Continuous Drainage Research Articles

Clinical features and outcomes of congenital chylothorax: a single tertiary medical center experience in China

ObjectiveCongenital chylothorax (CC) is an uncommon congenital disease. The objective of this study was to analyze the clinical features, treatment, and outcome of infants with CC in a Chinese tertiary medical center.MethodsCC was defined as a non-traumatic pleural effusion with ≥ 80% lymphocytes detected before birth or within 28 days after birth. Clinical data were collected in CC infants discharged from June 2017 to March 2021.ResultsA total of 24 CC infants were discharged during the study period, accounting for 67% of congenital pleural effusions. The median gestational age at birth was 36+4 weeks (range 29+5–41 weeks) and the birth weight was 3025 g (range 1850–4250 g). Twenty-one infants were diagnosed antenatally. The median gestational age at the time of diagnosis was 30+3 weeks (range 24–36+6 weeks). Nine infants presented with hydrops fetalis; 18 were bilateral. Prenatal interventions were performed in 13 fetuses. Nine infants (38%) had birth asphyxia. Compared with the infants without hydrops fetalis, the infants with CC and hydrops fetalis had lower Apgar scores at 1 and 5 min (P < 0.05) and a lower gestational age at birth (P < 0.05). Postnatally, 17 infants required continuous pleural drainage for 10 days (range 2–30 days). Analysis of the pleural effusion showed a higher cell count, lymphocyte fraction, and protein content after enteral feeding (P < 0.05). Fifteen infants required mechanical ventilation; 9 did not require any respiratory support. Ten infants received a delayed feeding strategy and 17 received a medium-chain triglyceride (MCT) formula. Only 1 infant received octreotide therapy. Twenty-one infants survived and 3 died. The main cause of death was pulmonary dysplasia. The duration of hospital stay in survivors was 21.5 days (range 10–43) days. For infants with CC and hydrops fetalis, prenatal therapy shortened the duration of pleural drainage and the length of hospital stay (P < 0.05).ConclusionCC is the most common cause of congenital pleural effusions. The poor prognosis is mainly associated with prematurity, hydrops fetalis, and pulmonary dysplasia. Prenatal intervention may improve the outcome of infants with hydrops fetalis.

Osmotic gradients and transretinal water flow-a quantitative elemental microanalytical study of frozen hydrated chick eyes.

Optical clarity and efficient phototransduction are necessary for optimal vision, however, how the associated processes of osmoregulation and continuous fluid drainage across the whole eye are achieved remains relatively unexplored. Hence, we have employed elemental microanalysis of planed surfaces of light-adapted bulk frozen-hydrated chick eyes to determine the unique intracellular elemental localization, compositions, and hydration states that contribute to maintaining osmotic gradients and water flow from the vitreous, across the retina, retinal pigment epithelium (RPE), to choroid and sclera. As expected, the greatest difference in resultant osmotic concentration gradients, [calculated using the combined concentrations of sodium (Na) and potassium (K)] and tissue hydration [oxygen-defined water concentration], occurs in the outer retina and, in particular, in the RPE where the apical and basal membranes are characterized by numerous bioenergetically active, osmoregulating ion transport mechanisms, aquaporins, and chloride (Cl) channels. Our results also demonstrate that the high intracellular Na+ and K+ concentrations in the apical region of the RPE are partially derived from the melanosomes. The inclusion of the ubiquitous osmolyte taurine to the calculation of the osmotic gradients suggests a more gradual increase in the osmotic transport of water from the vitreous into the ganglion cell layer across the inner retina to the outer segments of the photoreceptor/apical RPE region where the water gradient increases rapidly towards the basal membrane. Thus transretinal water is likely to cross the apical membrane from the retina into the RPE cells down the Na+ and K+ derived osmotic concentration gradient and leave the RPE for the choroid across the basal membrane down the Cl- derived osmotic concentration gradient that is sustained by the well-described bioenergetically active RPE ion transporters and channels.

Clinical Observation of Modified Implantation of ASD Closure Device to Treat BPFs

Objectives. The aim of the paper is to explore the clinical efficacy and prognosis of the modified implantation of atrial septal defect (ASD) closure device to treat bronchopleural fistulas (BPFs). Methods. This paper has reviewed the results of 13 BPF patients implanted with a modified ASD closure device in Shaw Hospital Affiliated with the Medical College of Zhejiang University from October 2018 to November 2021. Anesthesia was selected based on the patient’s condition. Different sizes of ASD closures were selected based on the characteristics of fistulas. The modified implantation of the ASD closure device was applied to treat BPFs. The closure effects, closure time, and Borg score were observed at 4 weeks, 8 weeks, and 12 weeks after the surgery. Results. All 13 BPF patients were successfully implanted with the ASD closure device, and the immediate clinical remission rate was 100%. Follow-up at 4 weeks after the surgery showed that 2 cases were automatically discharged within a few days and 4 cases had closed fistula at 1 day after the surgery; follow-up at 8 weeks after the surgery showed that 1 case with fistula closure was observed at 55 days after the surgery; follow-up at 12 weeks after the surgery showed that 1 case with fistula closure was observed at 82 days after the surgery. T/P values (T = 7.90, 5.99, 7.44, P &lt; 0.05 ) of paired t-tests before surgery and 4 weeks, 8 weeks, and 12 weeks after the surgery were rated by the Borg scale. The data were statistically different, and the clinical symptoms improved significantly. As of publication, the follow-up at 12 weeks after the surgery showed that the clinical remission rate was 9/11, namely, 81.8%, 3 of 11 cases had relieved clinical symptoms but still needed continuous drainage, and 2 cases had fistula closure. The median time of thoracic extubation was 63 (3,120) days. No patients died from surgical complications or BPF recurrence during the prognosis and the follow-up period. Conclusions. The modified implantation method has a high success rate and clinical remission rate, quick and early fistula closure, and simple and noninvasive operation, without the need for a dedicated delivery sheath and rigid endoscopy. Moreover, it has accurate positioning, reliable closure efficiency, and prognosis, and can be completed under local anesthesia. This reduces the operation time, difficulty, and risks of anesthesia.

Timing, approach, and treatment strategies for infected pancreatic necrosis: a narrative review

Timing, approach, and treatment strategies for infected pancreatic necrosis: a narrative review

PLEURITIS AND EMPYEMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA

PLEURITIS AND EMPYEMA AFTER TRANSARTERIAL CHEMOEMBOLIZATION OF HEPATOCELLULAR CARCINOMA

S2848 Massive Pseudo-Pneumoperitoneum After Endoscopic Necrosectomy

Introduction: Encapsulated peripancreatic fluid collection and walled-off necrosis are some of the complications of acute pancreatitis. Most resolve spontaneously but symptomatic pseudocysts or walled-off necrosis require drainage. The preferred therapeutic management is endoscopic ultrasound (EUS) guided drainage with stent placement. Known iatrogenic complications of the procedure include bleeding and perforation. Case Description/Methods: A 39-year-old woman with history of ulcerative colitis, in remission on certrolizumab presented with symptomatic walled-off necrosis after idiopathic necrotizing pancreatitis. EUS-guided drainage and stent placement was successfully performed. On subsequent upper endoscopy for necrosectomy, post-procedure large pneumoperitoneum was noted on imaging leading to emergent surgical evaluation with laparoscopy. However, no perforation or pancreatic fluid contamination was seen. On post-operative day 1, patient was asymptomatic and tolerating diet. She was discharged on post-operative day 2. At 3-month follow-up, patient remained asymptomatic and plastic stents were removed. Discussion: Pneumoperitoneum is an uncommon but dreaded complication of EUS guided cystogastrostomy. This occurs when there is separation of the gastric wall and the wall of the pancreatic cyst or walled-off necrosis. If perforation is detected during cystgastrostomy, it may be possible to use a LAMS to close the defect by bridging the walls or close the gastric defect endoscopically with clips or sutures. Immediate surgery (such as cyst-enterotomy with closure of the wall defect) should be performed if there is generalized contamination of the peritoneum with cyst fluid content and subsequent signs of peritonitis. (Figure) Our case, to our knowledge, is the only one that describes pneumoperitoneum after endoscopic necrosectomy, two weeks after placement of LAMS. Our hypothesis is that the walled-off necrosis moved away from the gastric wall after removal of LAMS, which had aided apposition of the gastric wall and cyst wall due to its flanges and short saddle length. Pneumoperitoneum, in the absence of peritoneal findings, is referred to as benign peritoneum. Our case describes massive benign pneumoperitoneum after endoscopic necrosectomy without perforation. There is a paucity of literature on non-surgical management of post-endoscopic pneumoperitoneum and we hope that our case, will help endoscopists carefully select patients who will benefit from surgical management of pneumoperitoneum.Figure 1.: Figure A. CT abdomen showing pancreatic walled off necrosis containing turbid fluid and debris. Figure B. Massive pneumoperitoneum seen on CT abdomen after EUS-guided drainage and double pig-tailed stent placement for continued drainage.

A proposed improvised pleural drainage system for veterinary use.

Active pleural suction devices may be required for continuous drainage of pleural fluid or air. Such devices may not always be available or economical to stock at all veterinary hospitals. Three designs of pleural drainage systems adapted from standard suction canisters are proposed. The designs were constructed from readily available materials from the veterinary hospital and consist of (1) a 1-bottle system intended for use with pneumothoraces, (2) a 2-bottle system, which can be used for draining air and fluid, and (3) an abbreviated 2-bottle system. The suction pressure was tested using a water manometer for each design. The suction pressure was consistently accurate with designs 1 and 2, with mild fluctuations, intermittently increasing suction pressure in design 1 due to bubbling through the air vent. Design 3 demonstrated a greater degree of pressure fluctuations, which was attributed to having the least water volume, reaching suction pressures up to 1cm H2 O above what was set. The improvised devices appear effective, allow accurate delivery of a set suction pressure, and can be rapidly constructed from inexpensive and readily available equipment.

Continuous lumbar drainage after aneurysmal subarachnoid hemorrhage decreased malondialdehyde in cerebrospinal fluid and improved outcome

The use of a continuous lumbar drain (LD) for the treatment of aneurysmal subarachnoid hemorrhage (aSAH), and malondialdehyde (MDA), a marker of oxidative stress, is correlated with clinical outcome. This study aimed to investigate the relationship between LD placement and MDA level after aSAH. Patients with modified Fisher's grade III and IV aSAH who underwent early aneurysm obliteration were enrolled. Cerebrospinal fluid (CSF) was obtained on day 7 after aSAH in non-LD group. In LD group, the LD was inserted on day 3 after aSAH for continuous CSF drainage. The levels of intrathecal hemoglobin, total bilirubin, ferritin, and MDA were measured. There were 41 patients in non-LD group (age: 58.7±13.7 years; female: 61.0%) and 48 patients in LD group (age: 58.3±10.4 years; female: 79.2%). There were more favorable outcomes (Glasgow Outcome Scale ≥4) at 3 months after aSAH in LD group (p=0.0042). The intrathecal hemoglobin, total bilirubin, ferritin, and MDA levels at day 7 after aSAH were all significantly lower in LD group. An older age (>60 years) (p=0.0293), higher MDA level in the CSF (p=0.0208), and delayed ischemic neurological deficit (p=0.0451) were independent factors associated with unfavorable outcomes. LD placement was associated with a decreased intrathecal MDA level on day 7 after aSAH (p<0.001). The intrathecal MDA level at day 7 after aSAH can be an effective outcome indicator in modified Fisher's grade III/IV aSAH. Continuous CSF drainage via a LD can decrease the intrathecal MDA level and improve the functional outcome.

Role of Ommaya Reservoir Placement in Hydrocephalus Management following Aneurysmal Subarachnoid Hemorrhage, an Initial Experience

Abstract Introduction Weaning from external ventricular drainage (EVD) of cerebrospinal fluid (CSF) in hydrocephalus induced by aneurismal subarachnoid hemorrhage (SAH) had been proposed either through the rapid, gradual or intermittent approaches. There are no uniform guidelines for it. Given this, we planned to study the comparative outcome between EVD drainage with intermittent clamping versus EDV followed by Ommaya reservoir. Material and Methods The present retrograde observational study was conducted from July 2018 to March 2021 in the department of neurosurgery with 67 patients who developed hydrocephalus following SAH after aneurysm rupture. We divided the patients into two groups. Group 1 had only EVD placed for CSF drainage with intermittent clamping before the placement of the ventriculoperitoneal (VP) shunt, and, in group 2, an Ommaya reservoir was placed after EVD before the shunt. Result There were 38 patients in group 1 and 29 in group 2. They were age-matched, with a mild male predominance in group 1. Shunt dependency was significantly reduced in group 2 patients (p = 0.011), along with reduced length of stay in ICU (p = 0,001) and length of stay in Hospital (p = 0.019). We found improved Glasgow outcome score in group 2 patients (p = 0.006) together with reduced incidence of infarct (p = 0.0095). Conclusion We may infer from the present study that continuous drainage through EVD, initially, in hydrocephalus induced by SAH following aneurysm rupture, increases cerebral perfusion pressure (CPP) and decreases intracranial pressure (ICP) leading to decreased infarct rate and intermittent drainage through Ommaya following EVD reservoir, decreases shunt dependency, reduces ICU and hospital stay, with improved Glasgow outcome score on follow-up, but these findings need to be validated in a prospective randomized control trial.

One-Dimensional Consolidation of Multilayered Soil with Continuous Drainage Boundaries and Under Time-Dependent Loading

One-Dimensional Consolidation of Multilayered Soil with Continuous Drainage Boundaries and Under Time-Dependent Loading

A treatment protocol for chronic post-pneumonectomy empyema associated with bronchopleural fistula: A single-centre retrospective study.

Chronic post-pneumonectomy empyema (CPPE) associated with bronchopleural fistula (BPF) is a potentially fatal complication and remains a surgical challenge. This study aims to propose a treatment protocol for managing this severe disease. From July 2009 to June 2021, 47 CPPE with BPF patients were treated in our department. CT scan with 3D reconstruction was used to detect BPF and to evaluate the location and volume of empyema cavity. Different surgical techniques were used to close BPFs according to they sizes. Multiple pedicled muscle flaps were chosen to fill the empyema cavity, and among them, latissimus dorsi (LD) was the mostly used flap. For cases that regional flaps were not suitable, free flaps were used. Patients were followed-up from 7.9 to 102.8months. Forty-four patients (93.6%) healed after the operation. Closure of BPFs failed in three patients (6.4%), leading to regional infection. These patients were treated by bronchoscopic application of sealants, continuous drainage and antibiotics, and they eventually healed. Total or partial flap loss was not seen in any of the cases. Treatment protocol was proposed based on these results. CT scan with 3D reconstruction is an effective examination to evaluate pleural cavity defect and BPF. Proper technique to close the BPF and right choice of flap to fulfil the empyema cavity are the two most important key points to treat CPPE associated with BPF patients.

Obstetric shock and shock in obstetrics - steady obstetrical syndrome.

Obstetric shock (OS) has been defined as a life-threatening cardiovascular collapse syndrome associated with pregnancy, childbirth and puerperium (obstetrics causes), and is the most significant cause of high maternal mortality (MM) throughout human history. Shock in obstetrics (SIO) refers to indirect causes of non-obstetrics causes in pregnancy, childbirth and puerperium (polytrauma, aesthetic incidents, cardiovascular or cerebrovascular incidents, other septic syndromes). The goals of OS treatment are: to quickly detect the location or cause of bleeding / injury / inflammation, prevent the progression of shock, prevent massive transfusions, preserve the uterus (and adnexa), and preserve fertility if possible. Surgical treatment of septic shock includes exploratory laparotomy (laparoscopy), ectomy or resection of the necrotized organ, abdominal lavage with multiple drainages, continuous peritoneal drainage with lavation, extensive triple antibiosis per admission or per antibiogram and thromboprophylaxis. OS seems to remain a permanent miasma in practical clinical obstetrics, which we will not be able to influence, because we have obviously caused today's increase in MM from haemorrhagic OS by iatrogenic increase in the number of caesarean sections, especially elective ones.

Incidence and management of surgical site infection in the cervical spine following a transoral approach.

Transoral approach can accomplish ventral decompression directly. However, surgical site infection (SSI) cannot be ignored. This paper aims to review the prevalence of infection and conduct advice for the treatment of SSI in the cervical spine following the transoral approach. A retrospective analysis of patients with SSI after transoral atlantoaxial reduction plate (TARP) surgery was performed. SSI was classified into three kinds according to the modified American CDC criteria. 2.9% (17/581) patients who underwent TARP surgery, experienced SSI, of which five had superficial SSI (SI), eight had deep SSI (DI), and four had organ/space SSI (O/SI). The patients with SI underwent intravenous antibiotic treatment and were ultimately cured. Among the remaining 12 patients with DI and O/SI, 11 underwent reoperation for TARP system removal and subsequently one-stage posterior occipitocervical fixation, and one patient experienced infection twomonths post-operatively and died without receiving treatment. Among patients who underwent revision surgery, three experienced intracranial infection due to intra-operative dural tears, and continuous lumbar cerebrospinal fluid drainage and intrathecal injection of antibiotics were used as effective and appropriate treatments, with outcomes of one recovery and two deaths. All patients with SSI were begun on intravenous antibiotics with conversion to oral antibiotics. The incidence of SSI was 2.9% (17/581). Adequate peri-operative preparation, early diagnosis, and appropriate treatment of SSI require further research.

Physics-informed neural networks for consolidation of soils

PurposePrediction of excess pore water pressure and estimation of soil parameters are the two key interests for consolidation problems, which can be mathematically quantified by a set of partial differential equations (PDEs). Generally, there are challenges in solving these two issues using traditional numerical algorithms, while the conventional data-driven methods require massive data sets for training and exhibit negative generalization potential. This paper aims to employ the physics-informed neural networks (PINNs) for solving both the forward and inverse problems.Design/methodology/approachA typical consolidation problem with continuous drainage boundary conditions is firstly considered. The PINNs, analytical, and finite difference method (FDM) solutions are compared for the forward problem, and the estimation of the interface parameters involved in the problem is discussed for the inverse problem. Furthermore, the authors also explore the effects of hyperparameters and noisy data on the performance of forward and inverse problems, respectively. Finally, the PINNs method is applied to the more complex consolidation problems.FindingsThe overall results indicate the excellent performance of the PINNs method in solving consolidation problems with various drainage conditions. The PINNs can provide new ideas with a broad application prospect to solve PDEs in the field of geotechnical engineering, and also exhibit a certain degree of noise resistance for estimating the soil parameters.Originality/valueThis study presents the potential application of PINNs for the consolidation of soils. Such a machine learning algorithm helps to obtain remarkably accurate solutions and reliable parameter estimations with fewer and average-quality data, which is beneficial in engineering practice.

Application of Transurethral Prostate Resection Instrumentation for Treating Low Rectal Anastomotic Leakage: A Pilot Study.

PurposeTo determine an accurate method of inspecting low anastomotic leakages and application of transurethral prostate resection instrumentation for treating low rectal anastomotic leakage.Patients and MethodsClinical data of eight patients treated for anastomotic leakage after rectal cancer surgery at Zhangye People’s Hospital (affiliated to Hexi University), from August 2019 to November 2021, were retrospectively analyzed. Transanal prostate resection instrumentation was used to assess the leakage and surrounding conditions. Using prostate resection instrumentation, the presacral and perirectal residual cavities were washed and removed, and indwelling suprapubic presacral, transanal presacral, and rectal drainage tubes were placed. Continuous presacral saline irrigation and drainage and open negative-pressure suction in the rectal cavity were performed until the patients’ fistula healed.ResultsOf the eight patients with anastomotic leakages, one had grade B and seven had grade C International Study Group of Rectal Cancer anastomotic leakage classifications following Dixon operation. Transanal prostate resection instrumentation showed that the leakage of the one patient with grade B was less than a third of the circumference of the anastomosis. Among the seven patients with grade C, one leakage was less than a third of the anastomotic circumference. One patient had complete separation of the anastomosis and one distal colon necrosis, which necessitated immediate descending colostomy. Conservative treatment was successful in six patients; the conservative overall cure rate was 75%, and the median healing time was 43 (21–68) days.ConclusionTransanal examination of rectal anastomotic leakage using prostate resection instrumentation is comprehensive, easy to perform, provides clear visualization, accurately guides catheter placement, and can be combined with continuous open negative-pressure drainage, which is a safe, convenient, and effective method for treating low rectal leakage.

Study on the Effect of Salinity and Water Content on CBM Adsorption/Desorption Characteristics of Coal Reservoir in Baode Block

The adsorption/desorption characteristics of a coal reservoir play an important role in coalbed methane (CBM) development. The proximate analysis, maceral analysis and methane isothermal adsorption/desorption experiment are carried out based on coal samples from no. 4+5 coal seam in Baode block. Combing with coal experimental data and the CBM well-produced water salinity data in the Baode block, the effect of salinity and water content on CBM adsorption/desorption characteristics of the coal reservoir and its influencing mechanism is discussed. The results show that the CBM adsorption and desorption capacity decreases with the increase of water salinity and the decrease value shows a decreasing trend. The increase of water salinity reduces the solubility of methane in coal seam water and then reduces the adsorption capacity of methane. With the increase of water content, the adsorption and desorption capacities of CBM decrease gradually. The CBM adsorption and desorption capacities decrease with the increase of water content in coal samples. The adsorption/desorption capacities of coal samples change rapidly in the low-water content stage and slowly in the high-water content stage. The competitive adsorption effect and water blocking effect between water and methane molecules are the main influencing mechanisms of water content on CBM adsorption/desorption. It can be seen that the salinity and water content will have a certain adverse impact on the adsorption and desorption capacity of CBM in the Baode block. The influence of the difference in water content and salinity in the coal seam cannot be ignored in reserve evaluation and productivity prediction of CBM. The continuous, stable, and effective drainage is one of the key factors to ensure the efficient development of CBM wells in the Baode block.

A numerical investigation into Metallic-Melt continuous drainage in the core support plate region of a BWR for the initial phase of core melt progression

Under a typical uncovered core scenario in a Boiling Water Reactor (BWR), it is not clear that a large core molten pool will result as occurred in the Three Mile Island, Unit 2 (TMI-2) accident. Sandia National Laboratories (SNL) has propounded the alternative “Continuous Drainage” melt progression for the scenario, where molten material drains from the core region without the formation of any stable crusts or blockages. Hence the present simulation study was conducted to investigate the behavior of the metallic-melt continuous drainage and the drainage pathways during the initial phase of core melt progression in a BWR under an uncovered core condition like that encountered in the Fukushima Daiichi Nuclear Power Plants (NPPs) accident experienced by Tokyo Electric Power Company Holdings (TEPCO). Researchers around the world have conducted numerous sophisticated and comprehensive studies using simulation codes and experiments to investigate the Fukushima accident. Melt drainage with deforming components is subject to many uncertainties in a core support plate region possessing rather complicated geometries. Additionally, there is very limited experimental and numerical simulation knowledge on melt drainage in such a region. Thus, in recent years, Japan Atomic Energy Agency (JAEA) has experimented on melt drainage using a simplified apparatus to reproduce the behavior. The present paper provides simulation results on melt drainage in the core support region using SAGITTARIUS, an in-house three-dimensional simulation code capable of consistently simulating melt drainage with crust formation, local blockage, and structural damage. The in-vessel simulation target with a prototypic BWR-composition and -geometry is composed of four fuel assemblies (4 × 4 fuel rods per assembly), an absorber blade, a support piece, a core support plate, an Instrument Guide Tube (IGT), and a Control Rod Guide Tube (CRGT) with a Control Rod Drive Housing (CRDH). We estimated the drainage speed for the JAEA experiment to validate the SAGITTARIUS function. The drainage speed was evaluated to be 3.1 m/s, a speed corresponding to that observed in the core support plate region. We also used SAGITTARIUS to simulate the behavior of the metallic-melt drainage and temperature rise of the structure. The results from SAGITTARIUS on the trend and values of the temperature rise agreed with the measured values. On the basis of this finding, we conducted numerical investigations on the metallic-melt drainage of B4C-Stainless Steel (SS) eutectic from the absorber blade and Zry-melt from the fuel rods. The simulation demonstrated the capacity to describe the following features: (i) visual demonstration of metallic-melt drainage from the absorber blade and fuel rods, (ii) aggressive Zry-melt attack to the inlet orifice, (iii) crust formation with local blockage in the narrow drainage paths, and (iv) sedimentation of solidified melt on the bottom faces. These findings were consistent with the concept of the “Continuous Drainage” proposed at SNL and we supported the SNL scenario by the numerical investigation. These investigations probably provide useful knowledge during the discharge of damaged fuels or crust in the Fukushima-Reactor Pressure Vessels (RPVs).

Timing of Urinary Catheter Removal Following Kidney Transplantation: A Retrospective Study

Kidney transplant outcomes have improved over recent decades because of medical and surgical advances.1 Bladder catheterization has remained constant.2-6 Foley catheter use facilitates bladder identification by retrograde saline infusion into the bladder before anastomosis. After transplantation, the Foley catheter prevents tension on the new anastomosis by continuous drainage of urine and is typically maintained in place for 4-10 days to prevent urinary complications.2,5 However, the optimal Foley duration to minimize urinary complications is unknown.

Lethal hemorrhagic necrotizing pancreatitis in a child with congenital immunodeficiency and COVID-19

PurposeVarious manifestations of coronavirus (SARS-CoV-2) have been reported since the pandemic began. Some articles have reported acute pancreatitis in adult patients due to COVID-19 infection. To our knowledge this is the first report of acute hemorrhagic necrotizing pancreatitis in children associated with SARS-CoV-2 infection.Case presentationA 7-year-old girl with congenital immunodeficiency was referred to the intensive care (ICU) unit with acute respiratory distress syndrome. She required mechanical ventilation (MV) due to pulmonary involvement of COVID-19 (chest CT with lower lung ground-glass opacities). SARS-CoV-2 infection was laboratory confirmed. Following a 49-day stay in the ICU, due to the clinical and radiological signs of acute abdomen and to the rapid deterioration in the clinical status, an indication to proceed an urgent surgerical intervention was made. Intra-operatively an adhesiolysis with blunt dissection of the of gastrocolic ligament was performed, then followed by debridement of the necrotic pancreas (more than 1⁄2 of the pancreas was damaged). Continuous lavage and drainage were placed. During the post-operative period, patient required aggressive MV and insulin therapy for persistent hyperglycemia. The CT scans reported a necrosis of the pancreas and we observed amylase and lipase elevation in the peritoneal lavage sample. Despite active intensive therapy, the patient's condition did not improve and she died 38 days after laparotomy as a result of multi-organ failure.ConclusionThe mechanism for the development of acute haemorrhagic necrotizing pancreatitis in the COVID-19 positive patients is unclear; perhaps it is due to a direct cytopathic effect from the COVID-19 virus, or due to the ACE2 expression in pancreas.

Contemporary management of pelvic fracture urethral injuries

Posterior urethral injuries in men usually result from polytrauma with pelvic fractures and severe associated injuries. If left untreated, posterior urethral injury can lead to severe complications and even death, so precise diagnosis should be made when urethral injury is suspected. The cardinal symptom of urethral injury is blood leakage from the meatus. Retrograde urethrography is the diagnostic tool of choice. In the case of complete urethral avulsion, the formation of aurethral stricture due to pronounced scarring fibrosis is inevitable. In principle, various therapeutic approaches are available. Often, urinary diversion by means of atransurethral or suprapubic catheter is performed first. However, there is also the possibility of direct endoscopic or open urethral realignment with subsequent temporary catheterization. Immediate surgical reconstruction is useful only in exceptional cases of simultaneous bladder neck or rectal injury. In cases of complete urethral avulsion, secondary transperineal bulboprostatic reanastomosis at the interval after three months of suprapubic continuous drainage with excellent success rate is the gold standard and can be supplemented with ancillary maneuvers if necessary to ensure atension-free anastomosis.