Previous Surgery Research Articles

Desmoid Fibromatosis Post-Cervical Spine Surgical Intervention

Abstract Desmoid tumors are rare benign tumors that show locally aggressive and invasive features leading to potential complications. They can be quite challenging for the treating surgeon if they occur adjacent to neurovascular structures. The etiology of these tumors is still unclear, but the incidence is higher in females and in patients with a history of trauma or surgical procedures raising the possibility of genetic and hormonal factors as well as post-traumatic or postoperative inflammatory changes promoting the formation of desmoid fibromatosis. We report a case of a 34-year-old Asian female who presented to our hospital with a history of difficulty in swallowing due to an enlarging lump on the left side of her neck. Patient had a past medical history of previous cervical spinal disc surgery due to a herniated disc. Diagnostic imaging showed a large soft tissue mass centered between the left common carotid artery and the cervical vertebrae displacing the trachea and esophagus to the right side. Biopsy was obtained and histopathological examination was suggestive of a desmoid tumor. Patient underwent surgical resection of the tumor but returned later with recurrence and had to undergo the surgery again to achieve full cure.

Plasmatic variability of direct oral anticoagulants in people with atrial fibrillation and previous gastric surgery: a pilot case series.

Data on cardioembolic prevention with direct oral anticoagulants (DOAC) in atrial fibrillation (AF) patients with previous gastric surgery are lacking. We report inter- and intra-individual differences in DOAC concentration in people with gastric surgery, to identify potential treatment options. Patients with previous gastric surgery receiving DOAC for AF as stroke secondary prevention, and undergoing peak-trough DOAC plasmatic testing were selected from the regional EDDIE-AF registry. DOAC levels were tested at least 75-102h after DOAC initiation with Siemens Innovance® assays. Eight patients with previous gastric surgery were included (mean age 75years, 50% women). Overall, only 20/36 tests were within range (55.5%; apixaban 75.0%; dabigatran 0%; edoxaban 64.3%; rivaroxaban 33.3%). Rivaroxaban and dabigatran failed to reach therapeutic peak-trough concentrations. Apixaban and edoxaban reached therapeutic levels in 4/6 and 3/7 cases respectively, with marginal out-of-target concentrations in all remaining cases. Our data support a consistent variability in DOAC absorption after gastric surgery, suggesting that implementation of DOAC plasmatic testing may help in ensuring therapeutic levels are met whenever DOACs are preferred over warfarin.

Arthroscopic ACL repair with suture tape augmentation: clinical, functional, and gait analysis outcomes at minimum 3-year follow-up.

Recent advancements in surgical techniques have led to renewed interest in ACL repair, particularly for acute, proximal tears. Suture tape augmentation (STA) has emerged as a promising technique to support ACL healing while preserving native tissue and potentially improving outcomes. This study aims to evaluate the outcomes of ACL repair with STA in patients with acute, proximal ACL tears. We retrospectively reviewed patients who underwent ACL repair with STA between June 2018 and October 2020. Inclusion criteria were acute (< 6weeks) ACL rupture, Sherman type I tears, and minimum follow-up of 3years. Exclusion criteria included mid-substance or distal ACL tears and previous knee surgeries. Clinical evaluation involved stability tests, PROMs, and gait analysis using Prokin WalkerView. Second-look arthroscopy and histological analysis were conducted on a subset of patients. Twelve consecutive patients (7 males and 5 females) with a mean age of 27.4 ± 7.9years and mean BMI of 23.3 ± 1.6kg/m2were included. Time to operation was 19.5 ± 8.7days. Mean follow-up duration was 53.2 ± 9.4months. One patient experienced a traumatic re-rupture. One had a contralateral ACL tear and one experienced hardware irritation. Clinical tests were negative for instability in all patients. Post-operative IKDC, Lysholm, and FJS-12 scores showed significant improvement (p < 0.001). All patients (100%) achieved minimal clinically important difference for all PROMs. Walking gait analysis revealed high symmetry indices for range of motion (93.50%) and step length (95.80%) with near symmetrical loading. Second-look arthroscopy showed intact repairs with healthy tissue morphology and integration. Histology revealed increased cellularity, high nuclear density, and preservation of vascular and neural components indicated by CD34 and S-100 markers. Arthroscopic ACL repair with STA provides favourable clinical, functional, and histological outcomes with low re-rupture rates when performed on acute, proximal ACL tears. This technique demonstrates fair-to-good PROMs, functional stability, and near-normal gait parameters.

Cerebral Oxygen Metabolic Stress in Children and Adults With Large Vessel Vasculopathy Due to Sickle Cell Disease.

Large vessel vasculopathy (LVV), or moyamoya syndrome, increases the risk of stroke in patients with sickle cell disease (SCD), yet effective treatments are lacking. In atherosclerotic carotid disease, previous studies demonstrated elevated oxygen extraction fraction (OEF) as a predictor of ipsilateral stroke. In a SCD cohort, we examined hemispheric hemodynamic and oxygen metabolic dysfunction as tissue-based biomarkers of cerebral ischemic risk in patients with LVV. Children and adults with SCD were recruited from a SCD clinic associated with a tertiary medical center and underwent prospective brain MRI and MR angiography. LVV was defined as ≥75% stenosis in a major anterior circulation artery, excluding occlusion or previous revascularization surgery. Baseline characteristics, cerebral blood flow (CBF), normalized OEF (nOEF), infarct volume, white matter microstructure, and brain volume were compared in hemispheres with vs without LVV. In a cross-sectional analysis, mixed-effects linear multivariable models examined the effect of LVV on: (1) CBF and nOEF, as tissue markers of hemodynamic and oxygen metabolic stress, respectively, and (2) endpoints of cerebral ischemic injury including infarct volume, white matter microstructure, and brain volume. Of 155 patients (22 [12-31] years, 57% female), 33 (21%) had ≥25% stenosis, 22 (14%) had ≥50% stenosis, 14 (9%) had 75%-99% stenosis, and 5 (3%) had 100% occlusion. After excluding hemispheres with previous revascularization surgery, LVV was present in 16 hemispheres from 11 patients. Hemispheres with (N = 16) vs without (N = 283) LVV had lower CBF (25.2 vs 32.1 mL/100 g/min, p = 0.01) and higher nOEF (0.99 vs 0.95, p = 0.02). On multivariable analysis, CBF was nonsignificantly lower (β = -0.16, p = 0.07) while nOEF remained higher in hemispheres with LVV (β = 0.04, p = 0.03). Moreover, LVV was associated with greater hemispheric infarct volume, microstructural disruption, and atrophy. Beyond greater infarct burden, LVV was associated with hemispheric atrophy and white matter microstructural injury. As an indicator of active hypoxia, elevated nOEF likely represents a compensatory response to flow-limiting stenosis in hemispheres with LVV. The study is limited by a small number of patients with severe stenosis. Future studies are needed to evaluate the potential of tissue-based CBF and nOEF in assessing stroke risk and guide timely treatment of vasculopathy in SCD.

Does Prior Lower Abdominal Surgery Prevent Laparoscopic Hernia Repair (Totally Extraperitoneal or Transabdominal Preperitoneal)? A Prospective Observational Study.

Objective: Totally extraperitoneal (TEP) surgeries were considered contraindicated in patients who underwent lower abdominal surgery until recently. However, in recent surgeries, it has been reported that they can be performed safely in those cases. Our aim in this study is to investigate the effectiveness of laparoscopic hernia repair methods in patients who have and have not had lower abdominal surgery before. Patients and Method: This study was a prospective observational study between May 2018 and May 2023. Two hundred eighty-eight patients were included in the study. The operation was started with the TEP technique in all patients. Patients, classified in two groups who had not previously undergone abdominal surgery (n = 216) (Group I) and who had surgery (n = 72) (Group II). Demographic characteristics of patients, intraoperative and postoperative complications were determined. In addition to descriptive statistical methods (mean, standard deviation), Shapiro-Wilk normality test, independent t test, and chi-square test were used to evaluate the data. Logistic regression analysis was performed to determine the factors affecting the presence of Previous Surgery and Peritoneal Tear. Results were evaluated at the significance level of P < .05. Results: Two hundred fifty-nine patients were operated with TEP method. TEP method was converted to transabdominal preperitoneal (TAPP) in 9 patients from Group I and 20 patients from Group II. Intraoperative and postoperative complications were recorded. Conclusion: With increasing experience in laparoscopic hernia surgery, it is now possible to perform hernia surgeries with preperitoneal (TEP) and abdominal approaches (TAPP) in patients who have previously undergone lower abdominal surgery.

Glaucoma drainage devices: Indications, intraoperative management and postoperative follow-up

Glaucoma drainage devices (GDD) are used for patients with secondary glaucoma, such as uveitic or neovascular glaucoma, which is uncontrolled under local therapy. They are also used in patients with conjunctival scarring, for example after a previous vitrectomy or after unsuccessful previous glaucoma surgery, such as trabeculectomy. They are also a treatment option for congenital glaucoma, aphakic glaucoma or for the treatment of iridocorneoendothelial syndromes. The conventional GDD were the Baerveldt, Molteno or Ahmed glaucoma implant, whereby the first two were valveless and the latter had a valve. Newer GDD include the PAUL glaucoma implant, the Ahmed Clear Path and the EyeWatch system. Hypotony is a feared complication after GDD surgery, and there are various options for avoiding it: external ligation of the tube or intraluminal suture obstruction. However, low IOP may still occur postoperatively. If early postoperative hypotension occurs in combination with a shallow anterior chamber, the injection of a viscoelastic can be helpful. Late hypotension is usually treated with permanent occlusion or removal of the tube. Furthermore, GDD erosion and migration can occur postoperatively, in such cases a surgical revision is required. Corneal decompensation can also occur after GDD; Descemet's membrane endothelial keratoplasty (DMEK) is the treatment of choice in many centers and is performed more frequently than a penetrating keratoplasty. Finally, double vision is a possible complication after GDI. Most patients have short-term, self-limited diplopia or can be adequately treated with prism glasses; a few require strabologic surgery.

Risk Factors, Clinical Characteristics, and Antibiotic Susceptibility Patterns of Streptococcal Keratitis: An 18-Year Retrospective Study from a Tertiary Hospital in China

Purpose: Our aim was to investigate risk factors, clinical characteristics, and antibiotic susceptibility patterns of cornea-isolated Streptococcus species collected at a tertiary hospital in China over 18 years. Methods: This retrospective study reviewed data from 350 patients diagnosed with Streptococcal keratitis at Beijing Tongren Hospital between January 2006 and December 2023, including demographics, risk factors, clinical signs, in vivo confocal microscopy (IVCM) imaging, and antibiotic susceptibility testing. Results: The predominant type was Streptococcus pneumoniae (n = 108, 29.8%), followed by Streptococcus mitis (n = 90, 24.9%) and Streptococcus oralis (n = 85, 23.5%). Main risk factors included previous ocular surface disease (24.6%), ocular surgery (21.4%), and trauma (16.3%). Significant differences in clinical characteristics were observed among S. pneumoniae, S. oralis, and S. mitis regarding infiltration location (p = 0.038) and size (p = 0.037), as well as hypopyon presence (p = 0.006). IVCM revealed deeper inflammatory cell distribution and structural disruption as the disease progressed. Resistance rates of aminoglycosides, β-lactams, and fluoroquinolones have increased, with significant differences among species for amikacin (p = 0.010), gentamicin (p = 0.007), and others. Poor outcomes correlated with disease duration over one month, central corneal ulcers, dense infiltrations, hypopyon, and scar tissue presence on IVCM. Conclusions:Streptococcal keratitis is a complex ocular infection with multiple risk factors. S. pneumoniae, S. mitis, and S. oralis are the primary causative agents, exhibiting varying clinical features and antibiotic resistance patterns. Key factors associated with poor outcomes include long disease duration, central corneal ulcers, and severe infiltration.

The Safety and Feasibility of Aquablation in Patients with Previous Surgery for Benign Prostatic Hyperplasia.

Objective: Aquablation for lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) has been adopted to treat a wide range of prostate anatomies including glands up to 150 cc. Patients with recurrence of LUTS after previous BPH procedure often present with variant anatomy, and a paucity of literature exists on the optimal treatment modality for these patients. Herein, we evaluate the safety and feasibility of aquablation in patients with previous BPH surgical history. Patients and Methods: A prospectively managed single institution database of aquablation patients with BPH/LUTS was queried from August 2020 to December 2022 for patients who failed previous BPH procedures. Patients were divided into two groups: those with and without previous BPH procedure. Primary outcomes were intraoperative and 90-day complications. Secondary outcomes included operative time (OT), number of Aquabeam passes, estimated blood loss, hospital length of stay, and catheter duration. Outcomes were assessed using chi-squared, Wilcoxon rank sum tests, and logistic regression. Results: A total of 200 patients with BPH/LUTS were treated with aquablation. We identified 26 patients with a history of previous BPH procedures. Patients who underwent previous BPH procedures had smaller prostate volumes (60 cc) compared with treatment-naïve (88 cc) patients, p = 0.016. There was no difference in perioperative and 90-day complications (29% for treatment-naïve vs 17% in the retreatment group, p = 0.32). Most secondary outcomes were the same including OT, but the retreatment group had fewer Aquabeam passes (2 [1-2] vs 2 [2-2] treatment-naïve, p = 0.037) and more additional procedures at follow-up (30% vs 8.3% treatment-naïve, p = 0.005). Conclusion: Patients with previous BPH interventions remain excellent candidates for aquablation, with similar perioperative and 90-day postoperative outcomes compared with intervention-naïve patients. Aquablation demonstrates efficient tissue ablation without the risk of increased injury or significant blood loss after prior failed BPH procedures.

Lower Urinary Tract Dysfunction Among Patients Undergoing Surgery for Deep Infiltrating Endometriosis: A Prospective Cohort Study

Background/Objectives: Postsurgical lower urinary tract dysfunction (LUTD) is a common problem following deep infiltrating endometriosis (DIE) resection. The condition may be caused either by surgically induced damage to the bladder innervation or by pre-existing endometriosis-associated nerve damage. The aim of this study is to evaluate the efficacy of preoperative and postoperative multichannel urodynamic testing (UD) in identifying pre-existing or surgically induced LUTD among patients with DIE. Methods: Women with suspected DIE and planned surgical resection of DIE at the Department of Obstetrics and Gynecology at the University Hospital of Bern from September 2015 to October 2022 were invited to participate in this prospective cohort study. UD was performed before and 6 weeks after surgery. The primary outcome was the maximum flow rate (uroflow), an indicator of LUTD. Secondary outcomes were further urodynamic observations of cystometry and pressure flow studies, lower urinary tract symptoms (LUTS) as assessed by the International Prostate Symptom Score (IPSS), and pain as assessed by the visual analog scale (VAS). Results: A total of 51 patients requiring surgery for DIE were enrolled in this study. All patients underwent surgical excision of the DIE. The cohort demonstrated a uroflow of 22.1 mL/s prior to surgery, which decreased postoperatively to 21.5 mL/s (p = 0.56, 95%CI −1.5–2.71). The mean bladder contractility index (BCI) exhibited a notable decline from 130.4 preoperatively to 116.6 postoperatively (p = 0.046, 95%CI 0.23–27.27). Significant improvements were observed in the prevalence of dysmenorrhea, abdominal pain, dyspareunia, and dyschezia following surgical intervention (p = &lt;0.001). The IPSS score was within the lower moderate range both pre- and postoperatively (mean 8.37 vs. 8.51, p = 0.893, 95%CI −2.35–2.05). Subgroup analysis identified previous endometriosis surgery as a significant preoperative risk factor for elevated post-void residual (43.6 mL, p = 0.026, 95%CI 13.89–73.37). The postoperative post-void residual increased among participants with DIE on the rectum to 54.39 mL (p = 0.078, 95%CI 24.06–84.71). Participants who underwent hysterectomy exhibited a significantly decreased uroflow (16.4 mL/s, p = 0.014, 95%CI 12–20) and BCI (75.1, p = 0.036, 95%CI 34.9–115.38). Conclusions: Nerve-respecting laparoscopy for DIE may alter bladder function. UD is not advisable before surgery, but the measurement may detect patients with LUTD.

Repeat surgeries using anterior abdominal wall flaps after single-stage breast reconstruction (literature review)

Immediate breast reconstruction using endoprostheses is the most commonly performed reconstructive breast procedure in both the UK, USA and Russia, reaching 80% of all types of reconstruction. Tertiary reconstruction after previous breast surgeries may be required in case of complications of failed breast reconstruction or recurrence of disease. In foreign literature, the term tertiary reconstruction is commonly used for repeat reconstructive surgery. A literature review was conducted using the keywords: “одномоментная реконструкция молочной железы”, “reoperation in breast reconstruction”, “secondary reconstruction after immediate breast reconstruction”, “tertiary reconstruction with autologous tissue”.It has been established that repeated operations using anterior abdominal wall flaps after one-stage breast reconstruction have a good healing outcome and satisfy the aesthetic needs of patients.Conclusion. Tertiary reconstruction after a long period of implant placement is motivated by undesirable symptoms (breast pain, psychological discomfort), cosmetic dissatisfaction of patients, late infections, development of cancer of the contralateral breast or recurrence of the disease on the side of reconstruction.

Giant benign mesenteric cysts (mesothelioma and lymphangioma): A report of two cases

Introduction and importanceMesenteric cysts are a rare group of intra-abdominal tumors located in the mesentery or omentum, most of this lesion are asymptomatically but occasionally presents with non-specific symptoms, which makes diagnosis difficult. Case presentationWe present two cases of giant mesenteric cyst in our Institution, the first case is a women of 23 years with previous gynecologic surgery with chronic abdominal pain and large abdominal mass CT showed a giant intraabdominal 30 × 25 × 15 cm, the patient went to laparotomy and a large mesenteric tumor found. The Histopathology reported a Benign cyst mesothelioma (BCM). The second case is a 47 year male with intermittent abdominal pain and abdominal CT shows a 20x21x15 cm tumor. Laparotomy was performed. Histopathology reported a large lymphangioma. Clinical discussionBCM tumors are rare intrabdominal lesions often diagnosed in premenopausal women. Its etiopathogenesis is still unclear, associated risk factors are endometriosis, pelvic inflammatory disease and previous pelvic surgery. Lymphangiomas are an infrequent cyst tumors. It results from a failure in the evolutionary development of the lymphatic system, often localized in the head and neck and its localization in the abdomen is even rare. The definitive diagnosis is made by histopathology. ConclusionMesenteric cysts diagnosis if often challenge due to nonspecific symptoms and significant overlap in imaging appearance between the different entities, its diagnosis should be in mind when encounter a cystic abdominal tumor, surgical complete removal of this tumors is the optimal treatment to prevent recurrence and complications.

Development and validation of the MRI-based deep learning classifier for distinguishing perianal fistulizing Crohn’s disease from cryptoglandular fistula: a multicenter cohort study

A singular reliable modality for early distinguishing perianal fistulizing Crohn's disease (PFCD) from cryptoglandular fistula (CGF) is currently lacking. We aimed to develop and validate an MRI-based deep learning classifier to effectively discriminate between them. The present study retrospectively enrolled 1054 patients with PFCD or CGF from three Chinese tertiary referral hospitals between January 1, 2015, and December 31, 2021. The patients were divided into four cohorts: training cohort (n=800), validation cohort (n=100), internal test cohort (n=100) and external test cohort (n=54). Two deep convolutional neural networks (DCNN), namely MobileNetV2 and ResNet50, were respectively trained using the transfer learning strategy on a dataset consisting of 44871MR images. The performance of the DCNN models was compared to that of radiologists using various metrics, including receiver operating characteristic curve (ROC) analysis, accuracy, sensitivity, and specificity. Delong testing was employed for comparing the area under curves (AUCs). Univariate and multivariate analyses were conducted to explore potential factors associated with classifier performance. A total of 532 PFCD and 522 CGF patients were included. Both pre-trained DCNN classifiers achieved encouraging performances in the internal test cohort (MobileNetV2 AUC: 0.962, 95% CI 0.903-0.990; ResNet50 AUC: 0.963, 95% CI 0.905-0.990), as well as external test cohort (MobileNetV2 AUC: 0.885, 95% CI 0.769-0.956; ResNet50 AUC: 0.874, 95% CI 0.756-0.949). They had greater AUCs than the radiologists (all p≤0.001), while had comparable AUCs to each other (p=0.83 and p=0.60 in the two test cohorts). None of the potential characteristics had a significant impact on the performance of pre-trained MobileNetV2 classifier in etiologic diagnosis. Previous fistula surgery influenced the performance of the pre-trained ResNet50 classifier in the internal test cohort (OR 0.157, 95% CI 0.025-0.997, p=0.05). The developed DCNN classifiers exhibited superior robustness in distinguishing PFCD from CGF compared to artificial visual assessment, showing their potential for assisting in early detection of PFCD. Our findings highlight the promising generalized performance of MobileNetV2 over ResNet50, rendering it suitable for deployment on mobile terminals. National Natural Science Foundation of China.

Danish cohort study of tympanic membrane retractions and manifestations of Eustachian tube dysfunction

AbstractObjectivesOur objective is to evaluate the prevalence of tympanic membrane (TM) retractions and management of signs of Eustachian tube dysfunction (ETD) in both children and adults following type 1 tympanoplasty or myringoplasty. Furthermore, to identify potential risk factors for developing ETD and TM retractions.MethodsRetrospective cohort study of 423 patients (5–86 years of age) undergoing 452 procedures. We extracted data from electronic patient journals during scheduled consultations to calculate prevalences and relative risks. The project was reported to the Danish Data Protection Authority, and access to electronic patient journals was approved by the Institutional Board of Gødstrup Hospital.ResultsAt 1 year postoperative follow‐up, the prevalence of TM retractions was 12.7% and ETD manifestations without a concurrent TM retraction was 4.2%. The graft failure rate was 11.0%. Risk factors for developing TM retractions included preoperative myringosclerosis, history of ipsilateral ear surgery, posterior perforations, and use of perichondrium graft. Conversely, previous contralateral ear surgery and temporal fascia graft use were associated with decreased risk. ETD manifestations were significantly increased in cases of preoperative bilateral perforation, history of ipsilateral ventilation tube, and traumatic TM perforation.ConclusionsTM retractions accounted for 12.7%, ETD manifestations without a concurrent TM retraction 4.2%, and graft failure 11.0%. The dynamic nature of these complications necessitates diligent follow‐up strategies.Level of evidenceLevel 4.

Intermediate- and long-term results after ATOMS (Adjustable Transobturator Male System®) implantation

ObjectivesTo assess outcomes of continence and complications after implantation of Adjustable TransObturator Male System (ATOMS) for the treatment of male stress urinary incontinence (SUI). Materials and MethodsData of 80 patients receiving an ATOMS implatation between 2010 and 2021 at a tertiary academic referral centre were retrospectively analyzed. Primary endpoints were outcomes of continence and complications. Implant survival rate was estimated by the Kaplan-Meier method, risk factors for explantation were analyzed by univariable Cox regression. ResultsDuring a median follow-up of three yrs. the number of pads decreased significantly from four to two pads per day (p<0.001). After five yrs., 17 patients experienced an explantation, eight of them during the first year following ATOMS implantation, resulting in one- and five-year-implant-survival rates of 0.89 (95%CI:0.80-0.95) and 0.71 (95%CI:0.56-0.81), respectively. During the total observation time, ATOMS was explanted in 22 (27.5%) patients (Kaplan-Meier estimate for explantation: 0.35 [95%CI:0.09-0.64]) after a median time of 2.3 (0.1, 10.2) yrs. The risk for explantation was higher in patients after previous incontinence surgery (HR=3.4, 95%CI:1.4-8.2, p=0.007), ISUP (International Society of Urological Pathology) > 4 (Gleason score >8) in surgery specimens (HR=4.4, 95%CI:1.03-27.1 compared to ISUP 1, p=0.046), and a preoperative daily pad weight >250g (HR=3.1, 95%CI:1.18-8.17, p=0.022). ConclusionATOMS lead to a significant reduction of pad usage. During the intermediate-term follow-up approximately every 3rd patient experienced device explantation. In particular, patients with recurrent SUI and patients with severe SUI have to be warned about a relevant risk of explantation.

CT-Based Lung Size Matching in Delayed Chest Closure for Systemic Sclerosis Lung Transplantation.

Delayed chest closure (DCC) during lung transplantation (LTx) is a controversial surgical approach that lacks research in systemic sclerosis (SSc) patients. We investigated outcomes, clinical risk factors, and CT-based lung size-matching parameters associated with DCC in SSc recipients. This retrospective study included 92 SSc recipients (age 51 years ± 10, 56/92 (61.0%) females) who underwent bilateral LTx between 2007 and 2020. Of the recipients, 34.8% (32/92) underwent DCC. Recipient lung and chest cavity volumes were automatically computed from CT imaging using deep learning algorithms. Survival between groups was compared using Kaplan-Meier analysis. Multivariate logistic regression was used to identify risk factors and predict DCC occurrence using preoperative variables. Recipients who underwent DCC had longer total vent duration (p=0.001), more use of postoperative mechanical support (p=0.001), longer ICU length of stay (p=0.008), and lower incidence of pneumonia post-operation (p=0.031). No significant difference in survival was observed between DCC and PCC recipients at 30 days (p = 0.713), 90 days (p = 0.267), 1 year (p = 0.941), and 5 years (p = 0.651). Clinical risk factors for DCC included BMI >30kg/m2 (p = 0.009), tracheostomy (p = 0.002), atrial fibrillation (p = 0.012), decreased preoperative FEV1/FVC (p=0.013), and previous chest operation (p = 0.020). Two CT-based measurements of lung matching were significantly associated with DCC occurrence (p = 0.021 and 0.050). The regression model achieved a mean AUC of 0.82 (0.70, 0.94) in retrospectively predicting DCC occurrence. SSc recipients undergoing DCC have similar survival rates but experience more complications than PCC recipients. Clinical risk factors and CT-based size matching can be leveraged to predict DCC pre-transplant.

Operative Treatment of Nonprimary Osteochondral Lesions of the Talus: A Systematic Review.

Nonprimary osteochondral lesions of the talus (OLT) pose a significant challenge in orthopaedics, with no definitive consensus on optimal surgical treatment. To consolidate the most recent evidence on operative treatments for nonprimary OLT by assessing patient-reported outcomes (PROs), postoperative complications, and clinical failures. Systematic review; Level of evidence, 4. This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 and PRISMA in Exercise, Rehabilitation, Sport medicine and Sports science guidelines. Searches were conducted in PubMed, Embase, and Cochrane Library databases through June 2023. Eligible studies evaluated operative outcomes in skeletally mature patients with nonprimary OLT after failed previous surgeries. Primary outcomes included clinical and functional PROs. Secondary outcomes included postoperative complications and clinical failures. Quantitative analyses involved weighted means, mean differences, minimal clinically important differences, success rates (95% binomial proportion confidence interval), and a pre-to-postoperative meta-analysis. Out of 3992 identified records, 50 studies involving 806 ankles from 794 patients were included. All operative treatments significantly improved PROs (P < .05), except osteochondral allograft transplantation (OCA) for American Orthopaedic Foot and Ankle Society and pain (visual analog scale/numeric rating scale [VAS/NRS]) scores and HemiCAP for pain (VAS/NRS) scores. Autologous chondrocyte implantation (ACI) and osteochondral autologous transplantation (OAT) demonstrated the greatest PRO success rates, exceeding 80%. Postoperative complications occurred in 4% of cases, most frequently with HemiCAP. Clinical failures affected 22% of cases, particularly with autologous matrix-induced chondrogenesis, OAT, OCA, and HemiCAP. Our systematic review demonstrated that ACI and OAT are promising treatments for nonprimary OLT, with ACI showing fewer clinical failures than OAT. Conversely, OCA and HemiCAP exhibited lower effectiveness and higher clinical failure rates, suggesting a need for reassessment.

A Case Report of Mesenteric Panniculitis and Fibrous Dysplasia with Primary Metabolic Syndrome.

Mesenteric panniculitis (MP) is a rare clinically diagnosed disease resulting from fibro-inflammation in the intestinal adipose tissue. Precedent intra-abdominal inflammation or trauma is often evident. Fibrous dysplasia (FD) is a benign uncommon childhood disease of the bones, with fibrous connective tissue replacing bone tissue. FD can cause pain, disfigurement, and entrapment of critical neighbouring structures. Adult-onset craniofacial involvement is rare. Metabolic syndrome is characterized by obesity and chronic subclinical inflammation, promoting abnormal cellular fibrosis and proliferation. The concomitant incidence of MP and FD in an older female adult with metabolic syndrome is unprecedented. An aberrant metabolic contributory pathophysiology for both MP and FD could be postulated. A 60-year-old Caucasian woman with primary long-standing well-treated metabolic syndrome with obesity presented for revision bariatric surgery. She had previous intra-abdominal surgeries and occasional intermittent abdominal pain. The surgery was abandoned due to extensively inflamed intestinal mesentery. Radiological studies and intra-abdominal biopsy confirmed MP. She subsequently developed pronounced unilateral facial swelling and radiological studies confirmed FD. Treatment has been suboptimal for both MP and FD. She developed venous thromboembolism on tamoxifen treatment for MP. The patient currently reports abdominal pain and swelling from MP, and facial disfigurement, pain, and tinnitus from FD. Blood markers for inflammation have remained consistently high, and there is statin intolerance. Most recently liver steatosis and diabetes have developed. A case of MP and FD with primary metabolic syndrome is unique. An increased awareness of such rare cases could lead to further research, and critically needed treatments to optimize outcomes. Mesenteric panniculitis (MP) is a rare disease as is craniofacial fibrous dysplasia (FD) in adults. The incidence of these two rare diseases in an older adult with primary metabolic syndrome is previously unknown, making this case the first of its kind.Metabolic syndrome is common condition of the industrialized population, and an aberrant common "systemic" metabolic pathophysiology could contribute significantly to the inflammatory and fibrotic cellular changes inherent to both these two localized diseases of MP and FD.Knowledge about rare diseases, particularly if clustered with a primary systemic disease, could lead to better treatment outcomes in the future and promote novel therapeutic targets.

Scar endometriosis, a form of abdominal wall endometriosis-a neglected obstetrical complication?

Scar endometriosis (EM) is defined by the presence of endometrial-like tissue outside the uterine cavity within the scar region after abdominal or pelvic surgery. It is a form of abdominal wall EM. This systematic review addresses the question of whether women after cesarean delivery (CD) are more frequently affected by scar EM than women after other pelvic surgical procedures. The primary aim is to analyze the distribution of previous operations in patients with scar EM. Secondarily, symptoms, diagnosis, and treatment are described. A systematic literature search in MEDLINE (Pubmed) was performed. Twelve studies were included. The terminology of scar EM is unspecific and the descriptions are, therefore, of limited comparability among authors. In 64-96%, patients with scar EM had a history of CD, followed by laparoscopy, laparotomy, and episiotomy. The main symptoms were pain, often cyclical, and the presence of local swelling. For diagnosis ultrasound, CT scan and MR imaging were used. All patients had undergone surgical resection and the diagnosis was confirmed. Most often scar EM develops after CD. Diagnosis and treatment are often delayed. As an objective classifications system is missing, we propose a simple objective descriptive tool for abdominal wall EM.

Simplified technique in total pancreatectomy with islet cell autotransplantation after Frey’s procedure: a case report

BackgroundThe selection of the surgical approach for chronic pancreatitis (CP) is determined by various factors including inflammatory location, presence of pancreatic duct dilatation, or possibility of cancer. Total pancreatectomy (TP), with or without islet cell autotransplantation, is considered for patients with refractory CP after the failure of other surgical treatments. Considering the increasing incidence of CP requiring surgical treatment, the number of cases in which TP is performed after previous surgical treatment is expected to increase.Case presentationWe reported a case of TPIAT in a patient with alcoholic CP who had previously undergone Frey’s procedure. During the operation, the sufficient length of the elevated jejunal loop for pancreaticojejunostomy in Frey’s procedure allowed it to be used directly for biliary jejunostomy during TP. In addition, jejunojejunostomy from the previous operation could be used, and these methods contributed to simplifying the operative procedure. We need open hemostasis on post-operative day (POD) 1and a percutaneous drainage tube replacement for an intraperitoneal abscess on POD 24. The patient was discharged from the hospital on POD 37 with normal serum C-peptide level, which suggests favorable insulin secretion from transplanted islets, and the epigastric pain that suffered her preoperatively resulted in a dramatic improvement.ConclusionsWhen performing the Frey’s procedure, the elevated jejunal loop and Y-anastomosis jejunal loop with sufficient length allow them to be used directly for the reconstructions in the possible subsequent TP.

Alterations in corneal sensitivity according to age and gender in healthy population in Turkey

ABSTRACT Clinical relevance Knowing the changes in corneal sensitivity according to age and gender is important for the correct evaluation of pathologies. Background The aim of this work was to analyse variability of corneal sensitivity according to age and gender in the healthy population in Turkey. Methods Healthy volunteers between the ages of 20 and 84, who applied to outpatient clinic due to routine examination, were included. Exclusion criteria were any ocular diseases other than refractive error, any systemic disease, contact lens use, chronic ocular and systemic drug use, and previous ocular surgery. Central and 4 quadrants (superior, inferior, nasal, temporal) corneal sensitivity measurements were performed with a Cochet-Bonnet esthesiometer (Luneau Ophthalmology, France). The patients were divided into 5 groups according to their ages (Group 1:20-29, Group 2:30-39, Group 3:40-49, Group 4:50-59, Group 5 ≥ 60). The data were evaluated in terms of groups and gender. Results The right eyes of 324 volunteers were included. The mean age was 44.31 ± 15.65 (20–84) and the female/male ratio was 165/159. The mean central, superior, inferior, nasal, and temporal sensitivities were 50.15 ± 9.7,48.62 ± 10.3,48.59 ± 10.3,47.73 ± 10.2,47.71 ± 10.3 mm, respectively. Sensitivities in all quadrants decreased significantly depending on age (p = 0.001 for all, central, superior, inferior, nasal and temporal correlation coefficients,r = −0.783, −0.791, −0.789, −0.760, −0.775, respectively). The decrease accelerated in Group 4 and 5. Gender-related changes were detected as significant in central and temporal quadrants (p = 0.038, p = 0.019). When sensitivity according to gender was evaluated within each decade, significant difference was detected in Group 2 and 4 (p < 0.05). Conclusion Corneal sensitivity decreases with age, most significantly in 5th and 6th decades. Sensitivity differs between genders in central and temporal quadrants. Geographic location, gender, and ethnicity may affect sensitivity values. The present study defines normal values in aTurkish population and may guide the evaluation of pathologies that impair corneal sensitivity.