Higher Complication Rate Research Articles

Comparing Wise Pattern to Non-Wise Pattern Skin Sparing Mastectomy: A Critical Evaluation of Patient Demographics and Surgical Outcomes.

Multiple skin-sparing incisions are utilized in immediate post-mastectomy breast reconstruction; however, the Wise pattern incision (WPI) may have superior cosmetic outcomes for large ptotic breasts compared to non-Wise pattern incisions (NWPI). We evaluated patient demographics and surgical outcomes with WPI versus NWPI. An electronic medical record search was performed for patients at a single academic institution from 2019 to 2022 with ICD-10-CM diagnosis code "Z42.1: encounter for breast reconstruction following mastectomy." Retrospective chart review evaluated patient demographics, intraoperative factors, postoperative complications, and surgical cost. 288 patients were included; 58 had WPI and 230 had NWPI. Median BMI differed between WPI (30.5) and NWPI (26.4) (P < 0.001). 57% of WPI had preoperative grade 3 ptosis versus 23% of NWPI (P < 0.001). No difference was found in median operative times (WPI: 219 minutes, NWPI: 194 minutes, P = 0.38). Overall rates of postoperative complications differed between WPI (62%) and NWPI (45%) on univariate, but not multivariate, analysis. Median total surgery charge was higher for WPI (WPI: $36,223, NWPI: $31,185, P < 0.001), while implant cost was higher for NWPI (WPI: $2,700, NPWI: $8,040, P < 0.001). There was no significant difference in operative time, overall complication rate, or charge between incision types once adjusted for confounding factors. The higher complication rate in the WPI group was likely driven by higher BMI, a known risk factor for surgical complications regardless of approach. Surgeons can consider WPI as a noninferior option for patients with higher BMI and ptosis.

Comparison of complications and degree of correction between the extensile lateral and sinus tarsi approaches in the treatment of calcaneus fractures: a cross-sectional observational retrospective study

Introduction: Calcaneus fractures are a challenge for traumatologists. Their complex anatomy, relative scarcity of surrounding soft tissue, and long learning curve for surgical treatment partly explain the difficulties encountered by surgeons, in addition to contributing to the high rate of complications. Objective: This study aimed to identify the differences in complication rates and degree of correction between extensile lateral access (ELA) and sinus tarsi (STA) approaches by reviewing medical records between 2018 and 2023 of patients who underwent open reduction and internal fixation of calcaneus fractures at a hospital in the interior of São Paulo. Methods: The present study followed a retrospective observational and cross-sectional model (STROBE). The Kolmogorov Smirnov test, Student-t test, Wilcoxon Rank test, Mann-Whitney test, Pearson Chi-Square test, and binary and predictive logistic regression analysis were used, adopting a confidence risk of 0.05. Results and Conclusion: A total of 77 patients were included (52 ELA and 25 STA). It was concluded that no statistical differences were observed after intergroup comparisons (ELA vs. STA). There was also no statistically significant influence of the predictor “age” on the predictors of the responses “Böhler and Gissane angles in degrees” in the final post-procedure phase. In general, STA presented a lower probability of complications with the use of the sinus tarsi route, reaching the same level of joint reduction and control of progression to osteoarthritis. All these results of the present study almost completely confirm the literary findings that appear under discussion.

Outcomes of osteoarticular ulna allograft for the reconstruction of proximal ulna tumour.

The ulna is an extremely rare location for primary bone tumours of the elbow in paediatrics. Although several reconstruction options are available, the optimal reconstruction method is still unknown due to the rarity of proximal ulna tumours. In this study, we report the outcomes of osteoarticular ulna allograft for the reconstruction of proximal ulna tumours. Medical profiles of 13 patients, who between March 2004 and November 2021 underwent osteoarticular ulna allograft reconstruction after the resection of the proximal ulna tumour, were retrospectively reviewed. The outcomes were measured clinically by the assessment of elbow range of motion (ROM), stability, and function, and radiologically by the assessment of allograft-host junction union, recurrence, and joint degeneration. The elbow function was assessed objectively by the Musculoskeletal Tumor Society (MSTS) score and subjectively by the Toronto Extremity Salvage Score (TESS) and Mayo Elbow Performance Score (MEPS) questionnaire. The mean follow-up of patients was 60.3 months (SD 28.5). The mean elbow flexion-extension ROM was 95.8° (SD 21). The mean MSTS of the patients was 84.4 (SD 8.2), the mean TESS was 83.8 (SD 6.7), and the mean MEPS was 79.2 (SD 11.5). All the patients had radiological union at the osteotomy site. Symptomatic osteoarthritic change was observed in three patients (23%), one of whom ended up with elbow joint fusion. Two patients (15.4%) had recurrence during the follow-up period. Surgical complications included two allograft fractures, two plate fractures, three medial instabilities, and two infections. Osteoarticular ulna allograft reconstruction provides acceptable functional outcomes. Despite a high rate of complications, it is still a valuable reconstruction method, particularly in skeletally immature patients who need their distal humerus physis for the rest of hand growth.

Manejo da fratura de fêmur e as principais complicações: Uma revisão sistemática

Objective: The general objective of the present study is to analyze the scientific literature on hip fractures in the elderly, seeking to identify the main risk factors, surgical treatment options and their complications, as well as long-term functional outcomes. Methodology: This is a systematic review focused on understanding the main aspects of the management of femoral neck fractures in the elderly. The research was guided by the question: "What is the best way to manage femoral neck fractures?". To find answers, searches were performed in the PubMed database using three descriptors combined with the Boolean term "AND". This resulted in 115 articles. 27 articles were selected for analysis and 19 articles used to compose the collection. The searches used were: (Femoral Neck Fractures) AND (Surgical Procedures, Operative) AND (Orthopedic Procedures); (Femoral Neck Fractures) AND (Postoperative Care); (Femoral Neck Fractures) AND (Intraoperative Complications). Results: Hemiarthroplasty and total hip arthroplasty (THA) are viable options, each with its advantages and disadvantages. Internal fixation with cannulated screws has a high complication rate, while the femoral neck fixation system shows promising results. The choice between cemented and uncemented prostheses continues to be debated. Conclusion: The choice of treatment should be individualized, considering factors such as age, comorbidities, and type of fracture. Early interventions are crucial to minimize complications and improve functional outcomes.

TROPIC: Transfascial Oblique Posterior Interbody Correction: Technical Note

Adult spinal deformity is a common problem in today's aging adult population, particularly in the thoracolumbar spine. This can lead to severe pain and disability, leading to a poorer quality of life. Traditionally, open deformity correction has been the mainstay of treatment for these patients as it provides an excellent operative corridor; however, this comes with severe risk and high complication rates. There has been a trend toward more minimally invasive approaches to correct the deformity while preserving the muscle and soft tissue surrounding the bony spine across the fusion. We describe a minimally invasive surgical technique through a Wiltse approach without invading the paraspinal musculature to gain access to the bony spine to perform lumbar interbody fusions and osteotomies. A total of 3 patients were identified for this technical note who underwent the transfascial oblique posterior interbody correction procedure for adult spinal deformity. The patients had severe coronal and rotational imbalances. We were able to achieve adequate correction through an approach without disturbing the spinal musculature and soft tissues. This technique provides benefits of spinal rotational and coronal plane correction and restores lordosis with current advancements of today's technologies without the downsides of an open surgical approach.

Cannulated compression screws with cable technique leads to a dramatic reduction in patella fracture fixation complications compared to tension band wiring.

The aim of this study was to compare the clinical, radiological and functional outcomes between cannulated compression screw with cable construct (CS) and tension band wiring (TBW) in transverse patella fractures. A retrospective study was conducted on patients surgically treated for AO/OTA 34C1 or 34C2 transverse patella fractures with CS or TBW technique between January 2019 and January 2023. Clinical outcomes included complications related to the implant, wound and fracture at 6 months and 1 year, time to achieving full weight bearing status and early perioperative clinical outcomes. Radiological outcomes included the time to fracture heals and delayed union. Functional outcome measures using the Oxford Knee Scale, 36-short form questionnaire and the Bartlett Anterior Knee Score were assessed. 73 patients were treated with CS (n = 33) or TBW (n = 40). TBW had higher complication rates: 25.0% (n = 10) required implant removal, 12.5% (n = 5) had wire breakage, 12.5% (n = 5) experienced fracture displacement while 52.5% (n = 21) experienced implant migration. In contrast, no CS patients had implant removals, wire breakage or fracture displacement and 3.0% (n = 1) experienced implant migration. At 1day post-operatively, 87.9% (n = 29) CS group patients were able to ambulate as compared to the 55.0% (n = 22) of TBW patients. Furthermore, CS patients ambulated further distances at 11.8 ± 10.6m than the TBW group (6.4 ± 7.4m). The CS group (25.9 ± 24.6 days) also achieved full weight bearing status faster than the TBW group (43.6 ± 39.4 days). The time taken for the fracture to heal and functional outcomes were comparable among the two groups. The CS technique demonstrated lower complications, in particular, no CS patient had implant removals, wire migration or fracture displacement. Additionally, CS technique showed a faster return to ambulation and time to achieving full weight bearing status.

The role of acetabular cement augmentation in 2-stage revision arthroplasty for prosthetic joint infection of the hip.

In the treatment of chronic prosthetic joint infection (PJI) of the hip, two-stage exchange arthroplasty is commonly employed. Various spacer designs, including Hemi-Spacers and Articulating Spacers, are utilized during this process. However, these spacers are associated with a high rate of mechanical complications and pose a risk of progressive bone loss. This study aims to compare these two types of spacers in terms of mechanical complications, center of rotation (COR) restoration, and preservation of acetabular bone stock. From 2019 to 2022, patients who underwent two-stage exchange arthroplasty for hip PJI across three hospitals were retrospectively reviewed. Data including demographic, clinical, and microbiological information were collected. Radiographic imaging was analyzed to measure acetabular bone erosion, COR, and periacetabular bone resected. Additionally, the average surgical time in the first and second stages, mechanical complications, and the mean duration of the inter-stage period were recorded. Forty patients were divided into two groups: Group A (Articulating Spacer, n = 23) received a preformed femur spacer with acetabular cement augmentation, while Group B (Hemi-Spacer, n = 17) received a preformed femur spacer alone. Acetabular cement augmentation slightly prolonged the first stage but facilitated a faster second stage during subsequent reimplantation. Spacer dislocation rates were 8.7% in Group A and 17.6% in Group B during the interstage period. Radiographic analysis revealed a statistically significant greater degree of acetabular erosion in Group B. A significant difference in Vertical-COR differential was observed, with a more proximalized revision cup compared to the primary cup in Group B, and Horizontal-COR values closer to the native hip in Group A. Dynamic spacers with acetabular cement augmentation help preserve peri-acetabular bone stock and prevent progression of acetabular bone erosion during the inter-stage period. Additionally, these spacers reduce the dislocation rates, making reimplantation easier and leading to better restoration of hip biomechanics during the second procedure.

Comparison of cost and complications of primary total hip arthroplasty versus oncologic proximal femur replacement

Aims and objectiveProximal femur replacement (PFR) is most commonly performed after a large resection of the proximal femur to remove tumor and is known to have high complication rates and worse function than a primary total hip replacement (THA). Many surgeons feel that current billing practices fail to adequately differentiate this procedure from a THA. This study aims to examine patients undergoing a primary THA or oncologic PFR and compare the relative economic impact and complication rates between cohorts. Materials & methodsPatient data was queried using a national database, identifying non-pediatric patients who underwent a primary THA or oncologic PFR. Exclusionary criteria were implemented, resulting in two cohorts, each with 380 patients matched in a 1:1 manner controlling for age, gender, and Charlson Comorbidity Index. Utilizing 2022 billing data, oncologic PFRs generated an average of 41.03 RVUs and primary THAs generated 19.60 RVUs. Total hospital cost was used to generate a cost:RVU ratio for each cohort. Key systemic and joint complication rates were additionally compared between cohorts. ResultsThe oncologic PFR cohort had significantly higher 90-day rates of anemia, deep vein thrombosis, and prosthetic dislocation compared to the primary THA cohort. The 90-day median hospital cost for oncologic PFR was $28,562.21 with a cost:RVU ratio of $696:1. The corresponding median hospital cost for primary THA was $9667.72, with a cost:RVU ratio of $493:1. ConclusionHospitals incur more cost per RVU for an oncologic PFR than a primary THA. Relative to primary THA, reimbursement for oncologic PFR is under-evaluated.

Complications of Percutaneous Nephrolithotomy: Experience From a Tertiary Care Center.

Introduction Renal stones are mineral concretions in the pelvicalyceal system. Their prevalence and recurrence are increasing globally. Percutaneous nephrolithotomy (PCNL) is a minimally invasive procedure for the removal of kidney stones. It is a safer technique offering the highest stone-free rates. However, a few complications may still occur. We aimed to evaluate our experiences of PCNL and classify the complications as intraoperative, early postoperative, and late postoperative events. We also aimed to find the predictors of complications in PCNL. Methods A single-center prospective observational study was conducted from June 2021 to October 2022 where all patients who were >18 years old with radiopaque calculus in the kidney and underwent PCNL were included. Statistical analysis was performed using the IBM Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY). A p-value of <0.05 was considered significant. Results Two hundred one patients including 137 males and 64 females participated in the study. The overall rate of complications was 21.9%. Most of the patients (16.4%) experienced minor complications of Clavien grades 1 and 2. A Clavien grade of >3 included major complications and was noted in 5.5% of patients. No mortality was seen in the postoperative period. Female patients (p = 0.028), a stone burden of >3 cm (p = 0.003), stones in multiple calyces (p = 0.001), hydronephrosis (p = 0.001), history of recently treated urinary tract infection (UTI) (p < 0.001), longer operative time (>91 minutes) (p < 0.001), Guy's stone scores (GSS) III and IV (p < 0.001), complex renal calculi (staghorn) (p = 0.002), and multiple punctures (p = 0.001) were associated with higher complication rates after PCNL. Conclusion Most PCNL-related complications are minor and resolve with conservative or minimally invasive management. However, there are certain complications that can limit the surgical outcome. The overall complication rate in the current study is similar to that reported in the literature. Bleeding was the most common intraoperative complication, whereas hematuria was the most common early postoperative complication. A stone burden of >3 cm, hydronephrosis, longer operative time, higher GSS, and multiple punctures can all affect the rate of complications.

A Systematic Review of Surgical and Pathological Outcomes in Patients With a CDH1 Mutation Undergoing Total Gastrectomy.

CDH1 (E-cadherin) genetic mutations are associated with a 30%-70% increased lifetime risk of hereditary diffuse gastric cancer (HDGC). Although prophylactic total gastrectomy (PTG) reduces long-term risk of gastric cancer, the associated morbidity and mortality remain unclear. This systematic review aims to characterise postoperative surgical outcomes in patients undergoing total gastrectomy. A systematic literature search was performed for studies reporting endoscopic surveillance, surgical and pathological outcomes for patients with CDH1 mutation undergoing a total gastrectomy. Thirty-nine studies included 1849 patients, of which 96% had a CDH1 (n = 1777) or CTNNA1 (n = 3) mutation. Endoscopy outcomes were reported for 1640 patients. Cancer foci were identified in 32% (n = 523/1640) and 71% of these patients went on to have a total gastrectomy (n = 369/523). The remaining 78% of patients did not have cancer foci detected on endoscopy (n = 1117/1640). Of these patients, 62% underwent a total gastrectomy (n = 688/1117) and 81% were found to have cancer on surgical histology (n = 556/688). Pathological staging was reported for 790 patients undergoing surgery, of which 68% had pT1 disease (n = 537). Postoperative complications were reported for 430 patients across 23 studies, with the most common complications being anastomotic strictures (25%), anastomotic leaks (13%), wound infections (12%) and pulmonary complications (11%). Only one postoperative death was reported within 30 days. Rates of early cancers are high in CDH1 patients undergoing PTG, highlighting the need for improvement in reliable endoscopic surveillance. Although postoperative mortality in this surgical cohort remains low, high rates of postoperative complications warrant careful patient counselling.

Analyzing learning curve for supine percutaneous nephrolithotomy in urology resident training programme: comparative analysis.

This article attempts to provide a comprehensive review of the learning objectives and importance of the supine percutaneous nephrolithotomy (PCNL) technique. We retrospectively reviewed the cases of Supine PCNL between January 2018 and January 2024. We divided the groups into 3: residents between 2 and 3 years (Group 1), residents between 4 and 5 years (Group 2), and endourologist (Group 3). The 2-3-year resident started to perform PCNL for the first time, while the 4-5-year resident started to perform Supine PCNL for the first time while previously performing prone PCNL. Access, fluoroscopy, and operation time were higher in Group 1, shorter in Group 2, and shortest in Group 3 (p < 0.001). Postoperative length of stay and the need for additional treatment were found to be shorter (p < 0.001), and the stone-free rate (SFR) increased (p < 0.001) from Group 1 to Group 3. The highest complication rates were observed in Group 1 (p = 0.002). SFR rate increased as the number of cases increased in Group 1 patients. Success was stable after 46-60 cases in terms of SFR. In Group 2, the SFR rate was stable after 31-45. The most complications were observed in Group 1 and the least in Group 3. In 2-3-year residents, access time and fluoroscopy time decrease with experience. In 4-5-year residents, due to their expertise in prone PCNL, the operation time and fluoroscopy time decrease with the number of cases performed. SFR is higher after 46-60 cases for 2-3-year residents and 31-45 cases for 4-5-year residents.

SP2.9 - National Emergency Laparotomy Audit (NELA) and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) risk prediction calculators are not accurate in predicting 30-day mortality in patients aged 80 and above

Abstract Background 30- to 50000 Emergency Laparotomies (EL) are performed annually in the UK. More than half of patients are aged 70 or over and have a high post-operative complication rate along with a 16-20% risk of 30-day mortality (30-dm). To date, the literature lacks a dedicated risk prediction tool for mortality and morbidity following EL in the elderly population. Methods A multi-center, retrospective study of patients aged ≥80 undergoing EL examined the correlation between predicted 30-dm using NELA and ACS-NSQIP and actual 30-dm. This occurred in two UK centers over a 2-year period. The primary outcome was defined as the correlation between actual 30-dm and NELA or ACS-NSQIP predicted 30-dm. GraphPad Prism 10.1.1. was used for statistical analysis. Results 141 cases were included in the final analysis (Table 1). The actual 30-dm was 17.73%, NELA predicted 30-dm 13.07% (7.21;27.84), and ACS-NSQIP 9.4% (3.8;20.6). NELA correlated positively with ACS-NSQIP predicted 30-dm (R²=0.79; p&amp;lt;0.0001). No association was found between actual 30-dm and predicted NELA 30-dm, R²=0.01; p&amp;lt;0.0001 or ACS-NSQIP, R²=0.01; p&amp;lt;0.0001. All data is expressed as Median + IQR. Conclusion In octo- and nonagenarians, following an emergency laparotomy, both NELA and ACS-NSQIP are not accurate in predicting 30-day mortality.Table 1Male/female ratio0.63Age (years)84 (81;87)BMI (kg/m²)24.27 (21.43;27)Lactate (most recent preoperative value) mmol/L1.7 mmol/L (1.14;3.01)ASA grade3 (2;4)Clinical frailty score3 (3;5)Charlson Comorbidity Index4 (2;5)

Indications and Long-Term Outcomes of Intercalary Reconstruction Techniques for Diaphyseal Bone Tumors

Objective: Intercalary reconstruction after resection of diaphyseal bone tumors allows for adjacent-joint preservation; however, despite implant advancements they continue to experience high failure rates. Free fibular autograft (FFA), allograft interposition, and metallic endoprostheses are used, but there is no consensus on optimal construct. Methods: We conducted an IRB-approved retrospective review of patients who underwent intercalary reconstruction for oncologic indications at a single institution (1999 to 2022). Inclusion criteria included intercalary reconstruction with FFA, allograft, or endoprosthesis for oncologic indications and with minimum follow-up of 3 months. Primary outcome was implant survival. Secondary outcomes included complication type, rate, and timing, resection length, distance from articular surface, and failure modes. Results: Thirty-five patients met inclusion criteria, 23 men and 12 women. Reconstructive options included: FFA (N=8), endoprosthesis (N=16), and allograft (N=11). Average follow-up was 3.9 years. Average patient age was 41.8 years; FFA patients were younger than endoprosthesis patients (P=0.0002). FFAs were closer to the articular surface than endoprostheses (P=0.0003). Overall implant survival was 36.6% at 21 years; median survival was 2.04 years. Overall complication rate was 65.7%, with no difference between groups. Ten patients (28.5%) ultimately ended with a joint-sacrificing operation. Conclusions: This study supports the existing literature’s reported high rate of complication and implant failure of intercalary reconstructions. Salvage options are available, including those for secondary joint-sparing operations; however, they often result in a joint-sacrificing endoprosthesis limiting function and longevity. With patients having improved life expectancy for both metastatic and primary bone tumors, implant optimization is critical.

Comparison of the results of active surgical treatment and serial stenting for urolithiasis in pregnant women

Introduction. Renal colic during pregnancy is a common cause of pain in the lower back. Currently, with a diagnosed kidney or ureter stone, the standard treatment is serial drainage of the urine tract using an internal ureter stent, with replacement of the drainage before delivery, followed by surgery to remove the stone after delivery.Objective. To study the effectiveness and safety of ureteroscopic interventions in the treatment of urolithiasis in pregnant women in comparison with the method of serial drainage of the upper urinary tract during gestation followed by surgical treatment of urolithiasis 4 weeks after delivery.Materials &amp; methods. The study group consisted of 119 patients with a confirmed diagnosis of urolothiasis using instrumental diagnostic methods and a gestational age up to and including the 27th week. Two groups were formed based on treatment approaches for urolithiasis: group 1 included 59 patients (49.6%) who underwent surgical removal of the stone; group 2 included 60 patients (50.4%) who underwent internal ureteral stent replacement every 4 – 6 weeks prior to delivery and subsequent ureteroscopy There were no significant differences in age, body mass index, or number of pregnancies between the two groups.Results. The frequency of complete stone removal in groups 1 and 2 was 96.6 and 96.7%, respectively. The median amount of time spent on urolithiasis treatment in groups 1 and 2 was 60 [45; 72] and 97 [54; 105] minutes, respectively (p = 0.002). Migration of the ureteral stent in group 2 was observed in 13.3% of cases (p = 0.05). Among group 1 patients who underwent ureteroscopic intervention aimed at stone removal, the incidence of internal drainage dislocation was 3.4%. Encrustation of the ureteral stent in groups 1 and 2 was observed among 2 (3.4%) and 17 (28.3%) patients, respectively (p &lt; 0.001). The bed-day (median time in days spent in hospital for drainage replacement and time of surgical treatment of urolithiasis) in groups 1 and 2 was four and eight days, respectively (p &lt; 0.05). The frequency of natural childbirth in groups 1 and 2 was 81.35% and 55.0%, respectively (p = 0.002).Conclusion. Urolithiasis among pregnant women is a complex multifactorial disease that affects not only the health of the mother, but also the condition of the developing foetus. It is possible to perform surgical treatment with high efficiency and low complication rate, which improves the quality of life.

Current Challenges in Coronary Bifurcation Interventions.

Coronary bifurcation lesions account for a significant proportion of all percutaneous coronary interventions (PCIs). Interventional treatment of coronary bifurcations is related to significant technical challenges, high complication rates, and worse angiographic and long-term clinical outcomes. This review covers the specific features and structure of coronary bifurcation and explores the main challenges in the interventional treatment of these lesions. This review evaluates various methodologies designed to address these lesions, considering factors such as plaque distribution and bifurcation geometry. It also emphasizes the limitations associated with current techniques. A novel combined optimization approach applied in the interventional treatment of coronary bifurcation may offer superior procedural and long-term outcomes. This combined technique could potentially address the drawbacks of each method, providing a more effective solution for optimizing stent placement in bifurcation lesions. Refining and evaluating these combined techniques is essential for improving clinical outcomes in patients with bifurcation lesions.

Liquid nitrogen-based cryoablation: complication rates for lung, bone, and soft tissue tumors cryoablation.

This study aimed to assess the complication rate during and 24 hours after cryoablation in lung, bone, and soft tissue tumors. We reviewed complications in a total of 85 consecutive patients who underwent cryoablation using a liquid nitrogen-based system in various lesions between April 2017 and October 2022. There were no liver and renal lesions. Complications were categorized using the Society of Interventional Radiology classification. Eighty-five patients were treated for 96 lesions in the bone (36.4%; 35 of 96), lung (18.8%; 18 of 96), and soft tissue (44.8%; 43 of 96). The primary technical success rate was 97.7% (83 of 85). The total grade 2 and 1 complication rates were 5.2% (5/96) and 20.8% (20/96), respectively. Two patients had asymptomatic pulmonary embolisms incidentally noted at the 24-hour follow-up computed tomography (grade 2). The most frequent complications were simple and hemorrhagic pleural effusions (18.7%; 18 of 96). Lung procedures had the highest complication rate, where 13 patients (72.2%; 13 of 18) reported complications, including 2 cases of symptomatic hydropneumothorax requiring drainage (grade 2) and an additional 2 days of hospital stay. Eight patients (24.2%; 8 of 33) with bone lesions and 4 (9.3%; 4 of 43) with soft tissue lesions experienced complications. Cryoablation using a liquid nitrogen-based system is safe, with only minor complications observed. This study provides data on the safety of liquid nitrogen-based percutaneous cryoablation in tumors located in lung, in bones and in soft tissues. Despite using larger diameter cryoprobes than those typically reported with argon-based system, our experience shows that complications are mostly low and comparable in frequency and severity.

MULTI-SYSTEM INFLAMMATORY SYNDROME IN PATIENTS ADMITTED AT NICU OF A TERTIARY CARE HOSPITAL

Multi-inflammatory syndrome in neonates (MIS-N) associated with COVID-19 is an emerging concern in neonatal intensive care units (NICUs). Understanding its clinical spectrum and outcomes is crucial for developing management strategies and improving neonatal care. Objective: To explore the clinical spectrum, associated laboratory markers, and outcomes of neonates diagnosed with MIS-N and COVID-19 admitted to the NICU. Methods: This case series was conducted at the NICU of Shifa International Hospital, Islamabad, from January 2023 to June 2023. It included 47 infants diagnosed with COVID-19 who developed MIS-N. Data collected encompassed clinical presentations, laboratory markers, treatments administered in the ICU, and clinical outcomes. Descriptive statistics were used to analyze the data, focusing on symptoms, treatment efficacy, and complications. Results: The neonates had a mean age of 20.65 ± 16.60 days and a mean gestational age of 36.40 ± 2.62 weeks. Elevated inflammatory markers were noted, with D-Dimers elevated in 46.8%, serum ferritin in 66%, and C-reactive protein (CRP) in 48.9% of patients. The most common symptoms included respiratory distress (74.5%), poor feeding (38.3%), and fever (29.8%). Significant findings included pulmonary hypertension in 27.7% of the patients, patent ductus arteriosus in 23.4%, and other cardiovascular anomalies. Complications such as sepsis (70.2%), oxygen dependency (21.3%), and renal failure (29.8%) were prevalent. The mortality rate was 12.8%. Conclusion: MIS-N presents a severe threat to neonates with COVID-19, demonstrating high rates of serious complications and a notable mortality rate. Echocardiography is essential for early detection of cardiac dysfunctions. These findings underscore the urgent need for specific guidelines for the early recognition and management of MIS-N in neonates.

Adenoma detection rate by colonoscopy in real-world population-based studies: a systematic review and meta-analysis.

Adenoma detection rate (ADR) is a quality indicator set at a minimum of 25% in unselected populations by the European Society of Gastrointestinal Endoscopy (ESGE). Nevertheless, a lack of pooled observational data resembling real-world practice limits support for this threshold. We aimed to perform a systematic review with meta-analysis to evaluate the pooled rates for conventional adenoma detection, polyp detection (PDR), cecal intubation, bowel preparation, and complications in population-based studies. The PubMed, Scopus, and Web of Science databases were searched until May 2023 for populational-based studies reporting overall ADR in unselected individuals. A random-effects model was used for meta-analysis. 31 studies were included, comprising 3 644 561 subjects. A high quality of procedures was noticeable, with a high cecal intubation rate and low complication rate. The overall pooled ADR, PDR, and rate of cancer detection were 26.5% (95%CI 23.3% to 29.7%), 38.3% (95%CI 32.5% to 44.1%), and 2.7% (95%CI 1.5% to 3.9%), respectively. ADR varied according to indication: screening 33.3% (95%CI 24.5% to 42.2%), surveillance 42.9% (95%CI 36.9% to 49.0%), and diagnostic 24.7% (95%CI 19.5% to 29.9%), with subgroup analysis revealing rates of 34.4% (95%CI 22.0% to 40.5%) for post-fecal occult blood test and 26.6% (95%CI 22.6% to 30.5%) for primary colonoscopy screening. Diminutive conventional adenomas yielded a pooled rate of 59.9% (95%CI 43.4% to 76.3%). The pooled rate for overall serrated lesion detection was 12.4% (95%CI 8.8% to 16.0%). Male sex and higher age were significantly associated with an ADR above the benchmark. This first meta-analysis relying on real-world observational studies supports the ESGE benchmark for ADR, while suggesting that different benchmarks might be used according to indication, sex, and age.

Noncompressive myelopathy in acute community-acquired bacterial meningitis: Report of seven cases and review of literature.

Bacterial meningitis is a severe disease with high rates of complications and unfavorable outcome. Complications involving the spinal cord are rarely reported. Cases of noncompressive myelopathy were identified from a nationwide cohort study of adults with community-acquired bacterial meningitis in the Netherlands. The American Spinal Injury Association Impairment Scale was used to classify the severity of spinal cord dysfunction. Subsequently, we reviewed the literature on noncompressive myelopathy as a complication of bacterial meningitis. Noncompressive myelopathy was reported in seven of 3047 episodes of community-acquired bacterial meningitis (0.2%). The median age of these patients was 51 years (range = 17-77). Causative pathogens were Streptococcus pneumoniae in three, Streptococcus agalactiae in two, and Neisseria meningitidis and Haemophilus influenzae both in one. Paresis of legs (n = 6) or arms and legs (n = 1) was the presenting symptom, occurring after a median duration of 9 days after admission (range = 2-28). Spinal magnetic resonance imaging showed T2-weighted abnormalities of the spinal cord in six of seven patients. Improvement of spinal cord function during admission was noted in four of seven patients. The literature review yielded 15 additional cases. Among patients from our cohort and the literature, there was no significant association between immunosuppressive therapy and subsequent improvement of spinal cord function (5/8 patients with immunosuppressive therapy [63%] vs. 5/14 without immunosuppressive therapy [36%], p = 0.44). Noncompressive myelopathy is an uncommon but severe complication of bacterial meningitis. Improvement after diagnosis is expected, but all patients had persistent neurological deficits.

COMPARAÇÃO ENTRE ABORDAGENS CIRÚRGICAS PARA REPARO DE HÉRNIA ABDOMINAL

This systematic review aims to compare open, laparoscopic, and robotic surgical techniques for abdominal hernia repair, evaluating their efficacy, benefits, and drawbacks. A comprehensive search of PubMed and ScienceDirect was conducted using terms related to "abdominal hernia repair" and "surgical techniques". The review included studies published from 2020 to 2024, focusing on randomized controlled trials, meta-analyses, and systematic reviews. The analysis revealed that laparoscopic and robotic repairs generally offer reduced recovery times, less postoperative pain, and lower complication rates compared to open surgery. However, robotic repairs, while offering precision and ergonomic advantages, come with higher costs and longer setup times. Open repairs, though associated with higher complication rates and longer recovery periods, are still preferred in certain complex cases due to their straightforward execution. This review highlights that laparoscopic and robotictechniques present notable advantages over traditional open surgery, particularly in terms of postoperative outcomes and patient recovery. The findings support the use of minimally invasive approaches where feasible but also underscore the importance of considering individual patient circumstances and the complexity of the hernia when selecting the most appropriate surgical technique.