Spontaneous Closure Research Articles

Spontaneous closure of full-thickness macular hole after pars plana vitrectomy for retinal detachment: evidence of ellipsoid zone restoration.

To describe a case of full-thickness macular hole (FTMH) occurred after pars plana vitrectomy (PPV) for a macula-sparing rhegmatogenous retinal detachment (RRD), which showed a spontaneous closure associated with outer retinal layers restoration. Case report. A pseudophakic 69-year-old man underwent PPV for a macula-sparing superior RRD in the right eye (RE). Best corrected visual acuity (BCVA) was 20/20 before surgery. Three weeks after treatment the patient complained about visual impairment, and a FTMH was detected at fundus examination as well as confirmed by optical coherence tomography (OCT) scan. The patient was scheduled for a repeated surgery, but FTMH spontaneously closed eighteen days after its occurrence as demonstrated at OCT showing only a point break of the ellipsoid zone (EZ) and Verhoeff membrane. The subsequent macular OCT scan showed a point-like irregularity at the Verhoeff membrane and regeneration of EZ, associated with a progressive improvement in BCVA. Forty-days after the FTMH occurrence, all the retinal layers were completely restored with a complete clinical recovery. FTMH formation and closure after macula-sparing RRD repair is a rare event that could be characterized by spontaneous and gradual anatomical restoration of the EZ associated with visual acuity improvement, underlying the retinal physiology recovery.

Traumatic Macular Hole and Uveitis: A Case Report

Introduction: Blunt ocular trauma may be associated with a variety of complications, including traumatic macular holes (TMH) and uveitis. Concerning the TMH, there is no standard treatment protocol. There have been reports of spontaneous closure and of the use of certain medications and surgical techniques. Our purpose is to present a case of bilateral blunt ocular trauma with TMH in the right (OD) and uveitis in the left eye (OS) in a 24-year-old Caucasian man.
 Case presentation: The patient had complaints of decreased vision in OD and redness and discomfort in OS. Three days previously, he had sustained trauma to both eyes with an exercise resistance band. The diagnosis was made with a thorough ophthalmic exam and optical coherence tomography (OCT). The best-corrected visual acuity (BCVA) of OD was 20/40 and of OS – 20/20. The intraocular pressure was within normal limits. There was a TMH in OD and iridocyclitis in OS. The therapy included prednisolone with an initial dose of 60 mg q.d. PO, a lutein/zeaxanthin supplement, and additional topical treatment for OS – dexamethasone and cyclopentolate. The TMH in OD had improved significantly within 6 days. BCVA of OD recovered to 20/20 in a month.
 Conclusion: We observed closure of the TMH with complete recovery of vision in the affected eye, most likely spontaneous, and with full resolution of the uveitis in the other, in the setting of short-term prednisolone therapy. The uveitis in OS was also treated with topical dexamethasone and cyclopentolate.

Spontaneous closure of transverse loop colostomy: A case report

Colostomy is an artificial colo-cutaneous fistula which can be temporary or permanent, depending on the purpose for which it was created. The indications for colostomy include protection of a distal intestinal anastomosis, control of sepsis in open injury to the colon or rectum, to facilitate the operative treatment of a high anal fistula

Phenomenology of spontaneous closure in degenerative and mixed type lamellar macular hole.

To the describe OCT imaging characteristics of a cohort of patients showing spontaneously closing degenerative or mixed type lamellar macular holes (LMH) and to compare them to the ones of a sex and age matched group showing stable lesions. Patients diagnosed with degenerative and mixed type LMHs showing OCT-documented spontaneous anatomical closure were retrospectively selected from 3 specialized retina centres. An equal number of age and sex matching subjects were randomly selected among patients with anatomically stable lesions. Eleven (11) spontaneously closing (SC group) and 11 stable (ST group) degenerative LMH with a mean follow up of 4 years were recruited. Hyperreflective inner border (HIB) and linear hyperreflectivity in the outer plexiform layer (LHOP) at baseline were significantly more prevalent in SC group in processed images (respectively p = 0.007 and p = 0.003). A borderline significance in lamellar hole associated epiretinal proliferation (LHEP) at last follow up was detected (p = 0.085). As for mixed type LMH, 10 patients for SC group and 10 for ST group were recruited. LHOP at baseline in processed images was significantly more prevalent in SC group (p = 0.005). Spontaneously closing LMHs show higher prevalence of HIB and LHOP at the beginning of the closing process, a difference which is enhanced by image processing. These signs might be a signal of microglial and Muller cells coordinated activation.

Intrahepatic portosystemic shunts, from prenatal diagnosis to postnatal outcome: a retrospective study

ObjectiveCongenital intrahepatic portosystemic shunts (IHPSS) are rare vascular malformations resulting in blood bypassing the liver to the systemic circulation. Previous studies included symptomatic patients diagnosed postnatally, but the outcome of...

Results of treatment of children with complications after burns of the esophagus from button batteries

Aim. To enhance the treatment outcomes in children with complications following an esophageal burn caused by a disk battery.Materials and Methods. We analyzed the treatment outcomes of 102 patients suffering from esophageal burns from a disk battery, who were treated at the N.F. Filatov Children’s City Hospital of the Moscow Healthcare Ministry from 2009 to 2021. Children who developed complications (n=57) were divided according to the treatment strategy employed: conservative tactics (n=36, 63.2%) and radical surgery (n=21, 36.8%).Results and Discussion. The types of surgical interventions carried out for tracheoesophageal fistula (TEF) (n=31) included laparoscopic fundoplication and gastrostomy (38.7%), separation of TEF (41.9%), and tracheal plastic surgery with an esophageal flap and extirpation of the esophagus (19.4%). Assessment of the outcomes of TEF post laparoscopic fundoplication and gastrostomy demonstrated spontaneous closure in 63.6% of the cases. The average time until closure was 5 months. Among children with esophageal stenosis (n=24), esophageal bougienage was performed in 95.8% of the cases. All children identified with esophageal perforation (n=4) were successfully treated conservatively. Tactics for managing laryngeal paresis or paralysis included conservative therapy and observation in 33.3% of cases, tracheostomy in 29.2%, and lateralization procedures in 37.5%.Conclusion. Conservative tactics demonstrated superior results in all complications, minimizing the number of postoperative complications (16.7%) and ensuring favorable long-term outcomes.

Spontaneous closure of a superior sagittal sinus dural arteriovenous fistula with an extensive angioarchitectural network: A case report and systematic review of the literature.

Intracranial dural arteriovenous fistulas (DAVFs) have been documented to occasionally spontaneously regress. However, the mechanism responsible for this occurrence remains speculative. We present a case of a Borden II - Cognard IIa+b DAVF involving the superior sagittal sinus (SSS) with bilateral external carotid artery supply that regressed spontaneously. A systematic literature review was conducted to explore the current theories explaining the spontaneous regression of DAVFs according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. A total of 26 studies and 54 cases were included in our results. Of the included cases, 57.14% of cases were Borden I, 16.33% were Borden II, and 26.53% were Borden III. Ruptured status or intracranial hemorrhage was documented in 24.1% of all cases, the majority of which (69.2%) were in cases with aggressive lesions (Borden II or greater). The most commonly involved location was the transverse sinus (38.89% of cases, n = 21), and the SSS was only involved in 12.96% of all cases. 50% of included cases proposed a mechanism responsible for spontaneous regression. The most frequently proposed mechanisms were thrombosis of the involved sinus/chronic inflammatory changes or direct endothelial injury, endoluminal stasis, and thrombogenic effects of contrast medium during angiography. We present the case of a 54-year-old woman with an aggressive ruptured DAVF that likely developed following a pediatric traumatic brain injury that was left untreated before she presented to our institution after significant delay. Her DAVF regressed on repeat angiography before neurovascular intervention without a clear identifying mechanism as proposed by the current literature. Our results suggest that spontaneous regression is not necessarily associated with lower risk DAVFs. The present case offers a unique long-term insight into the natural history of an aggressive ruptured DAVF of the SSS that regressed without intervention. Further research into the natural history of DAVFs will be helpful in deducing key factors leading to spontaneous regression.

Hemisection: a simple and elegant technique

Agenesis of lower second premolars in an uncrowded dentition can represent a significant clinical challenge. Leaving the second primary molars and ultimate prosthetic replacement places a dental and financial burden on the patient. Therefore, space closure while often the preferred option, can be very difficult while controlling the overbite and position of the lower labial segment. Also loss of alveolar bone may make this impossible. Hemisection of the lower second primary molar can facilitate space closure by maintaining bone and if done at the correct time, allow the first molar to move mesially resulting in spontaneous space closure. This article describes this technique and illustrates it clinically. CPD/Clinical relevance Hypodontia of the lower second premolars is a common problem and space closure to negate the need for expensive prosthodontics can be challenging. Hemisection of the second primary molar is a relatively simple procedure that can make space closure more predictable.

Retinal Arterial Macroaneurysm: Pathogenesis, Diagnosis, and Treatment

Retinal arterial macroaneurysms are dilatations of the great arterioles of the retina that usually occur within the first three bifurcations of the central retinal artery. They are often associated with macular exudation and bleeding, which can lead to a decrease in visual acuity. In this diagnosis, there is a 10% incidence of bilateral disease and an average 10% risk of more than one aneurysm in the same eye. For many patients with macroaneurysms, the visual prognosis is mostly good. The natural course of these lesions indicates the spontaneous closure of the aneurysm with the restoration of near-normal vision, while in some cases treatment is required. This review will focus on the current pathophysiology, diagnosis, and treatment of retinal arterial macroaneurysms.

Treatment of burn complications in the esophagus caused by button batteries in children (a literature review)

Introduction. Over the past 10 years, the number of severe and fatal cases of burns in the esophagus caused by button batteries in children has increased significantly. The tactics of managing children with complications after such burns has not been defined worldwide yet; few clinical cases are described in Russian sources. Material and methods. The literature search has covered databases of RSCI, Medline and GoogleScholar published in 1983–2022. More than 350 publications on this topic have been analyzed. Results. Electrolysis is recognized as the main mechanism of tissue destruction, which is accompanied by the development of colliquative necrosis in the area of negative pole of the battery. The National Capital Poison Center, Washington, USA, recommends to neutralize burns with honey and 0.25 % acetic acid solution. The most optimal tactics for managing tracheoesophageal fistulas caused by batteries is to perform laparoscopic fundoplication and gastrostomy, as a result of which spontaneous closure of the fistula may occur. In case of large defects and patient’s severe unstable condition more complicated reconstructive interventions have to be done. Esophageal stenoses should be treated with bougienage, and perforations are preferably treated conservatively. In case of laryngeal paresis or paralysis, laryngoscopy is required at the early stage so as to understand if tracheostomy is better instead of tracheal intubation. Esophageal aortic fistulas require aggressive surgical tactics even in the absence of visible bleeding. Conclusion. Currently, there is no common management strategy in any of the possible complications. Further statistical analysis of clinical cases and assessment of existing conservative and surgical techniques are needed; development of new surgical techniques to be applied in patients with abovementioned pathology is needed as well. Rational diagnostics and curative tactics will reduce high mortality rate and improve the quality of life of such patients.

Outcomes of neonatal critical congenital heart disease: results of a prospective registry-based study from South India

ObjectivesCongenital heart disease (CHD) is now a leading contributor of infant and neonatal mortality in many low/middle-income countries including India. We established a prospective neonatal heart disease registry in Kerala...

Echocardiographic parameters predicting spontaneous closure of ductus arteriosus in preterm infants.

To evaluate the value of echocardiographic parameters in predicting early spontaneous closure of ductus arteriosus in premature infants. 222 premature infants admitted to the neonatal ward of our hospital were selected, and patent ductus arteriosus was detected by echocardiography 48 h after birth. On the 7th day, whether the ductus arteriosus was closed naturally in this cohort was observed. The infants whose ductus arteriosus were not closed were identified as the PDA group (n = 109), and the other infants were included in the control group (n = 113). The echocardiographic parameters of the two groups of premature infants at 48 h after birth were single-factor statistically and Pearson correlation analyzed, and the parameters with statistically significant differences in single-factor analyzed were selected for multivariate logistic stepwise regression analysis. The ductus arteriosus shunt velocity and the pressure difference between the descending aorta and the pulmonary artery (ΔPs) in the PDA group were lower than those in the control group (P < 0.05). The pulmonary artery pressure (PASP) in the PDA group was higher than that in the control group (P < 0.05). According to the multivariate logistic stepwise regression analysis, only the maximum shunt velocity of ductus arteriosus was correlated with early spontaneous closure of ductus arteriosus in 48 h first echocardiographic parameters (P = 0.049). The receiver operating characteristic (ROC) curve indicates the optimal critical point of echocardiographic ductus arteriosus shunt velocity in premature infants 48 h after birth was 1.165 m/s. Echocardiographic parameters are of great value in predicting the early spontaneous closure of ductus arteriosus in premature infants. In particular, the ductus arteriosus shunt velocity is correlated with the early spontaneous closure of ductus arteriosus.

Management of Hypospadias in Identical Twins at Mali Gavardo Hospital

This is a prospective study of two cases of hypospadias in identical twins with the same location and the same symptomatology at Mali Gavardo Hospital. Hypospadias corresponds to hypoplasia of the tissues forming the ventral surface of the penis responsible for an ectopic abruption of the urethra. Its aetiology is multifactorial, the surgical management is adapted according to the anatomical location.the Mathieu urethroplasty technique was used in both patients, urine drainage was performed with 8fr silicone catheter for 5 days. Post-operative follow-up was marked by a skin fistula in one case on the fourth day with spontaneous closure on day 8. Material Methodology: This was a prospective study of two cases of hypospadias in identical twins at the Mali Gavardo Hospital. The following parameters were studied: age, reasons for consultation, physical examination, complementary examinations, surgical treatment and post-operative follow-up. Conclusion: Hypospadias is a congenital malformation in males, the frequency of which is increasing throughout the world, and should be treated from an early age. In our context, the presence of the same anatomical form and the same location in both twins is still very rare in the literature, hence the need to share our experience with others. The Mathieu technique remains the reference technique for the management of hypospadias.

Clinical Outcome of Arthroscopic Reconstruction of ACL with Lateral Extra-Articular Tenodesis (Let) to Reduce Anterolateral Rotatory Laxity

A gallstone ileus is a rare cause of intestinal obstruction, caused by the migration of a gallstone through an entero-biliary fistula and its impact in the digestive system, most often in the ileocecal valve. We report here the case of a 60-year-old woman who was admitted for a biliary ileus at the sigmoid level, which is an even rarer cause of intestinal obstruction. The fistula was located between the colon and the gallbladder. The gallstone was surgically removed by colotomy, without treating the fistula and afterwards. The follow-up was without complications. Surgical closure of an enterobiliary fistula is an option that should be considered, but it may result in higher morbidity. Therefore, we chose not to do it, especially considering that spontaneous fistula closure can occur.

Panniculectomy as a surgical option for the management of a deep surgical site infection after C-section in a morbidly obese woman: a case report

BackgroundObesity is an independent risk factor for the occurrence of surgical site infections (SSIs) following all types of surgeries, especially after Caesarean section (C-section). SSIs increase postoperative morbidity, health economic cost and their management is quiet complex with no universal therapeutic consensus. Herein, we report a challenging case of a deep SSI after C-section in a central morbidly obese woman managed successfully by panniculectomy.Case presentationA 30-year-old black African pregnant woman with marked abdominal panniculus extending to the pubic area, a waist circumference = 162 cm and BMI = 47.7 kg/m2 underwent an emergency CS indicated for acute fetal distress. By day five post-operation, she developed a deep parietal incisional infection unremitting to antibiotic therapy, wound dressings and beside wound debridement till the 26th postoperative day. A large abdomen panniculus and maceration of the wound enhanced by central obesity increased the risk of failure of spontaneous closure; thus, an abdominoplasty by panniculectomy was indicated. The patient underwent panniculectomy on the 26th day after the initial surgery and her post-operative course was uneventful. Wound esthetics was satisfactory three months later. Adjuvant dietary and psychological management were associated.ConclusionPost-Caesarean deep SSI is a frequent complication in obese patients. A panniculectomy may be a safe and promising therapeutic surgical option with good cosmetic results and little postoperative complications when used in a multidisciplinary anti-obesogenic approach.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

ISUOG Practice Guidelines (updated): fetal cardiac screening.

What Factors Delay Interatrial Communications Closure in the Oval Fossa?

Purpose: In most neonatal intensive care units, echocardiography is performed at the bedside. The lack of closure of interatrial communications (IACs) in the oval fossa can affect mortality and morbidity. This study aimed to establish the rate of spontaneous closure of IACs diagnosed in the neonatal period and predict the need for subsequent evaluation according to various factors, including defect size and shape.Methods: The study group comprised 1,242 newborns admitted between March 2017 and December 2020. We judged the closure of the IACs and evaluated the risk factors of each. Patients were classified into the absence or presence of IACs. The morphology of the IACs was classified into atrial septal defects, patent foramen ovale, and multiple holes.Results: A total of 317 patients (131 female, 186 male) were enrolled in the study, and the average defect size was 3.0±1.0 mm. An overall spontaneous closure rate of 89.9% was observed during an average follow-up interval of 5.1±1.1 months. When multiple Cox regression analyses were performed to analyze the risk factors for spontaneous closure, initial defect size was a significant factor. The optimal cut-off value for predicting spontaneous closure of the IAC was 3.05 mm, and the area under the receiver operating characteristic curve was 0.625 (95% confidence interval, 0.520 to 0.729). Preterm infants had a larger defect size corrected for birth weight and a higher closure rate than term infants.Conclusion: Other than large defect size, no factors delayed spontaneous closure. When defects in the oval fossa measure ≤3 mm, most patients experience spontaneous closure by 7 months of age.

Effect of possible risk factors for pharyngocutaneous fistula after total laryngectomy of laryngeal carcinomas and surgical wound infection: A meta-analysis.

A meta-analysis study to assess the effect of possible risk factors for pharyngocutaneous fistula (PCF) after total laryngectomy of laryngeal carcinoma. A comprehensive literature examination till January 2023 was implemented and 1794 linked studies were appraised. The picked studies contained 3140 subjects with total laryngectomy of laryngeal carcinomas in the picked studies' baseline, 760 of them were PCF, and 2380 were no PCF. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of possible risk factors for PCF after total laryngectomy of laryngeal carcinomas and surgical wound infection after total laryngectomy of laryngeal carcinoma by the dichotomous and continuous styles and a fixed or random model. The PCF had a significantly higher surgical wound infection (OR, 6.34; 95% CI, 1.89-21.27, P= .003) compared with the no PCF in total laryngectomy of laryngeal carcinomas. The smoking (OR, 1.73; 95% CI, 1.15-2.61, P= .008), and preoperative radiation (OR, 1.90; 95% CI, 1.37-2.65, P< .001) had significantly higher PCF as a risk factor in total laryngectomy of laryngeal carcinomas. The preoperative radiation had a significantly lower spontaneous PCF closure (OR, 0.33; 95% CI, 0.14-0.79, P= .01) compared with the no preoperative radiation in total laryngectomy of laryngeal carcinomas. However, the neck dissection (OR, 1.34; 95% CI, 0.75-2.38, P= .32), and alcohol intake (OR, 1.95; 95% CI, 0.76-5.05, P= .17), had no significant effect on PCF in total laryngectomy of the PCF had a significantly higher surgical wound infection, and preoperative radiation had a significantly lower spontaneous PCF closure in total laryngectomy of laryngeal carcinomas. Smoking and preoperative radiation were shown to be risk factors for PCF, however, neck dissection and alcohol intake were not shown to be risk factors for PCF in total laryngectomy of laryngeal carcinomas. Although precautions should be taken when commerce with the consequences because some of the picked studies for this meta-analysis was with low sample sizes.

An unusual case of posterior vitreous detachment

Purpose: To describe a case of spontaneous closure of a macular microhole induced by an acute posterior vitreous detachment (PVD). Methods: Retrospective case report and analysis of patient data. Case Report: We present a case of spontaneous closure of a posterior vitreous detachment (PVD) induced macular microhole. In our patient, macular microhole developed a few weeks after acute PVD. The development of macular hole secondarily to acute PVD is rare, and there are reports of spontaneous closure. Reporting this case is important to alert clinicians to the potential self-resolving nature of this pathology. Conclusion: Macular hole is a rare complication of acute PVD. Some cases resolve spontaneously without the need for surgical correction. A conservative approach may be an appropriate setting if no high-risk features are present.

Management of enteroatmospheric fistula: A ten-year experience following fifteen years of learning.

Enteroatmospheric fistulas are a serious complication of Open Abdomen. The goal of this study was to present the strategy and results of enteroatmospheric fistulas treatment during the last 10 years, after a long learning period. Seventy-seven patients with enteroatmospheric fistulas were treated and the data recorded between 2012 and 2021. For local treatment, 3 negative pressure methods were used, according to the wound characteristics. The results of conservative and surgical treatments were retrospectively identified and described, including nutritional recovery, morbidity and mortality. Predictors of spontaneous closure, as well as risk factors for the fistula's recurrence and mortality were analyzed. Nutritional and clinical recovery was achieved in 66 patients (85.7%). Fourteen patients (18%) were healed without surgery after a median of 57 days (range 35-426 days). Unique lesions (13/46; P= .02, OR 10.23), initial output ≤700 mL/day (9/28; P= .0035, OR 3.79) and deep fistulas (9/12; P= .00001, OR 33.6) were encountered and acknowledged to be as spontaneous closure factors. Fifty-six patients (72.7%) required reconstructive surgery of the intestinal tract after a median of 187 days since last laparotomy (range: 63-455 days). There were 9 postoperative recurrences (16%), 5 of them closed with conservative treatment. No significant risk factors for recurrence nor postoperative mortality were found. Fistula complete closure was achieved in 63 of the 77 patients studied (81.8%), and 7 patients died (9%). The combination of 3 vacuum methods used for enteroatmospheric fistula management was effective. Spontaneous closure of an enteroatmospheric fistula is unlikely but feasible when lesions are single, deep, with limited output, and when intestinal continuity is preserved. Surgical indications are well defined, although mortality and recurrence rates are still high.