Necrotic Part Research Articles

Rectum necrosis in a patient with severe COVID19 infection after CAR-T therapy: a case report

BackgroundCoronavirus disease 2019 (COVID19) can cause gastrointestinal complications as well as respiratory tract disease. Coagulation abnormalities and thrombosis frequently occur in COVID19, especially in cases with severe clinical outcome. The relationship between gastrointestinal perforation and coagulopathy due to COVID19 remains unclear.Case presentationA 49-year-old female received Chimeric antigen receptor T (CAR-T) therapy for an early recurrence of diffuse large B-cell lymphoma (DLBCL) that was refractory to chemotherapy. She was diagnosed with cytokine release syndrome (CRS) because of a fever and oxygen desaturation, and administered tocilizumab. Forty days after completing CAR-T therapy, she was infected with COVID19 and transferred to our hospital. Her general condition worsened and she developed COVID19 pneumonia, and then steroid pulse therapy was started. While her respiratory condition improved, she experienced pain in the anal region and computed tomography (CT) revealed a rectal perforation. An emergency surgery was undertaken, and the lower rectum wall was found to be completely necrotic. Removal of the necrotic part of the rectum tissue, and drainage and lavage of necrotic tissue in the pelvic cavity were performed. The remaining rectum was resected with partial sigmoidectomy, but we could not make the anal stump closed. In addition, an end colostomy in the sigmoid colon was performed. Histopathological findings showed thromboses in the rectal mesentery veins. After the first surgery, the pelvic abscess cavity persisted and her high-grade fever continued. Reoperation was laparoscopically performed, and she underwent a resection of anal canal with residual necrotic rectal and mesorectal tissue, and a drainage of the pelvic abscess. After the reoperation, her general condition improved and CT showed that the abscess cavity had significantly improved.ConclusionsGastrointestinal perforation, especially rectal necrosis due to coagulopathy caused by severe COVID19 infection, is a rare but life-threatening complication. Physicians should have a high degree of clinical suspicion for timely diagnosis and management, and surgical intervention is necessary in cases of rectal necrosis.

Multiscale segmentation net for segregating heterogeneous brain tumors: Gliomas on multimodal MR images

In this research, the 3D volumetric segmentation of heterogeneous brain tumors such as Gliomas- anaplastic astrocytoma, and Glioblastoma Multiforme (GBM) is performed to extract enhancing tumor (ET), whole tumor (WT), and tumor core (TC) regions using T1, T2, and FLAIR images. Therefore, a deep learning-based encoder-decoder architecture named “MS-SegNet” using 3D multi-scale convolutional layers is proposed. The proposed architecture employs multi-scale feature extraction (MS-FE) block the filter size 3 × 3 × 3 to extract confined information like tumor boundary and edges of necrotic part. The filter of size 5 × 5 × 5 focuses on varied features like shape, size, and location of tumor region with edema. The local and global features from different MR modalities are extracted for segmenting thin and meshed boundaries of heterogeneous tumors between anatomical sub-regions like peritumoral edema, enhancing tumor, and necrotic tumor core. The learning parameters on introducing the MS-FE block are reduced to 10 million, which is much less than other architectures like 3D-Unet which takes into consideration 27 million features leading to the consumption of less computational power. A customized loss function is also prophesied based on a combination of dice loss and focal loss along with metrics such as accuracy and Intersection over Union (IoU) i.e. the overlapping of ground truth mask and predicted value for addressing the class imbalance problem. For evaluating the efficacy of the proposed method, four evaluation metrics such as Dice Coefficient (DSC), Sensitivity, Specificity, and Hausdorff95 distance (H95) are employed for analyzing the model's overall performance. It is observed that the proposed MS-SegNet architecture achieved the DSC of 0.81, 0.91, and 0.83 on BraTS 2020; 0.86, 0.92, and 0.84 on BraTS 2021 for ET, WT, and TC respectively. The developed model is also tested on a real-time dataset collected from the Post Graduate Institute of Medical Education & Research (PGIMER), Chandigarh. The DSC of 0.79, 0.76, and 0.68 for ET, WT, and TC respectively on the real-time dataset. These findings show that deep learning models with enhanced feature extraction capabilities can be readily trained to attain high accuracy in segmenting heterogeneous brain tumors and hold promising results. In the future, other tumor datasets will be explored for the detection and treatment planning of brain tumors to check the effectiveness of the model in real-world healthcare environments.

Some Numerical Results on Chemotactic Phenomena in Stem Cell Therapy for Cardiac Regeneration

Biological models for cardiac regeneration and remodeling, along with the effects of cytokines or chemokines during the therapy with mesenchymal stem cells after a myocardial infarction, are of crucial importance for understanding the complex underlying mechanisms. This paper presents a mathematical model composed of three coupled partial differential equations that describes the dynamics of stem cells, nutrients and chemokines, highlighting the fundamental role of the chemokines during the myocardial tissue regeneration process. The system is solved numerically using mimetic difference operators and the MOLE library for MATLAB. The results show the tissue regeneration process in the necrotic part closest to the cell implantation area.

The Webspace Toe Fillet Flap: A Variant Fillet Flap for Wound Closure After Asymmetric Amputation of 2 Adjacent Toes

Wound closure after toe amputation for dysvascular necrosis of the toes extending proximally to the metatarsophalangeal joint could be challenging. When necrosis asymmetrically involves 2 adjacent toes, the healthy tissue of the partially necrotic toe could be used as a spare part for surgical wound closure after amputation. This paper reports a variant of the toe fillet flap, the webspace toe fillet flap, which could be performed when facing this clinical situation. After the amputation of the totally necrotic toe at the metatarsophalangeal joint level, the necrotic part of the partially necrotic toe is removed while preserving all the proximal healthy soft tissue, including the neurovascular elements. Therefore, closure is achieved using an axial-pattern digital flap rather than a random flap. In some instances, when necrosis is more distal, the proximal phalanx could be preserved and used as a spacer in the webspace that could possibly avoid lateral clawing of the remaining toes. The webspace toe fillet flap could be an excellent solution for wound closure after asymmetric amputation of 2 adjacent toes. Levels of Evidence: Level V, expert opinion.

Acute ischemic instructions due to the new coronavirus infection

The study included 23 patients with acute intestinal ischemia. The average age of the patients was 59,9 ± 15,0 years, the male prevailed — 17 men (73.91 %) vs. 6 women (26.09 %). The diagnosis of a new coronavirus infection caused by SARS-CoV-2 was confirmed in all patients by the results of PCR tests (polymerase chain reaction). All patients underwent Computed Tomography of Pregnant Women with contrast examination, which was validated by a valuable instrumental study in patients with COVID-19 with suspected acute intestinal ischemia. It was confirmed that ischemia of the small intestine is the most prominent case in surgical detection, resection of the necrotic part of the small intestine with the formation of anastomosis was the most common surgical procedure, it was performed in 14 (60,85 %) patients, in 7 (30,45 %) patients resections of the large intestine were performed, and only 2 (8,7 %) patients underwent open thrombectomy. Histopathological examination was performed in 21 patients (91,30 %), revealed general symptoms, including necrosis, ulcer, hemorrhage in 11 patients (47,82 %), neutrophilic infiltration in 7 patients (30.4 %) and abscess in 3 patients. (13,04 %). An assessment of the dynamics of blood biomarkers in patients included in the study showed a steady increase in such indicators as D-dimer, LDH, ferritin and IL-6. Because of the high incidence of GI ischemia, clinicians should always be on the lookout for this disease in order to prevent its progression and promptly treat any complications. Elevated levels of CRP, lactate and D-dimer may determine predictive value as possible prognostic factors as they can be found in any patient with severe course of COVID-19.

BIOS-02. RECAPITULATE TUMOR DIVERSION AND SPATIAL PATTERNING IN GLIOBLASTOMA BACKGROUND

Abstract BACKGROUND Intra-tumoral heterogeneity of glioblastoma multiforme (GBM) drives aggressive behavior and intrinsic therapeutic resistance. To investigate heterogeneity, high-resolution sequencing techniques provided us to feature tumor molecular subtyping and simulate differentiation. In our study, we proposed to dissect tumor heterogeneity in different anatomical regions by single cell transcriptome analysis. Material and Method We performed single-cell RNA sequencing on 10675 adult IDH-wild type GBM cells from six pairs of tumor core (central necrotic part of tumor) and tumor margin (junction between tumor and brain). Subtyping following RNA velocity was performed to investigate tumor diversity. Result Four subgroups of tumor cells (OPC-like (oligoprogenitor cell), NPC-like (neuroprogenitor cell), AC-like (astrocyte), and MES-like (mesenchymal) )were identified. The higher cell population of OPC/NPC at tumor margin and AC/MES at tumor core was found. The RNA velocity analysis showed the major diversity order was OPC at margin, OPC at core, NPC at margin, and AC with MES at core. CONCLUSION We explore the spatial pattern of tumorigenesis of GBM that OPC at margin part could be the tumor initiating cell. Further investigation of biological characteristics of OPC could be the strategies to block tumor differentiation and progression.

ОСТРЫЕ ИШЕМИЧЕСКИЕ ПОРАЖЕНИЯ КИШЕЧНИКА НА ФОНЕ НОВОЙ КОРОНАВИРУСНОЙ ИНФЕКЦИИ

Purpose of the study. Acute ischemic intestinal (AII) lesions developed against the background of a new coronavirus infection. Materials and methods. The study included 23 patients with AII. The mean age of the patients was 59.9±15.0 with male predominance (17 males, 73.91% versus 6 females, 26.09%). The diagnosis of all patients: a new coronavirus infection caused by SARS-CoV-2 was confirmed by the results of PCR tests (polymerase chain reaction). All patients underwent computed tomography of the abdominal organs (CT of the abdominal cavity). The diagnostic algorithm was contrast-enhanced computed tomography, which is considered a valuable instrumental method of investigation in patients with COVID-19 with suspected AII. Statistical processing of the results of the study was carried out using the program STATISTICA. Results. It was confirmed that ischemia of the small intestine is the most common case in surgical examination, resection of the necrotic part of the small intestine with the formation of anastomosis was the most common surgical procedure in 14 (60.85%) patients, resections of the large intestine were performed in 7 (30.45%) patients, and only 2 (8.7%) patients underwent open thrombectomy. Histopathological examination was performed in 21 patients (91.30%) and revealed general features including necrosis, ulcer, hemorrhage in 11 patients (47.82%), neutrophilic infiltration in 7 patients (30.4%) or abscess in 3 patients (13.04%). Following the dynamics of changes in blood biomarkers in patients included in this study, we can conclude that there were such changes in biomarkers as a persistent increase in blood biomarkers evaluated in this study, such as D-dimer, LDH, ferritin and IL-6. Conclusion. Because of the high mortality rate in GI ischemia, clinicians should always be alert for ischemia to prevent its progression and promptly treat any complications. If patients have clinical signs of peritonitis, regardless of the presence of concomitant pathology, an immediate operation should be performed to eliminate the source of infection in the abdominal cavity. Changes in biomarkers and elevated levels of CRP (C-reactive protein), lactate, and D-dimer may be of low predictive value as possible prognostic factors because they may be found in severe COVID-19 infection.

Characterization of hazelnut kernel responses to brown marmorated stink bug [Halyomorpha halys Stal (Hemiptera: Pentatomidae)] infestations: Changes in bioactive compounds and fatty acid composition

The brown marmorated stink bug (BMSB) (Halyomorpha halys Stal) has become a global threat to hazelnut yield and quality in the last decade by establishing a considerable population in hazelnut orchards in some countries. For the first time ever, we conducted an analysis on metabolic response of a necrotic hazelnut kernel, which is one of the most important damage types caused by BMSB feeding. In the present study, we investigated how hazelnut kernels respond to BMSB infestations in terms of the individual phenolics and fatty acid compositions in four different kernel types [i.e., control/healthy kernel (HK), whole of damaged kernel (WDK), healthy part of damaged kernel (HPDK), necrotic part of damaged kernel (NPDK)]. Individual phenolics were significantly affected by BMSB. Especially, epicatechin and catechin from flavan-3-ols, rutin from flavonol, and caffeic from phenolic acids increased significantly in kernel injured by BMSB. Major fatty acids were significantly affected by BMSB, except for palmitic. Oleic acid decreased in kernel injured by BMSB (WDK, HPDK and NPDK) compared with the HK, while palmitic, stearic, and linoleic acids increased. As from our results, it was revealed that BMSB affected the secondary metabolites in hazelnut and had a remarkable effect on epicatechin, rutin, caffeic acid and p-coumaric acid.

First Report of Target Spot Caused by Rhizoctonia solani AG-5 on Tobacco in China.

Tobacco is one of the vital economic crops in China. Nevertheless, tobacco diseases cause substantial economic losses each year. Tobacco target spot is a fungal disease which commonly found on the leaves. While both sexual and asexual reproduction can occur, asexual reproduction is much more common in tobacco. In June 2022, target spot was found on tobacco leaf samples from Yibin, Sichuan Province and Meitan, Guizhou Province, China. The typical symptoms were light brown tissue with concentric ring marks, and the necrotic part of the disease spot was fragile and forming perforation after falling off. The diseased tissue in the sample was cut off and sterilized in 75% ethanol for 1 min, and rinsed three times in sterilized distilled water. Finally, the tissues were placed on potato glucose agar (PDA) medium with kanamycin (0.1 mg/mL). After incubation at 28 °C in darkness for 3 days,the culture of the isolate grew in the form of radial mycelium on PDA dishes, the mycelium was white initially, turned brown generally at the later stage, and finally thickened and separated with the growth of the culture. Nine pathogenic strains were isolated, including four isolates from Yibin and five from Meitan. They were all used for pathogen identification. Genomic DNA of each isolate was extracted using the CATB method, and PCR analysis was performed with primers specifically designed to detect individual fusion groups or fusion subgroups of solani: AG-1 IA, IB, and IC; AG-3 PT; AG-4 HG-I, HG-II and HG-III; AGs-5-6 and P-21-22. Among the 11 specific primer pairs, only AG-5-specific primer amplified the fungal DNA, indicating that the nine isolates tested all belonged to the R. solani AG-5 fusion group. BLASTn search was performed on the gene sequences obtained from these strains and they deposited in GenBank under accession no. OP647851-OP647859. These gene sequences were aligned with the voucher specimen R. solani AG-5, with more than 99% similarity . The nine isolates were then tested for mycelial anastomosis reactions using the R. solani AG-5 standard strain following the method described by Ogoshi (1987). A decrease in the diameter of the mycelia at the anastomosis site and death of adjacent cells were observed, indicating their anastomosis response. Therefore, these nine strains were identified as R. solani AG-5 based on morphological and genetic analysis. Subsequently, one pathogenic strain from Meitan and another one from Yibin were selected for pathogenicity verification. Mycelial PDA blocks (6 mm in diameter) of the two isolates were inoculated on healthy tobacco plants, while leaves containing only PDA blocks were used as controls. A total of 6 replicates were conducted. After inoculation, they were incubated at 85% relative humidity and 15 to 25 °C. Koch's hypothesis was confirmed by reisolating pathogens from diseased leaves 5 days after inoculation. Typical symptoms were observed on tobacco plants inoculated with the pathogen strains but not on control tobacco plants. To the best of our knowledge, tobacco target spot has been reported caused by R. solani AG-3, AG-6 and AG-2.1 groups in the field in China and in Argentina. Up until now, this is the first report of R. solani AG-5 causing tobacco target spot on tobacco in the field in China. It was also found to be highly virulent to chickpea in Turkey. Due to serious damages caused by this disease in the last five years in China, more attention should be paid in disease control measures to avoid economic losses. In addition, it also provides some theoretical help for the damage caused by this pathogen on other hosts and helps people to better understand Rhizoctonia solani AG-5.

Diagnosis and Treatment of Vesico-Peritoneal Fistula after Robotic Surgical Treatment of Deep Endometriosis

<h3>Study Objective</h3> Demonstrate the diagnosis and surgical treatment of vesico-peritoneal fistula after robotic surgical treatment of deep endometriosis. <h3>Design</h3> Case report illustrated with a video. <h3>Setting</h3> Patient is placed in the semi-gynecological position on both surgical approaches. <h3>Patients or Participants</h3> A 38-year-old woman reports right iliac fossa pain, dysuria, and deep dyspareunia for 4 years. A 3 cm hard and painful nodule was palpable in the right iliac region of abdominal wall. MRI shows a 3.0 × 1.4 × 1.3 cm retrocervical lesion and irregular thickening of the uterosacral ligament insertion, suggestive of deep endometriosis. A 2.7 cm endometrioma on left ovary. And a 6 × 3 × 1.5 cm intramuscular nodule on the inferior abdominal aspect that affects virtually the entire muscle thickness. <h3>Interventions</h3> Robotic-assisted laparoscopic resection of pelvic endometriosis and abdominal wall nodules, with abdominal mesh placement. On the 7th postoperative day, the patient developed acute abdominal pain due to abdominal wall abscess and bladder catheter mechanical obstruction. Collection drainage was US-guided, but patient kept having recurrent urinary tract infections. CT showed a fistulous path communicating the bladder dome and the extraperitoneal space, and cystoscopy confirmed the fistula. Robotic-assisted laparoscopy was performed, Retzius space was developed for better exposure of the bladder and fistulous tract, with subsequent resection of the fistula and partial cystectomy with resection of the necrotic segment and part of synthetic mesh. <h3>Measurements and Main Results</h3> We obtained efficient diagnosis and treatment. The patient had complete resolution of the symptoms. <h3>Conclusion</h3> Vesico peritoneal fistula is a rare entity of epithelialized communication between peritoneal cavity and bladder, and it is usually associated with postoperative complications. As it has no specific symptoms, diagnosis is difficult.

A Case Study on Anaesthesia of a Patient with Pancreatic Necrosis in Bangladesh

Acute pancreatitis causes devastating changes in body involves organ dysfunction, metabolic imbalance, electrolyte disturbance as well as acid base disorder. Pancreatic necrosis complicates the condition. Patient may develops systemic inflammatory response syndrome (SIRS) followed by sepsis. Laparotomy and removal of necrotic part along with peritoneal toileting is the surgical management. We present a case of a 45 years old male admitted with a diagnosis of pancreatic necrosis is scheduled for exploratory laparotomy followed by peritoneal toileting along with excision of necrotic portion. Maintaining a smooth anesthesia is a challenge during surgery. Disease and its complications along with surgery produce extreme condition for anesthesiologist. Patient sometimes response badly therefore may need postoperative intensive care support. Meticulous fluid administration, inotrope support, choice of proper intraoperative drugs, monitoring vital signs including urine output, blood gas analysis- these should be focused during anaesthesia

Femoral head reduction osteotomy to improve femoroacetabular containment in Legg-Calve-Perthes disease

OperationszielWiederherstellung der Hüftkongruenz und des Containments durch zentrale Hüftkopfresektion/Reduktion über eine erweiterte chirurgische Hüftluxation unter Erhaltung/Respektierung der Hüftkopfdurchblutung. Eine gleichzeitige oder spätere Reorientierung des Acetabulums durch Triple-Osteotomie oder PAO bei instabiler Hüfte kann in speziellen Fällen notwendig werden.IndikationenDie Indikation zur chirurgischen Hüftkopfreduktion ist praktisch unabhängig vom Alter bei jeglicher inkongruenten, asphärischen Hüftkopfsituation mit „hinged abduction“ (zu erwartende Endsituation wie Stulberg IV und V) gegeben. Dies kann noch bei aktivem wie auch bei bereits ausgeheiltem Morbus Perthes der Fall sein. Zudem kann bei einer Stulberg-V-Situation selbst im adulten Alter noch eine Verbesserung erziel werden. Nach Resektion muss noch ein tragfähiger Resthüftkopf vorhanden bleiben, d. h. mindestens noch 50 % des ausgeweiteten Hüftkopfes. Die dafür beste Planung erfolgt in der „vergleichenden“ 3‑D-Rekonstruktion.KontraindikationenVöllig zerstörter Knorpel oder Hüftkopf.OperationstechnikIdentisches Operationsvorgehen wie für die klassische chirurgische Hüftluxation. Präparation der retinakulären Flaps. Unter Respektierung und in Kenntnis der Gefäßversorgung Spaltung des Hüftkopfes gemäß dem zu entfernenden, nekrotischen Kopfanteil. Bildung eines möglichst sphärischen Hüftkopfes und Verschraubung der beiden Kopfanteile auf Schenkelhalsniveau. Distalisation und Fixierung des großen Trochanters. Je nach Kongruenz und Stabilität des Hüftkopfs in der Hüftpfanne kann eine primäre oder sekundäre Triple-OT oder PAO notwendig werden.WeiterbehandlungDie intraoperative Stabilität des Femurkopfes im Acetabulum muss erzielt worden sein, um eine beckengipsfreie, funktionelle Nachbehandlung zu gewährleisten: Stockentlastung mit Bodenkontakt ist erlaubt; keine aktive Rotation; Flexion aktiv und passiv bis 90 Grad ist erlaubt; vorerst keine spezifische Physiotherapie; je nach Heilungsverlauf sind diese Maßnahmen 8 bis 10 Wochen einzuhalten.ErgebnisseGemäß unseren publizierten Nachuntersuchungen (aktuell 21 Jahre) sehen wir bei technisch korrekt durchgeführter Operation und korrekter Indikation sowie adäquater Nachbehandlung durchwegs gute Ergebnisse. Nekrosen des reduzierten Hüftkopfs haben wir nie beobachtet. Alle gespaltenen Hüftköpfe, respektive Schenkelhälse sind primär geheilt.

Chronic gastric dilatation with gastric fundus perforation in anorexia nervosa patient

IntroductionAs a complication of anorexia or bulimia nervosa, gastrointestinal problems such as stomach dilatation and necrosis are extremely rare. Our purpose is this case to pay attention on anorexia and bulimia patients to envisage the occurrence of chronic digestive injuries by performing the accurate diagnosis and selective prompt treatment.Case presentationA 40-year old female patient admitted to the emergency department with complaints of digestive symptoms. In his history there was just anorexia nervosa. Computed tomography and X-rays showed major gastric distension reaching the pelvis and perforation of the fundus. The large curvature of the stomach and the necrotic part was removed surgically. But the patient died in the second day after admission in the hospital because he was affected by a septic shock as a complication of distribution the infection because the doctors didn't resect whole the stomach during the open surgery.DiscussionWe report a rare case that shows gastric dilatation and necrosis post-anorexia nervosa, which requires accurate X-ray and CT scan, but treatment depends on whether or not gastric necrosis is present and the size of the necrosis. According to what mentioned in the medical literature this is the second case that cause death of the patient after surgery for treatment the gastric dilatation as a complication of anorexia nervosa.ConclusionThe thing that distinguishes this case is the large size of the extension of the stomach from the diaphragm to the pelvis and the perforation of the fundus with a diameter of 5 cm and the death of the patient after surgery, so we can add it in the medical literature to avoid the complications of these psychiatric diseases.

A rare complication of circumcision due to monopolar cauterization: Penile necrosis

Penile necrosis due to monopolar cauterization during circumcision is a rare complication and may cause organ loss. When monopolar cauterization applied on an end-organ, current flows through the organ and, causes disruption of blood flow and oxidative stress. Penile injury may include skin, glans and cavernous bodies. Injury can be limited with the help of medical treatment and hyperbaric oxygen treatment, but eventually the need for reconstruction arises. Some case reports of application of feminizing genitoplasty after total organ loss are present on the literature. However, lengthening of penis via dissection of cavernous bodies and application of skin graft seems more appropriate as a method of reconstruction. At this case report, three-year old male who had penile necrosis after having circumcised at another center will be discussed under the light of current literature. As soon as the patient was hospitalized, medical treatment and hyperbaric oxygen treatment started. However circulation of the necrotic tissue didn’t improve and necrotic part of the penile skin, glans and cavernous bodies were debrided. After the debridement, two centimeters of cavernous body remained. Once tissues recovered, as a second operation, cavernous bodies were dissected through pubic arms and skin graft was applied. As a result, five centimeters of penile body was achieved. Post-operatively no problem was encountered and patient was discharged 23 days after circumcision.

A rare complication of circumcision due to monopolar cauterization: Penile necrosis

Penile necrosis due to monopolar cauterization during circumcision is a rare complication and may cause organ loss. When monopolar cauterization applied on an end-organ, current flows through the organ and, causes disruption of blood flow and oxidative stress. Penile injury may include skin, glans and cavernous bodies. Injury can be limited with the help of medical treatment and hyperbaric oxygen treatment, but eventually the need for reconstruction arises. Some case reports of application of feminizing genitoplasty after total organ loss are present on the literature. However, lengthening of penis via dissection of cavernous bodies and application of skin graft seems more appropriate as a method of reconstruction. At this case report, three-year old male who had penile necrosis after having circumcised at another center will be discussed under the light of current literature. As soon as the patient was hospitalized, medical treatment and hyperbaric oxygen treatment started. However circulation of the necrotic tissue didn’t improve and necrotic part of the penile skin, glans and cavernous bodies were debrided. After the debridement, two centimeters of cavernous body remained. Once tissues recovered, as a second operation, cavernous bodies were dissected through pubic arms and skin graft was applied. As a result, five centimeters of penile body was achieved. Post-operatively no problem was encountered and patient was discharged 23 days after circumcision.

Small cell neuroendocrine carcinoma of the uterine cervix (SCNEC): a case report and review

Objective: Improving skill and knowledge to diagnose and manage a rare case of small cell neuroendocrine uterine cervical cancer&#x0D; Method: a Case report&#x0D; Result: A 51 years old, para 2, Indonesian woman with chief complaint post-coital vaginal bleeding. Gynecology examination revealed cervical exophytic fragile mass size 3x3x3,5 cm, easily bleeding, with a necrotic part, infiltrated both parametria but not reach the pelvic wall correspond to stage IIB. Initially, the histopathology result from punch biopsy was an adenocarcinoma well-differentiated, with no lymph vascular invasion, DD/ adenosquamous, neuroendocrine tumor. We did the histopathology review continued with immunohistochemistry examination. Immunohistochemistry result showed that although all the sample was not typical, immunohistochemical outward patterns can support morphological features of high-grade neuroendocrine carcinoma, small cell type. We proceed here for chemoradiation therapy.&#x0D; Conclusion: Small cell neuroendocrine carcinoma of the uterine cervix is a rare case. Histopathology and immunohistochemistry examination has an important role to develop the diagnosis. Although the prognosis is poor, adjuvant chemotherapy or chemoradiation was associated with improved survival in patients with advance staged.&#x0D; Keywords: SCNEC, immunohistochemistry, chemoradiation

CIRUGÍA DE CÁNCER DE PULMÓN EN ESTADIO TEMPRANO EN LESIÓN CAVITARIA QUE SIMULABA ABSCESO PULMONAR, REPORTE DE CASO.

Introduction Pulmonary cavitations are defined as a space filled with air, within a pulmonary area of consolidation, a mass or a nodule, they are produced by the expulsion or drainage of the necrotic part of the lesion through the bronchial tree. The most frequent causes are infectious by mycobacteria as in tuberculosis, or bacteria as in necrotizing pneumonia, pulmonary abscesses, although on rare occasions, it can also present in pulmonary embolism with infarction. Neoplasms should always be suspected, being squamous cell carcinoma the one that has been related to a greater extent to pulmonary cavitary lesion, and to a lesser extent to adenocarcinoma. Other less frequent causes are granulomatosis with polyangiitis, lymphomas, pneumoconiosis, silicosis. Case description Patient with respiratory symptoms of one year of evolution, characterized by cough with sporadic yellowish expectoration plus chest pain, in 03/2020 is accompanied by hemoptysis and progressive dyspnea, without weight loss or fever, private physician indicates antibiotic with partial improvement; On 08/2020 she presented hemoptysis, she went to the doctor again and requested a tomographic study in which she showed evidence of pulmonary cavitation associated with consolidation, a new antibiotic scheme was administered, without improvement, and she went to this clinic on 11/2020. New tomographic study showed cavitation with thick walls, preserved renal and hepatic function, infectious profile and negative immunological tests. Bronchoscopy with BAL cytology positive for malignancy, simple and contrasted body tomography and PET SCAN were indicated, showing hypermetabolic mass in the right lower lobe, with no evidence of distant metastasis or affected lymph nodes. Pulmonary function is assessed for surgical resolution, being adequate, right lower lobectomy is performed, showing free surgical edges, with negative regional nodes for malignancy, with pathology reporting lung adenocarcinoma, pathological staging T3N0, and according to the imaging study M0, determining stage IIB. He required chemotherapy and adjuvant radiotherapy. Conclusion Lung cancer symptomatology can be silent and mainly non-specific, in the study by Bradley et al. addressing lung cancer risk by symptomatology and by chest radiography, they conclude that chest radiography has limited sensitivity and that only hemoptysis has a statistically significant predictive value for malignancy. In relation to cavitated lesions as a presentation in lung cancer, they are evidenced in 5 to 15% of all patients. Within primary neoplasms the frequency with which we can observe cavitation of the lesion is related to the histological subtype, it is more frequent in squamous carcinomas (9-38%), rarer in adenocarcinomas (6-15%) and large cell carcinoma, and practically rules out small cell carcinoma. As conclusions, multidisciplinary management allows adequate orientation in both the diagnostic and therapeutic algorithm of patients, which will improve patient survival.

Versatility Of The Superior Lateral Genicular Artery Perforator Flap For Coverage Of Soft Tissue Defects Around The Knee

Background: Coverage of soft tissue defects around the knee is a reconstructive challenge. The superior lateral genicular artery perforator (SLGAp) flap provides an excellent alternative to muscle and musclocutaneous flaps with less morbidity, for coverage of these defects, especially when the gastrocnemius muscle flap is not available. The vascular basis of this flap, SLGA perforators, have consistent and reliable anatomy.Aim of The Study: This study is a retrospective analysis of our clinical experience with the superior lateral genicular artery perforator flap for coverage of soft tissue defects of the kneePatients and methods: This study was done at The Department of Plastic and Reconstructive Surgery, Menofia University Hospitals, from January 2017 to November 2018, with follow up period of 12 months. It included 7 patients, 6 males, and 1 female, with their age ranged from 19 to 46 years. The around-knee defects were due to different etiologies, 1 patient due to shotgun, 1 patient with post-burn contracture of the lateral popliteal fossa, and 5 patients with traffic accidents. The defects were reconstructed by the superior lateral genicular artery perforator (SLGAp) flap.Results: all flaps survived, except in 2 cases, 1 case managed conservatively and healed well, and in the second, the necrotic part was debrided and skin grafted. The donor site was closed primarily in 2 cases and skin grafted in 5 cases. Skin graft take was perfect, except in 3 cases with minor patches of graft loss and healed spontaneously. Infection around the defect site occurred in 2 cases and managed conservatively. The flap provided stable and durable coverage with minimal donor site morbidity and no functional loss.Conclusion: The superior lateral genicular artery perforator flap is a versatile option for reconstruction of soft tissue defects around the knee or popliteal fossa. The anatomy of the flap perforators is consistent and reliable. The flap is thin, pliable and provides stable coverage with adequate match of the surroundings. Donor site morbidity is minimal with no functional loss.Key Words: Superior lateral genicular artery_ Knee defects_ perforator flap.

Experience in treating gastrointestinal tract perforations in newborns in the Republic of Uzbekistan

Introduction. Despite of the fact that necrotic enterocolitis (NEC) is a common surgical disease in newborns, a significant breakthrough in its treatment has not been made yet.Purpose. To analyze outcomes of surgical treatment at the NEC surgical stage in newborns.Material and methods. Outcomes after surgical treatment of 71 newborns with necrotic enterocolitis at its surgical stage, who were admitted to the hospital in 2015-2020, have been analyzed.Results and discussion. Diagnostic laparoscopy (DL) was prescribed if the surgical stage of the disease was not complicated with pneumoperitonitis. 37 patients had DL; of them 11 (29.7%) had conversion to laparotomy. In 26 (70.3%) patients, diagnostic laparoscopy was ended with therapeutic laparoscopy and video-assisted mini-laparotomy; among them there were 7 (26.9%) patients in whom gastric perforation was sutured. Resection of the necrotic part of the intestine with followed end-to-end anastomosis was made in 8 (30.7%) patients; in 11 (42.3%) patients, an intestinal stoma was created. In 45 newborns with the NEC surgical stage, surgeons chose the traditional surgical tactics. 34 (75.5%) patients with diagnosed pneumoperitoneum had laparocentesis to achieve decompression; 8 (17.7%) patients out of them died. 37 (82.2%) patients had laparotomy; in 5 (11.1%) out of them stomach perforations were sutured. In 32 (71.1%) patients, intestinal stomas were created. If to compare the obtained results after video-assisted laparoscopic surgeries, the mortality rate was as follows: 6 (23.1%) patients after laparoscopic interventions and 64.4% after traditional ones.Conclusion. Diagnostic laparoscopy at the surgical stage of necrotizing enterocolitis allows to select tactics for radical surgical treatment, to transfer surgical treatment into non-surgical one, thus minimizing surgical trauma what impacts positively the postoperative survival of patients.

Clinical Profiles Of Frostbite In University Airlangga Teaching Hospital Surabaya – A Case Report

Background: We report 3 adults who suffered frostbite of the hand and face following Mount Denali Expedition (6192 meters above sea level). The patients get rewarming and analgetics as a first treatment. All cases presented to our institution on day 11th following the injury. One was performed amputation on day 71st after injury.Methods: All cases received standart antibiotic treatment as well as 3 days hospital observation. At first, no surgery were performed in any case. Regular wound evaluation and rehabilitation then managed in outpatient basis. On day 71st, amputation of 3rd and 4th finger was performed on one patient.Results: All cases showed remarkable improvements of wound epithelialization, resolution of edema, range of motion, and general condition. Demarcation of any devitalized tissue showed clear margination during the period of observation. Such a condition were found in one of the case which showed prominent necrotic part on his 3rd and 4th finger. Hence, we perform debridement and amputation of 3rd and 4th finger.Conclusions: Although frostbite is rare in tropical countries, it may happen in particular those who partake in extreme cold activity such as mountain climbing and winter sports. Prevention and the right management will ensure a good outcome. After an appropriate conservative management at the onset, surgeons must opt for surgical management provided the demarcation of the wound becomes clear. Long-term follow-up management is necessary to achieve a good functional outcome. Preservation and if necessary reconstruction of the finger should become a priority in the patient management.