Complicated Course Research Articles

In-hospital mortality of patients requiring unplanned postoperative ventilatory support: a multicenter observational study

BackgroundMost patients who are admitted non-intubated to surgery are extubated at surgery conclusion. Yet, 1–2% require unplanned postoperative ventilatory support. The outcome of these patients has not been thoroughly evaluated to date and is the focus of the present study.MethodsTwo-center observational study assessing characteristics and outcomes of surgical patients with unplanned mechanical ventilation during PACU stay between 2017 and 2019. Patients who arrived intubated to the operating room or were transferred directly to the intensive care unit (ICU) were excluded. The co-primary aims were to assess overall in-hospital mortality and to compare mortality between patients who were extubated in PACU and those who were discharged from PACU still intubated. The secondary aims were to compare postoperative respiratory infection and unplanned admissions to the ICU. Multivariate logistic regression was used to compare the groups and adjust for potential confounding variables.ResultsOverall, 698 patients were included. Of these, 135 died during hospital stay (mortality rate 19.3%, compared with 1.0% overall postoperative in-hospital mortality). Patients who still required ventilatory support at PACU discharge were significantly sicker, majority needed emergency surgery, and had more complicated surgical course compared to those who were extubated in PACU. In addition, their mortality rate [36% vs. 9%, adjusted OR (95% CI) 5.8 (3.8–8.8), p < 0.001], postoperative respiratory infection, and unplanned admission to ICU rates were also significantly higher.ConclusionUnplanned postoperative mechanical ventilation is associated with noteworthy morbidity and mortality, with significantly higher rates in those of need for protracted (vs. short) mechanical ventilation. The remarkable mortality rate in patients extubated shortly after arriving to the PACU emphasizes the need for further studies to explore prompting factors and whether we can intervene to improve patients’ outcome.

Associations of variants of folate cycle genes with features of the clinical course of severe intraventricular hemorrhages in premature infants.

Summary data indicate that it has increased attention to the study of the role of the folate cycle and the genes encoding its key components in the complicated course of the neonatal period in premature infants. Therefore, the aim of our study was to investigate the relationship of folate cycle gene variants with the features of the neonatal course in premature infants with severe intraventricular hemorrhages (IVH). The study included 24 preterm infants with with IVHs of 3d and 4th degree that received standard clinical, laboratory and instrumental examination. Apgar scores at 1 and 5 minutes were significantly lower in patients with AA genotype according to variant A1298C of the MTHFR gene. The concentration of total protein on 6th day after birth was negatively correlated with the A66G variant of the MTRR gene. The mean concentration of ionized calcium in the first day after birth was higher in the subgroup of patients with the AA genotype (according to variant A1298C of the MTHFR gene). In the subgroup of patients requiring mechanical ventilation, the frequency of AA genotype according to variant A2756G of the MTR gene was significantly increased. The presence of respiratory disorders and oxygen dependence was negatively correlated with variant A1298C MTHFR. The day of surfactant administration was positively correlated with variant A1298C of the MTHFR gene. The results of this study indicate that gene variants MTHFR (C677T, A1298C), MTRR (A66G), MTR (A2756G), RFC1 (G80A) may affect the neonatal course in premature infants with severe IVH.

ANATOMICAL RISK FACTORS FOR THE COMPLICATED POSTOPERATIVE PERIOD IN THE SURGERY OF EXTRACEREBRAL TUMORS OF THE POSTERIOR CRANIAL FOSSA

Tumors of the base of the posterior cranial fossa are among the most difficult for surgical treatment in neurosurgery. Numerous studies are being conducted on the factors that determine clinical manifestations and treatment outcomes. The aim of the study was to study the linear and angular parameters of the posterior cranial fossa in patients with extracerebral neoplasms and to evaluate their effect on the results of surgical treatment. Craniometric study of linear and angular parameters of the posterior cranial fossa was performed in 115 patients with sub-tentorial extracerebral tumors. A computer program was used to determine the longitudinal, transverse and height diameters of the head, the length, width and height of the posterior cranial fossa, the sagittal diameter of the foramen magnum, the length of the clivus, the length of the posterior part of the skull base, the basilar angle, the Boogard’s angle, the posterior angle of the base of the skull, angle of the cerebellar mantle, angle of inclination of the clivus, angle of inclination of the scales of the occipital bone and angle of convergence of the pyramids of the temporal bones. These parameters were determined on magnetic resonance tomograms in the sagittal projection on the median section and in the axial projection, on the section passing at the level of the internal auditory canals. The main group consisted of 15 patients who developed vascular complications after surgery, the second comparison group included 100 patients with uncomplicated postoperative course. The predominant head shapes according to the transverse-longitudinal index in both groups were brachycephalic (53.3 and 54%, respectively). There was no acrocephaly (high and narrow head forms) among patients with complications, while in the control group this type was registered in 12% of cases. Certain craniometric prerequisites for a complicated course of the postoperative period have been identified, allowing a more selective approach to the tactics of treating these patients. The risk group includes patients with large values ​​of the basilar angle and the angle of inclination of the scales of the occipital bone, having a narrower and elongated shape of the posterior cranial fossa.

EUTHYROID SICK SYNDROME: PREVALENCE AND PROGNOSIS IN ELDERLY PATIENTS WITH SEPSIS

Objective: Euthyroid sick syndrome (ESS) manifests by the decreased level of serum free thyroid hormones and with the normal or decreased secretion of thyroid-stimulating hormone. The study aims to identify the prevalence of ESS in elderly patients with sepsis and evaluate its possible effect on prognosis and mortality. Material and Methods: Two hundred and three patients diagnosed with sepsis were prospectively evaluated. They were divided into two groups, a geriatric group (≥65 years), and a control group (&lt;65 years). Patients with low free T3 (fT3) and/or free T4 (fT4) were considered to have euthyroid-sick syndrome. The demographic characteristics, comorbidities, laboratory results, hospitalization data, intensive care unit (ICU) duration, treatment outcomes, and mortality rates of the patients were recorded and compared. Results: The incidence of ESS was significantly higher in the geriatric group (88.5% vs. 77.8%) (p=0.04). There was no difference between the groups in regard to mortality rate and ICU stay. However, 91.3% of deceased patients in the entire group and all deceased patients in the geriatric group were ESS (+) patients. The mean fT3 was significantly decreased in the deceased patients, and ICU patients (p=0.017). Additionally, the decreased levels of fT4 in both the entire group and the geriatric group were significantly associated with mortality and ICU stay (p-value: 0.020 and 0.019, respectively). Conclusions: The higher prevalence of ESS (88.5%) in elderly patients with sepsis was clearly demonstrated. Additionally, approximately two-fold higher mortality and ICU stay risk was documented in the ESS (+) group. Thus, simply screening of ESS in septic elderly patients will certainly contribute to treatment decisions and early prediction of complicated clinical course and poor prognosis.

Seronegative Ocular Myasthenia Gravis in an Older Woman With Transient Dizziness and Diplopia

Myasthenia gravis (MG) is a neuromuscular junction disease caused by an autoimmune response against cholinergic receptors. The challenge in diagnosing MG in older patients is the variety of symptoms and clinical manifestations. Clinical reasoning, precise history, and physical examination leading to a logical diagnosis should be performed to diagnose seronegative MG. We report a case of seronegative MG with the chief complaint of dizziness in a 91-year-old female. Despite the complicated clinical course, continuous clinical reasoning and testing can lead to appropriate diagnosis and treatment. As the dizziness symptoms in this older patient could not be explained by chronic or peripheral symptoms alone, ocular MG was considered as a possible diagnosis based on her history and physical examination findings. Appropriate diagnosis of seronegative ocular MG reactivated older patients with a good quality of life. In community medicine, where the behavior of elderly patients varies, it is important to improve the accuracy of diagnosis and treatment through appropriate history and physical examination, which will lead to longer home life in older patients.

CAN PULMONARY SURFACTANT PROTEINS BE RELIABLE INDICATORS OF COVID-19-ASSOCIATED PULMONARY INJURY?

The COVID-19 pandemic is still raging all over the world. New variants of the coronavirus emerge and infect recovered from previous infections, vaccinated, and unvaccinated subjects. One aspect remains unchanged that is the lungs are the main targets of the pandemic coronavirus. This challenging situation requires the search for reliable predictive markers of severe and complicated course of the disease. Serum surfactant proteins are known to correlate with pulmonary injury severity in numerous diseases. Measurement of such protein levels may help timely predict the risk. Surfactant proteins can also be helpful diagnostic purposes in COVID-19.

Endoscopic Endonasal Transcavernous Transoculomotor Triangle Approach for the Resection of a Knosp 4 Pituitary Adenoma.

Objectives The current video presents the nuances of the endoscopic endonasal transcavernous transoculomotor triangle approach for the resection of a Knosp 4 pituitary adenoma protruding through the superior wall of left cavernous sinus. Design The video analyzes the clinical presentation, preoperative workup, and imaging, surgical steps and technical nuances of the surgery, the clinical outcome, and follow-up imaging. Setting The patient was treated by a skull base team with bimanual, three- to four-handed endoscopic technique. Participants The patient was a 54-year-old male with a Knosp 4 prolactinoma presented with headaches and blurred vision in both eyes for 3 weeks. He was managed with endoscopic surgery due to his preference of surgery as a rapid primary therapy to relieve mental stress of an invasive brain tumor after awareness of all therapeutic options, including the preoperative medical treatment. Main Outcome Measures The main outcome was measured in the following aspects, including the resection extent, the symptoms improvement, the radiological and endocrinological follow-up results, as well as the postoperative course of complications. Results Nearly gross total resection was achieved with one-stage endoscopic surgery. The patient recovered well with improved headaches. Postop oculomotor deficit was recovered in 2 months. Endocrinological remission was kept for 12 months with one pill of bromocriptine daily. Conclusion The endoscopic endonasal transcavernous transoculomotor triangle approach is an appropriate option for resecting Knosp 4 pituitary tumors with intracranial extension through the roof of cavernous sinus at one stage. The link to the video can be found at https://youtu.be/-YJ2PKP9voY .

Visual acuity reduction and silicone oil tamponade

Silicone oil is an established intraocular surgical aid, which enables the treatment of the most complex starting situations but no other alternative has been found; however, the available data indicate that an unclear loss of visual acuity during or after an intraocular silicone oil tamponade possibly occurs more frequently than assumed from the clinical routine. Various pathological mechanisms are under discussion as causes, but the exact causes are actually unclear. In addition to atrophic alterations in the optical coherence tomography (OCT) examination, there are a clear reduction in visual acuity and mostly a central scotoma with otherwise inconspicuous findings. Unclear loss of visual acuity can also occur after removal of the silicone oil. Whether this is caused by the same pathological mechanism is unclear. Furthermore, there are no reproducible risk factors that appear a priori to possibly cause an unclear loss of vision under silicone oil; however, oil removal as soon as possible and a good adjustment of the intraocular pressure are recommended by the authors. Overall, a silicone oil tamponade should be carefully weighed up even when using modern highly purified silicone oils and it should therefore continue to be reserved particularly for unfavorable initial situations or complicated courses with the necessity for a silicone oil tamponade. Against this background, a study for systematic recording and processing of cases of unclear loss of visual acuity after silicone oil tamponade seems to be meaningful.

Burden of Diabetes and Role of Medicinal Plants in Its Treatment

Diabetes is a growing health concern worldwide and now emerging as an epidemic world over. Diabetes mellitus is a metabolic disorder characterized by chronic hyperglycemia or increased blood glucose levels, resulting from insufficient or inefficient insulin secretion, with alterations in carbohydrate, protein and lipid metabolism. Type-2 diabetes is the most prevalent form, of the total diabetics about 90% have type-2 diabetes, which is characterized by post-prandial hyperglycaemia (increase in blood sugar level after a meal). Many medicinal plants are reported to have insulin-mimetic effect, modulation of insulin secretion and inhibition of carbohydrate digesting enzymes. The currently available anti diabetic agents include sulfonylureas, thiazolidinediones and alpha glucos idase inhibitors and are widely used to control the hyperglycemia. These drugs fail significantly to alter the course of diabetic complications. They have limited use because of undesirable pathological conditions and high rates of secondary failure. This it is essential to look for more effective antidiabetic agents with fewer side effects. Traditional medicinal plants having anti diabetic properties can be a useful source for the development of safer and effective oral hypoglycaemic agents. More than 350 traditional plants are used in the treatment of diabetes mellitus, which have been recorded. Only a small number of these have received scientific and medical evaluation to assess their efficacy. However, plant remedies are the mainstream of treatment in underdeveloped regions. This review focuses on diabetes mellitus and the role of plants in the treatment of diabetes mellitus.

Reading Beyond the Medical Chart

How can one understand a human life by reading a medical chart? Only so much can be conveyed through written words and the rest in conversation. While a patient’s social history is often overlooked, these details are the most revealing. It is late afternoon, and I am a physical medicine and rehabilitation resident working at a rehabilitation hospital. My pager buzzes, telling me that a new admission will arrive in one hour. The admissions liaison—the nurse in charge of identifying patients suitable for our hospital—brings me a large stack of documents made up of daily progress notes, routine lab reports, repeat imaging, and detailed medication changes. Thus, I begin a 90-day journey through my patient’s hospital course, one that I have only an hour to traverse. I sift through weeks of data, highlighting what I must know: how to dose his daily medications, how long to continue his antibiotics, and which physicians he needs to follow in the outpatient setting. The details of his complicated hospital course—the emergency surgery, complicated coagulopathy, and unexpected bacteremia—infuse my brain. When he arrives, I run upstairs to meet him. He is lying in bed talking on the phone, and when I enter, he pauses to tell the person on the line that he has to go. For the most part, patients look to be in better health than their doctors’ notes suggest, and I am impressed by the jolly voice that greets me after reading that he had been intubated for weeks. As our conversation begins, it becomes apparent that he has no interest in quizzing me on his medical complexities. He brushes over the details of his hospitalization and rushes to tell me that he wants to go home soon. He lives in a mobile home, and it scares him to think that this hospital is in the city because he has lived his entire life in the country. He cares for his 95-year-old father whose memory fades by the day—much like his once bright peonies, which have since withered in the summer heat. He is very busy managing his shop, but every week, he takes his father to Sunday brunch. Brunch helps his father remember that the day is Sunday. But for the past 90 days, there have been no more Sundays. His father calls daily, wondering what day it is and wondering when he will come home. His voice trails off, and I notice him blinking. His snowy white hair is overgrown, but it cannot hide the sadness in his heart. He hastily pushes his spectacles up his nose and reaches into the stash of peppermints hiding in his lap. He offers me a piece of candy as he nibbles on his own. “Remember, that life can be sweet,” he says. I accept the peppermint, and I tell him that we will work to get him home. Back in the workroom, I pause for a moment. It is an immense task to transcribe a patient’s story into a standard note. So often, we get caught up in studying and updating the medical chart. When we get to know our patients as human beings, however, we realize that providing care goes beyond triple-checking medication dosages. Providing care involves understanding the social context in which our patients live and appreciating their routines outside of the hospital setting. Human beings are gregarious creatures by nature, and a human being is the product of every person, every success, and every misfortune he or she has encountered. Thus, to truly care for a human being, we need to appreciate the social context in which they live. This is especially important in situations where patients are not afforded visitations. This patient taught me that having a plan to care for the loved ones who depend on the patient is equally important as caring for the patient. The lightness that he felt after our conversation eased my fingers as they clattered across the keyboard. I tap my fingers and shuffle again through his discharge documents, making sure his note is up to date. As I finish my note, I add one directive to his disposition plans: Please call to update his father every Sunday.

Risk of graft loss in kidney transplant recipients after aortic valve replacement.

Surgical aortic valve replacement (SAVR) in kidney transplant recipients (KTR) is associated with high morbidity and mortality, and an increased risk of postoperative graft failure potentially leading to graft loss. Transcatheter aortic valve implantation (TAVI) emerged as an alternative in high-risk patients. However, data on TAVI in kidney transplant recipients are limited. We performed a retrospective analysis of 40 KTR in which aortic valve replacement was performed at our center between 2005 and 2015. The outcomes and follow-up of TAVI (n=20; 2010-2015) and SAVR (n=20; 2005-2015) were analyzed with respect to patient and graft survival. Baseline characteristics in both groups were comparable. Hospital stay after TAVI was significantly shorter compared to SAVR (19 [11.5-21.75] days vs. 33 [21-62] days, p=0.001). Acute graft failure occurred more frequently after SAVR (45% vs. 89.5%; p=0.006). Thirty-day mortality was 10% in both groups. However, in-hospital mortality reached 25% in the SAVR group (TAVI 10%), indicating a more complicated course after surgery. Moreover, during a median follow-up time of 1928 days in TAVI patients and 2717 days in patients after SAVR, graft loss occurred only in the surgically treated group (n=7). While one-year survival after TAVR was 90% compared to 69% after SAVR, long-term follow-up showed comparable results (at 5 years: TAVI 58% vs. 52% SAVR; log-rank-test: p=0.86). In KTR, TAVI can be performed with good mid- to long-term results. Compared to SAVR, renal outcomes seem to be improved after TAVI, suggesting better graft survival.

Very Early-onset Schizophrenia With A Complicated Course

Introduction: Psychosis is the third most debilitating disorder among adolescents worldwide. Very early-onset schizophrenia (VEOS), before age 13

Clinical and psychopathological structure of depressive disorders in women against the background of postpartum inflammatory complications

The postpartum period is a sensitive time when mothers are subjected to increased risks of mental disorders. Aim: to study the structure of anxiety and depressive disorders in women against the background of the early postpartum complications. Material and methods. 150 patients, who underwent inpatient treatment at the Scientific Research Institute of Obstetrics and Gynecology, Baku, were selected for the study and divided into two groups: the main group - with postpartum complications (n = 100), the comparison group — with physiological postpartum period (n = 50). The average age was 29.9 ± 0.64 and 30.3 ± 0.86 years. All patients underwent a comprehensive examination using anamnestic data and the Hamilton Scale to assess the severity of anxiety (HARS) and depression (HRDS). Results. According to etiology and pathogenesis, the studied pathology is multifactorial. Significant risk factors for the complicated course of puerperia are inflammatory diseases of the pelvic organs. Attention is drawn to the adverse effect on the health of women in the puerperal period, the high frequency of diseases of the upper respiratory tract and kidneys in the anamnesis. Diagnosed postpartum inflammatory complications may serve as a risk factor for the development of anxiety and depressive disorders in the postpartum period. The average indicators in women of the control group are within the normal range. A high level of clinical severity of symptomatic anxiety was observed in the main group (48.0 + 5.00% versus 8.0 + 3.84% in the control group, χ2 = 44.19; p &lt; 0.0001), that is, early postpartum complications are a predictor of severe anxiety. Depression of an average degree was more often recorded with a complicated course of puerperia. Discussion. The presence of a burdened obstetric and gynecological anamnesis and extragenital pathology increases the risk of puerperal complications and the development of severe affective disorders. Changes in the emotional status affecting the anxious and depressive component were more often revealed in postpartum women with complications than in women with a physiological course of the postpartum period. Conclusions. Most of the anxiety-depressive conditions in the main group corresponded to moderate severity in the clinical and psychopathological study. Disorders of mild degree were observed more often in a physiologically proceeding postpartum period. When complications are detected, timely diagnosis and correction of anxiety and depressive disorders are necessary for easily women’s adaptation to the postpartum period.

A case of SARS-CoV-2-infection in a child with chronic kidney disease

Kidney disease and chronic renal failure are among the main comorbidities of the complicated course of COVID-19.Objective: to identify the clinical features of the course of a new coronavirus SARS-CoV-2-infection in a child aged 2 years 2 months with chronic kidney disease and dialysis-dependent renal failure.A new coronavirus infection typically began with a moderate intoxication syndrome and catarrhal symptoms, confirmed by the detection of SARS-CoV-2 RNA. Computed tomography of the chest revealed signs of bilateral pneumonia, 30% damage to the lung tissue. Progression occurred by the 4th day of hospitalization with the development of a multisystem inflammatory syndrome, including damage to the cardiovascular system of the digestive system against the background of the existing end-stage renal failure. Laboratory criteria for multisystem inflammatory syndrome were an increase procalcitonin, C-reactive protein, and ferritin. As a result of the developed multiple organ failure, a fatal outcome occurred.

Hepatopancreatobiliary surgery in a Mexican social security hospital during the COVID-19 pandemic.

Data on hepatopancreatobiliary (HPB) surgery and COVID-19 are scarce. The objective of the study was to determine the outcomes HPB procedures during the COVID-19 pandemic and compare results to the previous year. IRB approved study of HPB procedures (April, 2020-November, 2020). Primary endpoints: Thirty-day surgical morbidity/mortality, including COVID-19 infection. Secondary endpoints: Comparison between 2019 and 2020 procedures. Twenty-five patients were included. In 2020, HPB procedures decreased 31.6%. About 60% developed complications (Clavien-Dindo Grade III, 20%). Three patients developed post-operative COVID-19 infection (two deaths: 66% COVID-19 mortality). When compared to the previous year, there were more emergency cases, ventilator-assisted patients (p < 0.05) and pre-operative acute renal failure (p = 0.06). Clavien-Dindo complication grades were higher in 2020. Thirty-day mortality was also higher (16% vs. 5.6%). HPB surgical activity was negatively influenced by COVID-19 on 30-day morbidity/mortality. HPB patients who developed post-operative COVID-19 infection had a complicated course with significant mortality.

A complicated course of the membranous form of epidemic keratoconjunctivitis. A case report

A case report is presented of a film y form o f adenoviral epidemic keratoconjunctivitis (EKC) in an adult patient. The case is interesting in that the onset of EKC did not predict a complicated, hyperergic course of the condition, which ultimately led to cicatricial changes in the conjunctiva in the form of a partial external symblepharon. The ophthalmologists need to be on the alert for this form of EKC, which requires differential diagnosis, first of all, with true toxic diphtheria lesion of the conjunctiva. Adequate combined antiviral treatment of EKC using corticosteroids, immunomodulatory and symptomatic therapy helps to stop the process.

Faecal Myeloperoxidase as a Biomarker of Endoscopic Activity in Inflammatory Bowel Disease.

Inflammatory bowel disease [IBD], consisting of Crohn's disease [CD] and ulcerative colitis [UC], is a relapsing-remitting illness. Treat-to-target IBD management strategies require monitoring of gastrointestinal inflammation. This study aimed to investigate faecal myeloperoxidase [fMPO], a neutrophil granule enzyme, as a biomarker of IBD activity. Prospectively recruited participants with IBD, undergoing ileocolonoscopy for disease assessment, provided biological samples and completed symptom questionnaires prior to endoscopy. fMPO, C-reactive protein [CRP], and faecal calprotectin [fCal] were compared with validated endoscopic indices [simple endoscopic score for CD and UC endoscopic index of severity]. Receiver operating characteristic [ROC] curves assessed the performance of fMPO, CRP, and fCal in predicting endoscopic disease activity. Baseline biomarkers were used to predict a composite endpoint of complicated disease at 12 months [need for escalation of biologic/immunomodulator due to relapse, steroid use, IBD-related hospitalisation, and surgery]. A total of 172 participants were recruited [91 female, 100 with CD]. fMPO was significantly correlated with endoscopic activity in both CD [r = 0.53, p < 0.01] and UC [r = 0.63, p < 0.01], and with fCal in all patients with IBD [r = 0.82, p < 0.01]. fMPO was effective in predicting moderate-to-severely active CD [AUROC 0.86, p < 0.01] and UC [AUROC 0.92, p < 0.01]. Individuals with a baseline fMPO > 26 µg/g were significantly more likely to reach the composite outcome at 12 months (hazard ratio [HR] 3.71, 95% confidence interval [CI] 2.07-6.64, p < 0.01). Faecal myeloperoxidase is an accurate biomarker of endoscopic activity in IBD and predicted a more complicated IBD course during follow-up.

Clinical case of thrombosis in a newborn child with congenital heart disease against the background of hereditary thrombophilia

Introduction. The problem of neonatal thrombosis is becoming increasingly urgent in clinical practice due to its importance in the development of a complicated course of the neonatal period in children with hereditary and acquired thrombogenic risk factors. The aim of the investigation is to present a clinical case of multiple thromboses in a premature newborn infant with congenital heart disease on the background of multigenic thrombophilia, complicated by neonatal sepsis. Materials and methods. Materials for the investigation were the primary medical records: history of the newborn, medical history of the patient-newborn child with the established diagnosis of great-vessel thrombosis, with the congenital heart disease and the presence of genetic thrombophilia, who was under observation for 2 months. The findings of objective, laboratory (clinical blood tests, investigation of hemostasis parameters, homocysteine concentration, molecular-genetic study of hemostasis enzymes genes, folate cycle enzymes genes) and instrumental (CT angiography, ultrasonic examination of abdominal cavity and retroperitoneal organs, ECHO cardiography, ultrasonic Dopplerography) research methods were evaluated. Results and Discussion. In the clinical observation under consideration, there was a burdened molecular genetic background consisting of carriage of plasminogen activator inhibitor gene polymorphisms and folate cycle enzyme genes: MTHFR 677 – C/T, MTHFR 2756 – A/G, MTRR 66 – G/G, and hyperhomocysteinemia were the factors responsible for multiple thrombosis in a patient born with critical congenital heart disease (CHD), contributed to generalization of the infection process with the development of multiple organ failure, and exacerbated the postoperative period after correction of heart disease. Conclusion. The clinical case demonstrates the development of multiple thrombosis and septic process in a child born with CHD. The results of molecular genetic study proved the presence of hereditary thrombophilia in the child, which was a predictor of thrombosis development and probably a risk factor aggravating the severity of generalized infectious process, which complicated pre- and postoperative periods of the main disease, CHD.

Clinical outcomes of patients with complicated post-operative course after gastrectomy for cancer: a GIRCG study using the GASTRODATA registry

Gastrectomy for gastric cancer is still performed in Western countries with high morbidity and mortality. Post-operative complications are frequent, and effective diagnosis and treatment of complications is crucial to lower the mortality rates. In 2015, a project was launched by the EGCA with the aim of building an agreement on list and definitions of post-operative complications specific for gastrectomy. In 2018, the platform www.gastrodata.org was launched for collecting cases by utilizing this new complication list. In the present paper, the Italian Research Group for Gastric Cancer endorsed a collection of complicated cases in the period 2015–2019, with the aim of investigating the clinical pictures, diagnostic modalities, and treatment approaches, as well as outcome measures of patients experiencing almost one post-operative complication. Fifteen centers across Italy provided 386 cases with a total of 538 complications (mean 1.4 complication/patient). The most frequent complications were non-surgical infections (gastrointestinal, pulmonary, and urinary) and anastomotic leaks, accounting for 29.2% and 17.3% of complicated patients, with a median Clavien–Dindo score of II and IIIB, respectively. Overall mortality of this series was 12.4%, while mortality of patients with anastomotic leak was 25.4%. The clinical presentation with systemic septic signs, the timing of diagnosis, and the hospital volume were the most relevant factors influencing outcome.

Peculiarities of diagnostics of atypical course of perforated duodenal ulcer (clinical case)

Aim – to describe a clinical case of atypical course of complications of peptic ulcer disease and the possibility of timely urgent diagnosis. Materials and methods – a clinical case of atypical course of a perforated duodenal ulcer. The clinical case described demonstrates the difficulties of diagnosis in case of lack of time, a dubious clinical picture, ambiguous X-ray data, which requires a more thorough clinical analysis of the available information by urgent brigade of surgeons. For the timely diagnosis of surgical complications of peptic ulcer disease, it is necessary to use modern imaging methods.