Treatment Of Complications Research Articles

Clinical outcomes of silicon oil tamponade in patients with chronic exudative retinal detachments in effective with conservative treatment

Aims/Purpose: To investigate the surgical treatment outcomes and complications of pars plana vitrectomy and silicone oil tamponade in patients with chronic exudative retinal detachment that did not respond to conservative treatment.Methods: This retrospective study included 81 eyes of 81 patients diagnosed with chronic exudative retinal detachment who underwent pars plana vitrectomy and silicone oil tamponade after failing to respond to conservative treatment with oral steroids and intravitreal or sub‐Tenon's triamcinolone injections between February 2002 and September 2023. The best‐corrected visual acuity (BCVA) before and after surgery, postoperative complications, and recurrence rates were analyzed.Results: The mean duration of silicone oil tamponade was 17.98 ± 3.16 months. Successful retinal reattachment was achieved in 68 eyes (83.95%) after the initial surgery. Of the 51 eyes that had the silicone oil removed, 14 (27.45%) experienced retinal re‐detachment and required additional silicone oil injection. After final silicone oil removal, 39 eyes (48.15%) maintained stable retinal attachment. The mean BCVA improved significantly from logMAR 1.54 ± 0.134 preoperatively to logMAR 1.155 ± 0.139 after silicone oil removal (p = 0.029). Postoperative complications included cataract (n = 30), secondary glaucoma (n = 20), epiretinal membrane and macular edema (n = 8), and emulsified silicone oil (n = 4).Conclusions: Silicone oil tamponade is an effective surgical treatment that can improve visual outcomes in patients with chronic exudative retinal detachment refractory to conservative management. Although complications can occur, they are manageable, making this approach a reasonable option when conservative treatments fail.

Analysis of the accuracy of disease prediction in pediatric ward patients based on the modified early warning score for children: A randomized controlled trial.

Due to their young age and limited ability to communicate, pediatric patients in internal medicine wards are at risk of nursing assessment errors, which can lead to adverse events and disputes. To explore the application effect of modified pediatric early warning score (PEWS) in the early identification of critically ill children in pediatric general wards. A single-blind, two-arm randomized controlled trial was conducted using a convenience sampling method. A study was conducted on 300 pediatric inpatients admitted to the pediatric ward of a tertiary hospital in Guangdong Province between June 2021 and December 2023. The patients were randomly divided into an observation group (150 cases) and a control group (150 cases) using a random number table. The control group received standard treatment based on medical orders, along with routine basic and specialized nursing care. The observation group received an intervention combining the PEWS with a graded nursing management model. The PEWS scores of the observation group were analyzed upon admission, and the value of PEWS in assessing the severity of illness was evaluated using a receiver operating characteristic (ROC) curve. The study also compared treatment outcomes, complication rates, mortality, and parental satisfaction between the two groups. The observation group showed significantly lower mortality, complication rates, length of hospital stay, and hospitalization costs compared to the control group (P<0.05). Additionally, parental satisfaction in the observation group was significantly higher than in the control group (P<0.05). When using the need for nursing intervention in critically ill patients as a predictive indicator, a modified PEWS score of ≥1 point was identified as the threshold for distinguishing critically ill patients who require nursing intervention. The area under the curve (AUC) was 0.91, with a sensitivity of 92.1%, a specificity of 75.4%, and a Youden index of 0.675. As an effective tool for assessing patient conditions, the probability of receiving nursing care significantly increases for patients with a modified PEWS score above 1. The modified PEWS is valuable for early identification of illness and assessing changes in patient conditions. It enables timely recognition of deterioration and the provision of personalized nursing interventions, thereby reducing the incidence of complications in critically ill patients, preventing further deterioration, shortening hospital stays, and lowering hospitalization costs, ultimately improving parental satisfaction. This approach is worth promoting.

Analysis of complications of surgical treatment of acquired and congenital basal encephalocele in children

Analysis of complications of surgical treatment of acquired and congenital basal encephalocele in children

Effect of Diode Laser and Fluoride Varnish on Microhardness of enamel: An In Vitro Study

Introduction: White spots are a common complication of orthodontic treatment. Several prevention methods such as fluoride therapy and laser irradiation have been proposed, but there is still no conclusive evidence. Therefore, this study aimed to evaluate the combined application of diode laser and fluoride varnish in preventing white spots. Methods: Thirty-nine sound human premolars were extracted for orthodontic purposes and randomly divided into three groups of thirteen teeth each (C: Control, FV: fluoride varnish (5% sodium fluoride), and FV+L: fluoride varnish+980 nm diode laser (2 W)). The freshly extracted teeth were disinfected in a 0.5% chloramine T solution and stored in saline at room temperature. Each tooth was coated with nail polish, leaving a 2×3 mm2 window on the midbuccal. Surface treatments were applied, and primary Vickers microhardness was evaluated in the gingival sections. Then, the samples were immersed in alternating demineralizing (6 hours/day) and remineralizing (18 hours/day) solutions and incubated at 37 °C for 9 days to produce artificial caries. Afterward, the samples were immersed in a remineralizing solution for one day. Finally, secondary microhardness was measured. The data were analyzed using one-way ANOVA. Results: The primary microhardness was higher in groups C and FV than in group FV+L. The lowest secondary microhardness was recorded in group C, and there was no significant difference between the other two groups. The change in microhardness was greater in group C, while no difference was observed between the FV and FV+L groups. Conclusion: Within the limitations of this study, the combined application of laser irradiation and fluoride varnish may not improve white spot lesion (WSL) prevention compared to the use of fluoride varnish alone.

RESORBABLE WE43 VERSUS TITANIUM FIXATION DEVICES- EVALUATION OF TREATMENT OUTCOMES: A SYSTEMATIC REVIEW

Background: Internal fixation of mandibular fractures with Titanium (Ti) plates has become the gold standard for treatment in the adult population. Unfortunately, Ti plates had a tendency to undergo corrosion causing inflammation of surrounding bone that often led to failure of treatment. Magnesium (Mg) based newer materials such as WE43 alloy have been studied extensively for its ability to resorb in the presence of living tissue. Mg based WE43 alloy has demonstrated superior corrosion resistance and mechanical properties comparable to standard Titanium devices. The aim of this systematic review was to know whether WE43 based fixation devices can be used as an alternative to Ti based fixation devices for osteosynthesis. Materials and Methods: PubMed, Cochrane, Google Scholar, Web of Science, were searched to find the studies comparing the WE43 fixation devices and Ti based fixation devices for osteosynthesis. No filters were applied. Search terms related to WE43, titanium, fixation, osteosynthesis, corrosion resistance, fracture fixation, complications of treatment, etc, were used to search relevant studies. Data extraction, quality assessment, and summary synthesis for treatment outcomes including corrosion resistance,stability, osteosynthesis, adverse effects were carried out. Results: 5 studies consisting of 3 in-vivo animal studies and 2 clinical trials were included after the screening of search results. In the animal studies, i)16 rabbit specimens were divided into 2 groups -Group I received Ti based implants, while Group II received Mg based WE43 implants. ii)10 beagle dogs were divided into 2 groups and evaluated at 4, 12, and 24 weeks after implant placement. iii)18 hemi mandibles of sheep were tested to check the outcome of fracture fixation between Mg and Ti based fixation devices. Group I used Ti1.0, Group II used Mg 1.75, and Group III used Mg 1.5. In the clinical trials, i) fixation of mandibular head fracture was done in 31 using WE43 screws and 29 patients using Mg screws and ii) 11 patients treated with Mg compression screws and 10 patients with Ti compression screws. Conclusions: Comparison of properties of WE43 with Ti in the animal models has shown a non-inferiority of the Mg based material. Biomechanically, the human studies revealed promising results concerning the use of WE43 as a potential alternative to Ti in fracture fixation. Further evaluation is warranted under biomechanical loading conditions to verify the clinical performance of the material.

Let It Grow: The Role of Growth Factors in Managing Chemotherapy-Induced Cytopenia.

Chemotherapy-induced cytopenia (CIC) is characterized by neutropenia, anemia, and thrombocytopenia, which are common and serious complications in cancer treatment. These conditions affect approximately 60% of patients undergoing chemotherapy and can significantly impact quality of life, treatment continuity, and overall survival. The use of growth factors, including granulocyte colony-stimulating factors (GCSFs), erythropoietin-stimulating agents (ESAs), and thrombopoietin receptor agonists (TPO-RAs), has emerged as a promising strategy for managing CIC. However, the use of these growth factors must be approached with caution. This review provides an overview of the mechanisms, efficacy, and safety of growth factors in the management of CIC. Additionally, we discuss predictive markers for treatment response, potential risks, and highlight areas for future research.

Matched pair analysis of wide versus narrow focus during shockwave lithotripsy for urolithiasis

PurposeTo compare stone clearance and complications between a ‘wide’ (9 × 50 mm) and ‘narrow’ shockwave focus (6 × 28 mm) when undertaking shockwave lithotripsy (SWL) in patients with renal or ureteric stones.MethodsData from patients undergoing SWL using the dual focus Storz Modulith SLX-F2 lithotripter at a single centre were prospectively collected between February 2018 and September 2020. Patients were matched by stone size, location, and number of treatments. Stone clearance, re-presentation within 31 days, symptoms, complications, and need for post SWL-interventions were compared using McNemar’s test.ResultsPatients receiving wide focus SWL (WF-SWL, n = 152) were matched with patients receiving narrow focus SWL (NF-SWL, n = 152). Median stone size was 6 mm; energy delivered to WF-SWL and NF-SWL groups was comparable. Complete stone clearance was achieved in 55% of WF-SWL patients (n = 84) and 41% (n = 63) of NF-SWL patients (p = 0.04). Treatment was considered successful in 74% (n = 113) of WF-SWL cases and 66% (n = 100) of NF-SWL (p = 0.20). No difference in rates of readmission, post-procedural pain, haematuria, urinary tract infections, analgesia or antibiotic requirements were identified.ConclusionThis service evaluation demonstrates no differences in rates of overall treatment success nor complications on comparing WF-SWL and NF-SWL.

Comparison of the Efficacy and Safety of Thyroid Microwave Ablation and Radiofrequency Ablation versus Open Surgery for the Treatment of Benign Thyroid Nodules: A Propensity Score Matching Study.

With the advantage of preserving thyroid function while minimizing intervention-related morbidity, minimally invasive thermal ablation techniques such as microwave ablation (MWA) and radiofrequency ablation (RFA) have emerged as alternatives to traditional open surgery. This study compares the efficacy and safety of MWA and RFA with that of open surgery for the treatment of benign thyroid nodules by utilizing a propensity score matching study design to improve comparability. This retrospective study included patients with benign thyroid nodules treated at the North China Electric Power University (Baoding) School Hospital between May 2020 and May 2023. Following propensity score matching, the patients were equally divided into three treatment groups: MWA, RFA, and open surgery. Data on demographic characteristics, thyroid function, treatment outcomes (including nodule size reduction, postoperative pain, cosmetics, hospital stay, and quality of life (QoL)), and postoperative complications were analyzed. A total of 160 patients, including 55 patients who received MWA, 58 patients treated with RFA and 47 patients operated with open surgery, were initially included. Propensity score matching, aimed at minimizing baseline differences among the groups, was conducted, leaving behind 105 patients, who were equally distributed with 35 persons per group. Compared to open surgery, both MWA and RFA significantly reduced intraoperative blood loss, operation time, length of hospital stay, and pain scores (p < 0.05). The incidence of complications, such as hypothyroidism, hematoma, wound pain, and incision adhesion, was also significantly lower (p < 0.05). In addition, the MWA and RFA were superior to open surgery in terms of cosmetic satisfaction and overall QoL scores (p < 0.05). No significant differences were observed between the MWA and RFA groups in terms of treatment efficacy, complication rates, cosmetic satisfaction, and QoL scores (p > 0.05). At the 6-month follow-up, no significant differences in thyroid function were observed among the three treatment modalities (p > 0.05). MWA and RFA exhibit comparable outcomes, in terms of efficacy and safety, for the treatment of benign thyroid nodules, with advantages over open surgery including shorter hospital stays, lower level of postoperative pain, better cosmetic outcomes, higher QoL scores, and lower rates of certain complications.

Influence of dosimetry accuracy on the correlation with treatment outcome in a preliminary PSMA radiopharmaceutical therapy study.

Despite the potential of dosimetry in optimizing personalized radiopharmaceutical therapy (RPT), its limited clinical implementation impedes the development of simplified protocols for routine adoption. However, simplifications may introduce errors in dosimetry, prompting questions about their impact on clinical practice. In this retrospective study, we analyzed data from 21 patients diagnosed with metastatic castration-resistant prostate cancer (mCRPC) who underwent multiple cycles of 177Lu-PSMA-617 RPT treatment. Cumulative dosimetry of all the treatment cycles was calculated using both the standard multi-time point dosimetry (MTPD) method and the single time-point dosimetry (STPD,Hänscheidapproximation) method for the same cohort. Their correlations with treatment outcome (PSA decline rate and overall survival, OS) and complication risk (anaemia grade) were investigated. The Fisher's Z-Transformed test was performed to statistically evaluate the difference between the correlations. STPD showed a non-significant difference in correlation with PSA decline rate, despite a mean percentage error (MPE) of up to 36.44% in tumor dosimetry compared to MTPD (MTPD: rho = -0.39, p < 0.001; STPD: rho = -0.46, p < 0.001; Z = 0.58, p = 0.56). Both STPDtotal and MTPDtotal demonstrated a significant impact on OS (STPDtotal: Hazard Ratio = 1.05, p < 0.05, log-transformed MTPDtotal: Hazard Ratio = 3.41, p < 0.05, log-transformed STPDtotal: Hazard Ratio = 8.06, p < 0.05). Additionally, despite a MPE of up to -40.26% in bone marrow dosimetry, STPD showed a non-significant difference in correlation with anemia grade (MTPD: rho = 0.35, p < 0.001; STPD: rho = 0.40, p < 0.001; Z = -0.39, p = 0.70). The preliminary findings from a small cohort indicate that the reduced accuracy of a clinically simplified protocol may not diminish the clinical therapy outcome predictive value of dosimetry. Future thorough systematic investigations may be needed to determine the clinically acceptable level of accuracy for dosimetry.

Efficacy and Outcomes of Laser Treatment in Pilonidal Sinus Disease

AIM: In recent years, minimally invasive treatment methods have introduced significant innovations in the surgical management of pilonidal sinüs disease. This study aims to comprehensively evaluate the efficacy of laser treatment for pilonidal sinus disease, focusing on treatment success, recurrence rates, complications, and patients' return to normal life. MATERIAL AND METHOD: In this study, data from patients treated with laser ablation for pilonidal sinus disease between August 2020 and August 2023 were retrospectively analyzed. Patients aged 18-40 who were treated with laser for pilonidal sinus disease were included in the study. Patients with recurrence, those who had undergone chemotherapy/radiotherapy in the anorectal or sacrococcygeal region, those with concurrent malignancies, those with a history of inflammatory bowel disease, those on chronic steroids, diabetics, and patients with autoimmune diseases were excluded from the study. RESULTS: A total of 49 patients (5 females, 44 males) who underwent laser ablation for pilonidal sinus disease were included in the study. It was found that 16 (32.7%) of the included patients had a history of abscess drainage due to pilonidal sinus disease. In the postoperative period, the median (min-max) wound healing time was 28 (20-52) days. A total of 4 patients (8.3%) experienced recurrence. CONCLUSION: Considering pilonidal sinus disease as a subcutaneous infectious condition, laser ablation should be regarded as one of the primary treatment options for pilonidal sinus surgery, given its acceptable recurrence rates, low complication risk, rapid return to normal activities, and cosmetic advantages. Keywords: laser, pilonidal sinus disease, minimally invasive

Impact of anxiety symptoms on dialysis adherence and complication rates: A longitudinal observational study.

Anxiety is a common psychological comorbidity in patients undergoing dialysis, yet its impact on treatment adherence and complication rates remains understudied. We designed a longitudinal observational study to investigate these relationships, based on the hypothesis that higher anxiety symptoms would be associated with increased complication rates and negatively associated with adherence to the dialysis regimen. To investigate the relationship between anxiety symptoms, dialysis adherence, and complication rates in patients undergoing dialysis over a 24-month period. This observational study analyzed data from 250 adult patients who underwent hemodialysis or peritoneal dialysis at three Affiliated Hospitals of Youjiang Medical University for Nationalities over a period of 24 months. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale-Anxiety subscale at baseline and every 6 months. Dialysis adherence was evaluated through attendance records, interdialytic weight gain, and patient-reported medication adherence. We recorded complications (infections, cardiovascular events, and hospitalizations) and used mixed-effects models and survival analyses to infer associations between anxiety symptoms, adherence measures, and complication rates. Higher anxiety symptoms were significantly associated with poorer dialysis adherence, including increased missed sessions [incidence rate ratio = 1.32, 95% confidence interval (CI): 1.18-1.47, P < 0.001], greater interdialytic weight gain (β = 0.24, 95%CI: 0.15-0.33, P < 0.001), and lower medication adherence (odds ratio = 0.85, 95%CI: 0.78-0.93, P < 0.001). Patients with clinically significant anxiety (Hospital Anxiety and Depression Scale-Anxiety subscale ≥ 8) had a higher risk of complications [hazard ratio (HR) = 1.68, 95%CI: 1.32-2.14, P < 0.001], particularly infections (HR = 1.89, 95%CI: 1.41-2.53, P < 0.001) and cardiovascular events (HR = 1.57, 95%CI: 1.18-2.09, P = 0.002). The relationship between anxiety and complications was partially mediated by adherence measures. Anxiety symptoms in patients undergoing dialysis are associated with poorer treatment adherence and increased complication rates. Regular screening and targeted interventions to address symptoms may improve adherence and clinical outcomes.

European S2k guidelines for hidradenitis suppurativa/acne inversa part 2: Treatment.

This second part of the S2k guidelines is an update of the 2015 S1 European guidelines. These guidelines aim to provide an accepted decision aid for the selection, implementation and assessment of appropriate and sufficient therapy for patients with hidradenitis suppurativa/acne inversa (HS). The chapters have been selected after a Delphi procedure among the experts/authors. Certain passages have been adopted without changes from the previous version. Potential treatment complications are not included, being beyond the scope of these guidelines. Since the S1 guidelines publication, validation of new therapeutic approaches has almost completely overhauled the knowledge in the field of HS treatment. Inflammatory nodules/abscesses/draining tunnels are the primary lesions, which enable the classification of the disease severity by new validated tools. In relation to the degree of detectable inflammation, HS is classified into the inflammatory and the predominantly non-inflammatory forms. While the intensity of the inflammatory form can be subdivided by the IHS4 classification in mild, moderate and severe HS and is treated by medication accordingly, the decision on surgical treatment of the predominantly non-inflammatory form is based on the Hurley stage of the affected localization. The effectiveness of oral tetracyclines as an alternative to the oral combination of clindamycin/rifampicin should be noted. The duration of systemic antibiotic therapy can be shortened by a 5-day intravenous clindamycin treatment. Adalimumab, secukinumab and bimekizumab subcutaneous administration has been approved by the EMA for the treatment of moderate-to-severe HS. Various surgical procedures are available for the predominantly non-inflammatory form of the disease. The combination of a medical therapy to reduce inflammation with a surgical procedure to remove irreversible tissue damage is currently considered a holistic therapeutic approach. Suitable therapeutic options while considering HS severity in the therapeutic algorithm according to standardized criteria are aimed at ensuring a proper therapy.

Ears, Nose, and Throat in Leukemias and Lymphomas

Leukemias and lymphomas, encompassing a spectrum of hematologic malignancies, often exhibit manifestations in various tissues and organs, including the ears, nose, and throat (ENT) region, extending beyond the typical sites of bone marrow and lymph nodes. This manuscript explores these interactions, considering disease-related symptoms and treatment effects. ENT symptoms, such as otalgia, hearing loss, and nasal obstruction, may arise from direct infiltration or treatment complications, with chemotherapy-induced ototoxicity being particularly characteristic. Furthermore, immunotherapy complications, including cytokine release syndrome and mucosal irritation, can also contribute to ENT symptoms. Additionally, targeted therapy and radiotherapy can lead to mucosal dryness, dysphonia, and radiation-induced otitis media. Patients with hematologic malignancies are especially vulnerable to various ENT infections, including bacterial, viral, and fungal infections, due to compromised immunity resulting from both the disease and its treatments. Conditions such as rhinosinusitis, otitis media, and pharyngitis pose significant management challenges. Moreover, patients undergoing hematopoietic stem cell transplantation (HSCT) face unique ENT considerations, including mucositis, opportunistic infections, and graft-versus-host disease in cases of allogeneic HSCT. These patients require specialized pre-transplant evaluations, meticulous post-transplant surveillance, and tailored assistance to mitigate complications. This manuscript underscores the importance of a multidisciplinary approach that integrates diagnostics, pharmacological interventions, and supportive care to address both disease-related and treatment-induced ENT manifestations. Further research is needed to refine management strategies and improve outcomes in this complex clinical population.

Breast-Related Herniation: A Call for Multidisciplinary Awareness and a Proposal for a Classification.

Breast-related herniation (BRH) is a vague term for many clinicians. The absence of a universal nomenclature and the different nature of the herniation process involved, being true or false, contribute to this vagueness. BRH includes a spectrum of disorders ranging from a few congenital breast disorders to commoner herniation processes related to acquired breast diseases. We aim to raise multidisciplinary awareness about BRH by reviewing the related literature and reviewing our experience with BRH. We will also propose a classification for BRH. PubMed and Scopus databases were searched for any herniation disorders that are related to the breast in any clinical or pathological aspect. The literature review revealed 12 various groups of BRHs that we could classify into two anatomical categories: pectoral (mammary) BRH, in which the herniations occur at the pectoral site of the chest wall, and extra-pectoral BRH, in which the herniations occur at an extra mammary site but are related to breast pathologies. Pectoral BRH was further divided into clinicopathological subcategories, including congenital BRH, pulmonary BRH complicating breast cancer and breast infections, factitious BRH, and iatrogenic BRH. Extra-pectoral BRH was further divided into clinicopathological subcategories, including abdominal wall hernias following autologous breast reconstruction (ABR) and herniated siliconomas. Our study group included 19 patients with BRHs, among which congenital BRHs and pulmonary BRHs were the most common. Congenital BRHs are rare and are of main interest to plastic surgeons. However, abdominal wall hernias following ABR, pulmonary BRH, and factitious BRHs are relatively common complications of breast cancer treatment. This calls for a multidisciplinary approach to ameliorate the morbidity of BRHs. Further studies are needed to refine our proposed classification.

Comparison of radiofrequency thermocoagulation of ganglion Impar with block using a combination of local anaesthetic and steroid in chronic perineal pain

Abstract Background and Aims: Chronic perineal pain (CPP) is the anorectal and perineal pain without underlying organic disease. The prevalence of CPP is 6–18%. The etiology for CPP may be idiopathic, benign, or malignant. We compared radiofrequency thermocoagulation of ganglion Impar with block using a combination of local anaesthetic and steroid for management of chronic perineal pain, with respect to pain relief, patients’ self-reported belief about the efficacy of treatment, and side effects or complications, if any. Material and Methods: Forty patients attending the Pain Management Centre of either sex in the age group of 20–70 years with history, physical examination, and pain patterns consistent with chronic perineal pain, who had been investigated to rule out malignancy and failed to respond to 6 weeks of conservative treatment with a combination of analgesics, anti-inflammatory drugs, neuromodulators, and physiotherapy, were enrolled in the study. The patients were randomly divided into two groups of 20 each using a computer-generated randomization number table. Group-I (n = 20): Patients were administered ganglion Impar block using a drug mixture comprising of 8 ml of 0.25% bupivacaine plus 80 mg of triamcinolone acetate under fluoroscopic guidance. Group II (n = 20): Patients received conventional radiofrequency thermocoagulation of ganglion Impar at 80 degree Celsius for 90 seconds under fluoroscopic guidance. Outcome assessment was done after minimally invasive pain and spine intervention (MIPSI) with evaluation of pain using the Numeric Rating Scale (0–10), patients’ self-reported belief about the efficacy of treatment using Patient Global Impression of Change (PGI-C), and side effects or complications, if any. Results: The majority of the patients in our study were in the age group of 40–50 years, and 80% of the patients were females and weighed 60–70 kg. The majority of the patients in our study had history of trauma, which led to coccygodynia. There was statistically and clinically significant improvement in pain score after ganglion Impar block in both the groups at all time intervals during the study period (P &lt; 0.05). Patients’ self-reported belief about efficacy as per PGI-C was clinically and statistically better in group II as compared to group I at all time intervals throughout the study period (P &lt; 0.005). Four patients in group I required second ganglion Impar block during the 12 months study period. The most common side effect was temporary pain on injection. Conclusions: Both the techniques of MIPSI, that is, fluoroscope-guided ganglion Impar block using corticosteroid and local anaesthetic and radiofrequency thermocoagulation, are effective and provide good pain relief to the symptomatic patients. With respect to improvement in pain relief and patients’ self-reported belief about the efficacy of treatment and side effects or complications, fluoroscope-guided ganglion Impar radiofrequency thermocoagulation is better as compared to fluoroscope-guided ganglion Impar block using corticosteroids and local anesthetics.

Acute Form of Sarcoidosis (Löfgren Syndrome): A Case Report

Sarcoidosis is a disorder that affects multiple systems with unclear causes and is relatively rare. The defining characteristic of this disease is the presence of granulomas in various organs in the human body. The incidence and presentation are changeable according to many factors, such as geography, ethnicity, sex, and genetic background. It is highest in Scandinavians. Löfgren syndrome represents a sudden manifestation of sarcoidosis, constituting approximately 10% of all cases. The classical signs and symptoms include bilateral symmetric hilar lymphadenopathy, fever, multiple joint swelling, and skin lesions known as erythema nodosum. Diagnosis of the disease can be quite challenging owing to its infrequent occurrence and the limited availability of sensitive and specific diagnostic tools, tests, and changeable clinical pictures that may suggest different aetiologies. Early diagnosis of Löfgren syndrome will ensure rapid treatment and fewer complications. This review presents the case of a 27-year-old healthy female with sudden onset of bilateral knee joint pain, swelling, erythema nodosum, and fever. Laboratory tests revealed elevated inflammatory parameters. Chest CT and chest X-ray revealed mediastinal and hilar lymphadenopathy, suggesting Löfgren syndrome. This report emphasises the broad spectrum of mimicry observed in cases of acute sarcoidosis, with a focus on the clinical picture and standard differentials that must be carefully evaluated to exclude other inflammatory and malignant conditions. The patient achieved full remission following symptomatic treatment.

Severe Bone Marrow Suppression and kidney Injury Due to Multisystem Inflammatory Syndrome in Children: A Case Report

Introduction: Multisystem inflammatory syndrome in children (MIS-C) is a rare complication of COVID-19, and bone marrow suppression is an exceedingly rare manifestation of MIS-C. This report presents a 10-year-old boy with periorbital ecchymosis, lethargy, and a history of fever and cough, who was diagnosed with MIS-C accompanied by severe bone marrow suppression. Case Presentation: A 10-year-old boy was referred to our hospital with complaints of ecchymosis around the eyelids, especially the upper eyelids, and lethargy. He also reported a history of cough, fever, and bone pain over the past 10 days. Although fever and cough had subsided, the patient remained lethargic. Laboratory studies were performed, and a complete blood count (CBC) revealed severe bone marrow suppression. Additional tests showed markedly elevated urea and creatinine levels, severe hyperphosphatemia, and severe hyperuricemia, indicating renal failure. Given the laboratory findings and his lethargic condition, the patient was hospitalized and underwent hemodialysis. Blood products, including packed red cells and platelet units, were transfused following hematology consultation. Further laboratory tests ruled out rheumatological conditions, with all rheumatological tests reported as normal. However, Interleukin-6 (IL-6) and fibrinogen levels were significantly elevated, and the COVID-19 PCR test was positive. Based on these findings, the diagnosis of MIS-C was established. Treatment with remdesivir and methylprednisolone pulse therapy was initiated. Other potential infectious causes of bone marrow suppression, such as leishmaniasis, were excluded due to normal test results and a normal CBC performed one week prior to the onset of clinical symptoms. Following the completion of treatment, the hematological and nephrological complications resolved, and the patient was discharged in good condition. He remains under regular follow-up. Conclusions: Multisystem inflammatory syndrome in children can lead to bone marrow suppression, and a combination of remdesivir and methylprednisolone appears to be an effective treatment for managing this condition.

Risk Factor Analysis of Mechanical Complications in Surgical Treatment of Thoracolumbar Deformity with Osteoporotic Vertebral Fracture.

Objective: Adult spinal deformity (ASD) with osteoporotic vertebral fractures (OVF) often requires vertebral body resection and replacement. However, postoperative mechanical complications (MC) have been unsolved issues. This study retrospectively investigated the risk of MC following anterior-posterior spinal fusion (APF) with vertebral body resection and replacement for OVF with ASD. Methods: Among 91 cases undergoing APF with vertebral body resection and replacement, 43 cases met the deformity criteria. The mean age was 74.2 years, and the mean number of fused segments was 5.7. Pre and postoperative spinal alignments were measured, and the risk of MC occurrence, including PJK, DJK, and cage sinking, was determined through multivariate analysis. The AUC and cutoff values were calculated through ROC analysis. Results: The incidence of MC, PJK, and DJK were 28%, 12%, and 14%, respectively. Multivariate analysis for MC revealed postoperative PI-LL and operative time (cutoff: 40.5 degrees, 238 min) as significant risk factors, while postoperative PI-LL was a significant risk factor for PJK (cutoff: 42.4 degrees). Evaluation considering only thoracolumbar level showed postoperative local kyphosis as a significant MC risk factor (cutoff: 11 degrees). There was a positive correlation between operative time and preoperative local kyphosis, with a cutoff value of 238 min being equivalent to 21 degrees. Conclusion: The postoperative mismatch over 40 degrees and preoperative local kyphosis over 21 degrees were considered as a high risk for MCs. The postoperative kyphosis of 11 degrees was the risk factor of MC in the thoracolumbar level. The meticulous preoperative assessment, including local and global alignment, and local flexibility as well as detailed surgical planning of fixation range and the requirement of osteotomy, are crucial.

A new approach to repair recurrent vescicourethral anastomotic strictures after radical prostatectomy: The use of prerectal access.

Vesicourethral anastomosis stenosis (VUAS) is a well-known complication of prostate cancer treatments, observed in up to 26% of the cases after radical prostatectomy. Conservative management, with single or even repeated transurethral dilation or endoscopic incision of the stenosis, is successful in many cases, but up to 9% of patients are destined to fail after endoscopic treatment. In these cases, a revision of the vesicourethral anastomosis is necessary and can be realized with different surgical approaches. We aim to describe the technique and the outcomes of a new prerectal approach for VUAS repair. Twelve patients with recalcitrant VUAS following radical prostatectomy were enrolled between May 2014 and September 2018 for prerectal transperineal re-anastomosis. The evaluated outcomes were: the rate of successful anatomical repair at 3 months after surgery and at the last follow-up, postoperative incontinence and complications rate, and the need for further treatments. No major intraoperative complications occurred. After a median follow-up of 46 months (IQR 36-55), 10 patients (83.3%) achieved a good anatomical repair even if one man required an endoscopic urethrotomy, while two patients (16.67%) with a history of pelvic radiotherapy developed a surgical site infection that required toilette and external urinary diversion. Among the others, nine (75%) developed severe stress urinary incontinence, with resolution of their condition. No patient reported significant postoperative pain or fecal incontinence. The prerectal approach to VUAS repair allows direct access to the posterior urethra and the anastomosis, providing a better mobilization of the bladder neck for tension-free anastomosis. However, patients with a history of pelvic radiotherapy have a higher risk of complications. Postoperative incontinence is very common, but urinary continence could be restored with subsequent artificial urinary sphincter placement.

Surgical vs. conservative treatment for hip osteoporotic fracture in maintenance hemodialysis patients: a retrospective analysis.

HSip Osteoporotic fractures are common complications with high mortality in patients undergoing maintenance hemodialysis (MHD). It remains unclear whether surgical or conservative should be adopted for hip fractures in MHD patients. A retrospective analysis was conducted in Tianjin Hospital of Tianjin University from August 2019 to August 2023. A total of 43 MHD patients with hip fracture were included, with 30 cases in the surgical group and 13 cases in the conservative group. The differences in cumulative survival rates, time to first ambulation, Harris score, Barthel index, and incidence of complications were compared. The surgical group had remarkable lower mortality rates as compared with the conservative group at 1, 2, 3, 6, 12, 24 months (13.33 VS. 38.46%, 26.67 VS. 53.85%, 26.67 VS. 53.85%, 26.67 VS. 61.54%, 26.67 VS. 61.54%, and 26.67 VS. 69.23%). In the surgical treatment group, the first ambulation time was reduced to 28 (26) days, which was superior to the conservative group (134.17 ± 43.18 days, P < 0.001). The Harris score at 1 month (61.50 ± 4.10) and the Barthel index at 3 months (95, 11.25) were also significantly higher (P < 0.001). Furthermore, the surgical group had a significantly lower overall incidence of complications (60.00 vs. 92.31%, P = 0.034). The risk of death and complications of surgical treatment was only 23.0 and 32.4% of conservative treatment in MHD patients with hip fracture. Surgical treatment is effective and safe and should be the first choice for hip fracture in MHD patients.