Preoperative Investigations Research Articles

Double Cystic Ducts With The Single Gallbladder

Background: Cystic duct is forming one of the boundaries of triangle of cholecystectomy. The variations in cystic duct anatomy are of considerable importance during surgical excision of the gallbladder. A double cystic duct is very rare and poses a challenge for surgeons during cholecystectomy operation. If duplication of cystic ducts is present, it is associated with a double gallbladder 80% of the time. Presence of duplication of cystic duct associated with a single gallbladder is a extremely rare variant. Most of the times this variation is not picked up on routine preoperative investigations of patients planned for a laparoscopic cholecystectomy and often present as an unusual ‘surprise’ during surgery and creates a challenge to the surgeons. If they fail to identify this very rare variation they may create iatrogenic injury to these cystic ducts, which leads to bile leakage and other complications. Aim of the study: To find out the incidence of variations in the number of cystic duct in cadavers. Materials and Methods: Present study was done in 50 adult cadavers in the Department of Anatomy, Government Tiruvannamalai medical college, Tamil nadu. Meticulous dissection was done in the hepatobiliary system of these cadavers, and the variations in the number of cystic duct were noted. Observations: Presence of double cystic ducts were seen in three cadavers. Conclusion: If an anomaly of the biliary ductal system is not identified before or during surgery, it may turn out to be a bile duct injury which leads to bile leak. Hence Surgeons should keep in mind about the possibility of this rare variant double cystic ducts with a single gallbladder while performing cholecystectomy surgery. KEY WORDS: Cystic duct, Gallbladder, Cholecystectomy.

Every cloud has a silver lining: COVID-19 chest-CT screening prevents unnecessary cardiac surgery.

Unenhanced chest CT can identify incidental findings (IFs) leading to management strategy change. We report our institutional experience with routine chest-CT as preoperative screening tool during the COVID-19 pandemic, focusing on the impact of IFs. All patients scheduled for cardiac surgery from May 1st to December 31st 2020, underwent preoperative unenhanced chest-CT according to COVID-19 pandemic institutional protocol. We have analyzed IFs incidence, reported consequent operative changes, and identified IFs clinical determinants. Out of 447, 278 patients were included. IFs rate was 7.2% (20/278): a solid mass (11/20, 55%), lymphoproliferative disease (1/20, 5%), SARS-CoV-2 pneumonia (2/20, 10%), pulmonary artery chronic thromboembolism (1/20, 5%), anomalous vessel anatomy (2/20, 10%), voluminous hiatal hernia (1/20, 5%), mitral annulus calcification (1/20, 5%), and porcelain aorta (1/20, 5%) were reported. Based on IFs, 4 patients (20%-4/278, 1.4%) were not operated, 8 (40%-8/278, 2.9%) underwent a procedure different from the one originally planned one, and 8 (40%-8/278, 2.9%) needed additional preoperative investigations before undergoing the planned surgery. At univariate regression, coronary artery disease, atrial fibrillation, and history of cancer were significantly more often present in patients presenting with significant IFs. History of malignancy was identified as the only independent determinant of significant IFs at chest-CT (OR=4.27 IQR: [1.14-14.58], P=0.0227). Unenhanced chest-CT as a preoperative screening tool in cardiac surgery led to incidental detection of significant clinical findings, which justified even procedures cancellation. Malignancy history is a determinant for CT incidental findings and could support a tailored screening approach for high-risk patients.

Stone clearance by percutaneous nephrolithotomy (PCNL) in paediatric population.

Objective: To determine the stone free rate by PCNL in pediatric population. Study Design: Descriptive Study. Setting: Department of Urology & Kidney Transplantation, Faisalabad Medical University and Affiliated Hospitals. Period: July 2019 to December 2019. Material & Methods: Total 55 patients were enrolled. After history, examination, relevant pre-operative investigations and informed consent, the patients underwent standard prone PCNL, with ureteral catheter placement, system puncture under fluoroscopic/ultrasound guide, tract dilatation, nephroscopic stone manipulation and retrieval. Pre and post operative images were compared for determinations stone clearance. Other relevant data operative time, need of blood transfusion & complications were recorded. All the information was documented on a proforma. Results: In our study, of 55 cases, 87.27% (n=48) were between 2-10 years of age whereas 12.73% (n=7) were between 11-14 years of age, mean+sd was calculated as 8.44+2.31 years. 56.36% (n=31) were male and 43.64% (n=24) were female. Frequency of stone clearance was recorded in 80% (n=44) whereas 20% (n=11) didn’t stone clearance. Conclusion: Frequency of stone clearance is high with percutaneous nephrolithotomy (PCNL) in pediatric population.

White matter changes should not exclude patients with idiopathic normal pressure hydrocephalus from shunt surgery

IntroductionWhite matter changes (WMC) on brain imaging can be classified as deep white matter hyperintensities (DWMH) or periventricular hyperintensities (PVH) and are frequently seen in patients with idiopathic normal pressure hydrocephalus (iNPH). Contradictory results have been reported on whether preoperative WMC are associated with outcome after shunt surgery in iNPH patients. The aim of this study was to investigate any association between DWMH and PVH and shunt outcome in patients with iNPH, using magnetic resonance volumetry.MethodsA total of 253 iNPH patients operated with shunt surgery and clinically assessed before and 12 months after surgery were included. All patients were investigated preoperatively with magnetic resonance imaging of the brain. The volumes of DWMH and PVH were quantified on fluid-attenuated inversion recovery images using an in-house semi-automatic volumetric segmentation software (SmartPaint). Shunt outcome was defined as the difference in symptom score between post- and preoperative investigations, measured on the iNPH scale, and shunt response was defined as improvement with ≥ 5 points.ResultsOne year after shunt surgery, 51% of the patients were improved on the iNPH scale. When defining improvement as ≥ 5 points on the iNPH scale, there was no significant difference in preoperative volume of WMC between shunt responders and non-responders. If outcome was determined by a continuous variable, a larger volume of PVH was negatively associated with postoperative change in the total iNPH scale (p < 0.05) and negatively associated with improvement in gait (p < 0.01) after adjusting for age, sex, waiting time for surgery, preoperative level of symptoms, Evans’ index, and disproportionately enlarged subarachnoid space hydrocephalus. The volume of DWMH was not associated with shunt outcome.ConclusionsAn association between outcome after shunt surgery and volume of PVH was seen, but there was no difference between shunt responders and non-responders in the volumes of DWMH and PVH. We conclude that preoperative assessment of WMC should not be used to exclude patients with iNPH from shunt surgery.

Histomorphological spectrum of Phyllodes Tumours: A Restrospective Study

Abstract Introduction: Phyllodes tumours are rare fibroepithelial lesions of breast. Clinical examination, ultrasound, cytology and histopathology are the mainstay of the diagnosis. The present research was undertaken with the aim of studying the clinicopathological features of Phyllodes tumour reported in the past seven years in a Delhi government hospital. Method: A retrospective study of phyllodes tumour was carried out in females from 225 diagnosed cases of breast lesion reported in the pathology department of a government hospital in Delhi during the period of January 2013 to December2019. All the relevant history, findings of clinical examination and investigations performed were assessed from files of the patient. Results: Out of 225 cases of breast lesions reported in the pathology department 8 tumours were reported as phyllodes in the study period. The most common affected age group was 41- 50yrs. 5 (62.5 %) of 8 tumours were benign,2 (25) %) were borderline and only 1 was malignant. The tumour size was 15mm to 200mm. All the 8 cases (100%) presented with breast lump; 3 cases (30%) complained of pain in the lump. 2 cases developed ulceration and Peau D’ orange and in 1 case typical nipple retraction was seen. FNAC was done in 5 patients. No preoperative investigations were done in 2cases. Conclusion: Phyllodes tumour is a rare neoplasm of the breast. Histopathology plays an important role in differentiating it from fibroadenoma. Strict histologic assessment is definitely required for the diagnosis of the PT and for its treatment and management

Modified Tension band wiring vs Tension band with cannulated cancellous screws in treating transverse patellar fractures

Purpose: Despite being the most favoured modality of treatment in patellar fractures, modified tension band wiring (MTBW) technique has serious demerits with regards to clinical outcomes. Tension band with cannulated cancellous screws (TBCC) is a recent technique to overcome the demerits associated with former technique. This study was aimed to compare these two techniques, in terms of clinical outcomes, in treating patellar fractures. Methods: This hospital based prospective randomized study was conducted in a tertiary care hospital for 2 years. Thirty patients with Gustillo-Anderson grade 1 and 2 compound fractures were randomly divided into two treatment groups, viz MTBW and TBCC groups. After performing pre-operative investigations, patients were anesthetized, and knee was operated by the standard procedures. Post-surgery, radiographs were taken and range of motion, pain score (Visual Analogue Scale (VAS)), time taken for radiological union, clinical outcomes were recorded. Results: Mean age of the patients included in the MTBW and TBCC group were 53 years and 58.5 years, respectively. Between the groups, range of motion, IOWA score assessed at the end of 6 months, did not vary significantly (P&gt;0.05). Meanwhile, the difference noticed with average time taken for radiological union was also nonsignificant (MTBW =11 weeks. TBCC=10 weeks).

Clinical characteristics and surgical treatment of congenital cystic adenomatoid malformation in adults: the largest cohort of 46 patients.

BackgroundCongenital cystic adenomatoid malformation (CCAM) is a rare congenital malformation of the lungs, however it lacks a summary of pathognomonic clinical and imaging features in adults. Our study aims to evaluate clinical characteristics and surgical treatment in the largest case series of adult CCAM.MethodsThe records of 46 adult patients with CCAM admitted to West China Hospital between February 2009 and March 2019 were reviewed. All patients accepted the surgery and get fully recovered. Data were collected and analyzed regarding patient demographics, medical history, preoperative investigations, intraoperative findings, and postoperative outcomes.ResultsThe records of 22 men and 24 women were examined. The main systemic and respiratory symptoms included fever, productive cough, hemoptysis, and chest pain. Twenty lesions were found in the right pulmonary lobes and 26 in the left lobes. All CCAM lesions were successfully resected by surgery (35 patients had lobectomies, and the remaining 11 patients underwent wedge resections). Twenty-nine patients underwent video-assisted thoracic surgery (VATS), while 17 patients received posterolateral thoracotomy (PLT). The pathological analysis of surgical specimens revealed 26 cases of pure CCAM lesions and 20 cases of CCAM mixed with other diseases. More than 10% of patients had coexisting pre-malignant or malignant lung lesions. Four patients experienced postoperative complications. No intraoperative and postoperative deaths occurred.ConclusionsSurgical resection remains the preferred approach for adults with CCAM and has satisfied outcomes. Clinicians should be aware of possible coexisting infections and malignancies.

Feasibility of Tailored Unilateral Disconnection vs Callosotomy for Refractory Epilepsy in Patients with Bilateral Parieto-Occipital Gliosis Following Perinatal Insult.

Patients with perinatal hypoxia (PH) and drug-refractory epilepsy (DRE) often have bilateral parieto-occipital gliosis. Surgical management of such patients is a dilemma. To identify preoperative determinants for unilateral disconnection vs callosotomy, and analyze the surgical outcome in such patients. This was a retrospective analysis of patients with DRE and history of PH, with MRI abnormalities restricted to bilateral posterior quadrants. Preoperative semiology, epilepsy duration and seizure frequency were recorded. Based on the concordance between the results of non-invasive tests, patients underwent either posterior quadrant disconnection (PQD) or corpus callosotomy (CC). Preoperative variables were analyzed and corelated to the postoperative seizure freedom. Fourteen patients were identified, 6 underwent PQD and 8 underwent CC. At follow up of 39.17 ± 23.75 months, 66.66% of patients (4/6) in the PQD subgroup had an ILAE Class I outcome. While none in the CC group attained seizure freedom, 87.5% (7/8) had more than 50% reduction in seizure frequency (follow up: 42 ± 27.31 months). Patients with a poor outcome had significantly greater seizure frequency (P = 0.05) and history of drop attacks (P = 0.04) in both the groups. Magnetoencephalography (MEG) accurately localized the epileptogenic zone in all of the patients with good outcome (P = 0.015). Concordance with single photon emission tomography (SPECT) was also a predictor of favorable outcome (P = 0.041). A history of drop attacks with high seizure frequency is associated with poor postoperative seizure outcome. Unilateral PQD is feasible and leads to superior seizure-free outcomes, even in cases with widespread and bilateral imaging and electrical abnormalities, provided the other preoperative investigations are concordant in localizing the epileptogenic zone.

Preoperative Investigations: Practice Guidelines from the Indian Society of Anaesthesiologists.

Preoperative Investigations: Practice Guidelines from the Indian Society of Anaesthesiologists.

V12-03 TRANSURETHRAL LASER INCISION OF EJACULATORY DUCT OBSTRUCTION : AN UNDERUSED TERMINOLOGY REAWAKEN BY ENDOUROLOGY

You have accessJournal of UrologyCME1 May 2022V12-03 TRANSURETHRAL LASER INCISION OF EJACULATORY DUCT OBSTRUCTION : AN UNDERUSED TERMINOLOGY REAWAKEN BY ENDOUROLOGY Mohamed Omar Mohamed OmarMohamed Omar More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002638.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to study whether laser incision of obstructed ejaculatory duct would help in restoration of fertility in patients with abnormal semen parameters. METHODS: After obtaining Ethical Committee approval, we prospectively identified male patients with abnormal semen parameters secondary to obstructed ejaculatory ducts. Participants underwent history, examination and Preoperative routine investigations including semen analysis, hormone profile and transrectal ultrasonography. The steps of ejaculatory duct identification and laser assisted incision are declared in the attached video. RESULTS: A total of 6 patients were included with mean age 33±4 years. There means semen volume was 1.2±0.3 ml / ejaculate, semen concentration 10.2±3.2 / million per ml and mean progressive motility 13.6±7.5 (Table 1). Mean operative time 17±11 min and at 3-, 6- and 12-month follow-up after surgery, all semen parameters were significantly improved with 34 % of conception rate (Table 2). CONCLUSIONS: Transurethral incision of obstructed ejaculatory duct by laser has proved a short-term improvement in semen parameters and conception rates. Source of Funding: none © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e968 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Mohamed Omar More articles by this author Expand All Advertisement PDF DownloadLoading ...

The Value of Preoperative Laboratory Investigations in Healthy Individuals Undergoing Elective Cataract Surgeries.

PurposeTo evaluate the number of patients with abnormal preoperative laboratory test results and determine the benefits of these tests in healthy individuals scheduled for elective cataract surgeries.Patients and MethodsThis study was conducted at Songklanagarind Hospital, Thailand. The data were collected from January 1, 2020, to August 31, 2021. The results of laboratory investigations, consisting of a complete blood count (CBC), including hemoglobin (Hb), hematocrit (Hct), and platelet count; chest X-ray (CXR); electrocardiography (EKG); and anti-human immunodeficiency virus (anti-HIV), were evaluated and analyzed. Additional management actions and rates of postponement or cancellation of surgeries were also evaluated.ResultsIn total, 401 participants were enrolled in this study. The rates of abnormal investigation results were 40.2% for EKG, 15.5% for CXR, 12.7% for Hb, 11.7% for Hct, 2.0% for platelet count, and 0.2% for anti-HIV. The preoperative tests that required additional management and postponement/cancellation of surgeries were CXR (5.5% and 1.7%, respectively), EKG (2.5% and 0.5%, respectively), and anti-HIV (0.2% and 0%, respectively). Moreover, age ≥60 years was associated with a significantly higher rate of positive preoperative EKG findings (relative risk, 4.64; p = 0.017).ConclusionThe CBC test was not beneficial as a preoperative laboratory investigation for healthy individuals in any age group who were scheduled for elective cataract surgery. However, EKG, CXR, and anti-HIV test results were valuable. Patients aged ≥60 years were at risk of having positive EKG results that could result in cancellation or postponement of surgery.

Evaluation of Patients with Exploratory Laparotomy for Acute Abdomen with Intraoperative Finding of Acute Pancreatitis

Background: Acute pancreatitis (AP) is one of the main causes of acute abdomen that requires hospitalization and multidisciplinary management. The spectrum of the disease is wide with variable presentations that mimic the clinical features of other acute illnesses. Occasionally the diagnosis of AP is only made atlaparotomy, especially when there is doubt in the preoperative diagnosis. Objective: To evaluate the findings during exploratory laparotomy for patients with acute abdomen and were diagnosed as cases of AP intraoperatively, and to determine the postoperative outcome during the follow up period for these patients. Patients and Methods: A retospective study performed at the Department of General Surgery- Baquba Teaching Hospital- Diyala- Iraq, from January 2011 to December 2020. Thirty-three patients (16 male and 17 female) were included, all patients had history of acute abdomen with unknown cause preoperatively, in spite of doing the available preoperative investigations, and were found to have acute pancreatitis intraoperatively. A standardized data collection form was completed and analyzed for each patient. Results: The patients' ages ranged from 8 to 75 years with a mean age of 40.2 years. The majority of the patients were found to have pancreatic oedema (66.67%), followed by hemorrahgic pancreatitis (15.15%), pancreatic necrosis (12.12%) and pancreatic tumours that presented as acute pancreatitis (6.06%). During the follow up period 13 patients (39.39%) recovered with no complications while 20 patients (60.6%) developed one or more complication mainly surgical site infections in 18.18% of patients, pancreatic pseudocyst (15.15%), death (15.15%), ascites (9.1%), chronic pancreatitis (6.1%), pleural effusion (6.1%), while ileus, ARDS, DIC and acute renal failure occurred in (3%) for each. Conclusion: AP is an important cause of acute abdomen that is associated with severe mortality and morbidity and a high index of suspicion is needed to avoid the frequent misdiagnosis. Despite of rapid advances in the diagnostic strategy, still exploratory laparotomy is indicated in some cases to reach a sound diagnosis although such intervention is undesirable and might increase the postoperative morbidity and mortality. Keywords: acute abdomen, acute pancreatitis, explorative laparotomy, postoperative complications.

Feasibility, safety and effectiveness of laparoscopic transperitoneal pyeloplasty in children: Ain Shams University early experience

Background/purposeLaparoscopic pyeloplasty (LP) is now widely recognized as a minimally invasive alternative for the surgical repair of ureteropelvic junction obstruction (UPJO) in paediatrics. In this work, we aim to evaluate the feasibility, safety and effectiveness of LP in our early experience.Patients and methodsBetween April 2019 and April 2020, patients presented with indication for surgical repair of UPJO were offered laparoscopic transperitoneal Anderson-Hynes pyeloplasty. Demographic data, preoperative investigations, operative data and intra- or postoperative complications, as well as short and mid-term follow-ups were recorded.ResultsDuring the specified period, 13 patients underwent LP (8 girls and 5 boys) with a median age of 12 months (range from 5 to 150 months). There was no conversion to open approach with operative time ranging from 120 to 240 min (mean = 175 ± 34 min). No intra- or postoperative complications were encountered. One to 2 years postoperative follow-up was performed (median = 18 months) in 11 patients. One patient discontinued follow-up after 1 month and another after 6 months. Follow-up PAUS showed a reduction in the anteroposterior diameter of the renal pelvis in all cases. Postoperative diuretic renal scans (DTPA renography) were done for three patients with a persistent anteroposterior diameter of the renal pelvis greater than 20 mm which showed improvement in the washout. All patients had a good cosmetic outcome.ConclusionIn our early experience in LP, we found the procedure a safe, feasible and effective technique in managing UPJO in children and infants with good cosmetic outcome.Level of evidenceThis is a case series study (level IV evidence).

The MARECA (national study of management of breast cancer locoregional recurrence and oncological outcomes) study: National practice questionnaire of United Kingdom multi-disciplinary decision making

IntroductionEvidence based guidelines for the optimal management of breast cancer locoregional recurrence (LRR) are limited, with potential for variation in clinical practice. This national practice questionnaire (NPQ) was designed to establish the current practice of UK breast multidisciplinary teams (MDTs) regarding LRR management. MethodsUK breast units were invited to take part in the MARECA study MDT NPQ. Scenario-based questions were used to elicit preference in pre-operative staging investigations, surgical management, and adjuvant therapy. Results822 MDT members across 42 breast units (out of 144; 29%) participated in the NPQ (February–August 2021). Most units (95%) routinely performed staging CT scan, but bone scan was selectively performed (31%).For patients previously treated with breast conserving surgery (BCS) and radiotherapy, few units (7%) always/usually offered repeat BCS. However, in the absence of radiotherapy, most units (90%) always/usually offered repeat BCS. For patients presenting with isolated local recurrence following previous BCS and SLNB (sentinel lymph node biopsy), most units (95%) advocated repeat SLNB. Where SLNs could not be identified, 86% proceeded to a four-node axillary sampling procedure.For ER positive, HER2 negative, node negative local recurrence, 10% of units always/usually offered chemotherapy. For ER positive, HER2 negative, node positive local recurrence, this recommendation increased to 64%. For triple negative breast cancer local recurrence, 90% of units always/usually offered chemotherapy. ConclusionThis survey has highlighted where consistencies and variations exist in the multidisciplinary management of breast cancer LRR. However, further research is required to determine how these management patterns influence patient outcomes, which will further refine optimal treatment pathways.

Lung Transplant from a DCD Donor with a Previous Symptomatic COVID Infection

IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a worldwide pandemic affecting more than 172 million confirmed cases. The likelihood of historic donor infection is increasing. Here we report a lung transplantation of a previously SARS-CoV-2 positive organ donor.Case ReportA 49-year-old female who underwent left single lung transplantation for interstitial lung disease. The lung was obtained from a donation after cardiac death (DCD) using abdominal rerperfusion of a 23 years old female donor died of intracranial bleeding with history of covid infection 8 month prior to lung donation. According to the donor records, the symptoms were mild, and required no hospital admission. She had ongoing loss of taste and smell till time of donation. There were no respiratory symptoms. At time of retrieval, chest x ray was normal and blood gases were normal, however, bronchoscopy revealed severe inflammation of the right-side mucosa so the decision was to proceed with the left lung only as it had normal blood gases, good recruitment and no consolidation as well as non inflamed bronchial mucosa. patient had single off pump left lung transplant through left anterior thoracotomy approach. After the surgery, patient was extubated on day 1 in ICU, discharged from ICU on day 3 and discharged from the hospital after 27 days. There was no evidence for primary graft dysfunction or acute rejection. After 6 month of the surgery, FVC is 2.26 L (78.2% predicted) and FEV1 is 1.9L (70.2% predicted).SummaryThis case showed that it is possible to proceed with lung transplant from a donors who had previous mild covid infection. As DCD donation might limit preoperative invasive investigations such as bronchoscopies careful examination and proper radiological and functional assessment for the donor lung after donation including EVLP needs to be considered.

BULKING AGENTS IN FAECAL INCONTINENCE: LONG TERM FOLLOW UP RESULTS

Lost of faecal control is a very commune condition. Multifactorial causes can determinate faecal incontinence (sphincterial atrophy/atony, neuropathies, sclerosis, spinal damage, iatrogenic, etc). The quality of live, as well as social and working impacts of faecal incontinence are very important. Many surgical options can be avoid for faecal incontinence treatment. The bulking injectable agents represent the most mini invasive treatment that can lead to healing in same case of faecal incontinence. The technique is performed in local anaesthesia in “day surgery”. It consists in silicon polymer injections directly on weak sphincter points. Preoperative investigations and preparation is easy as well. In our experience we performed on enrolled patients to ano-rectal manometry and transanal ultrasound study with 360° rotating with BK probe. Surprisingly, the results in our experience were higher of expectations. The day after the PTQ (polidimetilstilossano/povidone) implants, near all of the patients claim to be extremely satisfied and able to keep and leak free. The long term follow up demonstrated stable results and patients satisfaction. The PTQ implants procedure can be considered a low cost valid minimally invasive option for faecal incontinence treatment able to lead to healing, reducing social costs, improving patients quality of life.

New research and changing paradigms of coagulopathy in children after cardiac surgery: A narrative review

Background: Congenital heart disease (CHD) is a disorder and abnormality of the heart or the great vessels of the thorax, which usually occurs during fetal development. It has been reported that CHD is a common condition. Nearly 25% of newborns with critical types of CHD require surgical intervention in the first year of life. Hence, increasing numbers of the annually conducted cardiopulmonary bypass (CPB) cardiac surgeries are usually associated with postoperative bleeding and coagulopathy. Bleeding after CPB usually requires a replacement therapy, including the transfusion of whole blood, red blood cells, coagulation factors, or platelets. Aim: to identify the pathophysiology of coagulopathy following cardiac surgery, how it impacts the clinical outcomes, and the available management options. Methods: In this review, we only included English articles from common electronic databases such as PubMed /MEDLINE, Web of Science, Scopus, and the Cochrane Library with the keywords "congenital heart disease", "cardiac surgery" combined with keywords involving "coagulopathy" The end date for this review is February 2022. Scientific novelty: This review aims to briefly review the problem of post-CPB bleeding in the pediatric population regarding multiple aspects. The medical literature lacks a comprehensive review regarding the problem of CHD, its prevalence, types, surgical options, post-cardiac surgery complications such as coagulopathy, the pathophysiology of the coagulopathy, and the preventive and therapeutic measures. The practical significance of the result obtained: This review may help surgeons and pediatricians deeply understand post-CPB coagulopathy's pathophysiology and how to anticipate, prevent, and manage it properly. Antifibrinolytic pharmaceuticals represent the mainstay for managing this problem; their administration during CPB reduces the risk of postoperative bleeding. Blood component transfusion is also an alternative option. Conclusion: Post-cardiac surgery, coagulopathy, and bleeding are major problems facing cardiothoracic surgeons. Postoperative bleeding, especially in the pediatric population, is one of the common causes of surgical re-exploration, leading to a higher risk of morbidities and mortalities. Meticulous preoperative examination, investigation, and intraoperative protective measures are important factors in avoiding and properly managing postoperative bleeding risk.

Paediatric tonsillectomy and adenotonsillectomy in a rural setting: a retrospective study over a period of 6-years.

Swan Hill District Health (SHDH) provides Otolaryngological services to outer regional Victoria. A preoperative checklist determines eligibility for tonsillectomy, and the role of preoperative investigations such as oximetry. Visiting specialists who provide T&A also remain on-site for 24 h post-surgery. Management of post-discharge complications is supported by SHDH's Emergency Department. Unstable patients are transferred to tertiary care hospitals. This study examines the safety outcomes associated with rural Tonsillectomy and adenotonsillectomy (T&A) and the impact of peri-operative protocols on these outcomes. This is a retrospective cohort study of all paediatric (2-18 years old) patients undergoing T&A from August 2014 to June 2020 at SHDH. Four external hospital databases which accept patient transfers from SHDH were searched for T&A-related complications. The primary outcome was complication incidence. Secondary outcomes were length of stay, and rates of hospital readmissions, return to theatre and inter-hospital transfer. Two hundred and four patients were included, with median age 6 years old; 68.1% (n=139/204) had obstructive sleep apnoea, or sleep disordered breathing, wherein 36.0% (n=50/139) had documented evidence of normal/inconclusive oximetry. The complication rate is 6.9% (n=14/204), with two intraoperative, five perioperative and seven post-discharge complications. All intra- and peri-operative complications were managed locally. All post-discharge complications presented to outer regional EDs. Two patients required inter-hospital transfer for monitoring of post-tonsillectomy bleeds in a specialist unit. Patients who pass a preoperative risk checklist can safely undergo T&A in selected rural settings which adhere to strict patient selection criteria and implement safety measures to address complications.

Sphenoid sinus mucocele: a review

&lt;p class="abstract"&gt;Sphenoid sinus mucocele (SSM) is a benign, encapsulated, expansile, locally destructive mass within the sphenoid sinus, filled with mucous and lined by epithelium. The exact etiology of the sphenoid sinus mucocele is still not known. The proximity of the SSM to the orbit and brain may cause morbidity and potential mortality if left without intervention. SSM has varied clinical manifestations. Headache and visual disturbances are common symptoms. Diagnostic nasal endoscopy and computed tomography (CT) scan and/or magnetic resonance imaging (MRI) are important pre-operative investigations. Diagnosis of SSM is done by computed tomography (CT) scan of the nose and paranasal sinus which shows a hypodense cystic lesion in the sphenoid sinus. MRI is helpful to detect the extension of the mucocele to orbit and cranium. Treatment of SSM is surgical which include endoscopic transnasal sphenoidotomy with sufficient removal of anterior and inferior walls of the sphenoid sinus for allowing adequate drainage and to avoid recurrence. The endoscopic approach is a safe and effective method of treatment for SSM with fewer recurrences than an open approach. Marsupialization of the mucocele via transnasal transsphenoidal approach is another option with a good outcome. The literature review for sphenoid sinus mucocele was performed from the database of Pub Med, Medline, Scopus, and Google scholar search with the term sphenoid sinus mucocele. Here, this review article is attempting to discuss the details of the sphenoid sinus mucocele including its history, epidemiology, etiopathology, clinical presentations, investigations, and current treatment. &lt;/p&gt;

Does a tailored magnetic resonance imaging technique affect the surgical planning and outcomes for different cystic urethral and periurethral swellings in females? Seven years tertiary center experience

PurposeTo evaluate the use of magnetic resonance imaging (MRI) in preoperative delineation and surgical planning for the management of female urethral and periurethral cystic vaginal swellings, with emphasis on postoperative surgical outcomes.Materials and methodsThis is a retrospective analysis of females complaining of periurethral and urethral cystic swellings referred to our tertiary center, who underwent MRI for preoperative planning in the period from January 2014 till January 2021, with a total number of 57 patients. Data retrieved from the medical records included: patients’ demographics, presenting symptoms and signs, preoperative radiological investigations, duration of symptoms, previous surgical intervention, detailed intraoperative data, postoperative complications, and postoperative follow-up.ResultsUrethral diverticulum was the commonest cystic lesion representing (64.9%) followed by Skene gland cysts in 14%, Mullerian cysts in 7%, Gartner cysts in 3.5%, and dermoid inclusion cysts in 10.5%. MRI precisely diagnosed the various pathological entities and anatomical complex lesions prior to surgery. This was confirmed after surgery and pathology analysis. All patients were followed up with a mean duration of 35 months, without any evidence of recurrence.ConclusionMRI as a standalone imaging technique is mandatory for diagnosis of all urethral and periurethral cystic lesions, as it offers the most accurate diagnostic modality for delineation of these lesions and hence aids in the preoperative surgical planning, aiming to avoid recurrence and improving surgical outcomes.