Complete Obstruction Research Articles

FOREIGN BODY ASPIRATION IN CHILDREN: CLINICAL, RADIOLOGICAL AND BRONCHOSCOPY FINDINGS

Background: Foreign body aspiration (FBA) is a serious problem that leads to partial or complete airway obstruction. Respiratory distress and pneumonia are the most common complications. The assortment of foreign bodies is very wide. The most common include candy, fish bones, peanuts and nuts, toys, food and batteries. Aim of this study was to determine how accurate the presenting symptoms and signs of foreign body aspiration are and to assess the radiologic findings, the types and sites of the foreign bodies removed. Patients and Methods: a retrospective study included101 patient from age of one month to 15 years with suspected foreign body aspiration based on history, clinical examination, Chest Xray. Rigid bronchoscopy was done for patients under general anaesthesia with muscle relaxation using neuromuscular blocking agents. For every patient gender, age, residence, interval between event and symptom onset, symptoms at admission, signs of respiratory insufficiency, pulmonary auscultation findings, Chest X-ray findings, interval between admission and bronchoscopy, the location of foreign body, type of foreign body, hospitalization days were studied and statistically analysed. A p-value of < 0.05 was considered statistically significant. Results: Seventy six (75.24%) were proved to have foreign body aspiration that was removed by rigid bronchoscopy. toddler was the common age group 43(42.6%). Male were affected more than females 1.2:1. A significantly higher percentage of patients who had a foreign body were witnessed by a family member than those who did not have a foreign body 61.8% vs 0% (p=0.001). Stridor and cough with breathlessness were the most common signs and symptoms while unilateral wheezes, crepitations and diminished air entry were less frequent while each of crepitations, unilateral wheezes and cough with breathlessness were significantly associated with foreign body aspiration (p=0.001, 0.001, 0.02 respectively). Abnormal chest X ray finding was significantly associated with FBA (p=0.02) with hyperinflation being the most frequent finding. The types of foreign bodies removed were sunflower seeds (27.6%), food particles (18.4%) and nuts (17.1%). The most common site of foreign body was the right main bronchus (52.6%) followed by left main bronchus (34.2%). There is a significant association between foreign body aspiration and the time interval between admission and bronchoscopy but no significant relation with age, interval between the event and onset of symptoms and hospitalization days. Conclusion: The history of being witnessed by a family member, the presence of stridor and cough and finding of unilateral wheezes and crepitations on examination as well as hyperinflation on chest X ray are significantly associated with FBA. The sunflower seeds and food particles are the most common types and the right main bronchus is the main site of foreign bodies removed by bronchoscopy.

Integrating local and distant radiation-induced lung injury: Development and validation of a predictive model for ventilation loss.

Investigations on radiation-induced lung injury (RILI) have predominantly focused on local effects, primarily those associated with radiation damage to lung parenchyma. However, recent studies from our group and others have revealed that radiation-induced damage to branching serial structures such as airways and vessels may also have a substantial impact on post-radiotherapy (RT) lung function. Furthermore, recent results from multiple functional lung avoidance RT trials, although promising, have demonstrated only modest toxicity reduction, likely because they were primarily focused on dose avoidance to lung parenchyma. These observations emphasize the critical need for predictive dose-response models that effectively incorporate both local and distant RILI effects. We develop and validate a predictive model for ventilation loss after lung RT. This model, referred to as P+A, integrates local (parenchyma [P]) and distant (central and peripheral airways [A]) radiation-induced damage, modeling partial (narrowing) and complete (collapse) obstruction of airways. In an IRB-approved prospective study, pre-RT breath-hold CTs (BHCTs) and pre- and one-year post-RT 4DCTs were acquired from lung cancer patients treated with definitive RT. Up to 13 generations of airways were automatically segmented on the BHCTs using a research virtual bronchoscopy software. Ventilation maps derived from the 4DCT scans were utilized to quantify pre- and post-RT ventilation, serving, respectively, as input data and reference standard (RS) in model validation. To predict ventilation loss solely due to parenchymal damage (referred to as P model), we used a normal tissue complication probability (NTCP) model. Our model used this NTCP-based estimate and predicted additional loss due radiation-induced partial or complete occlusion of individual airways, applying fluid dynamics principles and a refined version of our previously developed airway radiosensitivity model. Predictions of post-RT ventilation were estimated in the sublobar volumes (SLVs) connected to the terminal airways. To validate the model, we conducted a k-fold cross-validation. Model parameters were optimized as the values that provided the lowest root mean square error (RMSE) between predicted post-RT ventilation and the RS for all SLVs in the training data. The performance of the P+A and the P models was evaluated by comparing their respective post-RT ventilation values with the RS predictions. Additional evaluation using various receiver operating characteristic (ROC) metrics was also performed. We extracted a dataset of 560 SLVs from four enrolled patients. Our results demonstrated that the P+A model consistently outperformed the P model, exhibiting RMSEs that were nearly half as low across all patients (13±3 percentile for the P+A model vs. 24±3 percentile for the P model on average). Notably, the P+A model aligned closely with the RS in ventilation loss distributions per lobe, particularly in regions exposed to doses ≥13.5Gy. The ROC analysis further supported the superior performance of the P+A model compared to the P model in sensitivity (0.98vs. 0.07), accuracy (0.87vs. 0.25), and balanced predictions. These early findings indicate that airway damage is a crucial factor in RILI that should be included in dose-response modeling to enhance predictions of post-RT lung function.

Coagulation Parameters as a Prognostic Factor for Mortality in a Neonate with Duodenal Obstruction

Background: Although the mortality cases of duodenal obstruction are only about 5%, this abnormality remains a burden in pediatric surgery. Several conditions can worsen a patient’s outcome and a proper understanding of the coagulation parameters is vital for a good outcome. Methods: This study was a descriptive-analytic study. Data of duodenal obstruction in neonate patients were taken from medical records from 2016 to 2020 . The data were then processed using SPSS 26.0 Results: From 59 samples of neonates with duodenal obstruction, most of them were born aterm pregnancy 38 (64%) patients, with male 32 patients and female 27 patients. There were neonates died based on complete obstruction 12 (20.3%), there was no significantly different neonates died between low birth weight and normal birth weight 9 (15.3%). The most commonly performed surgical procedure was kimura procedure 43 patients, with 14% patients was died. Coagulation parameters platelets, Protrombine time (PT), and Activated Partial Thromboplastin Time (APTT), only APTT there was significance correlation with P- value (0.016) , OR 3.98 Conclusion: There was a significant correlation between Activated Partial Thromboplastin Time (APTT) and mortality, with abnormal APTT had 3.98 times higher risk of dying than normal.

Review of Challenges and Innovations in Occluded Facial Recognition in Disguise and Crowd

Abstract: Facial recognition technology is critical in modern security and identification systems, yet it faces significant challenges when dealing with occluded faces, whether due to disguises or in crowds. This review explores the complexities of occluded facial recognition, highlighting the obstacles presented by partial or complete obstruction of facial features by various elements like clothing, accessories, or other people in crowded spaces. These occlusions, intentional or otherwise, complicate the identification process, rendering traditional recognition systems less effective. Recent advancements in machine learning, particularly through Convolutional Neural Networks (CNNs) and Generative Adversarial Networks (GANs), have ushered in innovative solutions that enhance the system's ability to recognize faces even when significant portions are obscured. These developments signify a move towards more adaptable and precise occluded facial recognition technologies, essential for real-world applications where occlusions are unpredictable. The paper discusses ongoing challenges and innovations considerations, various occluded system performance metrics and conclude with way ahead for Researchers and Practioners

PARASTOMAL HERNIA REPAIR IN BRICKER TYPE URINARY DIVERSION USING THE MODIFIED PAULI TECHNIQUE: A CASE REPORT

Abstract Introduction The incidence of parastomal hernia (PH) associated with Bricker ileal urinary diversion is approximately 20%. Surgery becomes necessary in the presence of symptoms or development of complications. Clinical case A 77-year-old woman with a Bricker urinary diversion following radical cystectomy presented to the emergency department with 72 hours of evolving obstructive symptoms, coupled with a large PH featuring incarcerated bowel. A CT scan confirmed complete intestinal obstruction. Urgent surgery was conducted, revealing ileum incarceration without perforations. Reduction of the intestinal content was performed, restoring viability. Transversus abdominis release (TAR) around the stoma was executed, followed by the placement of a retromuscular progrip mesh using the Pauli technique. The patient was discharged after 8 days without complications. Discussion The surgical treatment of PH remains controversial, lacking a consensus as the most effective technique. We opted for modified Pauli technique, involving retromuscular dissection, subsequent components separation via TAR and mesh repair according to the Keyhole technique. This combination leverages the advantages of each of procedures to reduce the recurrence risk: retromuscular mesh placement physiologically pushing the wall, utilization of wider prostheses reinforcing a larger surface area, complete mesh contact with the wall facilitating integration around the defect, and direct stoma exit without the need for repositioning. Conclusions The modified Pauli technique with Keyhole mesh placement, while demanding, can provide advantages in emergency surgery without causing significant postoperative complications.

Efficacy of chlorophyll a fluorescence kinetics and JIP test for early detection of leaf-gall disease in Cordia dichotoma

Gall-induced oxidative stress impairs photosynthesis and ultimately negatively affects a plant’s productivity and yield. Cordia dichotoma is an economically important plant that suffers from galls produced by the insect Aceria gallae. So we investigated how plants deal with such biotic stress by studying chlorophyll fluorescence OJIP transient analysis. The results indicate the intensive variations in minimum-maximum fluorescence, electron transport, light-harvesting efficiency and density of active reaction centers. When reaction centers become inactive in severely infected leaves a significant rise in ABS/RC and TR/RC indicates the expanded antenna size of Photosystem-II which shows the plant's efforts to enhance photon absorption. But the electron transport was blocked due to OECs deactivation, remarkably altered ET/RC and phenomenological fluxes (ABS/CS, TR/CS and ET/CS). The J-curve distortion confirms blockage of electron transport towards PS-I since PQ is fully reduced and unable to grape electrons from QB. Leaf galls carry out noteworthy alterations in Kp, Kn, and primary and secondary photochemistry. But more severe infection causes complete obstruction for electron transport which finally diminishes performance indices (PIabs and PIcs) quantum yield of photosynthesis (φPo), and electron transport (φEo) which increases dissipation and eventually causes the death of the most severely infested leaf. Present studies reveal that measurement of FV/F0, PIabs, and PIcs may be used as a physiological marker for the early diagnosis of gall stress in C. dichotoma. Our results also suggest that repetitive detection of photosynthetic performance through chlorophyll a fluorescence analysis and a JIP-test can be used as potent tools to prevent plants from appearing the visible symptoms of any pathogenic infection.

Unlocking the secrets of success in probing for congenital nasolacrimal duct obstruction: investigating the factors that matter.

The objective of this study was to analyze the impact of different factors on the success rate of probing for congenital nasolacrimal duct obstruction (CNLDO). A retrospective analysis was conducted on 239 eyes of 202 patients who underwent probing for CNLDO between 2014 and 2019. Patients were divided into three age groups (12-24months, 25-36months, and over 36months) and two groups based on the type of membranous obstruction (MO) and incomplete complex obstruction (ICO), with complete complex obstruction (CCO) cases being excluded. The study involved administering general anesthesia (GA) to all participants during the probing procedure. The patients were then monitored at scheduled intervals for up to 6 months after the surgery. Success was defined as an improvement in symptoms and signs, and logistic regression and Fisher's exact test were used for statistical analysis. The mean age of the patients was 25.48 ± 13.38months, and the total success rate was 86.61%. The success rate for MO was 92.8%, 95.87%, and 97% in age groups 1, 2, and 3, respectively. The success rate for ICO was 91.17%, 80%, and 23.52% in age groups 1, 2, and 3, respectively. The success rate for MO was significantly higher than ICO in all age groups. The success rate for ICO was significantly lower in age group 3 (p = 0.009). The study found that probing performed within the first 36months had high success rates regardless of age and type of obstruction. However, the success rate significantly decreased in patients undergoing probing for ICO at 36months or later.

Application of Machine Learning Techniques for the Diagnosis of Obstructive Sleep Apnea/Hypopnea Syndrome.

Obstructive sleep apnea/hypopnea syndrome (OSAHS) is a condition linked to severe cardiovascular and neuropsychological consequences, characterized by recurrent episodes of partial or complete upper airway obstruction during sleep, leading to compromised ventilation, hypoxemia, and micro-arousals. Polysomnography (PSG) serves as the gold standard for confirming OSAHS, yet its extended duration, high cost, and limited availability pose significant challenges. In this paper, we employ a range of machine learning techniques, including Neural Networks, Decision Trees, Random Forests, and Extra Trees, for OSAHS diagnosis. This approach aims to achieve a diagnostic process that is not only more accessible but also more efficient. The dataset utilized in this study consists of records from 601 adults assessed between 2014 and 2016 at a specialized sleep medical center in Colombia. This research underscores the efficacy of ensemble methods, specifically Random Forests and Extra Trees, achieving an area under the Receiver Operating Characteristic (ROC) curve of 89.2% and 89.6%, respectively. Additionally, a web application has been devised, integrating the optimal model, empowering qualified medical practitioners to make informed decisions through patient registration, an input of 18 variables, and the utilization of the Random Forests model for OSAHS screening.

A rare case of biloma after ascending cholangitis and endoscopic retrograde cholangiopancreatography

Introduction: Biloma is an uncommon form of liver abscess composed of bile usually associated with procedures of the biliary tree and gallbladder. Cholangitis can be acute or chronic, can result in partial or complete obstruction of the flow of bile. The infection of the bile is so common, that positive blood cultures are highly characteristic. In the case of a suppurative cholangitis with signs of sepsis treatment alone with antibiotics is usually not sufficient to achieve medical remission. Multiple hepatic abscesses are often present, and the mortality approaches 100% unless prompt endoscopic or surgical relief of the obstruction and drainage of infected bile are carried out. Endoscopic retrograde cholangiopancreatography ERCP with endoscopic sphincterotomy is the preferred initial procedure for both establishing a definitive diagnosis and providing effective therapy. Case description: We present the case of a 69-year-old female patient with complex chronic comorbidities who presented with acute cholangitis initially managed with endoscopically inserted stent and later complicated by sepsis and biloma formation. The bile was drained, and it showed an infection with Candida spp. requiring antifungal therapy. Conclusions: The failure to perform sphincterotomy in patients with suppurative cholangitis can contribute to the backflow of bile and worse outcomes.

Magnetic compression anastomosis for the treatment of complete biliary obstruction after cholecystectomy

Background & AimsPost-cholecystectomy biliary strictures can be treated surgically or non-surgically. Although endoscopic or percutaneous treatments are the preferred approaches, these methods are not feasible in cases where complete stricture occlusion prevents the successful passage of a guidewire. The utility of magnetic compression anastomosis (MCA) in patients with post-cholecystectomy complete biliary obstruction that cannot be treated conventionally was evaluated. MethodsMCA was performed in 10 patients with post-cholecystectomy biliary strictures that did not resolve with conventional endoscopic or percutaneous treatment. One magnet was delivered through the percutaneous transhepatic biliary drainage tract, and another was advanced via endoscopic retrograde cholangiopancreatography(ERCP) of the common bile duct. After magnet approximation and recanalization, a fully covered self-expandable metal stent (FCSEMS) was placed for 3 months and then replaced for a further 3 months. Stricture resolution was evaluated after FCSEMS removal. ResultsAmong the 10 patients who underwent MCA for post-cholecystectomy biliary stricture, the biliary injury was Strasberg type B in 2, type C in 3, and type E in 5. Recanalization was successful in all patients (technical success rate 100%). The mean follow-up period after recanalization was 50.2 months (range 13.2–116.8 months). Partial restenosis after MCA occurred in two patients at 24.1 and 1.6 months after stent removal. ERCP with FCSEMS placement resolved the recurrent stenosis in both patients. ConclusionsMCA is a useful alternative nonsurgical treatment for complete biliary obstruction after cholecystectomy that cannot be resolved by conventional methods.

Understanding the Role of Central Parasympathetic Activation in Opioid-Induced Respiratory Depression and Peripheral Airway Constriction

Opioid-induced respiratory depression (OIRD) is a primary cause of mortality resulting from opioid overdose. Numerous mechanisms have been identified as contributors to OIRD, such as the suppression of central respiratory rhythmogenesis. Our recent research revealed that opioids' ability to suppress breathing extends beyond the central suppression of rhythmic activity, notably leading to airway constriction, which can culminate in complete obstruction. The autonomic nervous system plays a pivotal role in regulating the tone of airway smooth muscles with the parasympathetic system being mainly responsible for bronchoconstriction, and the sympathetic system facilitating bronchodilation. In this study, we evaluated the hypothesis that exposure to fentanyl results in the disinhibition of parasympathetic motor output, leading to centrally mediated peripheral airway constriction. After administering fentanyl (500μg/kg i.p.), minute ventilation dropped by nearly 50%, primarily due to a decrease in breathing frequency. Transient airflow obstructions during the inspiratory phase were observed following fentanyl administration, as indicated by an increased latency between diaphragm contraction and the start of inspiratory flow. These airflow obstructions were fully reversed by the sympathomimetics salbutamol or epinephrine. To determine whether the transient obstructions were a result of vagal activation, another group of mice underwent vagotomy prior to fentanyl administration. The vagotomy effectively eliminated the occurrence of airflow obstructions following fentanyl administration. Additionally, using neuronal activity-based fos-dependent labeling and in-vitro patch-clamp recordings, we showed that fentanyl administration led to a pronounced activation of parasympathetic motor neurons within brainstem areas, including the dorsal motor nucleus of the vagus and the nucleus ambiguus. Collectively, our findings suggest that fentanyl induces transient obstructions to airflow that may be attributed to heightened central parasympathetic activity, which in turn drives peripheral airway constriction. P01 HL090554 (J.M.R.), R01 HL126523 (J.M.R.), R01 HL144801 (J.M.R.), R01 HL151389 (J.M.R.), F32 HL154558 (N.J.B.), R00HL145004 (N.A.B.) and R01HL166317 (N.A.B.). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Safety and Effectiveness of Abre Self-Expanding Venous Stent for Treatment of Superior Vena Cava Syndrome.

Superior vena cava (SVC) syndrome is a constellation of symptoms that results from partial or complete SVC obstruction. Endovascular SVC stenting is an effective treatment for SVC syndrome with rapid clinical efficacy and low risk of complications. In this study, we assess the technical and clinical outcomes of a cohort of patients with SVC syndrome treated with the AbreTM self-expanding venous stent (Medtronic, Inc, Minneapolis, MN, USA). An institutional database was used to retrospectively identify patients with SVC syndrome treated with AbreTM venous self-expanding stent placement between 2021-2023. Patient demographic data, technical outcomes, treatment effectiveness, and adverse events were obtained from the electronic medical record. Nineteen patients (mean age 58.6) were included in the study. Thirteen interventions were performed for malignant compression of the SVC, 5 for central venous catheter-related SVC stenosis, and 1 for HD fistula-related SVC stenosis refractory to angioplasty. Primary patency was achieved in 93% of patients (17/19). Two patients (7%) required re-intervention with thrombolysis and angioplasty within 30days post-stenting. Mean duration of clinical and imaging follow-up were 228.7 ± 52.7 and 258.7 ± 62.1days, respectively. All patients with clinical follow-up experienced significant improvement in clinical symptoms post-intervention. No stent related complications were identified post-intervention. Treatment of SVC syndrome with the AbreTM self-expanding venous stent has high rates of technical and clinical success. No complications related to stent placement were identified in this study.

Adult ileal duplication cyst acting as lead point of ileo-caecal intussusception a rare case of complete bowel obstruction in adults

Enteric duplication cyst presenting as intussusception in adult and causing complete small bowel obstruction is a rare phenomenon. A 19 year old female presented with complaints of abdominal pain, bilious vomiting, abdomen distension and constipation for 2 days. Patient had similar episodes in the past. Computed tomography of abdomen showed dilated small bowels with “Target Sign” suggestive of Ileo caecal intussusception. Patients was taken for surgery and intraoperatively it was noted to have thick walled cystic swelling in the terminall ileum. Segmental resection done along with cyst and primary anastamosis was done. Histopathological confirmation was done as Duplication cyst.

Delayed presentation of Wilkie’s syndrome after scoliotic curve correction surgery: a case report

BackgroundSuperior mesenteric artery (SMA) syndrome, also known as Wilkie’s syndrome, is a rare but serious complication following scoliosis correction surgery. It occurs as a result of mechanical compression of third part of duodenum between the SMA and aorta. This condition occurs most commonly in significantly underweight patients with deformities, and usually during the first week following spinal deformity corrective surgeries. The angle between the abdominal aorta and the SMA gets reduced following spinal lengthening during deformity correction surgery causing compression of third part of duodenum resulting in development of SMA syndrome.Case presentation.We present a case of 17-year-old male with congenital scoliosis with a 70-degree scoliotic curve who underwent spinal deformity correction surgery with posterior instrumented fusion. Post-operative course was uneventful and the patient was discharged after suture removal on post-operative day 15. The patient presented after 21-days of symptom onset on post-operative-day 51, with a 3 week history of post-prandial vomiting, abdominal pain and distension which resulted in rapid weight loss of 11 kg. A CT-angiogram showed obstruction at third part of duodenum. After reviewing clinical and radiological profile of the patient, a diagnosis of SMA syndrome was made. Conservative management was tried, but due to rapid deterioration of patient condition and symptoms of complete intestinal obstruction, the patient was treated surgically by gastro-jejunostomy and side-to-side jejuno-jejunostomy, which improved his condition.ConclusionSMA syndrome can occur much later than previously reported cases and with potentially life-threatening symptoms following scoliosis correction. Having a high index of suspicion, early recognition of condition and institution of appropriate treatment are essential to prevent occurrence of severe complications including risk of intestinal perforation and mortality. This case highlights management of delayed onset of SMA syndrome, with presentation further delayed after symptom onset, as is common in developing parts of the world, due to limited availability and accessibility of resources, and low socio-economic status of large segments of the population.

On the way to the azygos vein: a road of return rather than ruined

BackgroundThe malposition of central venous catheters (CVCs) may lead to vascular damage, perforation, and even mediastinal injury. The malposition of CVC from the right subclavian vein into the azygos vein is extremely rare. Here, we report a patient with CVC malposition into the azygos vein via the right subclavian vein. We conduct a comprehensive review of the anatomical structure of the azygos vein and the manifestations associated with azygos vein malposition. Additionally, we explore the resolution of repositioning the catheter into the superior vena cava by carefully withdrawing a specific length of the catheter.Case presentationA 79-year-old female presented to our department with symptoms of complete intestinal obstruction. A double-lumen CVC was inserted via the right subclavian vein to facilitate total parenteral nutrition. Due to the slow onset of sedative medications during surgery, the anesthetist erroneously believed that the CVC had penetrated the superior vena cava, leading to the premature removal of the CVC. Postoperative contrast-enhanced computed tomography of the chest confirmed that the central venous catheter had not penetrated the superior vena cava but malpositioned into the azygos vein. The patient was discharged 15 days after surgery without any complications.ConclusionsCVC malposition into the azygos vein is extremely rare. Clinical practitioners should be vigilant regarding this form of catheter misplacement. Ensuring the accurate positioning of the CVC before each infusion is crucial. Utilizing chest X-rays in both frontal and lateral views, as well as chest computed tomography, can aid in confirming the presence of catheter misplacement.

Complete Obstruction, a Real Risk Factor: A Comprehensive Study on Obstruction in Stage IIA Colon Cancer With Propensity Score Matching Analysis

MicroabstractThis study evaluates the prognostic significance of obstructions in stage IIA colon cancer, distinguishing between partial and complete obstructions. It employs a retrospective review of 1914 patients with propensity score matching to analyze oncologic outcomes. Findings reveal complete obstruction as a significant risk factor for poorer outcomes, emphasizing the necessity for further research to refine treatment strategies, particularly regarding the efficacy of adjuvant chemotherapy across obstruction types. BackgroundThis study examined the prognostic impact of obstructions in stage IIA colon cancer. The analysis specifically differentiated partial and complete obstructions, analyzing their distinct influences of both on oncologic outcomes. Materials and MethodsA retrospective review was conducted of stage IIA colon cancer cases with the presence of an obstruction. Patients were stratified by whether it was partial or complete based on the severity of obstruction. Propensity score matching was employed to control for confounders. ResultsAmong 1914 consecutive patients diagnosed with stage IIA colon cancer, 758 patients (597 patients with partial obstruction, 161 patients with complete obstruction) exhibited obstruction, while 1156 patients had no obstruction. The median follow-up period was 126 months. Complete obstruction was associated with poorer disease-free survival (Hazard ratio (HR) = 1.785, P < .001) and overall survival (HR = 1.853, P = .001). This trend persisted after propensity score matching, patients with complete obstruction showing a worsened disease-free survival (HR = 1.666, P = .028) and overall survival (HR = 1.732, P = .041). Adjuvant chemotherapy showed improved outcomes overall, but its efficacy varied across obstruction types. ConclusionDifferentiating between complete and partial obstructions in stage IIA colon cancer is an important clinical distinction, as our findings suggest that complete obstruction is a significant risk factor for poorer oncologic outcomes. While adjuvant chemotherapy generally improves prognosis in stage IIA colon cancer, the correlation of obstruction type with its efficacy remains uncertain, necessitating further research to refine treatment strategies.

Efficacy and safety of a "radical" surgical strategy in the treatment of parasagittal sinus meningioma.

No standardized criteria for surgical resection of parasagittal sinus meningiomas (PSM) have been established, and different surgical strategies have been proposed. The aim of the present study was to investigate the efficacy and safety of a "radical" surgical strategy in the treatment of PSM. The clinical histories, radiological findings, pathologic features, and surgical records of 53 patients with PSM admitted by the same surgical team using the "radical" surgical strategy were retrospectively analyzed between 2018 and 2023. Among the 53 PSM cases, 16 (30.2%) had a patent sinus proper, 28 (52.8%) had partial obstruction of the sinus proper, and 9 (17.0%) had complete obstruction of the sinus proper before the operation. During operation, Simpson grade I resection was performed in 34 (64.2%) cases and Simpson grade II in 19 (35.8%) cases. Postoperative pathologic examination suggested tumors of WHO grade I in 47 (88.7%) cases, WHO grade II in 4 (7.5%) cases, and WHO grade III in 2 (3.8%) cases. Postoperative complications primarily included a small amount of delayed intracerebral hemorrhage in 3 (5.7%) cases, exacerbation of cerebral edema in 3 (5.7%) cases, exacerbation of motor and sensory deficits in 4 (7.5%) cases, and intracranial infection in 2 (3.8%) cases. There were no cases of death or new-onset neurological dysfunction. Dizziness and headache symptoms improved to varying degrees, and a seizure-free status was achieved postoperatively. Excluding one case lost to follow-up, the average follow-up period was 33 months, and there were no cases of recurrence. A "radical" strategy for the surgical management of PSM is effective, safe, and simple to perform, provided that the sagittal sinus is properly managed and its associated veins are protected.

Left Ventricular Mass, Geometric Patterns, and Diastolic Myocardial Performance in Children with Obstructive Sleep Apnea

Background: Obstructive sleep apnea (OSA), characterized by recurrent partial or complete upper airway obstructions during sleep, is an established risk factor for cardiovascular diseases in children. This study aims to determine the prevalence of left ventricular hypertrophy (LVH), abnormal left ventricular (LV) geometric patterns, and diastolic dysfunction in children with OSA and compare them with healthy controls. Materials and Methods: This was a cross-sectional comparative study conducted on 75 eligible children with OSA aged 2–14 years and 75 age- and sex-matched healthy children. Transthoracic echocardiography was used to assess the LV structures and diastolic function in all the subjects. Results: The mean LV mass index was significantly higher in the patients with OSA (36.53 ± 9.1 g/m2.7) as compared to the control group (32.82 ± 7.9 g/m2.7) (P = 0.008), and it showed a significant correlation with decreasing peripheral oxygen saturation (r = −0.35, P = 0.002). LVH was present in 8.0% of the patients with OSA and none (0%) of the controls. 29.3% of the patients with OSA and 1.3% of the healthy controls had abnormal LV geometry. LV diastolic dysfunction was present in 6.7% of the patients with OSA and 0% of the controls. LV diastolic dysfunction was significantly higher among the patients with OSA who have abnormal LV geometry compared to those with normal LV geometry (P = 0.002). Conclusion: LVH, abnormal LV geometry, and diastolic dysfunction are more common in children with OSA than in healthy controls. Children with OSA and abnormal LV geometry are more likely to have LV diastolic dysfunction.

Action protocol of medical staff for airway obstruction after anterior cervical spine surgery: A systematic review of case reports

BackgroundPostoperative airway obstruction after anterior cervical spine surgery (ACSS) can be a fatal complication. Occasionally, it rapidly progresses to complete obstruction. There are no established standardized protocols on how medical staff should assess for signs and symptoms, seek help, or facilitate airway management after ACSS to prevent unfavorable events. This study aimed to primarily describe a systematic approach by assessing the signs and treatment outcomes of airway compromise in patients who underwent ACSS. Further, it recommended an action protocol after extubation for medical staff according to patients’ symptoms to prevent unfavorable outcomes. MethodsAn extensive literature search was performed on PubMed, Web of Science, and the Cochrane Library to identify case reports, case series, and cohort studies restricted to English and published between January 1990 and March 2023. We included cases that described the signs, symptoms, and treatment of airway obstruction after ACSS. Meanwhile, cases involving complications of other known causes, cases of trauma or occipital-cervical fixation, or those using bone morphogenetic protein were excluded. ResultsTwenty cases from 17 studies were obtained, and their study quality was acceptable. Four patients died, and two presented with hypoxic ischemic encephalopathy. Further, five of six patients had fatal complications that initially developed within 7 h after surgery. Then, 9 (69%) of 13 patients with evidence of hematoma (69%) showed initial symptoms within 12 h after surgery. Finally, 9 of 11 patients with early-stage symptoms had favorable outcomes, and patients who developed late-stage symptoms commonly had unfavorable outcomes. ConclusionThe early identification of signs and symptoms and immediate treatment are important, particularly within 12 h postoperatively. We suggest a novel action protocol for medical staff according to symptom urgency, which includes the measurement of neck circumference using a string for evaluating neck swelling.

Performance Comparison of Standard Polysomnographic Parameters Used in the Diagnosis of Sleep Apnea

Obstructive sleep apnea (OSAS), which is one of the leading sleep disorders and can result in death if not diagnosed and treated early, is most often confused with snoring. OSAS disease, the prevalence of which varies between 0.9% and 1.9% in Turkey, is a serious health problem that occurs as a result of complete or partial obstruction of the respiratory tract during sleep, resulting in sleep disruption, poor quality sleep, paralysis and even death in sleep. Polysomnography signal recordings (PSG) obtained from sleep laboratories are used for the diagnosis of OSAS, which is related to factors such as the individual's age, gender, neck diameter, smoking-alcohol consumption, and the occurrence of other sleep disorders. Polysomnography is used in the diagnosis and treatment of sleep disorders such as snoring, sleep apnea, parasomnia (abnormal behaviors during sleep), narcolepsy (sleep attacks that develop during the day) and restless legs syndrome. It allows recording various parameters such as brain waves, eye movements, heart and chest activity measurement, respiratory activities, and the amount of oxygen in the blood with the help of electrodes placed in different parts of the patient's body during night sleep. In this article, the performance of PSG signal data for the diagnosis of sleep apnea was examined on the basis of both signal parameters and the method used. First, feature extraction was made from PSG signals, then the feature vector was classified with Artificial Neural Networks, Support Vector Machine (SVM), k-Nearest Neighbors (k-NN) and Logistic Regression (LR).