Single-center Case Series Research Articles

Assessment of the transscleral removal technique for subretinal proliferative tissues during vitrectomy for rhegmatogenous retinal detachment.

To provide insights into the transscleral removal technique for subretinal proliferative tissues (SRP). Retrospective, single-center case series. Patients who underwent transscleral removal of SRP during vitrectomy for rhegmatogenous retinal detachment (RRD) were included. The preoperative RRD extent, SRP distribution, intraoperative maneuvers, complications, and surgical outcomes were assessed. Seven eyes of seven patients were enrolled for surgery. The RRD extent involved four quadrants in two eyes, three quadrants in three eyes, and two quadrants in the remaining two eyes. SRP were widely distributed beneath the detached retina in all the cases, with submacular SRP present in six cases. In these six cases, all the SRP, including the submacular SRP, could be removed without creating retinotomies via 1 or 2 subretinal trocars. However, peripheral SRP with extensive and strong adhesion to the retina required multiple retinotomies and conventional bimanual removal in one case. Surgical failure, attributable to the transscleral technique, occurred in one case due to a missed retinal puncture that occurred during subretinal trocar insertion, resulting in recurrent RRD. This patient had RRD within two quadrants, and the subretinal space could not be adequately dilated before insertion. All the patients had achieved retinal reattachment without deterioration of visual acuity at the final follow-up visit. The transscleral removal technique was suitable for the removal of SRP, including the posterior pole area, with minimal retinal damage. However, this technique may not be appropriate for SRP removal with extensive and strong adhesions or for cases with relatively nonextensive RRD.

Increasing Number of Clinically Severe Mycoplasma pneumoniae Infections in Children After the COVID-19 Pandemic: A Single-Center Case Series.

In 2024, there have been increases in laboratory-confirmed infections caused by Mycoplasma pneumoniae worldwide. This case series highlights the increasing frequency of M. pneumoniae-positive PCR (polymerase chain reaction) specimens and an increased number of hospital admissions with M. pneumoniae clinical syndromes. Within this case series, we observed a change in the epidemiology and clinical burden of childhood M. pneumoniae disease in the post-COVID-19 era.

Evaluation of preventive medicine amongst people living with human immunodeficiency virus attending a hospital-based care setting.

With improved outcomes in human immunodeficiency virus (HIV) due to the use of anti-retroviral therapy, ensuring adequate preventative healthcare and management of HIV-related comorbidities is essential. To evaluate adherence with recommended guidelines for comorbidity and immunisation status screening amongst people living with HIV within a hospital-based setting across two timepoints. A single-centre retrospective case series was conducted at a hospital between 2011 and 2021. Inclusion criteria were ≥18 years, confirmed diagnosis of HIV and commencement of care within study period. Medical data were reviewed over two 12-month periods to capture comorbidity screening and vaccination adherence using established guidelines (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Alfred Screening tool and Australian Technical Advisory Group recommendations). Descriptive statistics were obtained with IBM spss (version 29.0). Of 102 patients, 82 (80.4%) were male and 55 (53.9%) born overseas. Nineteen (18.6%) patients entered in 2011, with a median of 36.5 months from service entry to exit. Within 12 months of entry 56 (55.4%) participants had influenza vaccination recorded. Within the last 12 months, 94.8% had recorded COVID-19 vaccination, with improvements in pneumococcal (72.3%) and hepatitis B (82.8%) since service entry. Recording of comorbidity screening was >90% for blood pressure, weight and renal function at both timepoints, however, suboptimal (<10%) for substance misuse, cognitive and osteoporosis screening. There is a disparity amongst comorbidity screening and documentation of vaccination status. Further measures are required to target improvements in immunisation, bone health, substance misuse and cognitive impairment screening.

Postnatal management of preterm infants with congenital diaphragmatic hernia.

Congenital diaphragmatic hernia (CDH) in the preterm population is increasingly common in the current era of fetal endoluminal tracheal occlusion (FETO) therapy. There remains a lack of clinical guidance for clinicians and surgeons regarding optimal management strategies for such infants. We aimed to describe our experience in managing preterm CDH in a single quaternary neonatal intensive care unit (NICU). This was a retrospective single-center observational case series of preterm infants born between 2017 and 2024 at less than 37weeks of gestation and diagnosed with CDH (pre- or post-natally). Thirty-two infants with a median (range) gestational age of 33.9 (27.0-36.9) weeks and a birth weight of 1975 (1070-3290) grams. Twenty-two infants (68.8%) were diagnosed with CDH prenatally and 43.8% underwent antenatal FETO. The median time of surgical repair was at 10 (2-47) days of life. The duration of invasive mechanical ventilation was 11 (1-115) days. Nineteen infants (59.4%) survived to discharge with a median postmenstrual age at time of discharge of 40.6 (36.0-51.0) weeks. Two infants developed a grade 3 or 4 intraventricular hemorrhage. Five infants required home oxygen at discharge. Preterm CDH confers high morbidity and mortality. Robust clinical evidence, multicenter studies and standardized guidelines are needed to improve outcomes in this challenging patient population.

Full-thickness arthroscopic rotator cuff repair demonstrates low repair failure rates and high return to sport rates in patients aged 30 years and under at 9-year follow-up: A single-center case series.

The purpose of this study is to assess the long-term clinical complications, outcomes, and return to sport (RTS) rates in patients aged 30 or younger with a primary full-thickness arthroscopic rotator cuff repair (ARCR). All patients who underwent a primary full-thickness ARCR at age 30 years or younger from 2003 to 2021 with a minimum of a 2-year follow-up were included. Complications, repeat surgeries, and return to sport rates were collected. 32 patients underwent primary full-thickness rotator cuff repair with a mean follow-up of 9.3[2.7-17.9] years. 5(15.6%) patients had postoperative shoulder stiffness, and persistent postoperative shoulder pain was reported in 4(12.5%) patients. There were 3(9.4%) reported repair failures, with complete rotator cuff re-tears reported in 2(6.3%) shoulders and partial rotator cuff re-tear in 1(3.1%) shoulder. There were 4(12.5%) reoperations at an average of 8.7[0.65-22.7] months from primary rotator cuff repair and 2(6.3%) revision rotator cuff repairs. There was a 78.6% RTS rate at an average of 6.5[4-12] months postoperatively, with 8(72.7%) athletes returning to the sport at the same level they initially participated in pre-surgery. Patients aged 30 and under who underwent full-thickness ARCR experienced promising clinical outcomes at an average 9-year follow-up. Retrospective Case Series; Level of Evidence, 4.

Clinical and Imaging Features of Head and Neck Metastasis of High-Grade Glioma: A Single-Center Case Series.

High-grade gliomas are the most frequent primary brain tumors, yet extraneural metastasis is exceedingly rare. This is in part secondary to the relatively poor survival of these patients and likely the shielding effect of the blood-brain barrier. Given the rarity of extraneural metastasis, the pathophysiology and imaging appearance of extraneural metastasis is under-reported and poorly understood. In this case series we present 6 patients with pathology-confirmed high-grade glioma and extraneural head and neck metastasis. We highlight imaging features of metastasis on CT, MRI, and PET/CT. We also explore potential correlations and pathophysiology of high-grade glioma metastasis to the head and neck region.

A Pilot Case Series on the Use of a Large Mushroom-Shaped Corneal Graft for the Surgical Management of Post-Penetrating Keratoplasty Ectasia and Endothelial Failure.

Objective: The aim of this study was to evaluate the effect of a surgical technique for managing post-penetrating keratoplasty (PK) ectasia complicated by late endothelial failure (LEF). Methods: A single-center pilot case series was conducted regarding consecutive patients affected by post-PK ectasia with late graft failure. Using a microkeratome, a single donor cornea was dissected to prepare a two-piece graft, comprising a larger anterior lamella made up of anterior stroma and a smaller posterior lamella made up of posterior stroma, Descemet's membrane, and endothelium. The two lamellae were then positioned on the appropriately prepared recipient cornea. The technique was applied to 15 patients between 2022 and 2023, and data were retrospectively collected from preoperative evaluations and at 1, 6, and 12 months, post-operatively. At each visit, patients underwent standard clinical evaluation, corneal topography, and endothelial cell density evaluation, and visual acuity was measured using a LogMAR chart. Results: The technique restored normal corneal curvature and achieved a clear graft in all patients, leading to the resolution of preoperative ectasia and improved corneal pachymetry. At the one-year follow-up, the average K was reduced from 51.1 ± 4.5 D to 43.5 ± 1.1 D; the best corrected visual acuity (BCVA) was improved from 1.1 ± 0.4 to 0.3 ± 0.2 LogMAR; the central corneal thickness was reduced from 629 ± 39 μm to 532 ± 45 µm; and the endothelial cell density was 1926 ± 199 cells/mm2. None of the patients developed severe complications. Conclusions: The two-piece manual mushroom PK may represent an effective technique for managing complex post-PK ectasia cases combined with endothelial decompensation.

The Use Of Cardiopulmonary Bypass In The Management Of Malignancies With Extensive Caval Involvement: A Single Center Case Series

The Use Of Cardiopulmonary Bypass In The Management Of Malignancies With Extensive Caval Involvement: A Single Center Case Series

Return to Sport after First Metatarsophalangeal Arthrodesis in Elite Athletes.

Arthrodesis of the first metatarsophalangeal joint (MTPJ) is a reliable procedure in alleviating pain and restoring function. However, there is limited published literature of the outcomes of this procedure and the ability to return to sport in elite athletes. This study aims to assess the outcomes of first MTPJ arthrodesis in the elite athlete population and their ability to return to professional sport. A single-center prospective case series of elite athletes undergoing first MTPJ arthrodesis between 2004 and 2016 was conducted. Patients were assessed a minimum of 2, 6, 12 weeks and 1-year post-operation and at final follow-up. Clinical outcomes were evaluated using the Foot and Ankle Outcome Score (FAOS) and Visual Analogue Scale (VAS) scores and assessing satisfaction. 16 elite athletes with a mean age of 27 years (range 19-32, 81%) and mean follow-up of 81 months (range 60-121 months) were included. At 1-year post-operation, 12 (75%) athletes returned to their original level of sport. Of the 4 unable to return, two soccer players dropped a division, an ATP tennis player never regained his original ranking, and a badminton player was unable to return to the same level of competition. Mean VAS scores improved from pre-operation to final follow-up (5.6 to 0.4, p < 0.001). All FAOS subscores showed significant improvement from pre-operation to final follow-up (all p < 0.05). All (100%) athletes were either very satisfied or satisfied at final follow-up. To our knowledge this is the first study investigating return to elite level sport post first MTPJ arthrodesis. Our results confirm that a significant majority will return to their elite level of sport post operatively. Improved clinical outcomes and pain reduction was achieved in all patients. IV LEVEL OF EVIDENCE: V.

Long-term Clinical Outcomes After Syndesmosis Fixation With K-wires in Ankle Fractures With Syndesmotic Instability.

Syndesmotic instability is a significant concern in the management of unstable ankle fractures, occurring in approximately 10% to 13% of these cases. Early recognition and stabilization of syndesmotic injuries are essential to ensure optimal long-term outcomes. Several techniques are currently in use, often involving complex procedure and/or costly devices. Our study presents a syndesmosis fixation technique using K-wires that is both simple and cost-effective. This is a retrospective single-center case series. Three hundred seventy-seven ankle fractures with intraoperative syndesmosis instability and subsequent syndesmosis fixation with a K-wire were treated between 2002 and 2012. Of the 377 patients, 51 died and we were able to obtain long-term questionnaire completions from 94 patients (29% of presumed living patients), with a mean follow-up of 10.6 ± 3.0 years. The mean age was 46.6 ± 18.5 years; 42% were Danis-Weber type B and 58% type C fractures. Syndesmosis fixation failure was observed in 9 (2%) patients, and 5 (1%) patients had K-wire displacement without loss of syndesmosis reduction. The Manchester-Oxford Foot Questionnaire (MOXFQ) was obtained 10±3 years after surgery. The mean MOXFQ pain score was 25.9 ± 25.4, the mean functional score was 18 ± 24.8, and the mean social score was 13.7 ± 22.2. We report long-term (10.6 ± 3 years) functional outcomes using a validated patient-reported questionnaire in patients who underwent syndesmosis fixation with 2 K-wires for unstable ankle fractures. In the subset of patients we were able to find in follow-up, we found low rates of syndesmosis fixation failure, low pain scores, and excellent functional outcomes. The availability and low cost of these implants make this technique an accessible and cost-effective solution to consider for syndesmosis fixation. Level IV, retrospective case series.

Castleman disease: A single-center case series in Nepal Mediciti Hospital

Castleman disease: A single-center case series in Nepal Mediciti Hospital

Neck extension with closed mouth position provides optimal airway patency after anterior cervical spine surgery at C3-4 and C4-5: a single-center retrospective case series

Airway compromise due to prevertebral soft tissue swelling is a potentially devastating complication following anterior cervical discectomy and fusion (ACDF). However, there are no studies on the postoperative patient posture for enhancing airway patency after ACDF. This study aimed to analyze the effect of neck and mouth postures on airway patency following ACDF and to suggest the beneficial postoperative patient posture for improving airway patency. A retrospective review of 39 patients who underwent ACDF in C3 or C4 level was conducted. Airway diameter and prevertebral soft tissue thickness were measured in six different neck-mouth postures using lateral radiographs. The diameters of the airway and prevertebral soft tissues showed significant changes in relation to the neck postures and mouth openings after ACDF (P < 0.001). Regarding postures, neck extension with closed mouth posture showed significant wider airway diameter than that of the other postures (P < 0.001). Moreover, this posture showed the thinnest prevertebral soft tissues; however, it showed no significant difference compared to the neutral-closed and extension-open postures (P = 1.00 and P = 0.053). In conclusion, neck extension with a closed mouth significantly widened the airway diameter and reduced prevertebral soft tissue swelling, making it the best posture to maintain airway patency after ACDF.

Clinical, laboratory, and orbital imaging features of giant cell arteritis in comparison to non-arteritic anterior ischemic optic neuropath: a single center case series.

Giant cell arteritis (GCA) is the most common vasculitis in patients older than 50 years and is considered a "do not miss" diagnosis. However, it remains a diagnostic challenge given overlapping clinical syndromes such as non-arteritic anterior ischemic optic neuropathy (NAION) and poorly explored imaging findings. In this retrospective study between the time period of January 2013 and December 2021, a total of 13 consecutive patients with a pathological diagnosis of GCA and 8 patients with clinical diagnosis of NAION were isolated. Demographic and clinical data for each patient were collected, including pertinent laboratory data. Pertinent physical exam data was also collected, including fundoscopic exam and visual acuity. Two neuroradiologist assessed the orbital MRI imaging findings of GCA and NAION for the presence and characterization of imaging abnormalities. Assessment for potential relationship between GCA orbital findings, laboratory and visual outcomes was performed. Finally, comparison between GCA and NAION imaging findings was performed. 13 GCA patients were assessed. 9 patients had abnormal orbital findings. Of these 8 patients had bilateral orbital involvement The most common imaging findings was perineuritis of the optic nerve sheath, present in 7 patients. In total, 8 NAION patients were assessed. All patients demonstrate optic nerve involvement. The Snellen test was converted to logmar, and visual acuity was assessed for both NAION and GCA for each eye at diagnosis and at the last follow-up. There was no statistical significance for either eye for both GCA and NAION at initial diagnosis and final follow-up. In the 4 GCA patients with normal MRI findings and 9 GCA patients with abnormal MRI findings, there was no statistical significance between initial presentation and final follow-up visual acuity. GCA and NAION are potentially overlapping clinical syndromes with different treatment approach and poorly explored imaging findings. Our case series assesses the orbital imaging findings of both syndromes while noting different imaging pattern of both on MRI, which can serve as a potential tool to aid in diagnosis of both. .

Feasibility of single low-dose olanzapine with triple antiemetic therapy for prevention of highly emetogenic chemotherapy-induced nausea and vomiting: a single-centre case series

Background: Olanzapine works well as an antiemetic; however, it causes significant somnolence during the day and has additional side effects when used at a standard dose. Our goal was to evaluate the safety and effectiveness of low-dose olanzapine in patients with different cancers following highly emetogenic treatment. Patients and Methods: This study was a retrospective, single-centre study in an Indian comprehensive cancer centre. Eight patients between the ages of 46 and 70 receiving cisplatin, a high emetogenic chemotherapy (HEC) drug, were chosen for different types of cancers and had an Eastern Cooperative Oncology Group performance level of 0–2. Patients underwent chemotherapy after receiving a prophylactic low-dose oral olanzapine regimen (2·5 mg) in conjunction with a triple antiemetic treatment. In the overall phase (0–120 hours), complete response (CR) and complete control (CC) were the major endpoints. The secondary outcome assessed safety according to the Common Terminology Criteria for Adverse Events V5.0 (CTCAE V5.0). Results: All the studied patients were reported to have CR and CC. According to CTCAE v5.0, adverse effects grades varied from 0 to 1. Interpretation: According to this study, prophylactic single low-dosage olanzapine (2·5 mg) was effective enough to prevent vomiting and nausea and reduce the incidence and severity of side effects in patients undergoing HEG; therefore, it should be deemed a new benchmark of care. Keywords: Olanzapine, Cisplatin, Chemotherapy, Complete Control, Complete Response

Nabilone for the treatment of gastrointestinal dystonia for children and young people with severe neurodisabilities: a single-centre case series

BackgroundFor children and young people with severe neurodisabling conditions (CYPSND), the clinical constellation of pain behaviour, retching, bloating, abdominal distension and constipation/pseudo-obstruction can be referred to as gastrointestinal dystonia (GID)....

Practical Considerations for Odevixibat Treatment in Patients with Progressive Familial Intrahepatic Cholestasis: A Single-Center Case Series.

Background: Patients with progressive familial intrahepatic cholestasis (PFIC) experience cholestasis-associated symptoms, including severe pruritus. Odevixibat is an ileal bile acid transporter inhibitor indicated for treatment of PFIC in the European Union and for the treatment of pruritus in PFIC in the United States. The aim of the current study was to characterize the real-world effectiveness and safety of odevixibat in patients with PFIC. Methods: This retrospective study included 9 patients with PFIC treated with odevixibat in a single center in Tübingen, Germany. Data were recorded using case report forms. Results: Of the 9 patients (PFIC1, n = 2; PFIC2, n = 7), 5 had improved serum bile acid levels, pruritus, liver function tests, and sleep with odevixibat treatment. Two siblings with periodic relapses of PFIC symptoms also had improved pruritus and sleep within 4 months of treatment. Two siblings with complete loss of bile salt export pump (BSEP) protein did not respond to treatment; both underwent liver transplantation (indications: hepatocellular carcinoma [HCC] manifestation [n = 1] and severe failure to thrive and refractory pruritus [n = 1]). Four patients reported abdominal complaints that were transient or responded to dose reduction; no other safety issues were reported. Conclusions: In this case series, clinical benefits were observed in most patients with PFIC1 and PFIC2 treated with odevixibat. In patients with periodic relapse of PFIC symptoms, ≥3 months of treatment with odevixibat may be required for symptom control. Patients with complete loss of BSEP did not have consistent symptom relief and require careful monitoring. Effectiveness and feasibility results from our cohort demonstrate potential for long-term benefits with odevixibat in real-world treatment of patients with PFIC.

Regorafenib Combined with BRAF/MEK Inhibitors for the Treatment of Refractory Melanoma Brain Metastases.

There are no active treatment options for patients with progressive melanoma brain metastases (MBM) failing immune checkpoint blockade (ICB) and BRAF/MEK inhibitors (BRAF/MEKi). Regorafenib (REGO), an oral multi-kinase inhibitor (incl. RAF-dimer inhibition), can overcome adaptive resistance to BRAF/MEKi in preclinical models. This is a single-center retrospective case series of patients with refractory MBM treated with REGO plus BRAF/MEKi (compassionate use). A total of 22 patients were identified (18 BRAF-mutant, 4 NRASQ61-mutant; 19 with progressive MBM; 11 on corticosteroids). Thirteen BRAFV600-mutant patients were progressing on BRAF/MEKi at the time of REGO association. BRAF-mutant patients received REGO (40-80 mg once daily) combined with BRAF/MEKi, NRAS-mutant patients were treated with REGO + MEKi (+low-dose BRAFi to mitigate skin-toxicity). Grade 3 TRAE included arterial hypertension (n = 4) and maculopapular rash (n = 3). There were no G4/5 TRAE. In BRAF-mutant patients, overall and intracranial objective response rates (overall ORR and IC-ORR) were 11 and 29%, and overall and intracranial disease control rates (overall DCR and IC-DCR) were 44 and 59%, respectively. In NRAS-mutant patients overall ORR and IC-ORR were 0 and 25% and overall DCR and IC-DCR were 25 and 50%, respectively. The median PFS and OS were, respectively, 7.1 and 16.4 weeks in BRAF-mutant and 8.6 and 10.1 weeks in NRAS-mutant patients. In heavily pretreated patients with refractory MBM, REGO combined with BRAF/MEKi demonstrated promising anti-tumor activity with an acceptable safety profile. In BRAFV600-mutant melanoma patients, responses cannot solely be attributed to BRAF/MEKi rechallenge. Further investigation in a prospective trial is ongoing to increase understanding of the efficacy.

Combined nutcracker syndrome and glomerulonephritis in pediatric patients: a single-center retrospective case series.

Nutcracker syndrome (NCS) has been reported to coexist with various glomerulonephritis (GN). This study investigated clinical features of NCS combined with GN in a pediatric case series and the possible relationship between these two conditions. Clinical and pathologic findings of 15 children with NCS and biopsy-proven GN were analyzed. NCS was diagnosed with renal Doppler ultrasonography, abdominal computed tomography, and/or magnetic resonance imaging. Glomerular lesions were divided into two pathological categories: minor glomerular abnormalities (MGAs) and definite GN. Mean age of all patients was 11 ± 3.36 years and mean follow-up duration was 53.8 ± 29.3 months. Chief complaint was proteinuria with or without hematuria. During follow-up, five patients developed left kidney enlargement. Abnormal levels in immunological tests were revealed in 10 patients. Extrarenal symptoms including gonadal varicocele, splenic cyst, syncope, and anemia were found in seven patients. On kidney biopsy, seven patients had MGAs and eight children showed definite GN (one case of focal GN, one case of mesangial proliferative GN, one case of focal segmental glomerulosclerosis, two cases of immunoglobulin A [IgA] vasculitis nephritis, and three cases of IgA nephropathy). While the MGA group showed a higher proportion of isolated proteinuria and a lower estimated glomerular filtration rate (eGFR) at the last visit, there were no differences in age, clinical features of NCS, extrarenal symptoms, immunological tests, and eGFR decline rate between the two groups. NCS may be associated with the presence of various GN. The causal relationship between NCS and GN should be further investigated.

The Safety of A New Device as A Monopolar Electrosurgical Unit in Carotid Endarterectomy: A Single Center Case Series

The Safety of A New Device as A Monopolar Electrosurgical Unit in Carotid Endarterectomy: A Single Center Case Series

The management of paediatric acute liver failure: results from an international multi-centre survey across Europe

BackgroundPaediatric acute liver failure (PALF) is a rare condition with high morbidity and mortality. The liver transplant era, and improvements in medical management, have transformed outcomes. However, differences in aetiology, management, experience and resources are reported across single-centre case series. This study aimed to survey current practices in the critical care of children with PALF across Europe.MethodsCross-sectional survey of PICUs in European countries was created and distributed by the Liver Failure Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) and ERN Rare-Liver. Participants were intensivists and hepatologists across PICUs in Europe. The survey was distributed using the EUSurvey platform April-June 2023.Results25 centres from 16 countries participated (response rate 66% of 38 relevant centres). Most centres (56%, n = 14) managed 1–6 cases of PALF per year. Therapeutic strategies varied across the participating centres. Overall, 80% (n = 20) routinely prescribed antibiotics. Invasive intracranial pressure monitoring was practiced by 20% (n = 5) of centres; cerebral perfusion pressure was targeted by 68% of centres (n = 17). All centres used renal replacement therapy (88% for hyperammonaemia, 50% hepatic encephalopathy); 64% (n = 16) made use of plasma exchange. Most centres used the King’s College Hospital Criteria (68%, n = 17) for listing.ConclusionsThis survey across Europe highlighted varied aetiologies in different settings, and variations in key aspects of management, for patients with PALF. International collaboration is needed to standardise guidelines to improve equity of access to treatment, and to foster research collaborations to improve outcomes, for this high-risk patient group.