Significant Obstruction Research Articles

Clinical and radiologic criteria to predict endoscopic third ventriculostomy success in non-communicating pediatric hydrocephalus.

Endoscopic third ventriculocisternostomy (ETV) became the relevant treatment option for non-communicating pediatric hydrocephalus. ETV success was predicted in relation to age, diagnosis, and previous shunt implantation. Radiological factors are usually taken for indication decision-making. The aim of this study is to investigate radiological signs of non-communicating hydrocephalus for ETV success in a single-center retrospective analysis. ETV interventions were collected from a 10-year period (2010-2019) from our institution. Clinical patient characteristics such as prematurity, age, diagnosis, and previous shunt treatment and follow-up in terms of possible shunt implantation or revision surgeries were investigated. Radiological data was retrieved from the in-house PACS system to analyze preoperative signs for non-communicating hydrocephalus such as ventricular size, pressure gradients at the third ventricle, and any signs of obstruction from internal towards external cerebral spinal fluid communication. Fisher's test was used to demonstrate the significance of each individual predictor. A multivariable model was built using the backward elimination method with multiple logistic regression. From 136 ETV interventions, 95 met the inclusion criteria (age < 18years; > 6-month follow-up; MR image data availability, treatment goal for shunt independence). In chi-square statistical evaluation of single parameters age > 6months (OR 32.5; 95% CI 4.8-364), ventricular width (FOHR < 0.56; OR 6.1; 95% CI 2.2-16.3) and non-post-hemorrhagic hydrocephalus as underlying diagnosis (OR 13.1; 95% CI 1.9-163) showed significant increased odds ratio for shunt independence during follow-up. Logistic regression analysis for multiple parameters showed age > 6months (OR 29.3; 95% CI 4.1-606) together with outward bulged lamina terminalis (OR 4.6; 95% CI 1.2-19.6), smaller FOHR (continuous parameter; OR 2.83 × 10-5; 95% CI 4.7 × 10-9-0.045), and non-4th-ventricular-outlet obstruction (4thVOO; OR 0.31; 95% CI 0.09-1.02) as significant factors for ETV success. ETV has become a relevant treatment for non-communicating hydrocephalus, with typical MR image characteristics. Analyzing radiological markers as predictors for success smaller ventricular width and outward displaced lamina terminalis was relevant in combination with age > 6months. Since the analysis is based on single-center experience, a larger cohort of patients with a multi-center approach should further investigate the combined clinical and radiological criteria.

An observational study on global longitudinal strain in acute coronary syndrome and its correlation with coronary angiogram

Background: Coronary angiography (CA) is crucial for diagnosing acute coronary syndrome (ACS) and assessing coronary artery disease (CAD), enabling healthcare providers to determine treatment options and assess the risk of cardiovascular events. Global longitudinal strain (GLS) is a sensitive marker of cardiac function. This study aimed to determine the correlation between GLS in ACS and CA findings. Methods: This prospective observational study was conducted at the cardiology department of the Salem government medical college. The study involved transthoracic echocardiography (TTE) to assess LV volumes, ejection fraction (EF), and LVGLS and strain analysis using 2D echocardiography to measure regional longitudinal peak systolic strain in different LV segments. CA was performed to visualise the coronary vessels and detect significant CAD. Results: The study population consisted predominantly of male patients (n=93, 62%), with notable smoking (n=48, 32%) and alcohol consumption (n=36, 24%). A significant majority of the patients (n=111, 74%) exhibited ECG abnormalities. Obstruction was present in 82% of the patients (n=123), with those showing impaired myocardial function compared to those without obstruction. GLS values below 13.95 were more common in patients with obstruction (n=8 out of 11), indicating reduced myocardial deformation. The GLS demonstrated excellent diagnostic performance for detecting significant coronary artery obstruction, with a high sensitivity of 88.89%, specificity of 90.63%, and overall accuracy of 90.24%. Conclusions: Our study revealed a strong correlation between reduced GLS and CAD, highlighting its importance in CAD assessment and risk stratification in ACS. GLS demonstrated excellent diagnostic performance for detecting significant CAD, showing high sensitivity and specificity.

Clinical features of 50 patients with primary intestinal lymphangiectasia

Objective: To investigate the clinical features of primary intestinal lymphangiectasia (PIL). Methods: This study was a retrospective case series study. Fifty consecutive patients diagnosed with PIL in Department of Lymphatic Surgery, Beijing Shijitan Hospital, Capital Medical University from March 2019 to March 2021 were included and their clinical data was retrospectively reviewed. There were 20 males and 30 females included, with an age of (M(IQR)) 14 (40) years (range:0 to 67 years). No patient had the family history. There were 26 children, including 9 males and 17 females, aged 0 (7) years (range:0 to 14 years). There were 24 adults, including 11 males and 13 females, aged 40 (26) years (range:20 to 67 years). The clinical manifestations and the results of laboratory examinations, gastrointestinal endoscopy, 99Tcm-labeled human albumin (99Tcm-HSA) scintigraphy, 99Tcm-DX scintigraphy, direct lymphangiography (DLG), histopathology, diet treatment, surgical intervention, and clinical symptom remission at discharge were collected. Comparisons between groups were performed using independent samples t-test, Mann-Whitney U test, or χ 2 test. Results: Among the 50 cases of PIL, the main manifestations were edema (86.0%), diarrhea (76.0%), and abdominal effusion (48.0%). Lymphedema (36.0%) and chylous ascites (18.0%) were not rare in PIL patients. In 99Tcm-HAS scintigraphy, 95.9% (47/49) cases showed signs of intestinal protein loss, and 91.7% (44/48) ceses showed positive findings in 99Tcm-DX scintigraphy. In DLG, 97.8% (45/46) cases showed signs of thoracic duct obstruction, 82.6% (38/46) cases showed retroperitoneal lymphatic hyperplasia, and 23.9% (11/46) cases showed backflow of contrast agent into intestine. No significant difference was seen in gender, course of disease, clinical manifestation, serum level of albumin or globulin, lymphocyte count, positive rate of fecal occult blood and prevalence of lymphedema between adults and children (all P>0.05). Conclusions: The clinical presentations of PIL between children and adults had no significant difference. The diagnosis of PIL should be made according to clinical manifestation, 99Tcm-HAS scintigraphy, 99Tcm-DX scintigraphy, DLG, gastrointestinal endoscopy and pathological findings.

Palliative treatment of malignant intestinal obstruction with EUS-guided ileosigmoidostomy - a case report.

We present the case of a 70-year-old patient of Caucasian origin under palliative chemotherapy for metastasized colorectal cancer, who presented with signs of complete small bowel obstruction six months after placement of a diverting ileostomy. Following previous tumor perforation, he was not considered a candidate for further surgical intervention.Thus, endoscopic ultrasound-guided enterocolostomy (i.e., ileosigmoidostomy) with a lumen-apposing metal stent was successfully performed in a coloenteric approach to restore the passage.Oral nutrition could be resumed the next day, and the patient could be discharged in substantially improved condition after three days.

Left Amyand’s Hernia in A 1-Year-Old Male Infant: Report of a Rare Case in Common Presentation

Abstract Amyand’s hernia is a rare type of hernia with the appendix and cecum trapped in a hernial sac. A one-year-old male infant was referred with irreducible left inguinal hernia for about 1 week. No signs of intestinal obstruction were presented, and pain was tolerated. A herniotomy was performed on the patient. Intraoperatively, the appendix and cecum were found in the left hernial sac, which this rare presentation named left Amyand’s hernia. Cecum and appendix were considered normal. No perforation and significant inflammation were found; hence, no appendectomy was performed. Left Amyand’s hernia is a very rare case, mostly in pediatric surgery, in which the current decision of diagnosis-making can only be made intraoperatively.

Loss of Myofibrils in Cardiomyocytes as a Morphological Indicator of Reduced Compensatory Capabilities of Hypertrophied Myocardium.

The functioning of the ventricular myocardium in hypertrophic cardiomyopathy (HCM) under high hemodynamic load leads to depletion of its resources and is associated with the risk of developing a dilated stage. In patients with HCM, the cardiomyocytes of the interventricular septum are hypertrophied, the proportion of cardiomyocytes in which myofibrils constitute less than 50% of the sarcoplasm volume increases with increasing the cardiomyocyte length and correlates with echocardiographic signs of left ventricular obstruction. These cardiomyocytes are characterized by ultrastructural signs of synthetic activity. In the myocardium of patients with HCM, single cardiomyocytes with "critical" loss of myofibrils and nonspecific degenerative changes corresponding to the picture of irreversible changes in the cardiomyocyte ultrastructure were revealed. The presence of cardiomyocytes with this ultrastructural phenotype is an early marker of exhaustion of the compensatory capabilities of the myocardium in HCM.

BS SO18 - Small bowel intussusception after Roux-en-Y gastric bypass: A case report and review of literature

Abstract Background Small bowel obstruction after RYGB for obesity can occur due to various common causes like internal hernia and adhesions. One of the rare complications of RYGB is retrograde intussusception of jejunum at the common channel. Since it does not present with typical symptoms of small bowel obstruction, it is often challenging to consider it as differential diagnosis at initial presentation. Also, managing the intussusception at non bariatric centres could prove difficult due to location of it in the common channel, which will require understanding of orientation of alimentary and biliary limbs as well as reconstruction after resection of the intussusception. Method We collected the details of our patients admission episode from a different centre where she was admitted initially to understand the clinical behaviour of the condition. Also, we conducted a systematic search of literature databases like PubMed, Embase, CINAHL, ProQuest Dissertations &amp; Theses using MeSH terms and keywords Intussusception, Retrograde intussusception, J-J intussusception, Intestinal Obstruction, Small bowel obstruction, Bowel obstruction, Obesity, Morbid obesity, Gastric Bypass, Roux-en-Y gastric bypass, Jejunojejunostomy, Jejuno-jejunostomy, Gastric by-pass, RYGB, Roux-en-Y. Data were extracted on to Excel sheet for analysis. Results The search yielded 41 case reports. Patients were operated in most instances except in seven cases where they had multiple episodes. The average age of presentation was 38 mostly in females and few instances being during pregnancy including our patient. Intussusception happened between 5 to 360 months after the initial operation with the average time after the operation being 66 months. Pain was the principal mode of presentation without classical symptoms of bowel obstruction. There were few instances of coffee ground vomiting. CT was the diagnostic modality in almost all cases. Recurrence was invariable when not managed with resection. Conclusion Small bowel intussusception after RYGB occurs retrogradely and does not present with classical symptoms and signs of small bowel obstruction. It can be reliably diagnosed with CT abdomen. Of note, medical management and no-resectional surgical management results in recurrence of this condition.

Effectiveness of therapy for patients with chronic acalculous cholecystitis based on the comprehensive use of therapeutic physical factors

Purpose of the study: to evaluate the effectiveness of the combined use of therapeutic physical factors (amplipulse and general magnetic therapy), as well as manual therapy in the treatment of patients with chronic acalculous cholecystitis. Material and methods. The study involved 125 patients with chronic biliary tract obstruction aged 31 to 60 years with a disease duration of 12.5±0.19 years. Using the simple fixed randomization method, all patients were divided into three proportional groups. Patients in the control group (n=42) received standard therapy according to the corresponding protocol. Patients in the comparison group (n=41) received standard therapy supplemented with manual interventions aimed at restoring the mobility and motility of the hepatobiliary system organs. Patients in the main group (n=42) additionally received a course of combined physiotherapy in the form of amplipulse and general magnetic therapy. Evaluation of clinical efficacy in the selected groups was carried out based on the dynamics of the severity of subjective signs of chronic biliary tract obstruction, laboratory parameters of duodenal intubation and biochemical blood parameters characterizing the state of the hepatobiliary system. Results. It has been established that, compared with standard therapy, the combined use of hardware physiotherapy methods and massage procedures significantly increases the effectiveness of treatment, which is manifested in a significant (more than 1.5 times) decrease in the severity of clinical symptoms of the disease, a decrease in bile lithogenicity by 45 %, an increase in the contractile function of the gallbladder by 24 %, with a decrease in the level of cholesterol in bile by 21 % and an increase in the concentration of cholecystokinin in the blood by 31 %. Correlation analysis showed that cholecystokinin claims the role of a kind of center of the correlation galaxy of pathogenetic reactions of chronic acalculous cholecystitis. The use of statistical analysis of predictors made it possible to reveal that the effectiveness of complex physiotherapy increases in younger patients and with a shorter duration of the disease, as well as with higher values of cholecystokinin in the blood and a reduced potential for lithogenicity of bile. Conclusion. Supplementation of the standard protocol for the treatment of chronic acalculous cholecystitis with methods of combined hardware physiotherapy in the form of amplipulse and general magnetic therapy is accompanied by the development of a pronounced clinical effect, confirmed by the dynamics of clinical and laboratory parameters.

Diagnosis and treatment of magnetic foreign bodies in the gastrointestinal tract: the experience of four centers

BACKGROUND: Magnetic foreign bodies in the gastrointestinal tract is a relatively rare problem in urgent pediatric surgery. Meanwhile, among cases with foreign bodies, they are the most difficult both in terms of timely diagnostics and timely treatment. There are no generally accepted therapeutic and diagnostic standards, and traditional algorithms of patient management are focused on the dynamic observation and are not correct. More so, algorithms described in the foreign literature contradict each other. The rate of surgical interventions and the risk of complications are high. Surgical tactics has many "white spots". All these issues remain open for discussion. AIM: To analyze the experience of four medical centers in the diagnostics and treatment of patients with magnetic foreign bodies in the gastrointestinal tract. METHODS: A retrospective analysis of diagnostic and treatment techniques applied in patients with magnetic foreign bodies in their gastrointestinal tract from four pediatric surgical hospitals in 2010–2023 was made. In the study there were patients with neodymium magnetic balls from the constructor (38 patients, 50%), neodymium magnets of other shapes and for other purposes (30 patients, 39.5%), ferrite magnets (6 patients, 7.9%), unknown types of magnets (2 patients, 2.6%). RESULTS: Patients’ average age was (4±3.65) years. The fact of foreign body swallowing was revealed in anamnesis of 46 (60.5%) patients. Mental illnesses were diagnosed in 4 children — 5.3%, which is higher than the average incidence in pediatric population. Clinical symptoms were registered in 4 (11.8%) children with a single magnet foreign body and in 33 (78.6%) children with multiple ones. The basic diagnostic technique was an overview radiography of the abdominal cavity (70 cases, 92%), which allowed to identify both a foreign body and complications (signs of intestinal obstruction, free gas in the abdominal cavity). Esophagogastroduodenoscopy was performed in 50 cases (65.8%), out of which one foreign body was detected in 34 (68%) cases, and in 28 patients, foreign bodies were removed. Other diagnostic methods (ultrasound, spiral computed tomography) were used much less frequently. Among curative techniques, open surgeries prevailed — 32 cases (42%). Laparoscopy was used in few cases. CONCLUSION: The timely diagnostics of magnetic foreign bodies in gastrointestinal tract often depends on anamnesis findings, and if there is no such, diagnostics most often is delayed and is made only intraoperatively. Among the diagnostic techniques, it is difficult to identify a universal one that can be recommended as the "gold standard"; however, the most widely used and well-informative is abdominal X-ray and esophagogastroduodenoscopy. As to surgical tactics, the role of laparoscopic interventions is relatively low. Most often, endoscopy or "open" surgery are performed.

Skeletal and respiratory muscle weakness contributes to decreased exercise capacity in hypertrophic cardiomyopathy

Abstract Background and Aims Although decreased exercise capacity (due to dyspnea or angina-like symptoms) constitutes the fundamental characteristics of hypertrophic cardiomyopathy (HCM), the pathophysiology of these symptoms remains only partly understood. We investigated clinical and functional determinants of decreased exercise capacity in a broad range of HCM patients irrespective of primary disease aetiology (either genetic disorder or e.g. infiltrative phenocopies in the course of cardiac amyloidosis), overt heart failure (HF) and the presence of haemodynamically significant left ventricular outflow tract obstruction (LVOTO). Further, we deterimined the contribution of skeletal and respiratory muscle weakness to decresed exercise capacity. Methods We analyzed clinical data and functional assessments (skeletal and respiratory muscle strength, physical fitness) in relation to symptomatology and sub-maximal exercise capacity in 82 clinically stable patients with HCM (females: 32 %; age: 62±16 years; left ventricular ejection fraction [LVEF] 59±7%; intraventricular septum wall thickness [IVS] 19±4 mm; median plasma N-terminal pro-B-type natriuretic peptide [NT-proBNP]: 818 pg/mL [lower and upper quartile: 208-1917]; New York Heart Association [NYHA] class 0/I/II/III: 38/18/33/11 % [0 indicates no HF]; significant LVOTO: 29%). Results HCM patients with more severe symptomatology (NYHA class II-III vs 0-I) were older, had more frequently significant LVOTO and greater comorbidity burden, and had higher NT-proBNP and worse estimated renal function (all p≤0.03). Gender distribution, percentage of beta-blocker therapy and implanted device, body mass index, major echocardiography parameters (including LVEF, left ventricular end-diastolic diameter and IVS), high-sensitive (hs) cardiac troponin type I and hs-C-reactive protein were comparable in these 2 groups of subjects (all p&amp;gt;0.05). In multivariable linear regression models more advanced age, higher circulating natriuretic peptides (NT-proBNP) and previous coronary revascularization were independent predictors of more advanced NYHA class (standardized β-coefficient=0.30, p&amp;lt;0.01; β=0.27, p&amp;lt;0.01; and β=0.22, p&amp;lt;0.05; respectively). Similarly, more advanced age, female sex and higher NT-proBNP were independent correlates of shorter distance in 6-minute walking test (6MWT) (β=-0.46, p&amp;lt;0.001; β=-0.26, p&amp;lt;0.001; and β=-0.36, p&amp;lt;0.001; respectively). All analyzed muscle parameters (including respiratory muscle strength parameters) and objective measures of physical fitness (Functional Fitness Test for older adults) remained independently associated with 6MWT distance (all p&amp;lt;0.001) when adjusted for aforementioned clinical and laboratory correlates of 6MWT. Conclusions Muscle weakness and low physical fitness are related to decreased exercise capacity in HCM and may be potential therapeutic targets to alleviate disease symptoms also in non-obstructive HCM phenotype.

Refining risk stratification in hypertrophic cardiomyopathy: the role of late gadolinium enhancement and syncope in predicting adverse outcomes

Abstract Background The presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging (MRI) is recognized as a significant marker of myocardial fibrosis and a predictor of adverse outcomes in hypertrophic cardiomyopathy (HCM). Nevertheless, the specific quantity of LGE that correlates with poor outcomes is still under debate. Therefore, this study sought to assess the combined impact of LGE presence and a history of syncopal events and its association with clinical prognosis. Methods Between May 2018 and June 2023, a total of 230 HCM patients was prospectively enrolled at our Medical University, a tertiary referral center. The primary endpoint was a composite of new-onset ventricular tachycardia (VT), appropriate ICD therapy, and all-cause mortality. Results Median age of enrolled patients was 56 (IQR 44-64) years and 40% (n=94) were female. Median interventricular septal thickness (IVS) was 21 (IQR 18–25) mm and 43 % (n=84) had significant left ventricular outflow tract obstruction (LVOTO). Over a median follow-up of 3.2 years, 30 patients (13%) met the composite endpoint. These patients had a significantly higher LGE quantity compared to the non-event group (1.1 % vs. % 9.0, P=0.012). An LGE threshold of 5.2% was identified as an optimal predictor of the composite endpoint, with an area under the curve of 0.72, which increased to 0.77 when including at least one syncopal event in medical history. LGE &amp;gt; 5.2% and/or syncope were independently associated with adverse outcomes after multivariable adjustment (Adj HR 7.26 [95%CI 2.54-20.72]). Furthermore, NTproBNP and hsTnT were associated with the presence of LGE or syncope (OR for a 1-unit increase in standardized log-transformed biomarker NTproBNP 3.35 [95%CI 1.42-10.85]; hsTnT 3.48 [95%CI 1.48-10.24], respectively). Interestingly, typically used variables for risk stratification, such as age, IVS or LVOT were not significantly associated with these cardiac biomarkers. Conclusion An extent of LGE &amp;gt; 5.2% and the history of at least one syncope are associated with unfavorable clinical outcomes in HCM patients. These findings call for detailed MRI appraisal and suggest adopting a holistic approach to accurately identify high-risk patients.

MINOCA: A Pathophysiological Approach of Diagnosis and Treatment-A Narrative Review.

Myocardial infarction with non-obstructive coronary arteries (MINOCA) is a clinical entity characterized by the absence of significant coronary artery obstruction in epicardial arteries (<50%) on coronary angiography in the setting of acute myocardial infarction (AMI). This article aims to provide a narrative review of the pathophysiological mechanisms, diagnostic challenges, and prognosis associated with MINOCA based on pathophysiology regarding the atherosclerotic and non-atherosclerotic causes. Etiological factors, including thromboembolism, coronary artery spasm, spontaneous coronary artery dissection, coronary microvascular disease, and supply-demand mismatch, are addressed. Imaging modalities such as echocardiography, advances in coronary angiography like intravascular ultrasound (IVUS) and optical coherence tomography (OCT), cardiac magnetic resonance (CMR), and coronary computed tomography angiography (CCTA) are also analyzed. MINOCA patients have a better short-term prognosis compared to those with obstructive coronary artery disease but face significant long-term risks, underscoring the need for precise diagnosis and management strategies. Elevated inflammatory markers and specific genetic predispositions are also associated with adverse outcomes in MINOCA. This review focused on MINOCA from a pathophysiological perspective on the diverse underlying mechanisms, the challenges in achieving accurate diagnosis, the importance of a tailored therapeutic approach and the necessity for further investigation of clinical outcomes.

Bezoar in Pediatrics: Case Series and Literature Review

Introduction: Bezoars are accumulations of indigestible material within the gastrointestinal tract, which, although rare, can lead to significant intestinal obstruction, especially in pediatric patients. This condition often necessitates not only surgical intervention to remove the obstruction but also a multidisciplinary approach to address underlying psychological issues due to the high recurrence risk associated with compulsive disorders. This study presents a series of cases involving children under 14 years old who experienced intestinal obstruction from bezoars and were treated at a tertiary care public hospital, complemented by a literature review to enhance understanding of this condition. Case Series: This descriptive case series study reviews three pediatric patients who underwent surgical treatment for intestinal obstruction caused by bezoars over the past two years. Results: The study identified three patients, all under 14 years of age, who required surgical intervention for bezoar-related intestinal obstruction. Among them, two were male and one was female. Two patients had trichobezoars (66.7%), located one in the stomach and one in the jejunum, while the remaining patient had a phytobezoar (33.3%) in the jejunum. Surgical treatment involved conventional laparotomy with exploration and two-layer enterorrhaphy in all cases. Discussion: Bezoars are categorized into four types: phytobezoars (plant material), pharmacobezoars (medications), lactobezoars (milk products), and trichobezoars (hair). Trichobezoars are most common in the studied cases, contrasting with existing literature that suggests a higher frequency of other types. Bezoars typically present with gastric symptoms but may also cause small intestine obstruction in about 10% of cases. The management of bezoars usually requires endoscopic or surgical removal, with psychological follow-up recommended due to high recurrence rates. The study emphasizes the importance of thorough surgical exploration for concurrent bezoars and integrating psychological care into treatment plans. Conclusion: Bezoars, although rare, are a serious concern in the pediatric population due to their potential to cause significant gastrointestinal obstruction. Effective management requires not only the surgical removal of the bezoar but also consideration of psychological factors to prevent recurrence. This case series highlights the need for a comprehensive approach, including psychological support and detailed surgical exploration, to optimize patient outcomes.

Awake Supraglottic Airway Placement in Pediatric Patients for Airway Obstruction or Difficult Intubation: Insights From an International Airway Registry (PeDI).

Small case series have described awake supraglottic airway placement in infants with significant airway obstruction and difficult intubations. We conducted this study to determine outcomes when supraglottic airways were placed in awake children enrolled in the international Pediatric Difficult Intubation Registry including success of ventilation, success of tracheal intubation, and complications. We reviewed the Pediatric Difficult Intubation Registry to identify all cases of awake supraglottic airway placement before planned tracheal intubation from August 2012 to September 2023 with subsequent review of details of awake supraglottic airway placement in the medical record. We present descriptive statistics of patient demographics, ventilation and intubation outcomes, and complications. A supraglottic airway was placed in an awake child in 95 of 8061 (1.2%) cases in the Pediatric Difficult Intubation Registry. Median age was 37 days (range 0-17.6 years) and median weight was 3.7 kg (1.6-46.7 kg). Sixteen (17%) cases were in patients older than 2 years and 7 (7%) were in adolescents. Adequate ventilation via a supraglottic airway was achieved in 81/95 (85%, 95% confidence interval [CI], 77%-93%) encounters. Inadequate (n = 13) or impossible (n = 1) ventilation occurred in 14/95 (15%). No complications were reported with supraglottic airway placement. For subsequent intubation, there was a 35% (33/95) first-attempt success rate and 99% (94/95) eventual success, with 1 patient awakened after failed attempts at tracheal intubation. Hypoxia occurred during the first intubation attempt in 9/95 (9%) encounters. The incidence of hypoxia was lower in encounters in which ventilation via the supraglottic airway was adequate (4/81, 5%) than in encounters in which ventilation via the supraglottic airway was inadequate or impossible (5/14, 36%). Although infrequently attempted, awake placement of a supraglottic airway in children with difficult airways achieved adequate ventilation and provided a conduit for oxygenation and ventilation after induction of anesthesia across a spectrum of ages.

Conservative Management of Necrotizing Enterocolitis in Newborns: Incidence and Management of Intestinal Strictures.

Necrotizing enterocolitis (NEC) is one of the main causes of acute abdomen in neonates. Surgical treatment entails important morbidity and mortality and conservative management, when possible, offers better outcomes. Post-NEC intestinal strictures are one of the main complications. Retrospective analysis from June 2011 to November 2022 of post-NEC strictures (PNS) after conservative management of neonates diagnosed with NEC (modified Bell stage IIA or higher) at a tertiary neonatal surgery center. Out of 219 NEC, 126 received initial conservative management (57.5%), 24 (19%) of which eventually underwent surgery for PNS. Average gestational age and weight at birth of our cohort were 31.3 ± 4.9 weeks and 1,694 ± 1,009 g.PNS diagnosis was made 38.4 ± 16.5 days after the NEC episode. 6/24 (25%) were asymptomatic and diagnosed by screening enema, 11 (46%) presented signs of intestinal obstruction before the enema could be performed and 7 (29%) after a normal previous protocol study.Median age at PNS surgery was 56 ± 17.9 days. A total of 2/3 strictures were found in cecum, ascendent, and transverse colon. Primary resection and anastomosis were performed in all cases. Feeds were restarted on postoperative day 4.3 ± 2.9. Two cases presented anastomotic complications (1 dehiscence and 1 stenosis), and no deaths were recorded. PNS is a frequent complication after conservative management. Deffered surgical treatment after the acute NEC episode is resolved allows for safer surgeries (since patients have reached hemodynamical stability and overcome septic shock), shorter resections, and favorable postoperative outcomes.

Successful repair of infracardiac total anomalous pulmonary venous connection with nonconfluent bilateral pulmonary veins.

We report a rare case of an infracardiac-type total anomalous pulmonary venous connection with nonconfluent bilateral pulmonary veins in a patient diagnosed with heterotaxy syndrome with right atrial isomerism, mitral valve atresia, a single atrium, and double-outlet right ventricle. On the fourth day of life, the patient underwent successful repair using a sutureless technique. Two years after the surgery, the patient remained well without any signs of pulmonary venous obstruction.

Early Results of Interventions in Patients with Venous Thoracic Outlet Syndrome

To determine the freedom from major complications and the efficacy, in the form of technical and clinical success, of different interventions in venous thoracic outlet syndrome (VTOS). Data from 3 centers regarding patients aged between (18 and 60years) with symptoms and signs of upper limb venous outflow obstruction was collected and analyzed to monitor outcome of different interventions. 23 patients (16 males) with mean age of 35 ± 9.33years (range 23-54years) were recruited. 17.4% of the patients were thrombotic, 56.5% were nonthrombotic, and 26.1% were postthrombotic. 73.9% had right side presentation with pain and swelling. Two techniques of thrombus removal, 2 techniques for first rib resection, and venoplasty were all used with 100% technical, 87% over all clinical success, and no major perioperative complications. The mean follow-up duration was 9.9months. Interventions in VTOS are both safe and effective in the short- and mid-term.

Death Due to Embolic Renal Cell Carcinoma

Abstract Introduction/Objective While most pulmonary embolisms are composed of blood clot resulting from venous stasis, tumor embolism is rarely encountered. We describe an autopsy patient with an unexpected renal cell carcinoma (RCC) who expired after a massive tumor embolism to the pulmonary artery. Methods/Case Report A 56-year-old male presented with complaints of shortness of breath and was found to have a large right-sided pulmonary embolism with an incidental finding of a 9.0 cm right kidney mass on imaging. He was subsequently admitted for further management consisting of thrombo-aspiration. The procedure was largely unsuccessful and the patient’s respiratory status continued to decline and he subsequently expired. On autopsy, a 9.3 x 6.2 x 6.0 cm, yellow-tan, well-defined mass was discovered primarily in the lower pole of the right kidney with invasion into the hilar structures. The mass grossly appeared to be invading into the renal vein. Two large yellow-tan emboli were found to be causing significant obstruction of the inferior vena cava at the level of the right renal vein and in the right pulmonary artery. Microscopic evaluation revealed the kidney tumor to be consistent with renal cell carcinoma morphologically and immunohistochemically. Interestingly, all emboli discovered at autopsy are primarily composed of sheets of cells identical to the patient’s renal mass. It is therefore concluded that the patient’s kidney cancer invaded into the renal vein and embolized to the pulmonary artery, ultimately resulting in death. Results (if a Case Study enter NA) NA Conclusion Tumor embolism is a rare cause of death. Renal cell carcinoma is a relatively common neoplasm that has been described to present as a tumor thrombus in 13.3% of patients. Of these patients with RCC tumor thrombus, 1% embolize to the right atrium. Our case represents this rare phenomenon and demonstrates why it is crucial to confirm the contents of a pulmonary embolism, as not all are composed of blood components alone.

Iliac vein obstruction: accuracy of Direct Multidetector Computed Tomographic Venography and duplex ultrasound.

To evaluate the accuracy of direct computed tomographic venography (DCTV) and duplex ultrasound (DUS) in the identification of iliac vein obstruction in highly symptomatic patients with severe chronic venous disease (CVD) compared with intravascular ultrasound (IVUS). this study involved patients who had advanced CVD (CEAP C3-6). All patients underwent DCTV, venous duplex scanning, and IVUS. The presence of iliac vein obstruction was detected, and degree of obstruction was classified into 3 grades (grade I, 0% to 49%; grade II, 50% to 79%; and grade III, 80% or greater). The sensitivity, specificity, PPV, NPV, and accuracy were calculated for each modality compared with IVUS. Inter-observer agreement was assessed using the κ coefficient. of 94 patients with CVD, IVUS identified iliac vein obstruction in 55 (58.5%) patients (25.5% was grade 1, 27.3% was grade 2, 47.3% was grade 3). The sensitivity, specificity of DCTV in diagnosing obstruction was (96%, 95% in grade 1; 100%, 100% grade 2; 100%, 100% in grade 3, respectively). The sensitivity, specificity of DUS was (63.9%, 65% in grade 1; 68%, 82% in grade 2, and 70%, 85% in grade 3, respectively). The overall agreement of DUS was 0.73 (95% CI, 0.70-0.79), and DCTV was 0.96 (95% CI, 0.91- 0.97). DUS is a reasonable initial imaging modality for the identification of significant iliac vein obstruction. DCTV provides an accurate reproducible imaging for accurate estimation needed for treatment planning. Direct CT Venography provides accurate reproducible radiological information required for treatment planning of patients with Iliac vein obstruction including accurate assessment of site of obstruction, its morphology, and degree of obstruction and it can replace the use of indirect CT venography using smaller amount of contrast media with accurate diagnosis.

Obstruction of the lawful activities of the Armed Forces of Ukraine and other military formations vs. complicity in evasion of military service during mobilization: problems of qualification in judicial practice

The article analyzes the final verdicts delivered in 2024 and posted in the Unified State Register of Court Decisions, in which the actions of the accused are qualified under Article 114-1 of the Criminal Code of Ukraine. The author identifies five variants of the defendants’ unlawful behavior which were qualified as obstruction of the lawful activities of the Armed Forces of Ukraine, namely, creation and/or administration of channels in Internet messengers for posting information on the delivery of summonses by employees of the Territorial Center for Manning and Social Training; drafting and issuance of knowingly false official documents which served as the basis for assigning a person a relevant disability group and which excluded the registration of vehicles for military use; issuing to other persons certificates, chevrons of membership in a public organization and enrollment in a volunteer military unit, which did not exempt such persons from military service; enrollment in a full-time higher education institution without relevant military registration documents for money and issuance of a certificate of enrollment; participation in blocking a vehicle in which employees of the Territorial Center for Recruitment and Social Training carried out mobilization activities on the territory of the. It is stated that most of the cases qualified under Article 114-1 of the Criminal Code of Ukraine are subject to criminal law assessment as complicity in evasion of conscription for military service under mobilization (Article 336 of the of the Criminal Code of Ukraine) or under other articles of the Special Part of this Code which provide for liability for the sole commission of the relevant crimes. The author identifies and characterizes the features of the object of the crime under Article 114-1 of the Criminal Code of Ukraine, as well as the signs of obstruction of lawful activity as a socially dangerous act.