Invasive Surgery Research Articles

EP361 - Left Sided Gall Bladder: A Surgical Surprise

Abstract Laparoscopic cholecystectomy is a minimally invasive surgical procedure used for the removal of a diseased gallbladder. Since the early 1990s, this technique has largely replaced the open technique for cholecystectomies. We present a unique incident where a left-sided gallbladder was incidentally discovered during a laparoscopic cholecystectomy, posing a technical challenge for the surgeon. Our patient was a 34-year-old female who visited our hospital with complaints of right upper abdominal pain and postprandial nausea lasting for three months. Ultrasound examination revealed two gallstones measuring 16mm and 13mm in the neck of the gallbladder. During the routine laparoscopic cholecystectomy, the surgeon encountered a left-sided gallbladder. To ensure a safe and effective dissection, an additional port was required during the surgical procedure. The prevalence of this rare congenital anomaly, known as a left-sided gallbladder, ranges from 0.1% to 0.7%. It is characterized by the gallbladder being located on the left side of the ligamentum teres and falciform ligament, with the cystic artery passing in front of the common bile duct from right to left. This anatomical variation is often associated with abnormalities in the biliary tree and the porto-venous system. Failing to recognize these variations can lead to serious complications, particularly in hepatobiliary surgery. Discovering a left-sided gallbladder during surgery is an infrequent finding that can increase the complexity and morbidity rate of the procedure.

A Novel Minimally Invasive Surgical Technique for Eight-Plate Hemiepiphysiodesis: Description and Evaluation.

Background: Temporary hemiepiphysiodesis with tension band plates or eight-plates is a common surgical procedure to treat malalignment of the lower limb axis in skeletally immature patients. The objective of this study was to compare a new minimally invasive surgical procedure with the conventional procedure and evaluate its safety and effectiveness in order to reduce the risk of hypertrophic scarring, which may cause functional impairment as well as cosmetic issues. Methods: Sixty-five growth plates of either the femur or the tibia were evaluated in 33 patients treated for genu valgum or varum between 2010 and 2017. Each growth plate was considered an individual case. The modified procedure was used in 17 cases and the conventional procedure in 48 cases. The modified surgical procedure is characterized by an 8 mm incision and preparation of the epi-periosteal layer, in which the eight-plate is positioned via a guide-wire. Positioning and implantation are controlled via fluoroscopy. Skin incision length, duration of surgery, revision rate, achievement of a defined correction goal, and correction rate were analyzed. Results: Using the minimally invasive procedure, the mean skin incision length (23.94 ± 10.18 mm vs. 8.75 ± 2.14 mm, p < 0.001) could be significantly reduced. No significant difference was found in regard to the duration of surgery, revision rate, achievement of the correction goal or correction rate. Conclusions: The minimally invasive procedure results in a reduction in incision length without significant impact on the duration of surgery, revision rate, achievement of correction goal or correction rate. Consequently, the modified procedure can be regarded as equally as effective and safe as the conventional procedure.

Safety and efficacy of autologous blood tattooing for preoperative colonic localization: a comparative study with conventional India ink tattooing.

India ink has been a popular choice for a tattooing agent in preoperative endoscopic localization but often results in unfavorable effects. Subsequently, autologous blood tattooing has arisen as an alternative option. Due to the limited availability of comparative studies on the matter, we conducted a study to compare the perioperative outcomes associated with India ink tattooing versus autologous blood tattooing. A total of 96 patients who underwent minimally invasive surgical procedures for left-sided colonic neoplasm following preoperative endoscopic localization were included in the study. These patients were categorized into two groups: 36 patients who received India ink tattooing and 60 patients who underwent autologous blood tattooing. The perioperative outcomes including procedure-related outcomes and postoperative outcomes were compared between the two groups. There was no significant difference in visibility and spillage of tattooing agent between India ink group and autologous blood group. However, India ink group showed a higher incidence of post-tattooing fever, higher level of postoperative C-reactive protein level, longer time to first flatus, resumption of surgical soft diet, and duration of hospital stay, and a higher occurrence of postoperative complications including ileus and surgical site infection compared with the autologous blood group. In the multivariate analysis, India ink tattooing was significantly associated with the occurrence of postoperative complications. In the subgroup analysis involving patients with intraperitoneal spillage, the autologous blood group demonstrated significantly favorable perioperative outcomes compared with India ink group. Autologous blood tattooing demonstrated comparable visibility and enhanced safety, establishing it as a potential alternative to India ink for preoperative endoscopic localization.

Long-term Survival in Esophageal Cancer: Comparison of Minimally Invasive and Open Esophagectomy

BackgroundThoracoscopic esophagectomy is a less invasive surgical procedure; however, evidence of its effect on long-term survival is limited. We evaluated long-term survival after the procedure in patients with esophageal carcinoma. MethodsThis retrospective multicenter study involved 1559 consecutive patients with esophageal carcinoma who underwent thoracoscopic esophagectomy or open esophagectomy between 2012 and 2019 at 2 Japanese high-volume cancer centers. Propensity score matching analysis was performed to compare short- and long-term outcomes. In addition, stage-specific survival rates were compared between the groups. ResultsThere were 313 patients who were matched and analyzed. The 1-, 3-, and 5-year overall survival rates were 84.5%, 60.5%, and 52.1%, respectively, in the matched open esophagectomy group; and 87.2%, 68.6%, and 61.8%, respectively, in the matched thoracoscopic esophagectomy group. The weighted Cox regression model showed significantly better survival in the thoracoscopic esophagectomy group than in the open esophagectomy group (hazard ratio, 0.74; 95% CI, 0.582-0.941). Deaths from other causes occurred more frequently in the open esophagectomy group than in the thoracoscopic esophagectomy group. Stratified analysis showed no significant survival differences between clinical stage I or II and pathologic stage 0 or I subgroups. However, the thoracoscopic esophagectomy groups with clinical stage III or IV and pathologic stage II, III, or IV had significantly better overall survival. ConclusionsThis study demonstrated the survival benefits of thoracoscopic esophagectomy, particularly for highly advanced esophageal carcinoma.

Risk factors analysis for severe acute kidney injury in septic patients and establishment and validation of an hour-specific prediction model

To explore the risk factors of severe acute kidney injury (AKI) in septic patients, and to establish an hour-specific prediction model. Based on the information of septic patients in the Medical Information Mart for Intensive Care- IV (MIMIC- IV) database, general information, comorbidities, vital signs, severity scoring system, laboratory indicators, invasive operations and medication use were recorded. The enrolled patients were randomized into a training set and a validation set according to a ratio of 7 : 3. AKI was diagnosed according to the guidelines of Kidney Disease: Improving Global Outcome (KDIGO). Based on Lasso regression and Cox regression, the risk factors of severe AKI (AKI stage 2 and stage 3) in septic patients were analyzed and hour-specific prediction model were established. Consistency index (C-index), area under the receiver operator characteristic curve (AUC) and calibration curve were used to assess the predictive efficacy of the model. A total of 20 551 septic patients were enrolled, including 14 385 patients in the training set and 6 166 patients in the validation set. Multivariate Cox regression analysis showed that atrial fibrillation [hazard ratio (HR) = 1.266, 95% confidence interval (95%CI) was 1.150-1.393], heart failure (HR = 1.348, 95%CI was 1.217-1.493), respiratory failure (HR = 1.565, 95%CI was 1.428-1.715), heart rate (HR = 1.004, 95%CI was 1.002-1.007), mean arterial pressure (HR = 1.245, 95%CI was 1.126-1.377), lactic acid (HR = 1.051, 95%CI was 1.025-1.077), simplified acute physiology score II (SAPS II, HR = 1.019, 95%CI was 1.016-1.023), serum creatinine (HR = 1.171, 95%CI was 1.127-1.216), anion gap (HR = 1.024, 95%CI was 1.010-1.038), serum potassium (HR = 1.155, 95%CI was 1.079-1.236), white blood cell count (HR = 1.006, 95%CI was 1.003-1.009) and furosemide use (HR = 0.414, 95%CI was 0.368-0.467) were independently associated with severe AKI in septic patients (all P < 0.01). The above predictors were applied to construct an hour-specific prediction model for the occurrence of severe AKI in septic patients. The C-index of the prediction model was 0.723 and 0.735 in the training and validation sets, respectively. The AUC for the occurrence of severe AKI at 12, 24, and 48 hours were 0.795 (95%CI was 0.782-0.808), 0.792 (95%CI was 0.780-0.805), and 0.775 (95%CI was 0.762-0.788) in the training set, and the AUC were 0.803 (95%CI was 0.784-0.823), 0.791 (95%CI was 0.772-0.810), and 0.773 (95%CI was 0.752-0.793) in the validation set, respectively. The calibration curves of the two cohorts were in good agreement. The hour-specific prediction model effectively identifies high-risk septic patients for developing severe AKI within 48 hours, aiding clinicians in stratifying patients for early therapeutic interventions to improve outcomes.

Trends of ankle arthroscopy in Italy: Analysis of an official national database

ObjectivesAnkle arthroscopy has become increasingly popular as a less invasive surgical diagnostic and therapeutic procedure for a variety ankle disorder previously managed with open surgery. Despite literature reports encouraging outcomes and low complication rates, nationwide trends in ankle arthroscopy have been poorly investigated. To fully understand the burden of an emerging surgical approach as well as helping to create global standards for the diagnosis and treatment of ankle diseases, this study aimed to evaluate the incidence and demographics of patients undergoing ankle arthroscopy in Italy from 2001 to 2016. MethodsData were obtained from the National Hospital Discharge Records (SDO) provided by the Italian Ministry of Health. The patient's age, gender, length of hospital stays, primary diagnosis, and primary procedure are among the anonymized data. Population data were obtained from the National Institute for Statistics (ISTAT). According to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) ankle arthroscopy was defined by the following procedure code: 80.27. ResultsA total of 23,644 procedures were performed in Italy. The 25 to 29 and 30 to 34 age groups underwent this type of surgery at most. The majority of patients were males. The median length of hospital stay was 2.1 ​± ​2.3 days. Each year in Italy, this surgery costs an average of 2,133,401€ ± 342,143€. The main primary codified diagnoses were: “contracture of joint, ankle and foot” (13.4 ​%), “articular cartilage disorder, ankle and foot” (8.6 ​%), “late effect of sprain and strain without mention of tendon injury” (7.5 ​%) and “other joint derangement, not elsewhere classified, ankle and foot” (6.4 ​%). ConclusionsThe present study evaluated the burden of ankle arthroscopy on the national health care system and the distribution of the main diseases requiring this type of surgery. Surgeons and policy makers can allocate healthcare resources more effectively and provide patients with high-quality care by having a better understanding of national practice patterns. Level of EvidenceIII.

EFFECTIVENESS OF CONTINUOUS AUTOMATIC BLADDER IRRIGATION BASED ON INTERNET OF THINGS IN TRANS URETHRAL RESECTION OF PROSTATE: ANALYSIS OF NURSES' KNOWLEDGE AND READINESS

Transurethral Resection of the Prostate (TURP) is a minimally invasive surgical procedure commonly performed to treat benign prostatic hyperplasia. However, complications such as TURP Syndrome can occur if the procedure is not performed correctly. Continuous Automatic Bladder Irrigation (CABI) based on the Internet of Things (IoT) is a technology developed to minimize the risk of these complications. This study aims to analyze the relationship between the knowledge and readiness of nurses in implementing IoT-based CABI on TURP complications at the Jombang Regional General Hospital. Quantitative methods were used in this study, including data collection techniques through observation and questionnaires. The results showed that nurse readiness significantly affected the effectiveness of CABI implementation and decreased TURP complications. The implications of this study indicate the importance of training and education for nurses in using IoT-based technology.

Development of injectable microgel-based scaffolds via enzymatic cross-linking of hyaluronic acid-tyramine/gelatin-tyramine for potential bone tissue engineering

Currently, the healing of large bone defects relies on invasive surgeries and the transplantation of autologous bone. As a less invasive treatment option, the provision of microenvironments that promote the regeneration of defective bones holds great promise. Here, we developed hyaluronic acid (HA)/gelatin (Ge) microgel-based scaffolds to guide bone regeneration. To enable the formation of microgels by enzymatic cross-linking in the presence of horseradish peroxidase (HRP) and hydrogen peroxide (H2O2), we modified the polymers with tyramine (TA). Spectrophotometry and proton nuclear magnetic resonance (1H NMR) spectroscopy analysis confirmed successful tyramine substitution on polymer backbones. To enable the formation of microgels by a water-in-oil emulsion approach, the HRP and H2O2 concentrations were tuned to achieve the gelation in a few seconds. By varying the stirring speed from 600 to 1000 rpm, spherical microgels were produced with an average size of 116 ± 8.7 and 68 ± 4.7 μm, respectively. The results showed that microgels were injectable through needles and showed good biocompatibility with the cultured human osteosarcoma cell line (MG-63). HA/Ge-TA microgels served as a promising substrate for MG-63 cells since they improved the alkaline phosphatase activity and level of calcium deposition. In summary, the developed HA/Ge-TA microgels are promising injectable microgel-based scaffolds in bone tissue engineering.

Situation and associated factors of needle stick and sharps injuries among health-care workers in a tertiary hospital: a cross-sectional survey

PurposeThis study aimed to assess the prevalence of and factors associated with needle stick and sharps injuries (NSSIs) among health-care workers (HCWs) in a tertiary hospital in China.Materials and methodsThis retrospective survey was conducted with 562 HCWs at a tertiary hospital in China in July 2023. Information was collected using a self-designed questionnaire, and all enrolled members were required to fill in the demographic characteristics, occurrence of NSSIs and other associated factors in the past year. Logistic analysis was used to identify variables associated with NSSIs.ResultsThe proportion of participants with at least one injury within the year preceding the investigation was 21.2%. Male (AOR = 2.116 [1.265, 3.538]), working hours per week > 40 (AOR = 1.718 [1.056,2.796]), rarely checking blood-borne infections before invasive operations (AOR = 2.219 [1.303,3.782]) were significantly associated with NSSIs.ConclusionThe prevalence of NSSIs was not low in the survey area, especially in male, individuals with longer working hours, and rarely checking blood-borne infections before invasive operations. Therefore, it is necessary to promote educational programs to enhance awareness of standard prevention measures, especially for key populations, and reduce heavy workloads to decrease the occurrence of such injuries.

Clinical Characteristics of Abdominal Infections Caused by Raoultella Spp.: A Retrospective Study.

Background: In recent years, Raoultella spp. have attracted clinical attention as a new type of pathogen. The most common of human infection with Raoultella are bacteremia, urinary tract infections, abdominal infections, etc. Abdominal infection is a serious and complex infection problem. However, there have been no systematic reports of abdominal infections caused by Raoultella. The objective of this study was to explore the clinical characteristics of Raoultella abdominal infections and provide a reference for clinical practice. Methods: A review of publications on abdominal infections caused by the genus Raoultella between 2009 and 2024 is carried out. This review studied seven parameters: infection type, number of cases, gender, age, comorbidities, treatment, and outcome, and descriptive statistical methods were used to analyze the results. Results: A total of 40 cases (16 Raoultella ornithinolytica and 24 Raoultella planticola) were analyzed: 20 cases of biliary tract infection, 5 cases of liver infection, and 4 cases of peritonitis. Fever and abdominal pain were the main symptoms, and some patients present with multiple skin flushes, systemic erythema. Of the 40 cases, 92.5% of patients had underlying diseases. Among them, malignant disease, immunodeficiency, and invasive operations increase the risk of infection. On the basis of the drug susceptibility results, the preferred antibiotics are quinolone, third generations of cephalosporins, carbapenems, and aminoglycoside. Last, patients with abdominal infections caused by Raoultella spp. mostly have a good prognosis after early use of sensitive antibiotics. Conclusions: According to existing literature reports, the main type of abdominal infection caused by Raoultella is biliary tract infection, and most patients have other underlying diseases. Malignancy, immune deficiency, and invasive procedures are risk factors for bacterial infections. This review also emphasizes that Raoultella spp. is a rarely found opportunistic pathogen, which can cause a high incidence of healthcare-associated infections after invasive procedures.

Ultrasound Imaging in Knee Osteoarthritis: Current Role, Recent Advancements, and Future Perspectives.

While conventional radiography and MRI have a well-established role in the assessment of patients with knee osteoarthritis, ultrasound is considered a complementary and additional tool. Moreover, the actual usefulness of ultrasound is still a matter of debate in knee osteoarthritis assessment. Despite that, ultrasound offers several advantages and interesting aspects for both current clinical practice and future perspectives. Ultrasound is potentially a helpful tool in the detection of anomalies such as cartilage degradation, osteophytes, and synovitis in cases of knee osteoarthritis. Furthermore, local diagnostic and minimally invasive therapeutic operations pertaining to knee osteoarthritis can be safely guided by real-time ultrasound imaging. We are constantly observing a growing knowledge and awareness among radiologists and other physicians, concerning ultrasound imaging. Ultrasound studies can be extremely useful to track the response to various therapies. For this specific aim, tele-ultrasonography may constitute an easy tool aiding precise and repeated follow-up controls. Moreover, raw radio-frequency data from US backscattering signals contain more information than B-mode imaging. This paves the way for quantitative in-depth analyses of cartilage, bone, and other articular structures. Overall, ultrasound technologies and their rapid evolution have the potential to make a difference at both the research and clinical levels. This narrative review article describes the potential of such technologies and their possible future implications.

A nomogram predicting intraoperative adverse events during minimally invasive radical nephrectomy and thrombectomy.

To define the incidence and independent predictive factors of intraoperative adverse events (IOAEs) after minimally invasive radical nephrectomy and thrombectomy (RNAT) and to determine the impact of intraoperative adverse events on oncological outcomes. A total of 294 patients underwent minimally invasive RNAT from January 2010 to December 2023 in our center were included. IOAEs are defined as any deviation from the normal surgical procedure during the operation course. Multivariate logistic regression analysis was performed to identify the independent predictive factors of IOAEs. The Kaplan-Meier curves was used to compare overall survival and cancer-specific survival between patients with IOAEs or not. Seventy-four IOAEs occurred in 57 of 294 patients (19.4%) and the most frequent IOAEs were conversion to open surgery (42/74, 56.7%), followed by excessive hemorrhage (20/74, 27.0%). In multivariate logistic analysis, side (OR 0.0929; 95%Cl 0.0367-0.2160; p < 0.001), operation approach (OR 0.1762; 95%Cl 0.06828-0.4109; p < 0.001), and Mayo grade (OR 6.321; 95%Cl 3.846-11.13; p < 0.001) were independent predictive predictors of IOAEs during minimally invasive RNAT. IOAEs (OR 2.713; 95%Cl 1.242-5.897; p = 0.012) was an independent risk factor of the occurrence of postoperative complications. Between the patients with IOAEs or not, neither overall survival (OS) nor cancer-specific survival (CSS) showed statistical differences. Patients with postoperative complications show shorter OS and CSS. We found that the independent predictive factors of minimally invasive RNATwere side, operation approach and Mayo grade, and it is a risk factor of the occurrence of postoperative complications. In addition, the occurrence of IOAEs had no effect on long-term oncological outcomes.

Facial Swelling and Neuritis After Internal Carotid Endarterectomy in an 81-Year-Old Woman With Type 2 Diabetes Mellitus: A Case Report.

Patients with type 2 diabetes mellitus (DM2) may develop carotid artery stenosis (CAS), requiring surgical intervention. Nerve injury following carotid endarterectomy (CEA) is a rare and often unrecognized post-operative side effect. This case report describes the diagnostic process and rehabilitation course of a patient with greater auricular and trigeminal neuritis symptoms following internal CEA. The patient is an 81-year-old woman with DM2 who underwent a left internal CEA. She subsequently developed swelling in her left neck and face, and pain along the greater auricular and trigeminal nerve pathways. Pertinent examination findings included incision placement across the path of the greater auricular nerve and cervical lymphatic vessels that drain the face, with overlying scar adhesion. A course of physical therapy was initiated 12days after surgery, and included mobilization and manual lymphatic drainage, modalities, and application of kinesiotape. The Patient Specific Functional Scale (PSFS) improved from 10/30 at evaluation to 27/30 at discharge. Swelling and pain were significantly reduced, with patient reporting no difficulty with sleeping, chewing, or talking at discharge. The reported pain level consistently correlated with fluctuations in face swelling throughout treatment. Patients with DM2 may present with symptoms of cardiovascular disease, requiring invasive surgical procedures. DM2 can cause damage to neural and vascular structures, predisposing patients to nerve injuries or hypersensitivity following procedures. This case report demonstrates a likely connection between post-operative facial swelling and nerve irritation in the head and neck. Mobilization and manual lymphatic drainage, modalities, and kinesiotape were effective to reduce pain and swelling. Physical therapists are uniquely qualified to identify, evaluate, and treat post-operative swelling and nerve pain associated with CEA.

The Experience of a Tertiary Referral Center with Endoscopic Management and Combining Percutaneous Intervention for the Treatment of Walled-Off Necrosis: A Stepwise Approach

Background: This study aimed to assess the effectiveness and safety of endoscopic management in patients with walled-off necrosis and additionally explore the results of a stepwise approach for combining percutaneous intervention in cases where endoscopic management was inadequate. Methods: We included cases of endoscopic management for walled-off necrosis between February 2019 and December 2023. Results: Endoscopic management was performed in 11 patients. The median largest dimension was 150 mm. Multiple cavities were present in four patients. Technical success was 90.9%, while clinical success with only endoscopic management was 36.3%. Clinical success could not be achieved with only endoscopic management in patients with a large diameter (≥125 mm) or multi-lobulated walled-off necrosis. Combining percutaneous intervention resulted in success for all patients. Two patients experienced major complications: one suffered from major bleeding, while the other experienced perforation, necessitating surgical intervention. The patient with perforation died due to multi-organ failure. Conclusions: Endoscopic management is recommended as the primary treatment method for walled-off necrosis due to its less invasive and higher safety profile. In cases involving large or multi-lobulated walled-off necrosis where clinical success cannot be achieved, combining percutaneous intervention is highly successful and safe. Ultimately, this approach can minimize the need for more invasive surgery.

Outcome research on esophagectomy analyzed using nationwide databases in Japan: evidences generated from real-world data.

Esophagectomy for esophageal cancer is a highly invasive gastrointestinal surgical procedure. The National Clinical Database (NCD) of Japan, initiated in 2011, has compiled real-world data on esophagectomy, one of nine major gastroenterological surgeries. This review examines outcomes after esophagectomy analyzed using the Japanese big databases. Certification systems by the Japanese Society of Gastroenterological Surgery (JSGS) and the Japan Esophageal Society (JES) have shown that institutional certification has a greater impact on short-term surgical outcomes than surgeon certification. Minimally invasive esophagectomy has emerged as a viable alternative to open esophagectomy, although careful patient selection is crucial, especially for elderly patients with advanced tumors. The NCD has significantly contributed to the assessment and enhancement of surgical quality and short-term outcomes, while studies based on Comprehensive Registry of Esophageal Cancer in Japan (CRECJ) have provided data on patient characteristics, treatments, and long-term outcomes. The JES has conducted various questionnaire-based retrospective clinical reviews in collaboration with authorized institutions certified by JES. The Diagnosis Procedure Combination (DPC) database provides administrative claims data including itemized prices for surgical, pharmaceutical, laboratory, and other inpatient services. Analyzing these nationwide databases can offer precise insights into surgical quality for esophageal cancer, potentially leading to improved treatment outcomes.

Photobiomodulation Therapy for Improvement of Body Contour: A Retrospective Study on Middle Eastern Participants.

The rising demand for body contouring and concerns about side effects of invasive surgical procedures have led to advances in providing new non-invasive alternative methods for weight reduction. The current retrospective study investigated the safety and efficacy of photobiomodulation technology in reducing local obesity in Middle Eastern participants. Providing data about body circumferences of 30 participants, with body mass index (BMI) >28 and localized obesity in the abdomen, thighs, buttocks, or arms were included in the final data synthesis. All the records were received at least 4 treatment sessions with the photobiomodulation technology (Volcano device) in Center for Research and training in Skin Diseases and Leprosy (CRTSDL) during June 2022-September 2022 Reductions in body standing circumferences as well as reported adverse effects and participants' satisfaction were retrospectively evaluated and reported. . The extricated data included 30 females participants aged 42.06 ± 11.6 years and localized obesity in the abdomen (15 cases), thighs (7 cases), hip (one case) and arms (7 cases). While BMIs were not significantly different from the baseline, abdominal, arm and tight circumferences showed a significant decline after receiving 4 and 6 treatment sessions (P<0.01).. There was no report of adverse effect and overall satisfaction was an "excellent" grade. This study demonstrated the effectiveness and safety of photobiomodulation in reduction of circumferential size in abdomen, buttock, thigh, and arm areas in Middle Eastern participants with high patient satisfaction and acceptable safety profile.

Revolutionizing orthodontics: Effective management of Class III skeletal malocclusion using innovative buccal shelf bone screws

The advent of the temporary anchorage devices has revised the envelope of discrepancy in modern orthodontic practice. Orthodontic camouflage is opted in situations where the patient is reluctant to have an invasive orthognathic surgical procedure and the associated risks or where, by the use of temporary anchorage devices, the orthodontic envelope can be expanded, and optimal orthodontic result can be obtained non surgically. In such cases, TAD’s can be used to obtain an acceptable orthodontic result with a cusp to fossa posterior relation, an optimal aesthetic outcome, and a functional occlusion. This case report showcases a camouflage treatment of a Class III non-growing patient treated by use of TAD’s, to cause clockwise rotation of maxillo- mandibular occlusal complex for achieving optimum molar relation, facial esthetics, and function.A case of skeletal and Angle’s Class III malocclusion is presented where orthodontic camouflage was carried out to deliver optimal orthodontic results. This was achieved effectively by in toto distalization of the lower arch. This was brought about with the use of two extra alveolar TAD’s placed in the buccal shelf region of the lower arch. Two 2 x 12 mm bone screws were used, after space creation by extraction of lower third molars bilaterally, and elastic chains was the chosen force delivery system. Here in toto distalization of the lower arch was achieved to end in an Angle’s class I molar and canine relationship with normal overjet and overbite. Total treatment duration was of 17 months.Challenging skeletal malocclusions can be treated non surgically by effective use of TAD’s and correct and efficient use of biomechanics.

Peripheral extracorporeal membrane oxygenation in perioperative medicine : Principles, indications and challenges

In recent years the number of patients treated in intensive care units by extracorporeal membrane oxygenation (ECMO) due to severe respiratory failure or cardiogenic shock has steadily increased [1]. Consequently, the number of invasive procedures and operations in these patients has also increased. Afundamental understanding of these systems and the clinical indications is therefore helpful for the practicing (non-cardiac) surgeon. This review article focuses on peripheral ECMO procedures: venovenous (V-V) ECMO for patients with respiratory failure and venoarterial (V-A) ECMO for circulatory support in cardiogenic shock.

Immunohistochemical study of hormone receptors in endometrium with abnormal uterine bleeding

In the case of AUB, estrogen and progesterone exert their effects by acting on specific nuclei. Receptor proteins such as estrogen receptor (ER) and progesterone receptor (PR). And periodic changes in its expression have been shown in human uterine tissue. Immunohistochemistry (IHC). Immunohistochemistry using specific monoclonal antibodies estimate the content of the receptor at the cellular level and interpret their exact location and distribution.A two-year descriptive study was conducted. There were a total of 50 cases clinically diagnosed with AUB who underwent hysterectomy and endometrial curettage, and 20 non-AUB controls were included in this study. IHC was performed for ER and PR receptors in all cases and controls.The age range was 29 to 65 years and the average age of the patients was 43.21 years. Out of 50 patients, 26 were pre-menopausal and 24 were post-menopausal, and the mean hemoglobin, fertility and bleeding duration were 10.34 g/dL, 2.8 and 8.4 days per cycle. The average thickness of the endometrium was 10.5 mm in the cases and 6.25 mm in the control group. Increasing endometrial thickness was statistically significantly related to AUB and increased ER and PR HSCORE in stroma and glands (p&amp;#60;0.001). In terms of histomorphology, the highest number of cases was endometrial hyperplasia without atypia (27 cases), followed by early proliferative phase (7 cases). ER expression was more abundant in glands and PR expression was more in stroma. In endometrial hyperplasia with atypia, the expression of ER and PR was higher than in other endometrial stages.In addition to pelvic ultrasound and histology, immunohistochemistry. ER and PR have the advantage of allowing these hormone receptors to localize to the tissue.Endometrial aspiration samples and anxiliary tests in patient treatment allong with AUB. Endometrial hyperplasia is more common in patients with AUB. The concentration of estrogen and progesterone receptors is significantly higher. Therefore, the location and concentration of ER and PR receptors increases and this makes it possible for targeted therapies and avoid invasive surgical procedures using selective progesterone receptor modulators and progesterone antagonists in the treatment of patients with AUB and endometrial hyperplasia.

Endoscopic detorsion of sigmoid volvulus in a young female: a case report

BackgroundA volvulus refers to the torsion or rotational twisting of a portion of the gastrointestinal tract, with a predilection for impacting the caecum and sigmoid colon, often resulting in the development of bowel obstruction. The risk factors associated are old age, chronic fecal impaction, psychiatric disorders, colonic dysmotility, prior abdominal surgical procedures, diabetes, and Hirschsprung's disease. Elderly are most commonly affected with sigmoid volvulus but there are few cases among young adults that culminate in grave complications. Although it is rare, but young individuals presenting with acute abdomen secondary to sigmoid volvulus need urgent attention. To prevent more invasive surgical procedures, endoscopic detorsion is preferred nowadays with complete recovery of patients. We present a case of young female who was successfully managed with endoscopic detorsion.Case presentation27 years old Asian Pakistani female presented with worsening abdominal distention, constipation and vomiting since 2 days. On examination she was afebrile, vitally stable. Abdomen was distended, tympanic percussion with generalized tenderness. Abdominal radiograph was obtained which showed dilated bowel loops followed by Computed tomography of abdomen which was suggestive of Sigmoid volvulus causing intestinal obstruction. Patient was immediately moved to endoscopy unit and endoscopic detorsion of volvulus was done. For individuals who present with sigmoid volvulus and do not exhibit signs of peritonitis or colonic gangrene, the recommended course of action involves acute endoscopic detorsion, followed by scheduled surgical intervention.ConclusionThis case report emphasizes the significance of clinicians considering sigmoid volvulus as a rare but important cause when evaluating abdominal pain in young and otherwise healthy patients. A delay in diagnosis and treatment extending beyond 48 hours leads to colonic necrosis, amplifying the associated morbidity and mortality. Swift intervention is imperative to mitigate these complications and attain a conclusive remedy.