Preoperative Evaluation Research Articles

Enhanced Cochlear Coverage and Hearing Preservation in High-Frequency Hearing Loss via Electric Acoustic Stimulation with Longer Electrode.

Electric-acoustic stimulation (EAS) is a promising treatment to improve hearing ability in patients with high-frequency hearing loss (HL). In EAS surgeries, shorter electrodes have been preferred to avoid the presence of an electrode covering the residual hearing region. However, our earlier studies showed that EAS with longer electrodes (28 mm) could preserve acoustic hearing. Additionally, we reported that the hearing preservation (HP) scores were independent of the length of the inserted electrodes, consistent with the systematic review. As most EAS patients gradually lose residual hearing over time due to the natural course of HL, in these cases, providing broader cochlear coverage using longer electrodes was beneficial toward better place-pitch matching. In addition to preparing for the deterioration inhearing inthe future, EAS with longer electrodes could offer various types of map strategies. Herein, we show the pre-, intra-, and post-procedures for EAS surgery. Appropriate preoperative evaluation, less invasive surgery, flexible lateral-wall electrodes, and steroid administration resulted in good HP following EAS with longer electrodes.

Benign Cystic Mesothelioma of the Uterus: Myth or Reality?

Mesothelioma is a very rare tumor of mesodermal origin that covers the surface of body organs such as the peritoneum, pleura and pericardium. This tumour in the majority of cases presents in its malignant form where it represents some characteristics: increased cellularity, cytological atypia, papillary formations, even invasion. We report the case of Mrs AB, 37 years old, blood group A positive with no particular pathological history, nulli gesture nulli pare, consulted for pelvic pain and abdominal bloating. The clinical examination showed a distended bloated abdomen with a 20 centimetre pelvic mass with regular contours and painlessness. Abdominal and pelvic ultrasound showed a globular uterus increased in size by 200 millimetres with a multilocular cystic image intra myometrial (corporal anterior and fundial) of 188*79 millimetres. Intraoperatively, a globular uterus was found to be enlarged with a 15 centimetre parovascular cystic mass, dependent on the anterior aspect of the uterus, with a rock water fluid content, without any other associated abnormalities The postoperative course was simple. To conclude, Benign cystic mesothelioma of the uterus is a tumour of diagnostic value. This tumour is spleen. The preoperative evaluation allows the diagnosis to be suspected, especially by pelvic magnetic resonance imaging.

Preoperative visualization of parathyroid pathology in patients with primary hyperparathyroidism using PAT/KT: a retrospective study

INTRODUCTION: Topical diagnosis of pathologically altered parathyroid glands in patients with primary hyperparathyroidism is a challenge both for specialists of radial diagnostics and for planning the scope of surgical intervention. The choice of diagnostic modality for localization of parathyroid glands depends on the availability of the method for a particular medical center. PET/CT is a promising method to determine the localization of parathyroid adenomaOBJECTIVE: To analyze the experience of using PET/CT with 11C-methionine and PET/CT with 11C-choline for preoperative diagnosis of parathyroid pathology in patients with primary hyperparathyroidism.MATERIALS AND METHODS: 72 patients diagnosed with PHPT and underwent surgical treatment were included in the study. Before surgical intervention all patients underwent laboratory and instrumental investigations in the scope of: blood tests for PTH, TTH, ionized calcium, calcitonin, 25(OH)D, creatinine, phosphorus, ultrasound of the neck, computer tomography of the neck with intravenous bolus contrasting.RESULTS: PET/CT showed the highest rates of DA in the patient group before primary surgery — 90.9%, compared with ultrasound (89.6%) and CT with IV contrast (84.9%). In the group of solitary adenomas of ectopic MTCS, PET/CT also had a higher DA — 92.8% than the other modalities. In patients with relapsed or persistent disease, the informativity rates of CT with intravenous contrast and PET/CT were similar (Se — 100%, Sp — 94.1%, DT — 96.2%).DISCUSSION: The algorithm for preoperative evaluation of patients to identify the location of pathologic parathyroid glands now includes imaging with two modalities: Neck ultrasound and radionuclide imaging: planar scintigraphy (washout/subtraction), SPECT, SPECT-CT. If the results are questionable, a CT scan of the neck with contrast or PET/CT is performed as a second step. None of the modalities has 100% diagnostic accuracy. Our study demonstrated the superiority of PET/CT over ultrasound and CT w/in contrast in a group of patients scheduled for primary surgical treatment. In a small group of patients, high informative rates of PET/CT and CT with contrast were demonstrated before reoperation, confirming the great potential of these techniques in these patients.CONCLUSION: PET/CT with 11C-methionine and PET/CT with 11C-choline have high diagnostic accuracy in patients with primary hyperparathyroidism before reoperation. PET/CT and CT with contrast showed similarly high diagnostic accuracy for the diagnosis of parathyroid adenoma with persistence or recurrence of the disease in patients with primary hyperparathyroidism.

Long-Term Weight Loss and Attendance Outcomes Following Metabolic and Bariatric Surgery: An Evaluation of The Cleveland Clinic Behavioral Rating System.

Interdisciplinary guidelines recommend preoperative psychological evaluation before metabolic and bariatric surgery (MBS). The Cleveland Clinic Behavioral Rating System (CCBRS) has been developed to evaluate the psychological state of individuals undergoing MBS. However, its predictive value concerning long-term weight loss and follow-up attendance has not been extensively studied. This study aims to assess the predictive value of the CCBRS regarding weight loss and follow-up attendance up to 5years after MBS. In this cohort study (n = 1236), psychologists administered the CCBRS to each patient prior to MBS in addition to the standard psychosocial-behavioral screening. The CCBRS consists of nine psychological domains and is scored on a five-point Likert scale, from "poor" to "excellent." Linear mixed models and ordinal regression analysis were used to analyze the percentage total weight loss over time and follow-up attendance up to 5years after surgery. A total of 1086 patients underwent subsequent MBS. Significant differences in weight loss and follow-up attendance were observed between some CCBRS groups compared to the reference group "excellent." However, these differences were not consistent across all groups within any given domain. In this cohort, the predictive value of the CCBRS for weight loss and follow-up attendance up to 5years after MBS was limited. It is important to consider certain limitations, such as considerable loss to follow-up. Nevertheless, the CCBRS remains valuable for structured psychological assessments by helping to identify patients' strengths and areas needing improvement.

Outcomes after Functional Nasal Surgery in Patients with Versus without Rhinitis Medicamentosa.

Topical nasal decongestants (TNDs) are used to reduce nasal soft tissue edema and obstruction. However, after frequent TND use, patients can develop rhinitis medicamentosa (RM) with rebound nasal edema and obstruction. Management of RM has centered largely on TND cessation ± intranasal corticosteroids. The purpose of this study was to compare nasal obstruction outcomes following nasal obstruction surgery in patients with versus without RM. A retrospective case-control study was conducted with adult patients who underwent bilateral inferior turbinate reduction (ITR) with or without septoplasty and nasal valve repair. Patients with versus without RM were assessed. RM was defined as at least daily TND use for ≥4 weeks. Preoperative and postoperative Nasal Obstruction Symptom Evaluation (NOSE) scores, and long-term TND cessation rates were collected. NOSE score changes were compared between patients with versus without RM. Of the 36 RM patients, mean age was 52.0 years, and 63.9% were male. Of 116 non-RM patients, mean age was 41.6 years, and 46.6% were male. Postoperative NOSE scores were collected at a mean 972.1 days postoperatively for RM patients, and 565.0 days for non-RM patients. Mean NOSE score reductions were - 9.8 for RM and - 8.6 for non-RM patients, both of which were significant (p < 0.0001). NOSE score reductions were not significantlybetween the two groups (p = 0.2438). Long-term TND cessation was maintained in 86.1% of RM patients. Patients with and without RM achieved similar long-term significant NOSE score reductions following nasal obstruction surgery, and 86.1% of RM patients maintained long-term TND cessation. Level 3 evidence Laryngoscope, 2024.

Frailty and Malnutrition in Surgical Outcomes of Elderly Breast Cancer Patients.

We evaluate the impact of frailty and malnutrition on breast cancer surgery outcomes in older adults using the ACS 5-factor modified frailty index (MFI) and Global Leadership Initiative on Malnutrition (GLIM) definition. Single institution retrospective review of a prospective database of the older adult (>60 years old) breast cancer surgery patients (2000-2016); cases stratified into groups as per MFI (0-2) and GLIM. Characteristics, 90-day post-op events, and 5-year follow-up data were analyzed to report survival and complication outcomes. Among 436 patients at diagnosis, 213 (48.9%) were >80 years old. 377 (86.5%) were alive at 5 years. 274 (62.8%) had MFI > 0, and 69 (15.8%) had malnutrition. Patients ≥ 80, MFI > 0, and PR-negative tumors had worse 5-year survival. There was no survival difference in patients >80 with/without malnutrition (HR = 1.01, p = 0.971), and there was no difference in mastectomy or lumpectomy (p = 0.560) between patients ≥ 80 or patients younger than 80; however, 94% of immediate reconstruction were in pts < 80. On multivariate regression, complications were associated with age < 80, readmission, MFI > 0, and history of HTN; serious complications were associated with age < 80, readmission, anticoagulation, and not receiving endocrine therapy. MFI showed a significant predictive value for 5-year survival for patients ≥ 80 and should be part of the preoperative evaluation.

Nasal Tip Reshaping in Orthognathic Surgery: A Novel Intraoral Minimally Invasive Approach.

Current concepts in orthognathic surgery focus on not just rectifying dentoskeletal irregularities but also improving facial aesthetic and function. In this respect, nasal reshaping holds extraordinary significance in determining surgery effectiveness and patient satisfaction. Facial preoperative evaluations emphasize the paramount functional and aesthetic impacts of caudal septum in tip reshaping. Deviations in this anatomical subunit could lead to significant nasal obstructions and aesthetic changes as twisted nasal tip, affecting projection, rotation, and columellar-alar relationship. These considerations are essential in orthofacial surgery, as maxillary movements might exacerbate or worsen preexisting nasal tip deformity. In this paper, we aim to describe a novel and innovative minimally invasive approach presenting a detailed account of a rhinoseptoplasty in which the entire nasal tip reshaping procedure was performed intraorally during orthognathic surgery. The technique focused on achieving optimal nasal tip projection and rotation, centering, and stabilization through strategic maneuvers such as incremental dissection of maxillary spine chondroperiosteal junction, superoposterior strut preservation, vertical and caudal septum resection, and anterior nasal spine tip support. Techniques including subnasal drilling and septal stabilization suture are detailed. Specific attention is given to addressing deficiencies in posterior septal angle and labiocolumellar relationship. Postoperative care is described and subjective evaluations were performed to assess patient and surgeon satisfaction with facial symmetry and overall aesthetic improvements. In our experience, the described approach offers valuable surgical finesse to orthognathic surgery, effectively targeting caudal septum deviations and nasal tip droopy. Its unique perspective enhances both functional and aesthetic results, particularly in the context of profiloplasty. No external nasal incision was performed and the totality of nasal tip reshaping was scarless and performed through an intraoral approach. Surgical precision in execution of this novel and tailored surgical approach has been shown to have a profound impact for enhancing outcomes of orthofacial surgery procedure.

The Influence of Previous Joint Arthroplasty on Fulfillment of Patients' Expectations of Subsequent Lumbar Surgery

Introduction: Hip, knee, and lumbar spine surgeries are prevalent with arthroplasty often preceding lumbar surgery. The objective of this analysis was to ascertain whether previous arthroplasty was associated with patients' postlumbar surgery fulfillment of expectations. Methods: Identical systematically acquired data were pooled from 3 prospective studies that included assessments of preoperative expectations of lumbar surgery and 2-year postoperative assessment of fulfillment of expectations using a valid survey with points assigned for amount of improvement expected for symptoms and function. The proportion of expectations fulfilled was defined as total points for improvement received postoperatively divided by total points for improvement expected preoperatively (range 0 [no expectations fulfilled] to &gt;1 [expectations surpassed]). Enrollment data included the expectations survey, demographic/clinical characteristics, Oswestry Disability Index (ODI) scores, and previous hip/knee arthroplasty. Postoperative data included follow-up expectations survey, ODI scores, and any spine complications. The proportion was the dependent variable in multivariable linear regression with demographic/clinical independent variables. Results: 1137 patients were included (mean age 59 years, 51% male); 993 (87%) did not have previous arthroplasty, and 144 (13%) had arthroplasty (51 hip only, 77 knee only, 16 both hip/knee). Patients with any arthroplasty had similarly high expectations compared with patients with no arthroplasty but lower proportion of expectations fulfilled (0.69 versus 0.76, P = 0.03). In multivariable analysis, variables associated with a lower proportion of expectations fulfilled were greater preoperative expectations (P &lt; 0.0001), not working (P &lt; 0.0001), positive depression screen (P = 0.0002), previous lumbar surgery (P &lt; 0.0001), previous arthroplasty (P = 0.03), surgery on ≥3 vertebrae (P = 0.007), less preoperative-to-postoperative ODI improvement (P &lt; 0.0001), and postoperative complications (P &lt; 0.0001). Conclusions: After accounting for a spectrum of highly associated covariates, patients with previous arthroplasty still had less fulfillment of expectations of subsequent lumbar surgery. For patients with previous arthroplasty, surgeons should discuss potential differences between arthroplasty and lumbar surgery during preoperative evaluations and during shared postoperative assessments of the outcome.

Report of a giant invasive, wall-penetrating cardiac lipoma

BackgroundCardiac lipoma, a seldom-encountered benign tumor positioned beneath the endocardium, has the potential to impair electrophysiological functions. Diagnosis is principally based on imaging modalities. The uniqueness of this case lies in the tumor’s extension both internally and externally within the right atrium, rendering it of special interest. From a clinical standpoint, surgical removal is commonly advocated, wherein early intervention is pivotal in improving patients’ long-term prognoses.Case presentationA 35-year-old male was admitted to the hospital for treatment subsequent to the identification of a cardiac mass two days prior. Initial diagnostic assessments, encompassing CT scans and echocardiography, identified a space-occupying lesion within the heart. The patient underwent surgical excision of the cardiac tumor, utilizing mild hypothermic extracorporeal circulation via femoral vessel access. Intraoperative findings revealed adipose-like tissue of a “dumbbell-shaped” configuration situated both within and external to the right atrium, measuring approximately 8 cm*9 cm internally and 7 cm*6 cm externally, with the extracardiac mass being marginally larger. Postoperative pathological analysis confirmed a cardiac lipoma diagnosis. A follow-up echocardiogram conducted three months post-surgery exhibited no notable abnormalities. The patient is under continuous observation to monitor for any recurrence or potential long-term complications.ConclusionIn this case report, we detail with precision a rare cardiac pathology manifested by an expansive infiltrative lipoma that pervades the endocardial and epicardial layers of the right atrium. After thorough preoperative diagnostic workup and evaluation, we contend that surgical intervention represents the optimal therapeutic approach for managing such conditions, with the goal of preemptively reducing the likelihood of cardiac compression or intracardiac obstruction.

Conservative Decompression in the Management of Odontogenic Keratocysts: Case Report

Aims: This study aims to assess the effectiveness of decompression as a conservative treatment for odontogenic keratocysts (OKCs), with emphasis on reducing recurrence rates, decreasing lesion size, and preserving adjacent anatomical structures. Additionally, it explores the combination of decompression with enucleation and other therapies to minimize recurrence risks. Presentation of Case: This is a case study focusing on conservative management of OKCs using decompression, with enucleation performed when necessary. A 15-year-old male patient with a mandibular OKC underwent decompression under local anesthesia. Preoperative radiographic evaluations were followed by aspirate puncture and placement of a thoracic drain to facilitate lesion size reduction. The patient was monitored over six months, with radiographic exams every 60 days to assess cyst shrinkage. Discussion: The patient showed a significant reduction in lesion size following decompression, allowing for easier enucleation while preserving the bone cortex. A review of the literature supports decompression as an effective treatment; however, recurrence rates remain problematic when performed without adjunctive therapies. Combining decompression with enucleation resulted in lower recurrence rates and improved long-term outcomes. Conclusion: Decompression is a promising conservative approach for managing OKCs, particularly when combined with enucleation and adjunctive treatments. This approach reduces lesion size and preserves critical structures, although recurrence remains a concern. Long-term follow-up and further research on recurrence mechanisms are essential to improving outcomes for patients treated with decompression for OKS.

Preoperative evaluation of the segmental artery of left upper lobe by thin-section CT and 3d-CTA.

Understanding pulmonary artery (PA) branches and their variations is crucial for successful lung resection. We aimed to evaluate the segmental PA branching pattern of the left upper lobe (LUL) using thin-section computed tomography (TSCT) images and 3D-CT angiography (3D-CTA). This study included 108 patients who underwent CTA and left upper lobectomy. The segmental PA branching pattern of the LUL was meticulously identified by two thoracic radiologists using 3D-CTA and TSCT images. The lingular artery branches from the left PA (LPA) were classified into mediastinal type (pars mediastinalis: PM), interlobar type (pars interlobaris: PI), and PI originating from the lower portion (PI'), specifically from A8. The intraoperative findings of the PA branches of the LUL were compared with the preoperatively obtained 3D-CTA and TSCT images in each patient's case. The median (range) number of LPA branches of the LUL was 4.36 (3-8). The most common number of A1 + 2 branches was two, seen in 34 cases (31.5%). One or more branches of A1 + 2c directly originating from the LPA were found in 63 cases (58.3%). The number of branches of A3 was single in 85 cases and the most frequent (78.7%). Instances where one or more branches of A3a directly originated from the LPA were found in seven cases (6.5%). A1 + 2 and A3 origins were separate and independent in 40 cases (37.0%). As the branching pattern of the lingular artery, PI/PI' was most frequent (61.1%). PI´ was observed in 26 cases (24.1%). Inter-observer agreement for A1 + 2, A1 + 2c, A3, A3a, and lingular artery branching patterns was moderate to substantial (κ = 0.53-0.72). Preoperative 3D-CTA and TSCT images identified 99.8% of LPA branches compared to intraoperative findings, except one. The segmental PA branching pattern of the LUL can be evaluated using TSCT and 3D-CTA images, providing precise preoperative information.

Last minute cancellation of elective lung cancer surgery is associated with poorer survival.

Our objective was to assess the incidence and reason of last-minute cancellations before surgery for lung cancer and their association with outcomes. Retrospective analysis on all consecutive patients booked for elective lung cancer surgery from January 2017 through December 2022 in a single centre.Last minute cancellation: a cancellation occurring within the last 24 hours from the planned operation. Cancellation categories: process-related and patient-related.The short-term and long-term outcomes of patients who experienced a last-minute cancellation were analysed. 197 patients of 1587 (12%) had a last-minute cancellation: 156 (79%) were process-related and 41 (21%) were patient-related.3% (5/156) of patients cancelled for process reasons did not receive surgery vs 39% (16/41) of those cancelled for patient-related reasons, p < 0.0001.The 90-day mortality rates of cancelled and non-cancelled patients were similar (4.6% vs 4.7%, p = 1).Five-year overall survival of patients with cancellation was 58% (95% CI 49-66) vs 69% (95% CI 66-71) of those without cancellations, p = 0.022.Among those who had a cancellation, the 5-year OS of those with process-related cancellations was 61% (52-60) vs 35% (14-58) of those with patient-related cancellations (adjusted p value for multiple comparisons = 0.14).Cox regression analysis showed that surgery cancellations within the last 24 hours for patient-related (HR 1.87, 95% CI 1.02-3.42, p = 0.043) reasons remained a factor associated with poorer overall survival after adjusting for clinical stage, type of operation and patient related variables. Implementing the patient's preoperative clinical evaluation to reduce the occurrence of related last-minute cancellations might mitigate its negative impact on survival.

Impact of Preoperative Counseling and Education on Decreasing Anxiety in Patients With Gynecologic Tumors: A Randomized Clinical Trial.

To evaluate the impact of counseling and preoperative education on reducing anxiety in patients undergoing surgery for gynecologic cancer. In this randomized clinical trial, patients with gynecological tumors undergoing surgical treatment between 15 and 60 days preoperatively, were included. The group was randomized to receive preoperative routine orientation plus preoperative counseling and education by nursing (experimental group [EG]) or receive preoperative routine orientation only (control group [CG]). We stratified the groups by surgical approach: open, laparoscopy, and robotic. We excluded patients treated in another service and with the need for an intensive care unit after surgery. We used the Hospital Anxiety and Depression Scale (HADS) to evaluate symptoms of anxiety and depression. The severity of symptoms was evaluated using the Edmonton Symptom Assessment System (ESAS-Br). We analyzed 54 women (CG 27, EG 27). No significant differences were observed regarding ESAS scores (total, physical, emotional, well-being, and anxiety) between preoperative and postoperative evaluation. However, in the EG, comparing the preoperative versus postoperative moments, there was a significant reduction in total, emotional, and anxiety scores of ESAS (p = 0.012; p = 0.003; p = 0.001). No difference in anxiety symptoms by HADS scale was noted between the two groups, comparing preoperative and postoperative moments, CG (40.7% and 22.2%) and EG (37.0% and 25.9%) (p = 0.78; p = 0.75), respectively. Also, in depression symptoms (HADS scale), we found no difference comparing preoperative and postoperative moments (p = 0.34; p > 0.99). When we stratified by surgical approach or time between intervention and surgery ( ≤ 15, > 15 to ≤ 30, and > 30 days), no difference was observed in the anxiety and depression symptoms evaluation, in both groups. The preoperative education by nurse orientation reduced the total, emotional, and anxiety symptoms of ESAS score between preoperative and postoperative moments. However, by the HADS scale, there was no difference in anxiety and depression symptoms.

Preoperative Evaluation, Informed Consent and Postoperative Care in Pediatric Vitreoretinal Surgery

In childhood, vitreoretinal surgery may be required due to trauma and some congenital or developmental disorders. Pediatric vitreoretinal surgery differs from that of adults in terms of etiology, anatomical and surgical characteristics, response to treatment and follow-up. This process has many challenges that require patient follow-up over many years as the child develops. Pre-operative preparation according to the age of the patient and the nature of the pathology will make it easier for the surgeon to manage all the processes. The consent of the child must be obtained in accordance with the child's cognitive abilities, in addition to the informed consent of the family. Despite surgical and technological advances in pediatric vitrectomy, anatomical and functional outcomes are worse than in adults. This article discusses pediatric vitreoretinal surgery in terms of preoperative preparation, informed consent and follow-up.

12268 Hypercalcemia Alert: Exploring The Link To Isolated Bone Marrow Sarcoidosis

Abstract Disclosure: M. Renzu: None. C.M. Hubers: None. V. mehta: None. A. Qazi: None. D.K. Yerasuri: None. Introduction: Sarcoidosis, a complex disorder marked by granuloma formation in diverse organs, often affects the lungs, but can involve various systems as well. Rare cases of bone marrow involvement may mimic conditions like multiple myeloma, emphasizing the need to consider sarcoidosis in patients with bone marrow abnormalities, especially those without typical myeloma features. Case Presentation: A 79-year-old white male with a medical history of hypertension, hyperlipidemia, deep venous thrombosis, prostate cancer in remission, chronic knee pain, and basal cell carcinoma presented for pre-operative evaluation, as he was scheduled for an elective orthopedic procedure. On routine lab work, he was found to have acute hypercalcemia and normocytic anemia. This finding raised suspicion for an underlying systemic pathology. He reported that he did not take any calcium or vitamin D supplements at home. Subsequent endocrine assessment, including evaluation of parathyroid hormone and vitamin D levels, revealed a non-PTH-mediated hypercalcemia. The persistence of hypercalcemia prompted further investigations, including assessments for multiple myeloma by oncology. The workup was negative for multiple myeloma but significant for granulomas on bone marrow biopsy, a finding consistent with sarcoidosis. Additionally, angiotensin converting enzyme levels were elevated at the time of diagnosis. Interventions led to the resolution of hypercalcemia following steroid therapy of prednisone 20 mg daily and close follow up with endocrinology. As part of his follow up, ACE levels are being regularly monitored, with the patient going for lab work every other month. Discussion: Bone marrow biopsies rarely reveal granulomas and sarcoidosis accounts for only a very small percentage of these findings. The standard workup for sarcoidosis typically does not include bone marrow biopsies. By integrating biopsies into the standard diagnostic protocol researchers may gain insights into the etiology and mechanisms driving this manifestation of sarcoidosis, ultimately improving diagnostic accuracy and patient care. Distinguishing sarcoidosis from multiple myeloma also poses diagnostic challenges, necessitating thorough evaluation in patients with bone marrow abnormalities. Despite its rarity, clinical suspicion for sarcoidosis should be considered in patients with underlying hematologic disorders or malignancies. Additionally, sarcoidosis exhibits geographical variation, being less common in Japanese men and more prevalent in African American women. This highlights the importance of considering demographic factors when evaluating patients for sarcoidosis and its extrapulmonary manifestations. Long-term outcomes in isolated bone marrow sarcoidosis remain unclear, warranting surveillance for progression to multiple myeloma or other lymphoproliferative disorders. Presentation: 6/2/2024

Vascular complications during appendectomy: severe adhesion of the appendix to the right iliac artery: a case report

IntroductionAppendicitis is a common cause of acute abdomen. Rarely, it may form adhesions to nearby structures, complicating surgeries, especially when involving vascular structures such as the internal iliac artery, potentially causing severe intraoperative hemorrhage.Case presentationA 65-year-old Middle Eastern male presented with abdominal pain and anorexia for 5 days. Examination and imaging confirmed acute appendicitis with complications. Additionally, a large pelvic mass was noted. During surgery, severe bleeding was encountered due to an adhesion between the appendix and the right internal iliac artery, managed by ligating the artery. The patient recovered well and was discharged in stable condition. Histopathology confirmed the diagnosis.ConclusionThis case highlights a rare vascular complication of appendectomy due to abnormal adhesions between the appendix and the internal iliac artery, associated with a large pelvic mass. This study emphasizes the need for thorough preoperative evaluation and careful surgical planning in patients with unusual anatomical variations or specific underlying conditions such as neurofibromatosis. Early recognition and strategic management of vascular adhesions are essential to optimize patient outcomes in appendectomies complicated by such rare scenarios.

Clinical effect analysis of vertebroplasty with high viscosity and standard bone cement for Kummell disease.

This study aims to observe and compare the effects of high-viscosity bone cement versus standard bone cement on the postoperative outcomes of percutaneous vertebroplasty (PVP) in patients with Kummell disease. A retrospective analysis was conducted on 135 patients with Kummell disease who underwent PVP between January 2019 and May 2023. Patients were divided into 2 groups: the high-viscosity group (group H, 63 cases) received high-viscosity bone cement during surgery, while the standard group (group S, 72 cases) received standard bone cement. Surgery duration, bone cement volume, bone cement leakage rate, as well as preoperative and postoperative evaluations using the Visual Analogue Scale (VAS) for pain, Oswestry Disability Index (ODI), anterior vertebral height, and kyphotic Cobb angle were recorded and compared between the 2 groups. In the group H, significant improvements were observed in VAS scores, ODI, anterior vertebral height, and Cobb angle at 24 hours, 3 months, and 1 year postoperatively compared to preoperative values (P < .01). In the group S, VAS scores and ODI showed significant improvement at 24 hours, 3 months, and 1 year postoperatively (P < .01), but there were no significant differences in anterior vertebral height or Cobb angle compared to preoperative values (P > .05). Comparatively, the group H demonstrated superior outcomes in terms of bone cement volume, leakage rate, recovery of anterior vertebral height, and Cobb angle correction at 24 hours, 3 months, and 1 year postoperatively (P < .05). However, there were no significant differences between the 2 groups in terms of surgery duration, VAS scores, and ODI at the same time points (P > .05). PVP is an effective treatment for Kummell disease, providing significant pain relief and improved spinal function. The use of high-viscosity bone cement allows for greater volume infusion, better restoration of vertebral height, and correction of deformities, while also reducing the risk of cement leakage.

Successful placement of a chest wall venous infusion port via persistent left superior vena cava: A case report.

Persistent left superior vena cava (PLSVC) is a rare congenital venous anomaly occurring in approximately 0.3% to 0.5% of the population. The presence of PLSVC complicates central venous catheter placement, increasing procedural risks. This case report describes the successful placement of a chest wall venous infusion port in a patient with PLSVC, offering valuable insights for managing similar cases and ensuring safer clinical outcomes. A 51-year-old female, 3 weeks post-right breast cancer surgery, was admitted for her first adjuvant hemotherapy session. She requested the placement of a venous infusion port due to the prolonged duration of chemotherapy. Imaging studies suggested the presence of PLSVC. Echocardiography revealed a dilated coronary sinus, and subsequent chest computed tomography and angiography confirmed the presence of PLSVC. A chest wall venous infusion port was inserted via the left internal jugular vein. Due to the PLSVC, the catheter was adjusted to ensure proper placement. The patient successfully completed chemotherapy without any complications or discomfort associated with the venous port. Imaging studies, including chest X-ray and computed tomography, confirmed proper port function and catheter positioning, with no evidence of thrombosis, infection, or other related issues. The patient remained in good overall condition throughout the treatment. Detailed preoperative evaluations, intraoperative imaging guidance, and postoperative follow-ups are crucial for the safe and effective management of PLSVC patients undergoing central venous catheter placement.

The Frequency of Presence of the Infraorbital Canal in the Maxillary Sinus and its Clinical Importance.

The infraorbital canal (IOC) houses critical structures like the infraorbital artery, vein, and nerve, and its atypical location within the maxillary sinus could pose risks during surgical procedures, making it crucial to understand its prevalence and distribution. The study aims to investigate the localization and frequency of the IOC within the maxillary sinus. This retrospective study analyzed computed tomography (CT) images from 1000 randomly selected patients (500 males, 500 females) aged 18 to 65 years who underwent paranasal region imaging at Istanbul Medipol University Medipol Mega University Hospital between 2015 and 2020. Exclusion criteria included major pathologies, prior surgeries, and poor image quality. The study focused on evaluating the localization of the IOC and its presence within the maxillary sinus, using coronal CT sections. The IOC was found within the maxillary sinus in 8% of cases (44 males, 36 females). This variation was bilateral in 34 cases and unilateral in 46 cases, with no statistically significant relationship between sex and the occurrence or type of variation. The study's findings align with previous research, which reported similar prevalence rates for this anatomical variation. The study confirms that the IOC is located within the maxillary sinus in a significant percentage of cases, emphasizing the importance of preoperative CT evaluation to prevent potential complications during maxillary sinus surgeries. These findings highlight the clinical relevance of considering individual anatomical differences in the localization of the IOC.

Successful Anesthetic Management for Mandibular Neoplasm Resection in a Patient with Osteogenesis Imperfecta: A Case Report

Background: Osteogenesis imperfecta (OI) is a rare genetic disorder characterized by bone fragility and deformities. Patients with mandibular neoplasms and suspected OI require careful anesthetic management to avoid complications. This case report describes the successful anesthetic management of a patient with a mandibular neoplasm and suspected OI. Case presentation: A 33-year-old man presented with a large mandibular tumor causing airway obstruction and difficulty eating. He had physical features suggestive of OI, including short stature, bone deformities, and abnormal tooth growth. Preoperative evaluation revealed a difficult airway due to the tumor and potential cervical spine instability. Anesthesia was induced with propofol and atracurium after securing the airway via ultrasound-guided tracheostomy under local anesthesia. The tumor was resected successfully, and the patient recovered without complications. Conclusion: Anesthetic management in patients with suspected OI and mandibular neoplasms requires careful planning and execution. A multidisciplinary approach, including preoperative evaluation, airway management strategies, and close postoperative monitoring, is crucial for successful outcomes.