Early Surgical Management Research Articles

Solid ovarian tumor: A diagnostic and management dilemma

Abstract Pure Sertoli cell tumors (SCTs) are an uncommon type of ovarian sex cord–stromal tumor. The variety of symptoms, solid in nature and different histopathological presentation make it difficult the proper diagnosis and optimal treatment regimens in such tumor. Due to nonspecific clinical appearance, diagnosis is mistaken by ultrasound as fibroid or uterine mass. Intraoperative surprises and suspicious for malignancy due to the solid nature of the tumor lead to surgical management dilemma. The diagnosis is confirmed by histopathological examination only. The prognosis is excellent as most are detected in the early stages and surgical management is often curative in most cases. In this case, a 22 year old unmarried female presented to us with irregular periods for 5 years. Her trans-abdominal ultrasound revealed a solid hypoechoic mass of 5 x 6 centimeter size, in close approximate to the uterus on the right side, with probable diagnosis of broad ligament fibroid. On operative laparoscopy, uterus and left ovary was normal, the mass was originated from the right ovary, which was removed and its histopathological and immunohistochemistry report shows elevated alpha inhibin and steroidogenic factor 1 (SF 1) (Sex cord stromal marker) which is suggestive pure Sertoli cell tumor. There was no family/personal history of malignancy. She was treated with surgical resection and remains clear of disease. Prognostic indicators for SCTs include degree and type of heterologous element differentiation. Thorough characterization of such elements is crucial for adequate diagnosis and treatment.

Necrotizing Fasciitis Due to Group A Streptococcus: A Case of a Deteriorating Biphasic-like Clinical Course Over Five Days with a Devastating Outcome.

Necrotizing fasciitis (NF) is a life-threatening disease with high mortality and rapidly progressive clinical manifestations1. Early detection and surgical management coupled with antibiotic treatment are crucial for the survival, and the patient survival is heavily dependent on clinical decisions2,3. However, it is not widely known that NF does not always follow a typical clinical course, and there have been no case reports of NF following an atypical clinical course. Although the course of the disease depends on the individual patient, it remains a challenge for physicians to determine the precise timing when patients are most likely to survive multiple surgical interventions. We encountered a challenging case presenting with an atypical clinical course. We herein report a 31-year-old man who followed a deteriorating biphasic-like clinical course and presented with extensive NF and streptococcal toxic shock syndrome due to Group A Streptococcus. This case serves to inform physicians of the existence of NF with an atypical and deteriorating biphasic-like clinical course, emphasizing the need for a careful evaluation of the patient condition.

Early surgical Management of pancreatic ascites in chronic pancreatitis-Single centre experience

Early surgical Management of pancreatic ascites in chronic pancreatitis-Single centre experience

Type IV Flexor Digitorum Profundus Avulsion: A Case Report

The avulsion of the flexor digitorum profundus, also known as the jersey finger, is a well-known injury that can be treated surgically. It has been classified into four types, among them type IV which involves tendon avulsion from an associated bony fragment with subsequent retraction to the palm or proximal interphalangeal joint is very rare. We present a case of type IV injury in a 45-year-old man with a pulling-on injury. The repair followed a pull-out technique (reinserting the tendon into the avulsed fragment); the entire reduction was tied over a button on the dorsal aspect of the nail and was augmented with a volar plate. The case was reported due to its rarity. We found that early surgical management of this problem greatly facilitates optimum surgical results and that early rehabilitation is essential for good long-term results.

Open Medial Meniscotibial Ligament Repair With Concomitant Open Superficial Medial Collateral Ligament Repair With Internal Brace Augmentation

The medial collateral ligament (MCL) is the most commonly injured ligament in the knee. Historically, nonsurgical management for these injuries has been favored for a majority of grade I-III sprains, particularly femoral-based. However, when coupled with other injuries such as meniscotibial ligament tears or distal Stener type avulsion tears, early surgical management for these cases is recommended. This will allow for stabilization and protection of the meniscus in addition to preventing residual valgus laxity, especially related to more severe Stener-like avulsions of the superficial MCL that can be seen with meniscotibial ligament tears. Utilizing an open approach, meniscotibial repair with suture anchors with internal brace augmentation for the MCL repair can provide a strong final construct, and a safe and fast recovery.

Early Surgical Management of Medial Patellar Luxation in Juvenile Dogs.

The aim of this study was to analyse a series of five cases of early surgical treatment in juvenile canine patients with high-grade medial patellar luxation. Canine patients, with immature skeleton, affected by grade III or IV medial patellar luxation and treated by multimodal surgical techniques were selected. Five dogs of different breeds, mean age 7.2 ± 3.0 months, met the inclusion criteria. Simultaneous distal femoral varus and external tibial torsion were identified in three of the five cases, whereas in the others, femoral varus with associated tibial valgus and isolated external tibial torsion were observed. Four of the five patients were treated surgically with closing wedge osteotomy of the distal femur, and three of them underwent tibial tuberosity transposition simultaneously. Only two animals required trochleoplasty. Mean time to beginning of weight bearing was 9.8 ± 5.5 days, whereas time to bone healing was 55 ± 24 days. Bone realignment of the extensor apparatus and return to limb support were achieved in all cases. Postoperative reintervention was needed in one patient; however, it was not linked to the initial surgery. Patients were followed up to 1 year postoperatively, with maintenance of extensor alignment and no late complications. The early surgical approach has been shown to be effective in the definitive treatment of juvenile dogs affected by high-grade medial patellar luxation.

Utilizing nanotechnology and advanced machine learning for early detection of gastric cancer surgery

Nanotechnology has emerged as a promising frontier in revolutionizing the early diagnosis and surgical management of gastric cancers. The primary factors influencing curative efficacy in GIC patients are drug inefficacy and high surgical and pharmacological therapy recurrence rates. Due to its unique optical features, good biocompatibility, surface effects, and small size effects, nanotechnology is a developing and advanced area of study for detecting and treating cancer. Considering the limitations of GIC MRI and endoscopy and the complexity of gastric surgery, the early diagnosis and prompt treatment of gastric illnesses by nanotechnology has been a promising development. Nanoparticles directly target tumor cells, allowing their detection and removal. It also can be engineered to carry specific payloads, such as drugs or contrast agents, and enhance the efficacy and precision of cancer treatment. In this research, the boosting technique of machine learning was utilized to capture nonlinear interactions between a large number of input variables and outputs by using XGBoost and RNN-CNN as a classification method. The research sample included 350 patients, comprising 200 males and 150 females. The patients' mean ± SD was 50.34 ± 13.04 with a mean age of 50.34 ± 13.04. High-risk behaviors (P = 0.070), age at diagnosis (P = 0.034), distant metastasis (P = 0.004), and tumor stage (P = 0.014) were shown to have a statistically significant link with GC patient survival. AUC was 93.54%, Accuracy 93.54%, F1-score 93.57%, Precision 93.65%, and Recall 93.87% when analyzing stomach pictures. Integrating nanotechnology with advanced machine learning techniques holds promise for improving the diagnosis and treatment of gastric cancer, providing new avenues for precision medicine and better patient outcomes.

Chicken bone-induced ileal perforation peritonitis mimicking duodenal perforation peritonitis: a case report

Introduction: Foreign body ingestion can lead to bowel perforation and peritonitis. We present a case of a 54-year-old male who ingested a chicken bone, resulting in ileal perforation that mimicked duodenal perforation peritonitis. Case Presentation: The patient has a history of peptic ulcer disease and regularly used non-steroidal anti-inflammatory drugs over the counter, adding more evidence to the provisional diagnosis of duodenal perforation. Exploratory laparotomy revealed the ileal perforation and the chicken bone was successfully removed. Wedge resection of the perforated segment and ileo-ileal anastomosis were performed. Discussion: Although history, examination, and investigation were more in favor of duodenal ulcer, our patient had ileal perforation due to chicken bone. Prompt identification and early surgical intervention are crucial to prevent complications and reduce mortality rates. The patient had an uneventful recovery. Conclusion: Timely referral to a tertiary care center is essential for early surgical intervention and successful management of bowel perforation caused by a foreign body.

Cutaneous Squamous Cell Carcinoma: A 7-year Review

Introduction: Cutaneous squamous cell carcinoma (SCC) is rare in sub-Saharan Africa. In Senegal, its prevalence was estimated at 0.09% in 2004. It occurs most frequently in pre-neoplastic acquired or genetic dermatoses. The aims of this study were to describe the epidemiological, clinical and therapeutic aspects of SCC, and to identify associated risk factors. Methodology: This was a descriptive cross-sectional study in the Oncology Department at the Joliot Curie Institute of the Aristide Le Dantec Hospital over a 7-year period (January 2015 to December 2021). We included all patients hospitalized and followed up for SCC. The diagnosis was confirmed by histopathology. Data entry and analysis were performed using epi-info software version 7.2.5.0 and Excel 365. Results: We recorded 189 cases of SCC, representing an incidence of 24 cases per year and a hospital frequency of 0.77%. The mean age was 51 and the sex ratio 1.28. The ulcero-budding form was predominant in 67.2% of cases. The majority of lesions were located on the lower limbs (30.6%) and 28.4% on the cephalic extremity. Squamous cell carcinoma was well-differentiated in 49.2%. Metastases were present in 40.2%. Pre-neoplastic dermatoses were noted in 28.6%. These were burn scars in 43%, chronic ulcer in 23.39%, discoid lupus in 2%, Buschke Lowenstein tumor in 4%. Geno dermatoses included albinism in 6 cases and xeroderma pigmentosum in one. Voluntary use of depigmenting cosmetics was noted in 11 cases. Patients underwent surgery in 32.3%, radiotherapy in 8.5% and chemotherapy in 32.8%. Favorable progression was in 20.6%. Recurrence was noted in 2 cases, metastasis in 3 and death in 5. Conclusion: Squamous cell carcinoma remains a serious tumor in Africa. There is a delay in diagnosis, with some tumors being very advanced. Early surgical management is the main factor in curing the cancer.

Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome–A “no-touch-approach”: A case report

<b>Introduction:</b> Herlyn-Werner-Wunderlich (HWW)/obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare Müllerian duct anomaly (MDA). Usually presenting after menarche classically with dysmenorrhea. Here we present a challenging case, where the diagnosis was missed initially.<br /> <b>Case presentation:</b> A 10-year-old girl presenting with dysmenorrhea and constipation, treated repeatedly with analgesics, laxatives and enema. A pelvic ultrasound and magnetic resonance imaging (MRI) confirmed the diagnosis of OHVIRA syndrome, which requires surgical intervention. We describe a “no -touch- technique” for resecting the septum. The patient had immediate relief of symptoms and a smooth post-operative recovery.<br /> <b>Conclusions:</b> Early diagnosis and surgical management are crucial not only to relieve symptoms but to prevent long term complications that may affect the patients’ reproductive potential. Despite pelvic ultrasound being an affordable and a useful diagnostic tool, the diagnosis can be missed by inexperienced operators. Therefore, MRI is recommended to confirm and classify MDAs. The hysteroscopic “no-touch-technique” to resect the septum is an effective, safe and a convenient approach to treat the condition while preserving hymen integrity.

The Use of Dorsal Bridge Plate Fixation in the Operative Management of Lisfranc Injuries – A Retrospective Cohort Study at Medium Term Follow-Up

IntroductionTraditionally, early surgical management of Lisfranc injuries with transarticular screws (TAS) was deemed to be the optimal treatment. However, concerns of potential iatrogenic articular cartilage disruption has led to discrepancies in opinion amongst surgeons, with many surgeons now utilizing dorsal bridge plates (DBP) for ORIF of Lisfranc injuries. ObjectivesThis study sought to investigate the clinical outcomes at medium-term follow-up of consecutive patients in our institution who underwent ORIF with DBP for Lisfranc injuries. MethodsAll consecutive patients who underwent ORIF with DBPs for Lisfranc injuries were identified. Outcomes of interest included; visual analogue scale (VAS), functional foot index (FFI), American Orthopaedic Foot & Ankle Surgeons (AOFAS) hindfoot scores, and complications. ResultsOverall, 37 consecutive patients (24 males) with a mean age of 34.8 ± 13.0 years underwent ORIF with DBPs for lisfranc injuries. After a mean 48.3 ± 28.7 months, the mean reported AOFAS and FFI scores were 77.4 ± 23.8 and 31.9 ± 32.7 respectively, with satisfactory reported pain scores as measured by VAS post-operatively at rest and whilst walking (2.2 ± 2.5 and 3.1 ± 2.6 respectively). The reported satisfaction rate was 86.5% (32/37). Overall, 25 patients (67.6%) had subsequent removal of metal or were listed for same, 88% (22/25) of whom did so electively in the absence of broken screws or infection. ConclusionThis study found that the use of Dorsal Bridge Plates for Open Reduction and Internal Fixation of Lisfranc Injuries resulted in satisfactory functional outcomes, high rates of patient-reported satisfaction and a low complication rate at medium-term follow-up. Level of EvidenceLevel IV; Retrospective Series of Consecutive Patients

Penetrating Neck Injury—Early Surgical Airway Management: A Case Report

Penetrating Neck Injury—Early Surgical Airway Management: A Case Report

Test Characteristics of Emergency Medicine-Performed Point-of-Care Ultrasound for the Diagnosis of Acute Cholecystitis: A Systematic Review and Meta-analysis

Acute cholecystitis accounts for up to 9% of hospital admissions for acute abdominal pain, and best practice entails early surgical management. Ultrasound is the standard modality used to confirm diagnosis. Our objective was to perform a systematic review and meta-analysis to determine the diagnostic accuracy of emergency physician-performed point-of-care ultrasound for the diagnosis of acute cholecystitis when compared with a reference standard of final diagnosis (informed by available surgical pathology, discharge diagnosis, and radiology-performed ultrasound). We completed a systematic review and meta-analysis, registered in PROSPERO, in adherence to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched 7 databases as well as gray literature in the form of select conference abstracts from inception to February 8, 2023. Two independent reviewers completed study selection, data extraction, and risk of bias (QUADAS-2) assessment. Disagreements were resolved by consensus with a third reviewer. Data were extracted from eligible studies to create 2× 2 tables for diagnostic accuracy meta-analysis. Hierarchical Summary Receiver Operating Characteristic models were constructed. Of 1855 titles/abstracts, 40 were selected for full-text review. Ten studies (n=2356) were included. Emergency physician-performed point-of-care ultrasound with final diagnosis as the reference standard (7 studies, n=1,772) had a pooled sensitivity of 70.9% (95% confidence interval [CI] 62.3 to 78.2), specificity of 94.4% (95% CI 88.2 to 97.5), positive likelihood ratio of 12.7 (5.8 to 27.5), and negative likelihood ratio of 0.31 (0.23 to 0.41) for the diagnosis of acute cholecystitis. Emergency physician-performed point-of-care ultrasound has high specificity and moderate sensitivity for the diagnosis of acute cholecystitis in patients with clinical suspicion. This review supports the use of emergency physician-performed point-of-care ultrasound to rule in a diagnosis of acute cholecystitis in the emergency department, which may help expedite definitive management.

SAT215 Sagliker Syndrome In A Filipino Female With End Stage Renal Disease

Abstract Disclosure: M.R. Pajanel: None. E. Clarito: None. K. Uytiepo: None. P. De La Peña: None. This is a case of a 29-year-old Filipina, with chronic kidney disease secondary to chronic glomerulonephritis, undergoing hemodialysis for 10 years. She presented with maxillary mass, associated with other craniofacial deformities such as mandibular enlargement and widening of teeth spaces. Other associated symptoms include difficulty in swallowing solid food, difficulty in ambulation due to bone pains, and with noted shortening of stature. Workup revealed elevated intact parathyroid hormone (iPTH) 1638.8pg/mL(20x ULN), low Vitamin D, elevated ALP, but with normal levels of calcium and phosphorus. Sestamibi scan showed focal uptake and retention along medial aspect of the right thyroid bed and inferior to both thyroid beds suggestive of parathyroid adenoma or hyperplasia. Parathyroid ultrasound was consistent with findings of Sestamibi scan which also showed parathyroid nodules in the middle segment right thyroid lobe, and inferior to right thyroid lobe. Bone mineral density is below the expected range for age. Right parathyroidectomy was done and she was discharged well. She came in for follow-up with persistent elevated PTH 4765pg/ml(60x ULN), still with symptoms. Repeat imaging on ultrasound showed a parathyroid nodule posterior to the superior aspect of left thyroid 0.9 x0.5cm. Sestamibi scan confirmed a functioning parathyroid adenoma left inferior and superior thyroid bed. Left parathyroidectomy was done with a histopathologic result of left superior parathyroid consistent with parathyroid hyperplasia. On follow up, repeat intact PTH still elevated at 3677pg/mL and persistently elevated 2 months after at 3626pg/mL. Parathyroid ultrasound showed Parathyroid nodule, left, measuring 1.5x1.7x0.9 cm, inferior and posterior to the inferior border of the left thyroid gland. 99mTc-Sestamibi scan was consistent with the ultrasound in the left thyroid lobe suggestive of parathyroid adenomas or hyperplasia. Completion Parathyroidectomy was done on November 2018. Pre-operative iPTH was 4205pg/mL, which decreased to 291.3pg/mL postoperatively. She was discharged improved. On followup in 2022, she reports of decrease bone pain and now able to ambulate without difficulty. Repeat bone mineral density has improved and now within expected range for age. CONCLUSION: Sagliker syndrome is an entity described as an “uglyfying face syndrome” seen in patients with chronic kidney disease, presenting with facial deformities. Patients usually present with elevated parathyroid hormone (PTH) levels, and has been refractory to medical therapy. Surgical treatment has been the course of approach to prevent further clinical decline of patients. Identification of the syndrome is important for clinicians to know when to maximize medical management, and to identify patients who will benefit with early surgical management. The patient’s quality of life improved even 4 years post-surgery. Presentation: Saturday, June 17, 2023

Direct to Surgery? Surgical Outcomes in Pediatric Patients With Facial Infantile Hemangioma: A Retrospective Case-Control Study

Background: The effects of medical pre-treatment prior to surgical excision of infantile hemangiomas (IH) remains understudied. We hypothesized that medical pretreatment may improve outcomes after surgical excision. This study aimed to evaluate the difference in surgical outcomes/complications between direct to surgery (NPT) versus medical pre-treatment prior to surgery (PT). Methods: A retrospective study was conducted at a pediatric tertiary center between 2007 and 2018. Children 0 and 18 years who underwent surgical resection (confirmed GLUT-1 positive IH) were included. Visceral and congenital hemangiomas, PHACE, and vascular malformations/neoplasms were excluded. Pre-treatment was the primary predictor for post-surgical complications. Literature meta-analysis was also performed. Results: Our institution identified 185 IH patients, 85 (46%) underwent surgical resection. Of these, n = 28, (32.9%) had pre-treatment (PT) (8.24% propranolol, 9.41% topical timolol, 12.94% steroids, 2.35% laser); n = 57, (67.1%) had no pre-treatment (NPT). Pre-surgical lesion size was comparable ( P = .829). Surgical outcomes between PT and NPT were comparable for wound dehiscence, infection, scarring, and repeat surgery ( P = .162, 1.0, 1.0, 0.483), including pooled complications ( P = .448). Where documented, PT had higher functional improvement ( P = .039). Results were comparable when selecting for beta-blockers versus NPT. Meta-analysis included 7 studies and 169 patients, 39.1% PT and 68.1% NPT. The most common PT was systemic/intralesional steroids. Five received beta-blockers. All patients had functional improvement where recorded. Complications were slightly higher for PT ( P = .041). Conclusion: The incidence of surgical complications is comparable between direct to surgery and medical pre-treatment patients. Early surgical management without pre-treatment was not associated with improved complications/outcomes except select subgroup analysis identified improved functional outcomes with pre-treatment. Future directions include defining appropriate candidates for early direct to surgery versus best candidates for medical pre-treatment using patient specific variables.

Our Experience in Managing Carotid Body Tumors in Tertiary Care Center

Abstract Introduction: Carotid body tumors (CBTs), also known as paragangliomas or chemodectomas, are rare neuroendocrine neoplasms that arise near the carotid bifurcation within glomus cells derived from the embryonic neural crest. The reported incidence of CBTs is 1–2 cases per 1 lakh cases. Surgery is the mainstay of treatment. Objectives: The objective of this study was to report our experience and describe the presentation, surgical approach, postoperative complications, and outcomes of surgical treatment. Materials and Methods: It is a single-institution experience where a retrospective analysis of 6 cases with CBTs of patients who were candidates for surgery from June 2018 to June 2021 with a mean follow-up period of 24 months was done. Results: The mean age was 37 years, with a female predominance of 66%. The mean size of the tumor was 4.4 ± 1 cm. Four (66%) cases were presented with pain and pulsating neck swelling, and 2 (33%) cases were incidentally detected. All the cases were unilateral tumors. Neck ultrasound was done in all cases as a primary investigation. Magnetic resonance imaging was performed in 5 (87.5%) cases, which revealed tumors having near circumferentially encasing the internal carotid artery (ICA). No cases were malignant. All cases were surgically approached through transcervical vertical incision. Four cases (66%) and 2 (33%) cases were classified as Shamblin’s type II and III, respectively. Two (33%) cases needed special maneuvers such as division of the posterior belly of digastric and nasal intubation for the extra length of ICA. No major complications occurred. One patient (16.6%), as the tumor could not be dissected from the adventitia of ICA so, had to resect it, and primary end-to-end anastomosis was done. External carotid artery ligation was performed in 1 (16.6%) case. Minor postoperative complications such as hoarseness of voice occurred in 2 (33%) patients. No operative mortality occurred. Conclusion: We found a predominance of women and pain as the most common presenting complaint. Resection of CBTs by surgeons with experience in vascular reconstruction is recommended. Early surgical management is recommended to avoid neurological deficit or vascular reconstruction due to a Shamblin’s class III tumor. Preferred approach was caudo–cranial during dissection. Cranial nerve injury continues to be the most common complication.

Long-term clinical outcomes after initial secondary pneumothorax surgery.

Given the heterogeneity of underlying lung disease and the higher morbidity and mortality associated with surgery for secondary pneumothorax (SP), treatment standardization and evidence-based early surgical management are challenging pursuits. Our aim was to document the clinical course of SP after initial surgical intervention and analyse related recurrence risk. We conducted a retrospective review of 160 patients, each with SP, using clinical records housed in an institutional database. Clinical, imaging, and operative data were retrieved, and Cox proportional hazards (PH) analysis was undertaken to identify risk factors for recurrence. During a mean follow-up of 58.7 months, the overall recurrence rate in this cohort was 18.75% (ipsilateral, 14; contralateral, 16). A total of 24 patients had ≥3 ipsilateral episodes <6 months prior to surgery, marked by initial index episodes. In multivariate Cox PH analysis, the strongest risk factor for recurrence was underlying lung pathology other than chronic obstructive pulmonary disease [COPD: hazard ratio (HR) =5.3; P<0.001]. In this setting, underlying lung disease of a non-COPD nature is a proven risk factor for postsurgical recurrence. There is also a tendency in some patients for multiple episodes of pneumothorax within short periods of time, especially in the absence of COPD. Underlying disease processes may thus merit consideration in treatment planning.

EARLY OPERATIVE MANAGEMENT OF COMPLICATED APPENDICITIS IS ASSOCIATED WITH IMPROVED SURGICAL OUTCOMES IN ADULTS: A SYSTEMATIC REVIEW

Introduction: Appendectomy is one of the most common surgeries in the US, with over 300,000 performed annually. In addition, 20% of adults may have complex appendicitis with extensive peritonitis, perforation, abscess, or phlegmon. In severe appendicitis patients, there is no unanimity on whether to operate or when. Statistics contradict each other. Non-operative care and radiologically guided percutaneous drainage have become prominent treatments. The aim: This article demonstrated an association between early surgical management of complicated appendicitis and enhanced surgical outcomes in adults. Methods: By comparing itself to the standards set by the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. So, the experts were able to make sure that the study was as up-to-date as it was possible to be. For this search approach, publications that came out between 2013 and 2023 were taken into account. Several different online reference sources, like Pubmed and SagePub, were used to do this. It was decided not to take into account review pieces, works that had already been published, or works that were only half done. Result: In the PubMed database, the results of our search brought up 68 articles, whereas the results of our search on SagePub brought up 51 articles. The results of the search conducted for the last year of 2013 yielded a total 19 articles for PubMed and 13 articles for SagePub. In the end, we compiled a total of 11 papers, 7 of which came from PubMed and 4 of which came from SagePub. We included three study that met the criteria. Conclusion: The benefits of immediate surgery for patients with complicated appendicitis include a reduction in hospitalization time, subsequent infections, and short-term mortality, according to research.

A complete spectrum of congenital cystic adenomatoid malformation of the lung deceptive clinical presentations and histological surprises; a single institutional study from a tertiary care hospital in North India.

Congenital Cystic Adenomatoid Malformations (CCAM) are rare congenital anomalies of the lungs characterised by bronchopulmonary foregut malformations due to a sudden arrest in the development of the bronchial tree in the first trimester of the gestational period. : The present study was aimed to describe the clinical and histopathological profiles of the patients and study patient outcomes after 1 year of surgical resection. All patients diagnosed with CCAM by histological examination of tissue obtained on surgical resection during the study period were included in the study. Data, such as patient demographics and clinical, radiological and histopathological findings, were recorded, and follow-up information was taken on OPD follow-up till 1 year after surgery regarding respiratory infections, haemoptysis or mortality. : Out of 21 patients, 11 were female and included in the study between the ages of 1 month and 32 years, with >50% younger than 2 years. Most patients in the study had recurrent pneumonia, with difficulty in breathing being the second most common presenting complaint. All patients had undergone computed tomography (CT) of the lungs, which was able to diagnose cystic lesions accurately in >80% of cases. Histologically, all cases were classified based on recent Strocker's classification, and Type 1 was the most commonly observed with 13 cases, followed by Type 2 in five and Type 3 in three patients. There was no evidence of malignant transformation in any of the cases. There was 100% survival at the end of 1 year, with six patients having respiratory infections and none of the patients getting hospitalised over 1 year after surgery. CCAM is a rare congenital anomaly associated with significant morbidity and may present at any age. It can be histologically classified into three subtypes, with Type 1 being the most common. Early surgical management is mandatory to prevent complications such as recurrent infections, respiratory distress, pneumothorax, lung abscess and malignant transformation. All patients included in the study had undergone surgical resection, and there was 100% survival at 1-year follow-up.

Treatment Outcomes With Conservative Management of Frontal Sinus Outflow Tract Fractures.

Historically, early surgical management of frontal sinus outflow tract (FSOT) fractures has been standard practice. There has been a paradigm shift toward nonsurgical or delayed management. Unfortunately, clinical indications and treatment outcomes for this approach are poorly understood. This study evaluates radiologic indicators, as well as sinus reaeration and complication rates for FSOT injuries treated nonsurgically. A retrospective cohort study of FSOT injuries between 2005 and 2019. Academic, tertiary care medical center. Radiographic fracture patterns of the frontal ostia (FO) and frontal recess (FR) were recorded as either patent, disrupted, or obstructed. Sinus reaeration, surgical rescue, and complication rates were documented. Patients with follow-up imaging >42 days were included. Patients undergoing immediate surgical intervention were excluded. One hundred patients were identified and 44 met the criteria (88 sinuses). Among nonobstructed FSOT injuries (ie, patent or disrupted), reaeration occurred in 91% of the FO and 98% of FR injuries. Two sinuses required surgical rescue including 1 Draf IIB (1%), and 1 obliteration (1%). Two sinuses had complications including 1 mucocele (1%) and 1 cerebrospinal fluid leak (1%). FO and FR fracture patterns had no identifiable correlation with long-term reaeration rates or the need for surgical intervention. Among nonobstructive injuries to the FSOT, average reaeration rates in observed patients were high (91%-98%). Rescue surgery (2%) and complication rates (2%) were low, suggesting that nonsurgical management of nonobstructed FSOT is a viable strategy. No radiographic features were clearly identified to be predictive of sinus reaeration.