Transient Complications Research Articles

Recurrent exposure of Preserflo Microshunt implant

Preserflo Microshunt is a novel trans-scleral device able to shunt aqueous humor from the anterior chamber to a filtering bleb under Tenon´s capsule and conjunctiva. Although commonly results a safe and effective technique for lowering IOP in patients with open-angle glaucoma, it is not exempt from transient complications. A careful individually selection of the patients and risk factors results important before planning the surgery in order to manage postoperative ocular surface complications.

Ethanol ablation of papillary thyroid carcinoma nodal metastases: Long-term outcomes

BackgroundPercutaneous ethanol ablation has emerged as a treatment for recurrent papillary thyroid carcinoma in the lateral neck after compartment-oriented therapeutic lymphadenectomy. However, the safety and utility of percutaneous ethanol ablation as a primary treatment modality for lateral neck metastases remains undefined. We aimed to investigate long-term outcomes of percutaneous ethanol ablation of lateral neck papillary thyroid carcinoma recurrence both with and without prior lymphadenectomy. MethodsWe conducted a retrospective study of patients with lateral neck papillary thyroid carcinoma treated with percutaneous ethanol ablation from 2013 to 2018. Patient characteristics, disease volume, morbidity, and recurrence (development of new lymphadenopathy within a percutaneous ethanol ablation-treated nodal compartment) were assessed. ResultsWe identified 117 patients who underwent percutaneous ethanol ablation for papillary thyroid carcinoma lateral neck metastases—67 (57%) had a prior lateral neck dissection. Median follow-up after percutaneous ethanol ablation was 5.5 years (interquartile range 3.1–7.5). On average, 1.4 lymph nodes (range: 1–6) were treated. Three patients (3%) developed transient nerve-related complications after percutaneous ethanol ablation. Of 15 patients who underwent lateral neck dissection after percutaneous ethanol ablation (including patients undergoing repeat lateral neck dissection), dissection was “difficult” in 8 (53%) (7 of whom had previously undergone lateral neck dissection), and 4 (27%) developed complications (transient nerve dysfunction = 3, lymphatic leak = 1). Thirty-three patients (28%) developed recurrent papillary thyroid carcinoma. No difference in recurrence was seen between patients who did or did not undergo pre-percutaneous ethanol ablation lateral neck dissection (no pre-percutaneous ethanol ablation lateral neck dissection: 24%, pre-percutaneous ethanol ablation lateral neck dissection, 31%; hazard ratio = 1.27, 95% confidence interval 0.62–2.58; P = .514). ConclusionPercutaneous ethanol ablation may be a safe primary treatment modality for papillary thyroid carcinoma lateral neck nodal recurrence in selected patients with low-volume nodal disease.

ULTRASOUND-GUIDED GENICULAR NERVE BLOCK FOR KNEE OSTEOARTHRITIS: A CASE SERIES.

Knee genicular nerve blocks have been a topic of discussion among various types of treatment for knee osteoarthritis. This study aims to evaluate the pain and function of patients diagnosed with knee osteoarthritis after undergoing ultrasound-guided genicular nerve blockade using pharmacological agents. The study included 36 patients diagnosed with knee osteoarthritis, comprising 17 bilateral cases, totaling 53 knees undergoing UGNB using a mixture of triamcinolone, ropivacaine, and lidocaine under ultrasound guidance. Epidemiological data, pain outcomes measured by the Visual Analog Scale (VAS), and function assessed using the Western Ontario and McMaster Universities (WOMAC) score were evaluated before and after 12 weeks of the procedure. The mean age was 75.5 years (standard deviation of 9.4 years), with a predominance of females and right-sided involvement. There was a mean reduction of 3.0 points in VAS (p < 0.001) and 15.4 points in WOMAC (p < 0.001). Two cases reported only minor and transient complications related to the procedure (skin anesthesia and edema). Ultrasound-guided genicular nerve blockade using pharmacological agents demonstrated pain reduction and improved function with a low complication rate after 12 weeks in patients with knee gonarthrosis. Level of Evidence IV, Case Series.

Transradial Access Versus Transfemoral Approach for Carotid Artery Stenting: A Systematic Review and Meta‐Analysis

Background Carotid artery stenting (CAS) has emerged as a viable alternative to carotid endarterectomy for managing carotid artery stenosis in high‐risk patients. Although transfemoral arterial access remains the preferred method, it is associated with inherent limitations and potential complications. Consequently, exploring transradial artery access as a potential option becomes crucial in optimizing patient outcomes and procedural success rates. There are limited data comparing the outcomes of the transradial with the transfemoral approach for CAS. This study aimed to systematically review and meta‐analyze the outcomes and complication rates between transradial and transfemoral access for CAS. Methods A systematic electronic search was conducted in 4 databases. Studies with randomized or nonrandomized designs, involving CAS by the transradial or transfemoral approach, were included. Outcomes of interest were stroke, transient ischemic attack, death, myocardial infarction, and access site complications. A meta‐analysis was performed, analyzing pooled odds ratios (ORs) and 95% CIs to assess the effect size. Results Six studies with a total of 6917 patients were included, of whom 602 (8.7%) underwent the transradial approach and 6315 (91.3%) the transfemoral approach. The meta‐analysis showed no significant difference in stroke occurrence between the transradial and transfemoral groups (transradial:1.7% versus transfemoral:1.9%; OR = 0.98 [95% CI, 0.49–1.96]; I 2 = 0%). Similarly, no significant difference was found in death (TR:1% versus transfemoral:0.9%; OR = 0.95 [95% CI, 0.38–2.37]; I 2 = 0%), myocardial infarction (transradial:0.2% versus transfemoral:0.3%; OR = 1.53 [95% CI, 0.20–11.61]; I 2 = 0%), transient ischemic attack (transradial:0.4% versus transfemoral:1%; OR = 0.46 [95% CI, 0.11–1.95]; I 2 = 0%), or access site complications (transradial:2.2% versus transfemoral:1%; OR = 0.97 [95% CI, 0.48–1.98]; I 2 = 0%). Conclusion No significant differences were observed in stroke, death, myocardial infarction, transient ischemic attack, or access site complications on comparing thetransradial and transfemoral approaches for CAS. The transradial approach shows promise as an alternative method for CAS, offering potential benefits without increased risk of complications. However, further studies are needed to confirm these findings.

Quality of life of patients with singleand multigland parathyroid disease in sporadic primary hyperparathyroidism before and after surgical treatment

Background. In 15–25 % of cases, the cause of primary hyperparathyroidism (PHPT) is multigland parathyroid disease. The complexity of clinical and laboratory prognosis, low efficiency of imaging methods, inaccurate assessment of the radicality of the surgery are the components of the problem of this variant of the disease. Quality of life (QOL) is an important criterion for the effectiveness of surgical treatment. A study of the QOL in patients with multigland parathyroid disease in PHPT has not been previously conducted in our country. The aim of the study. To assess the quality of life of patients with single- and multigland parathyroid disease in sporadic primary hyperparathyroidism before and after parathyroidectomy (PTE). Methods. As part of a prospective observational study, the quality of life of 64 patients with PHPT before and after PTE was assessed using SF-36 (Short Form 36) questionnaire: main group (n = 13) – patients with multigland parathyroid disease; comparison group (n = 51) – patients with single-gland parathyroid disease. The quality of life indicators of the patients were compared with those in a sample of the Irkutsk region population similar in gender and age. Results. Before performing PTE, the quality of life of patients with PHPT was lower than that of the Irkutsk region population. The greatest decrease in both health components was registered in the main group. In 90 % of patients, the quality of life improved after PTE, while in the main group changes were established 1 year after the surgery, in the comparison group – 6 months after the surgery. Transient complications (laryngeal paresis) and disease outcomes (hypocalcemia, hypoparathyroidism) did not interfere with the improvement of quality of life in both groups. When persistence was detected, no significant improvement in QOL was established. Conclusion. The quality of life of patients with PHPT is significantly reduced. PTE improves the QOL of these patients, and only persistence of the disease does not allow this to be achieved. Therefore, surgical tactics aimed at reducing the frequency of persistence will achieve a decent quality of life in the majority of patients with multigland parathyroid disease in PHPT.

Arthroscopic treatment of massive rotator cuff tears involving subscapularis

Introduction. Massive rotator cuff tears represent a major challenge in shoulder surgery. Contemporary arthroscopic techniques allow for repair in majority of cases. In the setting of a massive rotator cuff tear, engagement of subscapularis plays a significant role in function deterioration and is a risk factor for pseudoparalysis.&#x0D; Materials and methods. We present our experience and clinical results with arthroscopic repair of massive rotator cuff tears engaging subscapularis in 32 patients, followed for 12,5 months.&#x0D; Results. Complete repair was performed in 25 (78.1%) and partial repair in 7 (21,9%) of the cases with significant improvement in active forward flexion and good to excellent functional result in 68,8%, according to Constant score. Acute pseudoparalysis was successfully reversed in 8 out of 9 cases (88,8%). Transient neurologic complication was observed in 1 case (3%).&#x0D; Conclusion. Subscapularis plays an important role in massive rotator cuff tears and should always be repaired. Arthroscopic repair of massive rotator cuff tears engaging subscapularis is safe and efficient with good clinical results during one year follow up. While complete repair of all torn tendons with secure reattachment to the tuberosities is the preferred surgical treatment, repair of subscapularis and lower portion of infraspinatus is crucial for normal rotator cuff function. Careful patient selection and individually tailored surgery is important for successful treatment.

Efficacy of splanchnic nerve neurolysis in the management of upper abdominal cancer pain: A systematic review and meta-analysis.

Neurolytic splanchnic nerve block (NSNB) is practised in intractable abdominal pain secondary to intra-abdominal malignancies. This review evaluated the efficacy of NSNB. PubMed, Embase, Scopus, and Cochrane databases were searched for articles published from January 2001 to October 2023. Two independent reviewers extracted the data from the included studies. The quality of randomised controlled trials (RCTs) was assessed using the revised Cochrane risk-of-bias tool (RoB 2), and the Newcastle-Ottawa scale was used for cohort studies. Fourteen articles (4 RCTs, 3 non-randomised prospective, and 7 retrospectives) were included. Ten articles were quantitatively assessed and demonstrated significant pain relief at 1 week (standardised mean difference (SMD): 3.46 [2.09, 4.83], P < 0.001, I2 = 95%), 2 weeks (SMD: 4.45 [2.61, 6.29], P < 0.001, I2 = 95%), 4 weeks (SMD: 3.35 [2.23, 4.47], P < 0.001, I2 = 97%), 8 weeks (SMD: 3.7 [2.71, 4.7], P < 0.001, I2 = 86%), 12 weeks (SMD: 4.01 [2.66, 5.36], P < 0.001, I2 = 95%), and 24 weeks (SMD: 2.54 [1.71,3.37], P < 0.001, I2 = 84%). Daily narcotic consumption and quality of life (QOL) significantly improved post neurolysis, but survival rates showed controversial results. Significant heterogeneity was reported, and sub-group analysis revealed a moderate level of variability [I2 = 47.3%] pertaining to study design as a source of heterogeneity. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Pro GDT recommendation for the primary objective was 'high' for the analysis of RCTs and 'very low' evidence quality for observational studies. Only transient minor complications were reported. NSNB appears to be an efficacious technique that provides substantial pain relief, reduces opioid consumption, and ameliorates QOL.

Supplementary Motor Area Syndrome After Resection of a Dominant Hemisphere Parasagittal Meningioma: A Case Report

BACKGROUND AND IMPORTANCE: Supplementary motor area (SMA) syndrome is a common, transient postoperative complication of intra-axial tumor resections involving the SMA and posterior cingulate gyrus. It is also reported as a rare complication of resecting extra-axial lesions. Meningiomas represent the most common, nonmalignant primary central nervous system tumor in adults, which present most commonly in parasagittal locations. Resection of dominant hemisphere parasagittal meningiomas overlying or infiltrating into the SMA region carry a recognizable risk for developing SMA syndrome postoperatively. CLINICAL PRESENTATION: We present a 58-year-old woman with intermittent headaches and concern for new-onset seizures. MRI demonstrated an extra-axial mass involving the left frontal convexity and SMA region with homogenous postcontrast enhancement. There was radiographic involvement of the superior sagittal sinus and inner table of the skull. Fluid-attenuated recovery signal and perilesional vasogenic edema were also noted. The imaging findings favored a parasagittal meningioma, and surgical resection was performed. Arachnoid invasion and pial infiltration of the tumor over the SMA were evident during the operation. CONCLUSION: A detailed understanding of the functional neuroanatomy and clinical pathophysiology of eloquent cortical regions is important for preoperative planning and patient counseling. Surgical resection of lesions in such areas can result in rare complications uniquely implicated in specific patient subsets. Recognizing these patients in the preoperative setting is imperative for proper counseling of patients and families.

3D4K exoscope in epilepsy surgery: a seminal experience.

To report the progressive introduction of the exoscope (EX) from surface lesionectomy to antero-mesial temporal lobectomy (AMTL) in an epilepsy surgery practice. We describe a population of ten consecutive patients undergoing EX surgery, with a minimum follow-up of 6months, that was compared to a similar population of patients referred to operative microscopic surgery (OM). All surgeries were performed with the use of EX or OM alone. Transient neurological complications for surgery in eloquent regions were recorded in one patient for each population. Nine and seven patients undergoing, respectively, EX and OM surgery resulted in Engel class Ia (90% vs. 70%). The mean duration of EX and OM surgery resulted in 265.5 and 237.9min, respectively, with a mean of 308.3 and 253.3min for AMTL cases, respectively. This preliminary study revealed that ORBEYE EX can be safe and effective in different types of epilepsy surgeries. The transition from OM to EX is fast, even though it is slower for the more challenging mesial temporal structure removal. Ergonomic and operative team interaction is improved by the use of EX. Our data need to be confirmed by larger studies.

Abstract 220: Transradial Access Versus Transfemoral Approach for Carotid Artery Stenting: A Systematic Review and Meta‐analysis

Introduction Carotid artery stenting (CAS) has emerged as a viable alternative to carotid endarterectomy for managing carotid artery stenosis in high‐risk patients (1). While the transfemoral arterial approach (TF) remains the preferred method, it is associated with inherent limitations and potential complications (2‐4). Consequently, exploring the transradial artery access (TR) as a potential option becomes crucial in optimizing patient outcomes and procedural success rates. Limited data exists comparing the outcomes of TR approach in CAS to TF approach. This study aims to systematically review and meta‐analyze the outcomes and complication rates between TR and TF access for CAS. Methods A systematic electronic search was conducted in four databases up to May 10th, 2023. Studies with randomized or non‐randomized designs, involving CAS through TR or TF approach, were included. Outcomes of interest were stroke, transient ischemic attack (TIA), death, myocardial infarction (MI), and access site complications. A meta‐analysis was performed, analyzing pooled odds ratios (ORs) and 95% confidence intervals (CI) to assess the effect size of the vascular access approaches. Results Six studies with a total of 6,917 patients were included, out of which 602 (8.7%) underwent the TR approach, and 6,315 (91.3%) underwent the TF approach. Meta‐analysis results showed no significant difference in stroke occurrence between TR and TF groups (TR: 1.7% vs. TF: 1.9%; OR = 0.98; 95% CI 0.49 – 1.96; I2 = 0%). Similarly, no significant difference was found in death (TR: 1% vs. TF: 0.9%; OR = 0.95; 95% CI 0.38 – 2.37; I2 = 0%), MI (TR: 0.2% vs. TF: 0.3%; OR = 1.53; 95% CI 0.20 – 11.61; I2 = 0%), TIA (TR: 0.4% vs. TF: 1%; OR = 0.46; 95% CI 0.11 – 1.95; I2 = 0%), and access site complications (TR: 2.2% vs. TF: 1%; OR = 0.97; 95% CI 0.48 – 1.98; I2 = 0%). Conclusion In the comparison of TR and TF approaches for CAS, no significant differences were observed in stroke, death, MI, TIA, or access site complications. TR approach shows promise as an alternative method for CAS, offering potential benefits without increased risk of complications. However, further studies are needed to confirm these findings and establish guidelines for optimal access site selection.

XEN®-45 implantation for refractory uveitic glaucoma

PurposeTo evaluate the efficacy of XEN®-45 gel stent ab interno implantation for medically uncontrolled uveitic glaucoma.MethodsRetrospective analysis of 25 eyes receiving XEN® gel stent for medically uncontrolled uveitic glaucoma from February 2019 to February 2023 with recording of intraocular pressure (IOP) values, ocular hypotensive medication, requirement for revision or secondary surgery and complications. Prerequisites for XEN® implantation were a clear cornea, an open iridocorneal angle and an unscarred, mobile conjunctiva at the implantation site. Minimum follow-up required for inclusion was 3 months. The primary outcome measure was IOP compared to baseline. Complete and qualified success were defined as final IOP of ≤ 18 mmHg without or with topical antiglaucomatous treatment, respectively. Failure was defined as IOP > 18 mmHg on two consecutive visits, IOP reduction < 20%, persisting complications from hypotony and open conjunctival bleb revision. Further glaucoma surgical intervention was defined as complete failure.ResultsMean preoperative IOP was 35.3 ± 10.9 mmHg on 2.9 ± 0.9 topical antiglaucomatous agents. 19 of 25 patients (76%) received additional oral acetazolamide. 19 eyes were pseudophakic, 5 eyes phakic and 1 aphakic.Early postoperatively, mean IOP reduced to 7.7 ± 3.0 mmHg (75.8% reduction). At final follow-up (mean 17.7 months) mean IOP was 12.0 ± 3.8 mmHg (62.5% reduction) on 0.2 ± 0.6 medications.Six eyes (24%) required bleb revision at mean 28 weeks and therefore were categorized as failure. One eye failed despite bleb revision and restart of topical ocular hypotensive medication. Three other eyes (12%) had IOP spikes with uveitis flare-ups. Transient hypotony complications occurred in 32%. At final follow-up, 18 eyes (72%) achieved complete success and one eye (4%) qualified success.ConclusionThe XEN® gel stent effectively reduced IOP in uncontrolled uveitic glaucoma, with 72% complete success. Bleb revision was required in 24%. IOP spikes occurred in 12% despite functioning blebs. Further follow-up is needed to determine long-term outcomes.

Long-term functional outcomes and complications of microsurgical resection of brainstem cavernous malformations: a systematic review and meta-analysis.

Brainstem cavernous malformations (CMs) encompass up to 20% of all intracranial CMs and are considered more aggressive than cerebral CMs because of their high annual bleeding rates. Microsurgical resection remains the primary treatment modality for CMs, but long-term functional outcomes and complications are heterogenous in the literature. The authors performed a systematic review on brainstem CMs in 4 databases: PubMed, EMBASE, Cochrane library, and Google Scholar. We included studies that reported on the long-term functional outcomes and complications of brainstem CMs microsurgical resection. A meta-analysis was performed and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The search yielded 4781 results, of which 19 studies met our inclusion criteria. Microsurgery was performed on 940 patients (mean age 35years, 46.9% females). Most of the brainstem CMs were located in the pons (n = 475). The pooled proportions of improved, stable, and worsened functional outcomes after microsurgical resection of brainstem CMs were 56.7% (95% CI 48.4-64.6), 28.6% (95% CI 22.4-35.7), and 12.6% (95% CI 9.6-16.2), respectively. CMs located in the medulla were significantly (p = 0.003) associated with a higher proportion of improved outcome compared with those in the pons and midbrain. Complete resection was achieved in 93.3% (95% CI 89.8-95.7). The immediate postoperative complication rate was 37.2% (95% CI 29.3-45.9), with new-onset cranial nerve deficit being the most common complication. The permanent morbidity rate was 17.3% (95% CI 10.5-27.1), with a low mortality rate of 1% from the compiled study population during a mean follow-up of 58months. Our analysis indicates that microsurgical resection of brainstem CMs can result in favorable long-term functional outcomes with transient complications in the majority of patients. Complete microsurgical resection of the CM is associated with a lower incidence of CM hemorrhage and the morbidity related to it.

Use of intravascular lithotripsy in non-coronary artery lesions.

Intravascular lithotripsy (IVL) is a novel technique increasingly used for plaque modification and endovascular revascularization in patients with severe calcification and peripheral artery disease. However, much of the available literature on IVL is focused on its use in coronary arteries, with relatively limited data on non-coronary artery use. To analyze the safety and efficacy of current IVL use in non-coronary artery lesions, as reported in case reports and case series. We searched EMBASE, PubMed, and Reference Citation Analysis databases for case reports and case series on IVL use in peripheral artery disease. We then extracted variables of interest and calculated the mean and proportions of these variables. We included 60 patients from 33 case reports/case series. Ninety-eight percent of the cases had IVL usage in only one blood vessel, while four had the IVL used in two vessels (2.0%), resulting in 64 Lesions treated with IVL. The mean age of the patients was 73.7 (SD 10.9). IVL was successfully used in severe iliofemoral artery stenosis (51.6%), severe innominate, subclavian, and carotid artery stenosis (26.7% combined), and severe mesenteric vessel stenosis (9.4%). Additionally, IVL was successfully used in severe renal (7.8%) and aortic artery (4.7%) stenosis. There were complications in 12% of the cases, with dissection being the commonest. IVL has successfully used in plaque modification and endovascular revascularization in severely calcified and challenging lesions in the iliofemoral, carotid, subclavian, aorta, renal, and mesenteric vessels. The most severe but transient complications were with IVL use in the aortic arch and neck arteries.

Are We Focused on the Wrong Early Postoperative Quality Metrics? Optimal Realignment Outweighs Perioperative Risk in Adult Spinal Deformity Surgery.

While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications. Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. Retrospective cohort study of a prospectively collected multicenter database. ASD patients with two-year (2Y) data included. Groups were propensity score matched (PSM) for age, frailty, body mass index (BMI), Charlson Comorbidity Index (CCI), and baseline deformity. Optimal radiographic criteria are defined as meeting low deformity in all three (Scoliosis Research Society) SRS-Schwab parameters or being proportioned in Global Alignment and Proportionality (GAP). Cost-per-QALY was calculated for each time point. Multivariable logistic regression analysis and ANCOVA (analysis of covariance) adjusting for baseline disability and deformity (pelvic incidence (PI), pelvic incidence minus lumbar lordosis (PI-LL)) were used to determine the significance of surgical details, complications, clinical outcomes, and cost-utility. A total of 930 patients were considered. Following PSM, 253 "optimal" (O) and 253 "not optimal" (NO) patients were assessed. The O group underwent more invasive procedures and had more levels fused. Analysis of complications by two years showed that the O group suffered less overall major (38% vs. 52%, p = 0.021) and major mechanical complications (12% vs. 22%, p = 0.002), and less reoperations (23% vs. 33%, p = 0.008). Adjusted analysis revealed O patients more often met MCID (minimal clinically important difference) in SF-36 PCS, SRS-22 Pain, and Appearance. Cost-utility-adjusted analysis determined that the O group generated better cost-utility by one year and maintained lower overall cost and costs per QALY (both p < 0.001) at two years. Fewer late complications (mechanical and reoperations) are seen in optimally aligned patients, leading to better long-term cost-utility overall. Therefore, the current focus on avoiding short-term complications may be counterproductive, as achieving optimal surgical correction is critical for long-term success.

Comparative Study between Total Thyroidectomy with Ipsilateral versus Bilateral Prophylactic Central Neck Dissection in Patients with Clinically Node – Negative Papillary Thyroid Carcinoma. A Meta-Analysis

Abstract Background Papillary thyroid carcinoma (PTC) accounts for &amp;gt; 80% of all thyroid malignancies. It is generally slow-growing and the overall prognosis is excellent, with 5-year, 10-year, and 20-year survival rates of 94%, 89%, and 87%, respectively. Aim of the Work The aim of this study is to compare between unilateral PCND and bilateral PCND in patients with clinically unifocal cN0 PTC using meta-analysis approach Methodology A Systemic review and meta-analysis Study was performed after the data extraction process. Five studies comparing the out-comes of unilateral PCND and bilateral PCND procedures in adult patients with PTC CN0 were included in this study. The publicly available literature on PubMed, and, the Web of Knowledge, and the China Journal Net, EMBASE, Cochrane Library, and Scopus databases and the ClinicalTrials.gov registry. Published from January 2005 to December 2020 concerning TT plus ipsilateral PCND versus TT plus bilateral PCND for PTC CN0 will be retrieved by searching the national and international online databases. Results The result of our study revealed that: Bilateral central neck dissection had higher insignificant operative time than ipsilateral one, bilateral central neck dissection had higher overall significant complications rate than ipsilateral one, bilateral central neck dissection had higher significant permanent hypo PTH and insignificant hematoma, seroma, and transient hypo PTH rate than ipsilateral one, ipsilateral central neck dissection had higher insignificant PRLNP, TRLNP rate nearly equal with bilateral one, ipsilateral CND appears to be sufficient in patients with tumors&amp;lt;1 cm as bilateral central neck dissection had higher insignificant tumor size than ipsilateral one, there was no statistically significant difference found between unilateral PCND and bilateral PCND regarding rate of recurrence. Conclusion We suggest that, ipsilateral central neck dissection may be a reasonable surgical option for prophylactic CND in unilateral PTC with clinically negative lymph nodes because of its lower rates of contralateral paratracheal node metastasis and transient hypoparathyroidism and lower complications than bilateral pCND. and effective for selected patients undergoing a total thyroidecto- my for cN0 unilateral PTC.

Upper Extremity Blocks for Hand Surgeons: A Literature Review of Regional Anaesthesia Techniques, Efficacy, and Safety.

Introduction: Regional anaesthesia (RA) techniques have increased in popularity due to evidence of reductions in acute pain, chronic pain, postoperative nausea and vomiting (PONV), and pulmonary complications. While upper extremity blocks (UEBs) have been the subject of several comprehensive reviews, no review to date has synthesised the information on their use in hand surgery. Methods: A search of PUBMED and Cochrane databases was performed to identify the evidence associated with upper extremity blocks. The results of this search and extant literature on UEBs were examined and the relevant information extracted. Results: Supraclavicular block is associated with transient complications such as Horner's syndrome and phrenic nerve palsy, affecting up to 54% and 50% of patients, respectively. The incidence of pneumothorax in supraclavicular blocks is up to 4%. Infraclavicular, interscalene and axillary blocks have a lower rate of all complications, however, each may require a supplementary block at a different anatomical site as each spares significant regions of the upper extremity. Epinephrine in concentrations of 1:100,000-200,000 is safe for use in digital blocks with no association digital gangrene. Current evidence suggests digital blocks are safe and efficacious when appropriately performed. Conclusion: UEBs are safe and may be administered by an anaesthesia provider or an appropriately trained surgeon. The choice of block is contingent on the anatomical location of the surgical procedure, procedure duration, patient preference, patient co-morbidieis, and the surgeon's experience. Most upper extremity surgeries can be performed using RA. Current evidence illustrates outcome benefits for patients, surgeons, and healthcare institutions utilising RA.

Prenatal testing for imprinting disorders: A clinical perspective.

Imprinting Disorders (ImpDis) are a group of congenital conditions caused by aberrant imprinting resulting in disturbed expression of parentally imprinted genes. ImpDis are rarely associated with major malformations, but pre- and/or postnatal growth and nutrition are often affected. In some ImpDis, behavioral, developmental, metabolic and neurological symptoms might present in the perinatal context or later in life, and in single ImpDis there is a higher risk of tumors in childhood. Prognosis depends in part on the molecular cause of each ImpDis, but due to high clinical variability and (epi)genetic mosaicism, predicting the clinical outcome of a pregnancy solely based on the underlying molecular disturbance is difficult. Therefore, interdisciplinary care and treatment approaches play an important role in the management and decision making of affected pregnancies, especially taking into account fetal imaging in addition to genetic findings. Prenatal findings influence perinatal management, and thereby improve the prognosis of ImpDis associated with severe but sometimes transient clinical complications in the neonatal period. Therefore, prenatal diagnosis can be crucial for appropriate management not only of the pregnancy itself but might also have a life-long effect. This article is protected by copyright. All rights reserved.

Surgical removal of an orbital liposarcoma in a dog using the cavitron ultrasonic surgical aspirator

AbstractA 9‐year‐old boxer presented with unilateral exophthalmos, reduced globe retropulsion and central exposure keratitis in the right eye. On the superolateral orbital quadrant, a firm, well‐limited mass in close proximity to the globe was detected. Ultrasonic and computed tomography examinations confirmed a retrobulbar mass. The biopsy examination revealed the presence of a tumour of adipocytes, consistent with hibernoma. The retrobulbar mass was surgically removed using dorsal orbitotomy with a cavitron ultrasonic surgical aspirator. Complete retrobulbar mass removal was achieved with minimal and transient postoperative complications. The histopathological examination of the mass fragment obtained during surgery showed liposarcoma. Controlled computed tomography performed 4 months after surgery did not reveal signs of recurrence or metastasis. Ophthalmic examination was within normal limits during 1 year of follow‐up. The cavitation ultrasonic surgical aspirator allows precise mass excision with preservation of delicate orbital structures and is particularly useful in cases with challenging anatomical access.

Intracranial Neuroendoscopy in Children and Adults: Where Do the Differences Lie?

Intraventricular neuroendoscopy has evolved into an essential adjunct in neurosurgery and is used across all age groups for various indications. However, studies comparing neuroendoscopic procedures between children and adults are scarce. The aim of this study is to compare various aspects between adults and children undergoing neuroendoscopy. We retrospectively analyzed the data from consecutive patients dichotomized into 2 cohorts, pediatric (age <18 years) and adult (age ≥18 years) groups, in whom intracranial neuroendoscopy was performed between 2013 and 2020 (pediatric group) and 2010 and 2020 (adult group). Of 132 patients who underwent intracranial neuroendoscopic surgery, 47 (35.6%) were children and 85 (64.4%) were adults. The most common indications for the children and adults were intraventricular or paraventricular tumors (23.4%) and aqueduct stenosis (40%), respectively. Their clinical condition at the last follow-up was unchanged or improved for 90.5% of the children and 92.1% of the adults. An increased endoscopic third ventriculostomy success score was predictive of endoscopic third ventriculostomy success in the pediatric cohort (odds ratio, 1.073; P= 0.043). The postoperative rates of transient (pediatric, 23.4%; adult, 18.8%) and permanent (pediatric, 0%; adult, 1.2%) complications were comparable. The rate of secondary surgery was higher for the pediatric cohort (38.3%) than for the adult cohort (17.6%). The indications for neuroendoscopy vary between adults and children, although the long-term clinical outcome is comparable. The rate of secondary surgery is significantly higher for pediatric patients, especially for those aged <1 year. Because neuroendoscopy is considerably more frequent in pediatric patients, including pediatric neurosurgeons in adult neuroendoscopic cases could potentially help lower the complication rates and increase the success rates.

Early satisfactory results of percutaneous repair in neglected achilles tendon rupture

PurposeThis investigation aimed to study the outcome of percutaneous repair of Achilles tendon ruptures regarding patient-reported and objective outcomes.MethodsThis is a retrospective review of a cohort of patients (n = 24) who underwent percutaneous repair of neglected Achilles rupture in the period between 2013 and 2019. Included patients were adults with closed injuries, presented 4–10 weeks after rupture, with intact deep sensation. All underwent clinical examination, X-rays to exclude bony injury and MRI for diagnosis confirmation. All underwent percutaneous repair by the same surgeon, using the same technique and rehabilitation protocol. The postoperative assessment was done subjectively using ATRS and AOFAS score and objectively using a percentage of heel rise comparison to the normal side and calf circumference difference.ResultsThe mean follow-up period was 14.85 months ± 3 months. Average AOFAS scores at 6,12 months were 91 and 96, respectively, showing statistically significant improvement from pre-op level (P < 0.001). Percentage of heel rise on the affected side and calf circumference showed statistically significant improvement over the 12 month follow up period (P < 0.001). Superficial infection was reported in two patients (8.3%), and two cases reported transient sural nerve neuritis.ConclusionPercutaneous repair of neglected Achilles rupture using the index technique proved a satisfactory patient-reported and objective measurement at a one-year follow-up. With only minor transient complications.