Emergency Surgical Intervention Research Articles

Catastrophic rupture of an internal carotid aneurysm in a neurofibromatosis type 1 patient: A critical case study

Catastrophic rupture of an internal carotid aneurysm in a neurofibromatosis type 1 patient: A critical case study

Multifocal superficial thrombophlebitis of the extremities in HIV infection

Long-term observations indicate an increased risk of developing venous thromboembolic conditions in people with the human immunodeficiency virus, their tendency to relapse or a widespread nature. In addition, the incidence of thrombosis increases several times in HIV-infected people compared to the average rates characteristic of people of the same age. A clinical case of multiple bilateral lesions of the subcutaneous veins of the upper and lower extremities in a young patient with HIV infection is presented. Ineffective outpatient treatment and ascending superficial thrombophlebitis of the lower extremities required emergency hospitalization and surgical treatment of the patient to prevent thromboembolic complications. In the postoperative period, in order to prevent the progression of the thrombotic process, as well as to relieve the symptoms of an acute inflammatory reaction of the venous wall and paravasal tissues, a complex application of compression therapy, modern oral anticoagulant drugs, phlebotropic drugs with proven efficacy was carried out. The postoperative period proceeded without complications. In the next few days, the patient’s condition improved, there was a clear regression of thrombotic limb damage. Conclusion: In case of multiple thrombotic lesions of the subcutaneous veins of the upper and lower extremities on the background of HIV infection, the combination of timely surgical intervention with systemic anticoagulant therapy and phlebotropic agents of general and topical use has significant effectiveness in the medical rehabilitation of the patient.

AN UNCOMMON CASE OF SUPERIOR VENA CAVA SYNDROME FOLLOWING CARDIAC SURGERY

Abstract Superior vena cava (SVC) syndrome (SVCS) is due to the obstruction of the SVC leading to swelling of the upper body and to low cardiac output. Non tumoral causes, mainly thrombosis of endovascular devices, account for 30% of cases. We report a case of acute iatrogenic SVCS. A 7 years old 16 kg boy underwent mitral valve surgery in severe rheumatic mitral regurgitation. After induction a 15 cm 5.5 Fr 3 lumens central venous catheter (CVC) was inserted in the right internal jugular vein (IJV) under ultrasound guidance without issues. After achieving proper anticoagulation ascending aorta (18 Fr) and bicaval cannulation were performed (20 Fr single stage cannula with right–angled metal tip in the SVC and 26 Fr single stage cannula in the inferior vena cava). Cardiopulmonary bypass (CPB) was performed with pediatric circuit and the mitral valve was repaired. Despite apparently good result of the repair and uneventful weaning from CPB a more accurate transesophageal echo (TEE) showed moderate iatrogenic mitral stenosis. Cannulation was re–performed with same size cannulas and mitral valve replacement (St.Jude 25 mm) was provided. After weaning from CPB with mild cardiovascular support (adrenaline 0.03 mcg/kg/min and noradrenaline 0.05 mcg/kg/min) the TEE showed no abnormalities and the patient was transferred to the ICU in stable conditions. The central venous pressure (CVP) never raised over 10 mmHg. In the ICU the patient developed sinus tachicardia and hypotension, unresponsive to fluids and vasopressors, and swelling of the face with no increase in CVP. The chest Xray showed enlargement of the right upper mediastinum with TEE evidence of accellerated flow in the SVC around the CVC (fig.1). The patient was taken to the operating room and a too tigh pursue string suture was found on the SVC. After optimization of the suture the flow through the SVC was restored with immediate clinical improvement and de–escalation of the cardiovascular support. The face oedema quickly decreased allowing extubation on the day after surgery. The following course was uneventful. SVCS is a life threatening complication of cardiac surgery. A too tight pledgetted pursue–string suture is an uncommon cause compared to clot compression. The CVP measured by a IJV CVC is generally elevated in SVCS, but in our case the tip of the CVC was downstream to the stenosis so showing normal values. Multimodal monitoring is mandatory to lead to emergency surgical treatment in case of need.

Inflammatory myofibroblastic tumor of the stomach. Literature review and case study

We have presented a very interesting theoretical, practical and methodological clinical observation of a rare disease, extremely difficult for clinical and morphological diagnosis. A 35-year-old patient with gastric bleeding underwent emergency surgical treatment for a myofibroblastic tumor of the stomach, morphologically difficult to differentiate from gastrointestinal stromal tumors.

Emergency Surgical Treatment and Triage: Targeting Optimal Outcomes for Emergency Surgical Patients From Index Encounter Through Definitive Care.

Patients with emergency surgical conditions (ESCs) experience higher complication rates than those without emergency conditions. Our purpose was to improve time-based key performance indicators (KPIs) of care for ESC patients, including diagnostic workup, empiric stabilization, and referral to definitive care. A rapid response program (ESTAT) was developed to screen for and coordinate optimal, timely care for a spectrum of high-risk ESCs, from the patient's index clinical encounter up to definitive care. The Mann-Whitney test assessed whether any differences in KPIs were statistically significant (P < .05) before compared to after the implementation of ESTAT. 98 patients were identified: 44 in ESTAT group (70% age ≥55, 57% male); 54 in control group (57% age ≥55, 44% male). There were significant decreases from time of index clinical encounter to resuscitation (5min. vs 34min., P < .001), to diagnostic imaging (52min. vs 1hr. 19min., P = .004), and to definitive care (2hr. 17min. vs 3hr. 51min., P = .007) in the ESTAT group compared to the control group, respectively. Improving time-based KPIs for delivery of clinical services is a common goal of medical emergency response systems (MERS) in numerous specialties. Implementation of an ESTAT program provides a screening tool for at-risk patients and reduces time to stabilize, diagnose and triage to definitive surgical intervention. These time benefits may ultimately translate to reduced complication rates for ESC patients. ESTAT may also represent a patient onboarding mechanism for surgical specialty verification programs promoted by quality improvement committees of various professional societies.

Symptomatic corpus luteum hemorrhage in adolescent females with ITP.

Patients with immune thrombocytopenia (ITP) usually present with minor mucocutaneous bleeding. Corpus luteum hemorrhage (CLH) is generally asymptomatic but may, rarely, lead to severe intraperitoneal bleeding, mostly in patients with coagulation disorders. CLH causing intraperitoneal bleeding has only been described in few individuals with ITP. The objective of this retrospective observational study was to assess the clinical course and incidence of symptomatic CLH in adolescent females with newly diagnosed or chronic ITP. Additionally, a comprehensive literature review was conducted to scrutinize cases of pediatric female patients with ITP, complicated by CLH. We identified three patients with ITP and hemoperitoneum secondary to CLH. They presented with acute abdominal pain, had severe thrombocytopenia (platelet counts below 20 × 109/L), and required blood transfusions as well as ITP-directed therapy. All the patients were hemodynamically stable and did not require emergency surgical intervention. Conclusion: CLH could potentially pose a significant complication in the context of adolescent females with ITP, requiring a strong index of suspicion to direct expedient therapy. What is Known: • Immune thrombocytopenia is typically associated with minor bleeding tendency. • Corpus luteum hemorrhage is generally asymptomatic; however, in women with bleeding disorders, it has the potential to result in substantial intra-abdominal bleeding. What is New: • Corpus luteum hemorrhage leading to intra-abdominal bleeding is a potential severe complication of immune thrombocytopenia in adolescent females.

Papillary fibroelastoma as a cause of myocardial ischemia: clinical case

Papillary fibroelastomas are the most common tumors of the heart valves. Among all primary heart tumors, the incidence of papillary fibroelastoma is about 15 %. The clinical picture is often asymptomatic, however, it can be complicated by a transient ischemic attack, acute cerebrovascular accident, acute myocardial infarction, heart failure, pulmonary embolism, and etc. The article presents a clinical case of a 55-year-old female patient with papillary fibroelastoma of the aortic valve, which caused angina attacks and was a probable cause of several myocardial infarctions. Complex radiation diagnostics using aortic computed tomography with ECG synchronization, transthoracic and transesophageal echocardiography made it possible to visualize a formation in the commissure area between the right coronary and non-coronary aortic valve flaps as the cause of the patient’s clinical manifestations. Comprehensive diagnostics made it possible to successfully perform emergency surgical treatment.

The role of an abbreviated ultrasound in the evaluation of necrotizing enterocolitis.

Bowel ultrasound is a useful diagnostic tool in the diagnosis and management of necrotizing enterocolitis (NEC) but can be time-consuming and requires technical expertise, particularly for assessing pneumatosis. Previous literature on sonographic evaluation of NEC has focused on a full bowel ultrasound protocol, but the utility of an abbreviated protocol primarily aimed at identifying high-risk sonographic findings without focused bowel assessment has not been well studied. This study aims to describe the diagnostic accuracy of an abbreviated ultrasound protocol for identifying high-risk NEC findings. This is a retrospective, institutional review board-approved study. We identified all abbreviated NEC ultrasounds performed between January 2014 and August 2022 at our institution. Exams were reviewed for the presence of high-risk findings including pneumoperitoneum, fluid collections, and complex free fluid. Clinical outcome was categorized as poor or good depending on if emergent surgical intervention or death related to NEC occurred. The frequency of follow-up NEC ultrasounds was reviewed to determine if new findings affected outcome. Sensitivity, specificity, and positive and negative predictive values were generated to assess the performance of the abbreviated ultrasounds to identify high-risk findings. A total of 84 abbreviated abdominal ultrasounds were performed on 73 children. Median age at the time of ultrasound was 41 days (interquartile range (IQR) 53 days) and median gestational age was 35 weeks and 3 days (IQR 80 days), and 44/73 (60%) were male. Thirteen ultrasounds had at least one high-risk finding with nine (69%) resulting in a poor outcome, including seven surgical interventions and four deaths. Two patients had surgical intervention and died as a result of necrotizing enterocolitis. Ultrasounds without high-risk findings were not associated with poor clinical outcomes. Sensitivity, specificity, positive predictive value, and negative predictive value of the abbreviated NEC ultrasound were 100% (95% CI 60-100%), 95% (95% CI 86-98%), 69% (95% CI 39-90%), and 100% (95% CI 94-100%), respectively. Twelve abbreviated ultrasounds were followed by a second NEC ultrasound within 5 days. Five follow-up ultrasounds demonstrated new high- or low-risk findings, but the new findings did not correlate with a change in outcome as predicted by the initial ultrasound. An abbreviated NEC ultrasound can be of clinical utility in predicting poor outcomes, particularly during non-business hours when resources are limited.

Pedestrians injuries in the north east region of Jamaica: a cross sectional study

To describe the sociodemographic data of injured pedestrians, temporal patterns of injury, injury patterns, and the independent predictors of hospital admission. A two year cross-sectional study was conducted at the Saint Ann’s Bay Regional Hospital in pedestrians with injuries post collision with a motor vehicle. A census was performed in all patients who received either emergency room treatment, hospital admission, or surgical intervention. A 30-item interviewer questionnaire was administered to collect the data. A logical regression model was used to determine independent predictors for hospital admission. Ninety pedestrians were included. Age range: 6-86 years old (Mean=39.9). Males were 63.3%, 75.6% were employed, 31% had a chronic illness and 27% reported marijuana use. Most injuries occurred in April, lowest injury rates occurred in August and September. Twenty two percent of collisions occurred on Saturdays. Most injuries occurred at 5pm and 3pm. Many (54.4%) had a fracture, 73.5% were closed. Approximately 32% had contusions and 6.7% had lacerations. Independent predictors of admission were history of marijuana use and having a fracture. Those with history of marijuana use were 4.21 times more likely to be admitted. Those with fractures were 7.10 times more likely to be admitted. Injury patterns spanned a wide age range. They often involved a high energy mechanism of injury as evidenced by the frequency of fractures, hospital admission and surgery intervention rates. The data also suggests a need to implement marijuana testing programmes in our road users.

The Substantial Burden of Iatrogenic Vascular Injury on the Vascular Surgery Workforce at an Academic Medical Center

Vascular surgeons are often called upon to provide emergent surgical assistance to other specialties for iatrogenic complications, both intraoperatively and in the inpatient setting. The management of iatrogenic vascular injury remains a critical role of the vascular surgeon, especially in the context of the increasing adoption of percutaneous procedures by other specialties. This study aims to characterize consultation timing, management, and outcomes for iatrogenic vascular injuries. This study identified patients for whom vascular surgery was consulted for iatrogenic vascular complications from February 1, 2022 to May 12, 2023. Patient information, including demographic information, injury details, and details of any operative intervention, were retrospectively collected from February 1, 2022 to October 13, 2022 and prospectively collected for the remainder of the study period. Analyses were performed with R version 2022.02.03. There were 87 patients with consultations related to iatrogenic vascular injury. Of these, 42 (46%) were female and the mean age was 59 years (± 18 years). The most common consulting services were cardiology (32%), cardiothoracic surgery (26%), general surgery (8%) and neuro-interventional radiology (10%). Reasons for consultation included hemorrhage (36%), limb ischemia (36%), and treatment of pseudoaneurysm (23%). 24% of consults were intraoperative, 20% of consults related to ECMO cannulation, and 16% of consults related to ventricular assist devices including LVAD and IABP. The majority of these consult requests occurred during evening and night hours (5 pm - 7 am) (60%) (Figure 1). Emergent intervention was required in 62% of cases and consisted of: primary open surgical repair of arterial injury (54%), endovascular intervention (21%), and open thromboembolectomy (15%). Overall, in-hospital mortality for the patient cohort was 20% and the reintervention rate was 23%, reflecting the underlying complexity of the illness and nature of the vascular injury in this patient group. Vascular surgeons play an essential role in managing emergent life-threatening hemorrhagic and ischemic iatrogenic vascular complications in the hospitalized setting. The complications require immediate bedside or intraoperative consult and often emergent open surgical or endovascular intervention. Furthermore, many of these require urgent management in the evening or overnight hours, and therefore the high frequency of these events represents a potential significant resource utilization and workforce issue to the vascular surgery workforce.

Postoperative Outcomes of Emergent Gastrointestinal Surgical Interventions in COVID-19 Positive versus COVID-19 Negative Patients: A retrospective Study

Postoperative Outcomes of Emergent Gastrointestinal Surgical Interventions in COVID-19 Positive versus COVID-19 Negative Patients: A retrospective Study

Analysing predictors of surgical site infections in patients undergoing emergency surgery for traumatic pulmonary haemorrhage.

Identifying predictors for surgical site infections (SSIs) after emergency surgical treatment for traumatic pulmonary haemorrhage (TPH) is crucial for improving patient outcomes. This study aims to ascertain these predictors. In this comprehensive retrospective study, conducted from January 2020 to December 2023 at our institution, 75 patients were analysed, including a case group of 25 patients with SSIs and a control group of 50 without SSIs post-TPH surgery. Inclusion criteria focused on patients aged 18 and above undergoing thoracotomy or minimally invasive thoracic surgery for TPH. Exclusion criteria included compromised immune systems, chronic pulmonary diseases, prior thoracic surgery or active infections at admission. We assessed several predictors: anaemia; operation time over 2 h; hospital stay over 5 days; intraoperative blood loss exceeding 500 mL; body mass index (BMI) ≥25 kg/m2; age ≥ 50 years; use of surgical drains; the presence of open wounds; diabetes mellitus and non-prophylactic antibiotic use. Statistical analysis involved univariate and multivariate logistic regression, using SPSS Version 27.0. Univariate analysis revealed significant associations between SSIs and surgical drain placement, diabetes mellitus, open wounds and non-prophylactic antibiotic use (p < 0.01). Multivariate analysis confirmed these factors as significant predictors of SSIs, with notable odds ratios. Other variables like anaemia, extended hospital stay, excessive intraoperative blood loss, older age and higher BMI did not significantly predict SSIs. Significant predictors for SSIs following TPH surgery include surgical drain placement, diabetes mellitus, open wounds and non-prophylactic antibiotic use. Identifying and managing these risks is crucial in clinical practice to reduce SSIs incidence and improve patient outcomes.

Features of the course of the psycho-organic syndrome in various brain pathologies on the example of patients of the neurosurgical department

The high urgency of research in the field of neurosurgery of this category of brain injury is evident. Severe brain injuries, vascular pathologies, aggressive neoplasms, and degenerative processes entail changes in the emotional and volitional sphere and neurological status of the patient. Notably, the degree of changes is based on three main factors: individual peculiarities of the cerebral circulation pattern, compensatory mechanisms of the nervous system of a particular individual, and the severity of the lesion or, in the case of neoplasms, the intensity of their growth. The nature of the brain tissue lesion should be taken into account when selecting and adjusting therapy in order to avoid and prevent negative dynamics and manifestation of pathologic positive or negative symptoms. The greatest danger in terms of the development of psychoorganic syndrome is brain edema. The primary task of the neurosurgeon is to eliminate the edema as soon as possible. With increasing symptoms, the patient may make sudden unconscious movements and demonstrate aggression towards the staff against the background of loss of orientation, which can lead to injuries and deterioration of the condition. It is recommended to make the patient lie down and hospitalize them in the intensive care unit for rapid dehydration and antihypertensive therapy. At the time of transfer, a CT scan of the brain should be performed in order to detect acute pathology or recurrence of the underlying pathology for urgent or emergent surgical intervention.

Outcomes of emergency surgical intervention for complications in the cardiac catheterization laboratory

Outcomes of emergency surgical intervention for complications in the cardiac catheterization laboratory

Evaluation of Prehospital Undertriage in Relation to Trauma Team Activation-Results from a Prospective Study in 12 Level one German Trauma Centers.

Background/Objective: This prospective, multicenter observational cohort study was carried out in 12 trauma centers in Germany and Switzerland. Its purpose was to evaluate the rate of undertriage, as well as potential consequences, and relate these with different Trauma Team Activation Protocols (TTA-Protocols), as this has not been done before in Germany. Methods: Each trauma center collected the data during a three-month period between December 2019 and February 2021. All 12 participating hospitals are certified as supra-regional trauma centers. Here, we report a subgroup analysis of undertriaged patients. Those included in the study were all consecutive adult patients (age ≥ 18 years) with acute trauma admitted to the emergency department of one of the participating hospitals by the prehospital emergency medical service (EMS) within 6 h after trauma. The data contained information on age, sex, trauma mechanism, pre- and in-hospital physiology, emergency interventions, emergency surgical interventions, intensive care unit (ICU) stay, and death within 48 h. Trauma team activation (TTA) was initiated by the emergency medical services. This should follow the national guidelines for severe trauma using established field triage criteria. We used various denominators, such as ISS, and criteria for the appropriateness of TTA to evaluate the undertriage in four groups. Results: This study included a total of 3754 patients. The average injury severity score was 5.1 points, and 7.0% of cases (n = 261) presented with an injury severity score (ISS) of 16+. TTA was initiated for a total of 974 (26%) patients. In group 1, we evaluated how successful the actual practice in the EMS was in identifying patients with ISS 16+. The undertriage rate was 15.3%, but mortality was lower in the undertriage cohort compared to those with a TTA (5% vs. 10%). In group 2, we evaluated the actual practice of EMS in terms of identifying patients meeting the appropriateness of TTA criteria; this showed a higher undertriage rate of 35.9%, but as seen in group 1, the mortality was lower (5.9% vs. 3.3%). In group 3, we showed that, if the EMS were to strictly follow guideline criteria, the rate of undertriage would be even higher (26.2%) regarding ISS 16+. Using the appropriateness of TTA criteria to define the gold standard for TTA (group 4), 764 cases (20.4%) fulfilled at least one condition for retrospective definition of TTA requirement. Conclusions: Regarding ISS 16+, the rate of undertriage in actual practice was 15.3%, but those patients did not have a higher mortality.

Delayed neurological dysfunction following posterior laminectomy with lateral mass screw fixation: A case report and review of literature

BACKGROUND While most complications of cervical surgery are reversible, some, such as symptomatic postoperative spinal epidural hematoma (SEH), which generally occurs within 24 h, are associated with increased morbidity and mortality. Delayed neurological dysfunction is diagnosed in cases when symptoms present &gt; 3 d postoperatively. Owing to its rarity, the risk factors for delayed neurological dysfunction are unclear. Consequently, this condition can result in irreversible neurological deficits and serious consequences. In this paper, we present a case of postoperative SEH that developed three days after hematoma evacuation. CASE SUMMARY A 68-year-old man with an American Spinal Injury Association (ASIA) grade C injury was admitted to our hospital with neck pain and tetraplegia following a fall. The C3-C7 posterior laminectomy and the lateral mass screw fixation surgery were performed on the tenth day. Postoperatively, the patient showed no changes in muscle strength or ASIA grade. The patient experienced neck pain and subcutaneous swelling on the third day postoperatively, his muscle strength decreased, and his ASIA score was grade A. Magnetic resonance imaging showed hypointense signals on T1 weighted image (T1WI) and T2WI located behind the epidural space, with spinal cord compression. Emergency surgical intervention for the hematoma was performed 12 h after onset. Although hypoproteinemia and pleural effusion did not improve in the perioperative period, the patient recovered to ASIA grade C on day 30 after surgery, and was transferred to a functional rehabilitation exercise unit. CONCLUSION This case shows that amelioration of low blood albumin and pleural effusion is an important aspect of the perioperative management of cervical surgery. Surgery to relieve the pressure on the spinal cord should be performed as soon as possible to decrease neurological disabilities.

Complex management of larger strangulated incisional hernia in a post-multiple abdominal surgery in a morbidly obese patient-a case report and surgical review

Strangulated incisional hernia following a post-hernia repair is a serious and potentially rare life challenging condition that can occur after surgical intervention. Incisional hernias accounts for 15-20% of all abdominal hernias which occur at the site of a previous surgical incision where the integrity of the fascia has not been fully restored. We are presenting a case report of a 49 years lady who came with complaints of abdominal swelling and pain abdomen following multiple abdominal surgeries diagnosed with strangulated incisional hernia following post hernia repair. It was managed by emergency surgical intervention that is removal of previously kept mesh and resection of gangrenous segment of bowel with end ileostomy after keeping overall patient’s condition.

Prehospital point-of-care ultrasound in ruptured abdominal aortic aneurysms-a retrospective cohort study.

Patients with ruptured abdominal aortic aneurysm (rAAA) require immediate vascular treatment to survive. The use of prehospital point-of-care ultrasound (POCUS) may support clinical assessment, correct diagnosis, appropriate triage and reduce system delay. The aim was to study the process of care and outcome in patients receiving prehospital POCUS versus patients not receiving prehospital POCUS in patients with rAAA, ruptured iliac aneurysm or impending aortic rupture. We performed a retrospective cohort study in patients diagnosed with rAAA in the Central Denmark Region treated by a prehospital critical care physician from 1 January 2017 to 31 December 2021. Performance of prehospital POCUS was extracted from the prehospital electronic health records. System delay was defined as the time from the emergency phone call to the emergency medical service dispatch centre until the start of surgery. Data on patients primary hospital admission to a centre with/without vascular treatment expertise, treatments and complications including death were extracted from electronic health records. We included 169 patients; prehospital POCUS was performed in 124 patients (73%). Emergency surgical treatment was performed in 71 patients. The overall survival in the POCUS group was 39% versus 16% in the NO POCUS group (hazard ratio (HR) (95% 0.60, 95% CI: 0.41-0.89, p = .011). In the POCUS group 99/124 (80%) were directly admitted to a vascular surgical centre versus 25/45 (56%) in the NO POCUS, RD 24% (95% CI: 8-40)), (p = .002). In the POCUS group, system delay was a median of 142 minutes (interquartile range (IQR) 121-189) and a median of 232 minutes (IQR 166-305) in the NO POCUS group (p = .006). In a multivariable analysis incorporating age, sex, previously known rAAA, and typical clinical symptoms of rAAA, the HR for death was 0.57, 95% CI 0.38-0.86 (p = .008) favouring prehospital POCUS. Prehospital POCUS was associated with reduced time to treatment, higher chance of operability and significantly higher 30-day survival in patients with rAAA, ruptured iliac aneurysm or impending rupture of an AAA in this retrospective study. Residual confounding cannot be excluded. This study supports the clinical relevance of prehospital POCUS of the abdominal aorta.

Poland syndrome: A case of difficult weaning of ventilation after surgery

IntroductionPoland syndrome is a rare congenital anomaly that occurs in 1 in 30,000 children. It is characterised by unilateral underdevelopment or lack of the chest wall muscle that is apparent at birth. Rarely is it discovered to involve a bilateral chest muscular deficit. Poland syndrome presents in a wide variety of ways, which can often make diagnosis challenging.AimWe would like to highlight the rarity of Poland syndrome, and the challenges of post-operative recovery, primarily the ventilation.Case studyWe presented a case of a 44-year-old female with non-investigated chest wall deformity, whom required emergency surgical intervention under general anaesthesia. Post-operatively, she required prolonged ventilatory support, and was then diagnosed with Poland syndrome.Results and discussionThe patient had undergone an emergency laparotomy and left lateral hepatectomy for left hepatolithiasis with liver abscess. Post-operation, she required prolonged ventilation, with gradual weaning of oxygen. Imaging studies showed absence of left pectoralis major, thus a diagnosis of Poland syndrome. Gradually she was weaned off and had a successful post operative recovery.ConclusionsPoland syndrome is a rare congenital abnormality. In patients undergoing general anaesthesia, the normal mechanics of breathing while ventilated are absent. Their recovery is longer and requires prolonged ICU admission.

Surgical Management and Outcome of the Planum Sphenoidale Meningioma: A Single-Center Strobe Compliant Study

BackgroundThe resection of the jugum (planum) sphenoidale meningioma (JSM) is challenging and there is a scarcity of available data in the literature. This study aimed to describe the surgical management and long-term outcome of jugum sphenoidale meningioma. MethodsThis was a retrospective, single-center, cohort study of 91 JSM patients treated in our department from 2005 to 2022. All the included patients have undergone surgical treatment. Clinical, radiological, and surgical data were extracted with specific attention to the age at onset, family history, duration from symptoms to diagnosis, clinical presentation, quality of excision, recurrence, and treatment outcome. ResultsWHO grade I and grade II meningioma were 83.5% (n=76) and 16.5% (n=15) respectively. Fronto-lateral 42.9% (n=39) and pterional approaches 57.1% (n=52) were the two major surgical approaches used for the management of planum sphenoidale meningioma. Twelve patients needed emergency surgical treatment at admission: 4 (4.4%) External CSF Shunt and 8 (8.8%) VP-Shunt. We have found a statistically significant (p=0.032) association between the quality of excision and the risk of recurrence. The GTR (Hazard ratio = 1) of the planum meningioma protects the patient from recurrence within 60 months of follow-up. Post-operative complications encountered were CSF-Leak in 2.2%, Meningitis 4.4%, surgical site infection 2.2%, and surgical site hematoma 3.3%. The overall postoperative favorable outcome was 68.1% (n=62). ConclusionThe pterional approach has allowed the achievement of GTR for jugum sphenoidale meningioma with protective odds from recurrence risk.