while patients between 15 and 44 years old account for only 25%. The purpose of the study: to demonstrate a clinical case of surgical treatment of a patient with CNS metastasis of brainstem medulloblastoma. Methods. The article presents our clinical case of surgical treatment of a patient with medulloblastoma metastasis to the right temporal lobe. Results. Medulloblastoma is a heterogeneous brain tumor that is very rare in adults, especially those over 40 years of age, and accounts for less than 1% of all primary brain tumors in adults. Medulloblastoma metastases are most often found in the spinal cord and its membranes, less often in the cerebral hemispheres and ventricular system, which is associated with cerebrospinal fluid pathways. In foreign and Russian literature, there are relatively few publications on studies of metastatic lesions of medulloblastoma in adults; these studies are either considered as separate clinical observations or in conjunction with the development of medulloblastoma metastases in children. Non-specific neurological symptoms of medulloblastoma in adults can lead to later instrumental studies and specific therapy, and can also act as an unfavorable prognostic factor for the disease. Conclusion. Early detection and neurosurgical intervention are the key to preventing mortality and improving patient outcomes. Currently, only a few cases of medulloblastoma in adults are known; to prevent patient mortality, more detailed genetic and molecular studies of MB, including cerebrospinal fluid, risk stratification, description of oncological treatment, and monitoring of results to analyze MB sensitivity to chemotherapy and EBRT, as well as maintaining a registry of patients over 18 years old with brain medulloblastoma and dynamic observation of their family members in connection with oncological vigilance are needed.

A clinical case of surgical treatment of coronary heart disease against the background of concomitant pathology: infective endocarditis of the aortic valve, Gerbode defect and complete atrioventricular block

A clinical case of surgical treatment of coronary heart disease against the background of concomitant pathology: infective endocarditis of the aortic valve, Gerbode defect and complete atrioventricular block

Thoracic Spine Neurinoma Removal by Transthoracic Approach: Clinical Case and Literature Review

A clinical case of surgical treatment of thoracic spine neurinoma is presented. A block resection of the tumor from the transthoracic access was performed. The technical nuances of the intervention are described and the operational possibilities of transthoracic access for the removal of tumors of the posterior mediastinum of neurogenic origin are demonstrated. The experience of using transthoracic access has shown its effectiveness in removing thoracic spine neurinomas.

Clinical examples of correct orientation of a toric intraocular lens in patients with postkeratotomic corneal ectasia

BACKGROUND: Surgical treatment of cataract in patients with postkeratotomic corneal ectasia has various features. First, difficulties arise when calculating the optical strength of an intraocular lens and its cylindrical component and determining the location of the main axes of astigmatism for toric intraocular lens implantation. Additionally, not all modern keratotopography installations are able to accurately determine the refractive power of the cornea in such patients owing to pronounced irregular astigmatism and a large difference in keratometric parameters in the main meridians. CLINICAL CASES DESCRIPTION: Two clinical cases of surgical treatment of cataract in combination with postkeratotomic keratectasia are presented. Patients underwent a standard preoperative ophthalmological examination. TMS-4 Tomey keratotopograph was used to accurately determine the refractive power of the cornea. The optical power of toric intraocular lens were calculated using the Holladay 2 formula with amendments for radial keratotomy and the Johnson Johnson VISIC online calculator. SN6AT9 intraocular lens (Alcon) and a Tecnis ZCT800 toric intraocular lens (Johnson Johnson) were implanted in patients. The orientation of the position of the cylinder axis of toric intraocular lens was performed perpendicular to the most flattened meridian, corresponding to the position of the keratectasia zone, determined by the most expanded keratotomy scar. Before surgery, the best corrected visual acuity of patient M was OD=0.2, OS=0.4 and that of patient K was OD=0.4, OS=0.2. After surgery, the best corrected visual acuity of patient M was OD=0.8, OS=0.8 and that of patient K was OD=0.8, OS=0.7. CONCLUSION: This study aimed to familiarize practicing ophthalmologists, clinical residents, and postgraduates with a possible treatment option for cataracts by phacoemulsification with implantation of a toric intraocular lens in patients with postkeratotomic keratectasia. The resulting high visual acuity and subjective satisfaction of patients indicate the accuracy of chosen treatment tactics. A reliable visual guide for choosing the cylinder axis is the meridian of the greatest degree of keratectasia (cornea flattening), which is determined by the maximally expanded keratotomy scar position. The intraocular lens cylinder axis is oriented perpendicular to the keratectasia meridian. Ultrasound phacoemulsification of cataract with implantation of a toric intraocular lens is an effective method for correcting induced ametropia after radial keratotomy against the background of postkeratotomy keratectasia with high astigmatism.

Тактика лікування гігантської тератоми шиї в новонародженої дитини: клінічний випадок

Teratoma can be diagnosed with ultrasound examination and screening, which is carried out in intrauterine period of the fetal development. Early diagnostics of the pathology is of the great importance of its treatment. The detailed management of newborns with giant neck teratoma have not been found in current literature. Furthermore, there is no information concerning preparation of the patient for the radical operation. The aim is to present the clinical case of surgical treatment of giant neck teratoma in newborn child using EXIT-procedure (intrauterine treatment to establish a functioning airway) and angiography before the radical excision of the tumor. The clinical case describes the diagnostics and treatment of newborn child with giant neck teratoma, who was taken to the first clinical Lviv association “St. Nicholas hospital”. The tumor was diagnosed intrauterine. The child underwent EXIT-procedure. Selective angiography and embolization of carotid branches were carried out on third day after birth. The surgical intervention regarding the removal of the tumor, which was removed radically with blood loss up to 50 ml, was performed on fourth day after birth. Conclusions. Prenatal screening with alpha-protein detection in mother blood is essential for diagnostics of probable pathologies of the fetal development. EXIT-procedure has led to save lung ventilation and effective support of the cardiovascular system. The selective angiography allowed to assess the bloodstream within branches of the internal carotid artery. The embolization of the branches of the external carotid artery, which vascularized the tumor, led to minimization of the blood loss up to 50 ml. As the removal of tumor was radical, further specialized treatment was not needed. The research was carried out in accordance to principles of the Helsinki declaration. The informed consent of the child’s parents was given for conducting the research. The authors declare no conflict of interest.

РЕЗУЛЬТАТЫ ПОСЛЕДОВАТЕЛЬНОГО ХИРУРГИЧЕСКОГО ВМЕШАТЕЛЬСТВА И ТЕРАПИИ ИНТЕРФЕРОНАМИ МЕТАСТАЗОВ НЕЙРОЭНДОКРИННОГО РАКА ПОДЖЕЛУДОЧНОЙ ЖЕЛЕЗЫ У ПАЦИЕНТКИ С БОЛЕЗНЬЮ ФОН ГИППЕЛЯ-ЛИНДАУ

Abstract. Introduction. The article provides a literature review on the epidemiology, diagnosis, and treatment of neuroendocrine tumors. The morpho-functional classification by WHO 2022 is presented with the division of neuroendocrine tumors into three groups. Justifications are given for the choice of instrumental methods of topical diagnostics and the need for determining universal and specific biochemical markers in blood serum or plasma. The principles are indicated for choosing the advanced methods of treating neuroendocrine tumors. Aim. To review the scientific literature on neuroendocrine tumors, providing our own clinical observations. Materials and Methods. Russian- and English-language literature sources on this disease were searched for in the databases, such as PubMed, Medscape, Cochrane Library, and eLibrary. Clinical case of our female patient V., 36 years old, with von Hippel-Lindau disease (heterozygous mutation R167W of the VHL gene). Results and Discussion. As an example, we describe a clinical case of surgical treatment followed by long-term use of interferons in a female patient with neuroendocrine pancreatic cancer with metastases to the liver and retroperitoneal lymph nodes. Histological examination of the surgical material revealed highly differentiated neuroendocrine cancer with low malignant potential. A screening examination of the genetic syndrome components revealed a heterozygous mutation R167W of the VHL gene. Her survival under treatment exceeded 9.5 years, including more than 4.5 years from the start of interferon therapy. This pathology occurred in a young woman with one of the rare genetic multiorgan hereditary forms of neuroendocrine tumors, Von Hippel-Lindau disease that manifested itself as a combination of benign (retinal angiomatosis of both eyes and adenomas of both adrenal glands) and malignant diseases (pancreatic cancer). Conclusions. The given clinical example demonstrates that in a patient with highly differentiated metastatic pancreatic cancer, after distal subtotal resection of the pancreas, splenectomy, retroperitoneal lymphadenectomy, followed by treatment with interferons, life expectancy was more than 9.5 years, including more than 4.5 years from the start of therapy with interferons only. Despite the numerous side effects of interferons described in the literature, the patient tolerated the treatment well. At the same time, a connection between the hypothyroidism detected in the patient and treatment with interferons cannot be ruled out, since dysfunction of the thyroid gland is one of its side effects.

Sacrococcygeal pilonidal cyst with the disease onset as an anterior perianal abscess: a clinical case

The aim. To analyze the clinical case of surgical treatment of a patient with a pilonidal cyst (PC) of the sacrococcygeal area, which manifested as an anterior perianal abscess, and to justify the need for an in-depth differential and diagnostic search in patients with corresponding clinical manifestations of perianal pathology. Description of a clinical case. The article describes a clinical case of successful treatment of a 24-year-old patient with a pilonidal cyst of the sacrococcygeal area and a purulent secondary fistula that mimicked a perianal abscess with an incomplete external fistula of the rectum. Data are given on the step-by-step performance of the diagnostic process and the choice of optimal surgical treatment tactics. Results and discussion. The described clinical case is interesting for specialists and its detailed coverage due to: a) the presented atypical course of PC; b) selected diagnostic tactics; c) the selected method of operative treatment of the patient. The points mentioned above are described in detail in the section, with coverage and visualization of possible alternative options for the patient's diagnosis and the use of various tactics for surgical treatment. Conclusions. Conducting an extended differential diagnostic search using additional instrumental imaging methods is justified in patients with pilonidal disease with an atypical or blurred course. Performing a complete perioperative set of examinations allows for choosing the correct surgical tactics for treating such patients. The use of a full-fledged invasive examination of the perianal area using methods of regional or general anesthesia is reasonably justified in case of suspicion of insufficient informativeness of clinical-instrumental, laboratory, and imaging methods of examination

A clinical case of surgical treatment of appendiceal stump abscess

In Ukraine, the share of patients with acute appendicitis is 89.1% of the total number of patients with acute surgical pathology. In modern surgical practice, early and late complications occupy the first place in the structure of acute surgical diseases of the abdominal organs, regardless of the age and gender of the patients, and the postoperative mortality is on average 0.15%. In the remote period after an appendectomy, despite the progress of modern surgery, a very rare complication known as inflammation of the stump of the appendix can occur. The patient, 25 years old, turned to the department of purulent surgery with complaints of a «small wound» at the site of the postoperative scar in the right inguinal area and minor purulent discharge from it. Four months ago, in July, he was operated on for acute phlegmonous appendicitis. On November 1, after physical exertion, the wound reappeared, and on November 3, the patient independently sought a consultation at the reception department of the Clinical City Hospital No3. He was examined by a surgeon and hospitalized. During the revision of the wound, a tumor‑like formation measuring 2.5x3.0x2.5 cm, as well as the parietal peritoneum, was revealed. Appendectomy was performed by the method of pouch ligation with drainage of the abdominal cavity through a separate contraperture with polyvinyl chloride drainage. After the operation, a diagnosis was established: abscess of the stump of the appendix, and external fistula of the anterior abdominal wall. The postoperative wound healed with primary tension, and the sutures were removed. The diagnosis of appendicitis may be mistakenly excluded from the clinical search due to the presence of a postoperative scar after appendectomy. A clear clinical picture of acute appendicitis or the opening of a fistula at the site of a postoperative scar in the right iliac region indicates the need for a computer tomography of the abdominal organs with contrast to establish an accurate diagnosis and choose the correct treatment tactics. The only treatment for inflammation of the appendiceal stump is a complete appendectomy with appendix removal either by open or laparoscopic surgery, which should be performed urgently to avoid further complications.

Surgical treatment of locally advanced desmoid tumor of the anterior abdominal wall

Desmoid tumor (DO) is a rare monoclonal connective tissue tumor arising from deep soft tissues, characterized by invasive growth and a tendency to local relapses and incapable of metastasis [1].The purpose of presenting this clinical case is to assess the significance of timely diagnosis, the choice of an individually correct treatment method, tactics of further observation, therapy.To achieve this goal, a number of literature sources were studied, a clinical case of surgical treatment of a desmoid tumor of the anterior abdominal wall was presented in our medical institution (Northwestern State Medical University named after I.I.Mechnikov, St. Petersburg).The difficulty of the case was the significant size of the indolent tumor, insensitive to systemic therapy, in a young man, and therefore the decision on surgical treatment tactics was also ambiguous. In each clinical case, it is worth taking an individual approach to treatment tactics. When choosing observational tactics, strict outpatient monitoring and regular follow-up should be performed.

Treatment of a multimorphic form of vertebral infection (clinical case)

A clinical case of surgical treatment of a patient with a multimorphic form of vertebral infection is presented (spinal epidural abscess, paraspinal abscess, subdural epiema, iliopsoitis, purulent meningitis, complicated by sepsis and bilateral pneumonia). The patient underwent three surgical interventions and underwent targeted antibacterial therapy.

Surgical treatment of Ahmed glaucoma valve’s tube protrusion relapse. Clinical observations

In the practice of an ophthalmic surgeon, patients with a large number of concomitant conditions after repeated surgical interventions are seen with increasingly frequency. One of the grave complications in such patients is secondary glaucoma with a refractory type of course. After successful compensation of intraocular pressure in such patients, the risk of complications increases many times, for example, protrusion of the Ahmed valve drainage tube, which becomes the entrance gate for infection, which can lead to endophthalmitis. This article presents clinical cases of surgical treatment of recurrent protrusion of the Ahmed valve drainage tube.

Clinical case of surgical treatment of a malignant tumor from the sheaths of peripheral nerves of retroperitoneal localization

Clinical case. The article presents a clinical case of malignant retroperitoneal schwannoma, which was a diagnostic finding. The clinical picture of the disease was dominated by pain in the lower abdomen and lower back, frequent urination. After a diagnostic examination and preliminary preparation, the patient was operated on in a hospital at the oncogynecology department of the Tashkent City branch of the Republican Specialized Scientific and practical Medical Center of Oncology and Radiology with a preliminary diagnosis of an ovarian tumor. Interrooperatively, a tumor of the retroperitoneal space with lesions of the obturator nerve was revealed. Subsequently, immunohistochemical analysis clarified the histological type of the tumor, which turned out to be a malignant schwannoma of the retroperitoneal space.Conclusion. These data may help in the management of patients with this pathology and improve the diagnosis of patients with small pelvic tumors.

A clinical case of maxillofacial dirofilariasis in a child

The article presents a clinical case of surgical treatment of dirofilariasis in the maxillofacial region in a child. Diagnosis is difficult due to the complex mechanism of transmission, long incubation period and polymorphism of symptoms. The method of ultrasonic diagnosis allows the most accurate and clear verification of the diagnosis (the presence of a dense capsule, in the lumen of which linear hyperechogenic moving structures are determined). Treatment of dirofilariasis is only surgical - excision of the capsule with the helminth within healthy tissues with subsequent pathomorphologic examination and clarifying of the etiology of the parasite.

A clinical case of surgical treatment of a large kidney cyst in a 9-year-old girl with autosomal dominant polycystic kidney disease

BACKGROUND: Autosomal dominant polycystic kidney disease is currently the most common inherited form of cystic kidney disease, the frequency of which is about 1 per 400–1000 newborns, what makes the problem relevant. Its progressive course in patients with polycystic disease is primarily associated with the ischemic component, the severity of which depends on the number, location and size of cysts. Arterial hypertension, which is an autosomal dominant polycystic kidney disease complication, plays a leading role in renal failure progression. Given the current lack of specific treatment, the main therapeutic goal is to prevent complications, postpone the development of renal failure. Therefore, if there are large and giant cysts, surgical treatment is an effective modality and should be performed in a timely manner.
 CLINICAL CASE DESCRIPTION: The authors present a clinical case of a successful endovideosurgical cyst excision in a -year-old patient with a giant cyst in the right kidney, autosomal dominant polycystic disease, and hypertension of renal genesis.
 Endovideosurgical cystectomy in the patient with autosomal dominant polycystic kidney disease has become an important pathogenetic link in the treatment of this pathology. Currently, the patient is under dynamic follow-up for more than one year. During the follow-up period, the patient demonstrates relief of urinary syndrome in the form of disappeared haematuria, stabilization of albuminuria indices, improvement of blood flow parameters in the renal parenchyma, as well as stabilization of arterial pressure.
 CONCLUSION: The given clinical example demonstrates that reasonable surgical intervention with the choice of a rational method of access, taking into account the anatomical localization and size of the cystic formation, allowed to obtain a good result in the form of stabilization of renal hemodynamics in a patient with autosomal dominant polycystic kidney disease.

Promontofixation Using Titanium Mesh Implant in a Patient with Genital Prolapse: A Clinical Case

Introduction. Pelvic organ prolapse is increasingly spreading around the world. Therefore, surgical interventions in this pathology are becoming more frequent. Non-mesh surgery for pelvic organ prolapse is reported to have a higher incidence of disease recurrence, and polypropylene mesh implants appear to cause implant-associated complications, thereby limiting their application in clinical practice. Materials and methods. When a patient with an apical prolapse and high risk of postoperative complications sought medical care in the Clinic, the specialists decided to perform promontofixation using a titanium mesh implant. Results and discussion. The present paper describes a clinical case of surgical treatment of genital prolapse using a titanium mesh implant. Since the patient who was admitted for surgical treatment had a family history of genital prolapse, an application of non-mesh technologies implied a high probability of genital prolapse recurrence, as well as a high risk of the vaginal erosion after surgery. Therefore, a promontofixation was performed using a titanium mesh implant, and the 6-month follow-up period showed no postoperative complications. Conclusion. Analysis of postoperative complications demonstrated a considerable potential of using titanium mesh implants for the prevention of implant-associated complications.

A clinical case of surgical treatment of a child with aneurysms of the abdominal aorta and aortic bifurcation, superior mesenteric artery and multiple aneurysms of the main arteries

A brief literature review on abdominal aortic aneurysms in children and our own observation of surgical treatment of a 5-year-old child with an aneurysm of the abdominal aorta and aortic bifurcation, an aneurysm of the superior mesenteric artery, and multiple aneurysms of the arteries of the lower extremities has been presented in the paper. Staged replacement of the aortic aneurysm and superior mesenteric artery with synthetic polytetrafluoroethylene prostheses was performed. The features of surgical interventions, difficulties and complications that the authors encountered during the treatment of the child are described.

A specific course of tuberculous spondylitis with concurrent HIV infection

The article describes a clinical case of surgical treatment of tuberculous spondylitis and tuberculous pleurisy in a HIV positive patient with disseminated pulmonary tuberculosis. A severe pain syndrome in tuberculous spondylitis was the fi rst clinical manifestation of generalized multiple drug resistant tuberculosis.Surgical treatment of spinal deformity relieved the pain syndrome, microbiological results of surgical biopsy of the vertebrae and pleura allowed prescribing the eff ective treatment for generalized tuberculosis

A clinical case of surgical treatment of duodenal diverticulum in a 15-year-old girl

Introduction. Duodenal diverticula account for about 10% of all diverticula in the gastrointestinal tract and occupy the second place in the incidence structure after colon diverticula. They are characterized by the asymptomatic course, as a result of which they are often detected by chance. Clinical manifestations of duodenal diverticula inflammation are not typical, and this diagnosis is a diagnosis of exclusion. Most often, they are revealed after developed complications: first place - strictures of the diverticulum with intestinal obstruction as a result of chronic inflammation, then - bleeding associated with the possible ectopia of pancreatic tissue and peritonitis in case of diverticulum perforation.Material and methods. Since 1972, 19 patients have been treated for duodenal diverticula at Rostov State Medical University (Rostov-on-Don) and Regional Children's Clinical Hospital (Rostov-on-Don). The main clinical manifestation, almost in all cases, was bleeding. X-ray with contrast examination of the gastrointestinal tract was made almost to all patients. If the contrast leakage into the duodenum was seen at the examination, plus clinical manifestations, it was an indication for surgical management. A clinical case of girl I. ,15 y.o., is given as an example.Conclusion. Duodenal diverticulum is extremely rare in childhood. So as to verify the diagnosis, it is necessary to follow the examination algorithm, which promotes the choice and tactics of treatment. To the authors' opinion, the key role in the diagnostics of the discussed pathology belongs to fibrogastroduodenoscopy. An indication for surgical treatment is the combination of instrumental diagnostic findings and clinical manifestations. During the duodenal diverticulum resection, surgeons must have a clear visualization of large duodenal papilla localization relative to its mouth.

Perfusion Computed Tomography in the Choice of Treatment Tactics for Chronic Critical Tandem Lesion of the Internal Carotid and Middle Cerebral Artery (Case Report)

A clinical case of surgical treatment in patient with tandem ipsilateral lesion of the right internal carotid artery: (95–99 % stenosis at the ostium) and the middle cerebral artery (occlusion) described in the article. Further treatment tactics could be determined with the help of PKT performed on the patient during hospitalization. Changes in the blood supply to the cerebral hemisphere revealed by PKT were of decisive importance in determining the further treatment tactics for this patient. The patient was operated in the range of right side carotid endarterectomy. Control brain tomography perfusion, performed 6 months after surgery, demonstrated the absence of areas with impaired blood flow in the cerebral hemispheres.

Комбинированная операция на переднем и заднем отрезках глаза с дооперационным разрывом задней капсулы

Nowadays intravitreal drug administration occupies one of the leading places in the structure of the treatment of eye diseases. the technique for performing this manipulation is simple and universal. however, there may be complications during it. among them are transient ophthalmohypertension, uveitis, endophthalmitis, as well as damage to the lens and retina. a clinical case of surgical treatment of patient d., aged 81, with damage to the posterior lens capsule and fast cataract development was analyzed. Тhe operation was performed on the device EVa (dorc). retrobulbar anesthesia with ropivacaine (ropivacaine Kabi) FrESEnIUS KaBI norgE, aS (norway) 5.0 ml. paracentesis was performed at 2 and 10 o’clock, tunnel 2.2 mm, introduction of viscoelastic discoVisc (alcon). Сapsulorhexis 4 mm was performed using capsular tweezers. the swollen lens masses were washed with an irrigation-aspiration system. 25g ports were installed 3 mm from the limbus in the lower outer, upper outer, upper inner segments of the eyeball. Тotal vitrectomy was performed in the usual mode (vitreotome cuts 10 thousand per minute and irrigation 70 mm hg). the dislocated lens was also removed using a vitreotome with a frequency of 4,000 cuts per minute. Implantation of the intraocular lens rayone hydrofobic aspheric +22.0 diopters (rayner Intraocular lenses limited, United Kingdom) on the anterior capsulorhexis. Fixation of the Iol was not required because the diameter of the anterior rexis of 4 mm (which is smaller than the diameter of the Iol optics of 6 mm) made it possible to hold the lens. Interrupted 7/0 vicryl sutures were put on the sclera. Тhe approach to surgical treatment chosen by us, based on the patient’s history, examination, tactics of performing surgical intervention, showed its timeliness and effectiveness. Keywords: intravitreal injections, complications, damage of the lens capsule, lens luxation