Visceral Complications Research Articles

Gastrointestinal complications and visceral circulation changes after intentional celiac artery embolization during complex endovascular aortic repair

Intentional celiac artery embolization (CAE) is an oft-used strategy to extend proximal or distal seal during complex endovascular aortic repair. Prior reports document a wide range of GI-related complications. However, associated changes in collateral circulation are poorly defined. We sought to report the long-term outcomes and adaptive changes in collateral visceral circulation following CAE during complex endovascular aortic repair. All patients undergoing complex endovascular aortic procedures (EVAR and TEVAR) with CAE at a single-institution over a 12-year period were included. Pre- and post-operative clinical, radiologic, and laboratory data were reviewed to identify mesenteric complications related to CAE and to assess long-term survival and radiologic changes in collateral anatomy. Multivariable logistic regression was used to determine the association between collateral vessel diameter change and mesenteric complications. From 2011 to 2023, 70 patients underwent planned CAE during complex endovascular aortic repair. With regards to mesenteric complications not attributable to the SMA stent, 11.4% had 30-day mesenteric complications, including upper gastrointestinal bleed (UGIB) or perforated ulcer (n=3), cholecystitis (n=2), pancreatitis (n=2) and ischemic hepatitis (n=1). During 31-90 days after CAE, 2 additional patients (2.9%) had UGIB. With regards to 90-day mesenteric complications related to the SMA stent, 4 additional patients (5.7%) had SMA stent complications leading to mesenteric ischemia. On Kaplan-Meier analysis, patients with any 90-day mesenteric complication had significantly lower overall 2-year survival (42.5% vs 75.0%; P=.002). On pre-operative imaging, 20% of patients had variant SMA anatomy with the GDA as the dominant SMA-celiac collateral pathway in 68.6%. Post-operatively, patients without mesenteric complications had a greater increase in the collateral diameter at both SMA and celiac junctions at 1, 3-6, 12, and 24 months with a statistically significant difference in diameter at 1 month compared to patients with complications (median: 16.2% vs -2.1% at celiac, P=.006 and 20.8% vs 7.7% at SMA, P=.021). On adjusted multivariate regression, increase in collateral diameter at the SMA junction on first post-operative CT was significantly protective of 90-day mesenteric complications (OR: 0.93, 95% CI: 0.87-0.96; P=.046). CAE during complex endovascular aortic repair is a useful adjunct to increase seal zone in select patients; however, mesenteric complications occur in 14% of the patients over a 90-day post-operative period and patients with mesenteric complications have a higher long-term all-cause mortality. CAE should be a technique within the toolbox of vascular surgeons for urgent circumstances that do not allow for celiac preservation. Careful selection of candidates for CAE and early postoperative surveillance of collateral pathways may help with prevention and early identification of long-term visceral complications.

Amelioration of Systemic Amyloidosis by Blocking IL-17A and Not by IL-17F, and Arteriosclerosis by Blocking Both IL-17A and IL-17F in an Inflammatory Skin Mouse Model.

There are comorbidities and complications in atopic dermatitis and psoriasis that often occur after the appearance of skin inflammation. Statistically, data show that patients with psoriasis and atopic dermatitis have a shorter life expectancy than patients without psoriatic dermatitis, due to the occurrence of arteriosclerosis, myocardial infarction, and cerebral infarction. Many types of skin inflammation are treated with various antibody preparations, and marked improvement in patients' quality of life can be achieved. The next theme is to understand the pathogenesis of arteriosclerosis, myocardial infarction, stroke, and other complications associated with dermatitis and to find treatments and drugs to reduce their occurrence. The skin, a crucial immune organ, generates large amounts of inflammatory cytokines in response to various stimuli, leading to systemic inflammation and potential damage to internal organs. The link between inflammatory skin conditions like psoriasis and atopic dermatitis with serious health complications such as vascular disorders and systemic amyloidosis has been increasingly recognized. In psoriasis, biological treatments targeting Interleukin (IL)-17A, a key cytokine, have shown promise in reducing cardiovascular risks. Recent developments include treatments that target both IL-17A and IL-17F in the psoriasis field, though each cytokine's impact on internal organ damage is still under debate. Among visceral complications secondary to dermatitis, systemic amyloidosis and atherosclerosis have been reported to be controlled by suppressing IL-17 in the early stages of dermatitis. Still, it remains unclear whether suppressing IL-17 prevents organ damage in the late stages of persistent severe dermatitis. A study using a long-lasting dermatitis mouse model that overexpressed human caspase-1 in keratinocytes (Kcasp1Tg) investigated the effects of deleting IL-17A and IL-17F on visceral complications. Cross-mating Kcasp1Tg with IL-17A-, IL-17F-, and IL-17AF-deficient mice assessed the skin and visceral organs histologically, and RT-PCR analysis of aortic sclerosis markers was performed. Despite less improvement in dermatitis, deletion of IL-17A in Kcasp1Tg mice showed promising results in reducing multiple organ amyloidosis. On the other hand, the effect was observed in both IL-17A and IL-17F deleted mice for aortic sclerosis. The inhibition of IL-17A and IL-17F was suggested to reduce the risk of developing comorbidities in internal organs. IL-17A and IL-17F were found to act similarly or produce very different results, depending on the organ.

Impact of pre-existing mesh at the hiatus at revisional hiatal hernia surgery.

Recurrence after laparoscopic hiatus hernia repair (LHR) is high, with few symptomatic patients undergoing redo LHR. Morbidity is higher in redo surgery compared with the primary operation. Tens of studies have explored the safety of redoing LHR. However, the impact of existing mesh on operative risk is rarely examined. We aim to assess the impact of mesh at the hiatus on the safety of redo LHR. This was a cohort study examining redo LHR patients from a prospectively maintained database from January 2002 to December 2023. The primary outcome was intra-/postoperative complications. Follow-up was extracted from clinical records. Predictors of complications were assessed using univariable and multivariable logistic regression analyses. Redo LHR was performed in 100 patients; 22 had previous mesh. One encountered mortality with 23 complications. Five patients had absorbable mesh, with the remainder nonabsorbable. Overall complications were significantly higher with mesh at nine (40.9%) compared to no mesh redo at 14 (17.9%), P = 0.023. There was no difference in rates of visceral injury with mesh at four (18.2%) and no mesh at six (7.7%), P = 0.22. The median follow-up was 7months; there was no difference in reflux rates (P = 0.70) but higher rates of dysphagia (P = 0.010). Higher overall complications were noted in patients with previous hiatal mesh repair at the time of LHR. However, major visceral complications were similar regardless of mesh use. Mesh at the hiatus should not be a deterrent for reoperative hiatus surgery.

Prevalence and outcomes of polycystic kidney disease in African populations: A systematic review.

Polycystic kidney disease (PKD) is the most common genetic cause of kidney disease. It is a progressive and irreversible condition that can lead to end-stage renal disease and many other visceral complications. Current comprehensive data on PKD patterns in Africa is lacking. To describe the prevalence and outcomes of PKD in the African population. A literature search of PubMed, African journal online, and Google Scholar databases between 2000 and 2023 was performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses were followed to design the study. Clinical presentations and outcomes of patients were extracted from the included studies. Out of 106 articles, we included 13 studies from 7 African countries. Ten of them were retrospective descriptive studies concerning 943 PKD patients with a mean age of 47.9 years. The accurate prevalence and incidence of PKD were not known but it represented the third causal nephropathy among dialysis patients. In majority of patients, the diagnosis of the disease was often delayed. Kidney function impairment, abdominal mass, and hypertension were the leading symptoms at presentation with a pooled prevalence of 72.1% (69.1-75.1), 65.8% (62.2-69.4), and 57.4% (54.2-60.6) respectively. Hematuria and infections were the most frequent complications. Genotyping was performed in few studies that revealed a high proportion of new mutations mainly in the PKD1 gene. The prevalence of PKD in African populations is not clearly defined. Clinical symptoms were almost present with most patients who had kidney function impairment and abdominal mass at the diagnostic. Larger studies including genetic testing are needed to determine the burden of PKD in African populations.

Pedicle screw accuracy placed with assistance of machine vision technology in patients with neuromuscular scoliosis.

Pedicle screws are the primary method of vertebral fixation in scoliosis surgery, but there are lingering concerns over potential malposition. The rates of pedicle screw malposition in pediatric spine surgery vary from 10% to 21%. Malpositioned screws can lead to potentially catastrophic neurological, vascular, and visceral complications. Pedicle screw positioning in patients with neuromuscular scoliosis is challenging due to a combination of large curves, complex pelvic anatomy, and osteopenia. This study aimed to determine the rate of pedicle screw malposition, associated complications, and subsequent revision from screws placed with the assistance of machine vision navigation technology in patients with neuromuscular scoliosis undergoing posterior instrumentation and fusion. A retrospective analysis of the records of patients with neuromuscular scoliosis who underwent thoracolumbar pedicle screw insertion with the assistance of machine-vision image guidance navigation was performed. Screws were inserted by either a staff surgeon, orthopaedic fellow, or orthopaedic resident. Post-operative ultra-low dose CT scans were used to assess pedicle screw accuracy. The Gertzbein classification was used to grade any pedicle breaches (grade 0, no breach; grade 1, <2 mm; grade 2, 2-4 mm; grade 3, >4 mm). A screw was deemed accurate if no breach was identified (grade 0). 25 patients were included in the analysis, with a mean age of 13.6 years (range 11 to 18 years; 13/25 (52.0%) were female. The average pre-operative supine Cobb angle was 90.0 degrees (48-120 degrees). A total of 687 screws from 25 patients were analyzed (402 thoracic, 241 lumbosacral, 44 S2 alar-iliac (S2AI) screws). Surgical trainees (fellows and orthopaedic residents) inserted 46.6% (320/687) of screws with 98.8% (4/320) accuracy. The overall accuracy of pedicle screw insertion was 98.0% (Grade 0, no breach). All 13 breaches that occurred in the thoracic and lumbar screws were Grade 1. Of the 44 S2AI screws placed, one screw had a Grade 3 breach (2.3%) noted on intra-operative radiographs following rod placement and correction. This screw was subsequently revised. None of the breaches resulted in neuromonitoring changes, vessel, or visceral injuries. Machine vision navigation technology combined with careful free-hand pedicle screw insertion techniques demonstrated high levels of pedicle screw insertion accuracy, even in patients with challenging anatomy.

Prognostic factors for wellbeing in patients with hyaline fibromatosis syndrome.

Hyaline fibromatosis syndrome (HFS) is a congenital disorder characterized by subcutaneous skin nodules, congenital multiple arthrogryposis, gingival hyperplasia, and chronic pain. The intellectual ability of patients with HFS is generally normal. This syndrome arises from variants of ANTXR2. Thus far, about 100 cases have been reported but few of these were reported from Japan. This study reports five additional Japanese patients with genetically confirmed HFS, from unrelatd families, and discusses the clinical course and quality of life of these patients. At our last visit the ages of the patients were 3-19 years (the median age was 5 years). All the patients had arthrogryposis, skin nodules, and gingival hyperplasia, and four patients had chronic pain, all of which are distinctive, clinical characteristics of HFS. Four of the patients (80%) had pruritic skin nodules, and three experienced sleep disruptions due to pruritis. The visceral complications are an index of HFS severity. One patient in the present cohort had a mucosal abnormality without any gastrointestinal symptoms. Preventive and routine management of pruritis caused by skin nodules should be shared with the patient's family. Even asymptomatic patients might have endoscopic finding, which would be a soft marker that could predict the development of protein losing enteropathy.

Scoping Review of Deep Learning Techniques for Diagnosis, Drug Discovery, and Vaccine Development in Leishmaniasis

Leishmania, a single-cell parasite prevalent in tropical and subtropical regions worldwide, can cause varying degrees of leishmaniasis, ranging from self-limiting skin lesions to potentially fatal visceral complications. As such, the parasite has been the subject of much interest in the scientific community. In recent years, advances in diagnostic techniques such as flow cytometry, molecular biology, proteomics, and nanodiagnosis have contributed to progress in the diagnosis of this deadly disease. Additionally, the emergence of artificial intelligence (AI), including its subbranches such as machine learning and deep learning, has revolutionized the field of medicine. The high accuracy of AI and its potential to reduce human and laboratory errors make it an especially promising tool in diagnosis and treatment. Despite the promising potential of deep learning in the medical field, there has been no review study on the applications of this technology in the context of leishmaniasis. To address this gap, we provide a scoping review of deep learning methods in the diagnosis of the disease, drug discovery, and vaccine development. In conducting a thorough search of available literature, we analyzed articles in detail that used deep learning methods for various aspects of the disease, including diagnosis, drug discovery, vaccine development, and related proteins. Each study was individually analyzed, and the methodology and results were presented. As the first and only review study on this topic, this paper serves as a quick and comprehensive resource and guide for the future research in this field.

A study of mortality frequency and clinical course of postoperative renal and abdominal visceral complications following open aortic surgery for abdominal aortic aneurysm requiring supra renal aortic cross-clamp

ABSTRACT Background: Endovascular interventions for abdominal aortic aneurysms (AAAs) are fast evolving; however, due to higher rates of reintervention and no survival benefits after 2 years, open surgical procedures are pivotal. Here, we present mortality and morbidity analysis of open surgical procedures requiring suprarenal cross clamping for AAA repair. Materials and Methods: The present study is a retrospective hospital record-based study selecting 34 cases that required suprarenal cross-clamping out of 200 abdominal aortic aneurysm surgeries. Out of the total 34 patients, 22 (64.7%) were males and 12 (35.3%) were females. The mean age of all participants was 58.05 years (with an 8.1 standard deviation). Out of 34 cases, 20 cases (58.8%) were classified as suprarenal and pararenal aneurysms and 14 cases were juxtarenal aneurysms (41.2%). Out of the 14 juxtrarenal aneurysm cases, 7 (50%) were atherosclerotic and 2 (14.3%) were Marfan’s Syndrome, while inflammatory were 2 (14.3%) and infected were 2 (14.3%) and 1 was a case of Takayasu’s arteritis (7.1%). Mortality and morbidity, including renal function decline, need for hemodialysis, acute pancreatitis, and hepatic and gastrointestinal (GI) complications, were recorded as early (up to 30 days) and late (up to 1 year). The results were recorded separately for suprarenal, pararenal, and juxtarenal aneurysm types and presented in that way, which is the highlight of our study. Results: Early mortality occurred in 3/34 (8.8%) cases, where late mortality happened in 2/34 (5.9%) cases, which are exclusive of early mortality cases. Considering the early mortality and complications, 2 out of 4 cases (50.0%) of the suprarenal group died early, renal dysfunction happened in 4/34 cases (11.8%), of which 3 (8.8%) required dialysis. No cases of pancreatitis, while acute liver failure complicated 3 out of 34 (8.8%) cases. GI bleed and mesentric ischemia each complicated 2 out of 34 cases (5.9%). Prolonged ileus was noticed as the most common GI complication complication. Early mortality was highest in the suprarenal group with renal dysfunction. Considering late mortality and complications, 1 out of 16 cases (6.3%) of the pararenal group died late, and 1 out of 14 cases (7.1%) of the juxta renal cases died late. There was no late mortality in the suprarenal group. Renal dysfunction happened in 2/34 cases (5.9%), of which none required dialysis. Complete data have been presented as per the aneurysm type. Conclusions: Patients requiring suprarenal aortic cross-clamping for open surgical repair of abdominal aorta aneurysm are usually high-risk surgical candidates, considering both early and late mortality and morbidity. Early mortality was maximum in the suprarenal group (50.0%), as were postoperative renal dysfunction and hemodialysis requirements. Visceral complications (acute liver failure and GI complications) were also maximum with the suprarenal group. Late mortality was recorded in the pararenal and juxtarenal groups, with renal dysfunction being recorded in the suprarenal and juxtarenal groups. Visceral complications were recorded in both pararenal and juxtarenal groups. One confounding factor could be the high early mortality in the suprarenal group, resulting in less number of survivors for late postoperative recording. Overall, we conclude that suprarenal aortic aneurysms carry the highest burden of early mortality with renal and visceral complications postoperative.

Off-the-Shelf Single-Fenestrated Endograft for Emergent Juxtarenal and Pararenal Abdominal Aortic Aneurysm.

Endovascular solutions to emergent juxtarenal and pararenal abdominal aortic aneurysms (AAAs) are complicated. Endovascular aortic repair (EVAR) with in situ laser fenestration (ISLF) is promising but requires a period of visceral ischemia. With an off-the-shelf, single superior mesenteric artery (SMA)-fenestrated device mesenteric ischemia is avoided and renal ischemia decreased. The aim was to develop an optimized design of such an endograft suitable for >90% of juxtarenal and pararenal AAAs. Single-center analysis on 44 consecutive preoperative CTs for previously elective fenestrated EVARs for juxtarenal and pararenal aneurysms. Anatomical characteristics were analyzed to define: (1) shortest aortic coverage above SMA fenestration to achieve ≥4 cm seal; (2) feasibility of a scallop for the celiac artery; (3) shortest distance between the SMA and lowest renal, to facilitate renal ISLF in a straight endograft; (4) distance from the lowest renal to the aortic bifurcation, to allow an overlapping zone >40 mm with a bifurcated stent graft; (5) aortic diameter in the sealing zone, for optimal proximal stent graft diameter with 10% to 30% oversizing; (6) the final design was then tested on individual level. (1) The stent graft needs to start 40 mm above the SMA fenestration to achieve a 4 cm sealing zone in >90% of cases. (2) A proximal sealing zone of 40 mm without a scallop covers 77% of celiac arteries. With an addition of a 20 mm deep, 20 mm wide scallop at 12:30, the stent graft still covers 27% of celiacs. This suggests that a scallop would not be practically feasible. (3) In >90% of cases, the lowest renal was <31 mm from the SMA, suggesting that the tapering should start 30 mm below the SMA. (4) The distance from the lowest renal to the aortic bifurcation ranged from 82 to 166 mm. This allows for a 20 mm tapering and 50 mm straight part in all cases. (5) The 5th and 95th percentile of the aortic diameter in the sealing zone was 22 and 31 mm, respectively. Thus, 2 different stent graft diameters (28 and 34 mm) would fit >90% of cases. (6) The final design was suitable in 91% cases. Two sizes of a single-fenestrated aortic stent graft without scallop cover >90% of juxtarenal and pararenal anatomies. Emergent juxta- and pararenal aortic aneurysms is a difficult clinical scenario that continuously challenges physicians. An endovascular option is in situ laser fenestrated endografts. One risk with these is the complete visceral ischemia occurring before the fenestrations are completed. An off-the-shelf single-fenestrated stent graft facilitates the treatment by removing the ischemia time for the SMA and reducing the ischemia time for the celiac and renal arteries thus decreasing the risk of visceral ischemia complications.

Antimony resistance and gene expression in Leishmania: spotlight on molecular and proteomic aspects.

Leishmaniasis is a vector-borne parasitic disease caused by Leishmania parasites with a spectrum of clinical manifestations, ranging from skin lesions to severe visceral complications. Treatment of this infection has been extremely challenging with the concurrent emergence of drug resistance. The differential gene expression and the discrepancies in protein functions contribute to the appearance of 2 distinct phenotypes: resistant and sensitive, but the current diagnostic tools fail to differentiate between them. The identification of gene expression patterns and molecular mechanisms coupled with antimony (Sb) resistance can be leveraged to prompt diagnosis and select the most effective treatment methods. The present study attempts to use comparative expression of Sb resistance-associated genes in resistant and sensitive Leishmania, to disclose their relative abundance in clinical or in vitro selected isolates to gain an understanding of the molecular mechanisms of Sb response/resistance. Data suggest that the analysis of resistance gene expression would verify the Sb resistance or susceptibility only to a certain extent; however, none of the individual expression patterns of the studied genes was diagnostic as a biomarker of Sb response of Leishmania. The findings highlighted will be useful in bridging the knowledge gap and discovering innovative diagnostic tools and novel therapeutic targets.

Clinical features of pulmonary arterial hypertension associated with systemic sclerosis.

Systemic sclerosis is an autoimmune disorder of the connective tissue characterized by disordered inflammation and fibrosis leading to skin thickening and visceral organ complications. Pulmonary involvement, in the form of pulmonary arterial hypertension and/or interstitial lung disease, is the leading cause of morbidity and mortality among individuals with scleroderma. There are no disease-specific therapies for pulmonary involvement of scleroderma, and pulmonary arterial hypertension in this cohort has typically been associated with worse outcomes and less clinical response to modern therapy compared to other forms of Group I pulmonary hypertension in the classification from the World Symposium on Pulmonary Hypertension. Ongoing research aims to delineate how pathologic microvascular remodeling and fibrosis contribute to this poor response and offer a window into future therapeutic targets.

Colocutaneous fistula with recurrent urinary tract infection: a delayed complication following laparoscopic transabdominal pre-peritoneal repair

There has been an increase in incidence of delayed complications following transabdominal pre-peritoneal repair (TAPP) for inguinal hernia in the last two decades. Mesh related visceral complications (MRVCs) are difficult to diagnose and treat. Colocutaneous and colovesical fistualas are rare yet devastating delayed complications caused by mesh migration. We present the case of a 40-year-old man who presented to us after numerous hospital visits with urinary symptoms and a recurring fistula on the left abdominal wall at a previously operated site. Computed tomography revealed an ill-defined collection in left loin region abutting the sigmoid colon and urinary bladder. Owing to acute angulation, the colonoscope could not be passed beyond 30 cm. The patient was managed with cystoscopy, laparotomy, mesh explantation, and sigmoid colon resection.

The Russian registry of primary hyperparathyroidism, latest update.

Until recently no major epidemiological research of primary hyperparathyroidism (PHPT) has been conducted in the Russian Federation, this led to the creation of the Russian online registry. The objective of this study is to estimate the clinical and biochemical profile, classical and non-classical complications, surgical intervention and medical therapy of the patients with different forms of PHPT in the Russian Federation. The cross-sectional, observational, continuous study was conducted at the Endocrinology Research Centre (Moscow). The present study explored retrospective data from 6003 patients submitted to the Registry between 12.12.2016 and 25.10.2022 from 81 regions of the Russian Federation (http://pgpt.clin-reg.ru/). The median age was 59 [60; 66] years with a female:male ratio of 11.7:1. Symptomatic PHPT was observed in 74.3% while asymptomatic form - only in 25.7% of cases. Bone pathology was the predominant clinical manifestation in 62.5% of cases (n=2293), mostly in combination with visceral complications 45.7% (n=1676). The majority of patients (63.3%) had combined visceral disorders including kidney damage in 51.8% and gastroduodenal erosions/ulcers in 32.3% of patients. Symptomatic patients were older (60 [53; 67] vs. 54 [45; 62] years, p<0.001) and had more severe biochemical alterations of calcium-phosphorus metabolism. Cardiovascular disease (СVD) was recorded in 48% of patients, among them the most frequent was arterial hypertension (up to 93.9%). A genetic test was conducted in 183 cases (suspicious for hereditary PHPT) revealing the mutations in MEN1, CDC73, RET genes in 107, 6 and 2 cases, respectively. Surgery was performed in 53.4% of patients with remission achievement in 87%, the relapse/persistence were recorded in 13% of cases. Histological examination revealed carcinoma in 4%, atypical adenoma in 2%, adenoma in 84% and hyperplasia in 11% of cases. Drug therapy was prescribed in 54.0% of cases, most often cholecalciferol. The detection rate of PHPT has increased in the Russian Federation in recent years. This increase is associated with the start of online registration. However, the majority of patients remain symptomatic with significant alterations of phosphorus-calcium metabolism that indicates delayed diagnosis and requires further modifications of medical care.

The Child's Age and the Size of the Curvature Do Not Affect the Accuracy of Screw Placement with the Free-Hand Technique in Spinal Deformities in Children and Adolescents.

The current method of treatment of spinal deformities would be almost impossible without pedicle screws (PS) placement. There are only a few studies evaluating the safety of PS placement and possible complications in children during growth. The present study was carried out to evaluate the safety and accuracy of PS placement in children with spinal deformities at any age using postoperative computed tomography (CT) scans. 318 patients (34 males and 284 females) who underwent 6358 PS fixations for pediatric spinal deformities were enrolled in this multi-center study. The patients were divided into three age groups: less than 10 years old, 11-13 years old, and 14-18 years old. These patients underwent postoperative CT scans and were analyzed for pedicle screw malposition (anterior, superior, inferior, medial, and lateral breaches). The breach rate was 5.92% for all pedicles. There were 1.47% lateral and 3.12% medial breaches for all pedicles with tapping canals, and 2.66% lateral and 3.84% medial breaches for all pedicles without a tapping canal for the screw. Of the 6358 screws placed in the thoracic, lumbar, and sacral spine, 98% of the screws were accurately placed (grade 0, 1, and juxta pedicular). A total of 56 screws (0.88%) breached more than 4 mm (grade 3), and 17 (0.26%) screws were replaced. No new and permanent neurological, vascular, or visceral complications were encountered. The free-hand technique for pedicle screw placement in the acceptable and safety zone in pedicles and vertebral bodies was 98%. No complications associated with screw insertion in growth were noted. The free-hand technique for pedicle screw placement can be safely used in patients at any age. The screw accuracy does not depend on the child's age nor the size of the deformity curve. Segmental instrumentation with posterior fixation in children with spinal deformities can be performed with a very low complication rate. Navigation of the robot is only an auxiliary tool in the hands of the surgeons, and the result of the work ultimately depends on the surgeons.

Predicting Features of Visceral Stent Failure in Fenestrated Endovascular Aortic Aneurysm Repair.

Visceral stents in fenestrated endovascular aortic repair (FEVAR) have a significant risk of complications and carry a considerable burden of reinterventions. The aim of this study is to identify preoperative and intraoperative predictors of visceral stent failure. A retrospective review of 75 consecutive FEVARs in a single center from 2013 to 2021 was undertaken. Data on mortality, stent failure, and reintervention pertaining to 226 visceral stents were collected. Anatomical features including aortic neck angulation, aneurysm diameter, and angulation of target viscerals were obtained from preoperative computed tomography (CT) scans. Stent oversizing and intraprocedural complications were recorded. Postoperative CT scans were analyzed to determine the length of cover of target vessels. Only bridging stents through fenestrations to visceral vessels were considered; 28 (37%) cases had 4 visceral stents, 24 (32%) had 3, 19 (25%) had 2, 4 (5%) had 1. Thirty day mortality was 8%, a third of which was related to visceral stent complications. Intraprocedural complexity was documented during the cannulation of 8 (3.5%) target vessels, with a technical success rate of 98.7%. A significant endoleak or visceral stent failure was identified in 22 stents (9.8%) postoperatively, of which 7 (3%) had in-patient reintervention within 30 days. Further reinterventions at 1, 2, and 3 years were 12 (5.4%), 2 (1%), and 1 (0.4%), respectively. Most reinterventions were for renal stents (n=19, 86%). A smaller stent diameter and a shorter length of visceral stent were significant predictors of failure. No other anatomical feature or stent choice was found to be a significant predictor of failure. The modality of visceral stent failures varies, but renal stents with a smaller diameter and/or shorter length are more likely to fail over time. Their complications and reinterventions are common and carry a significant burden; therefore, close surveillance must be continued long term. With this work we share the methodology adopted at our centre to treat juxtarenal aneurysm with FEVAR. Thanks to this detailed review of anatomical and technical features we provide guidance for endovascular surgeons to face hostile aneurysm with peculiar visceral vessels anatomy. With our findings will also motivate industries in their attempt to produce improved technologies able to overcome issues identified in this paper.

OC-119 Specialization is essential: our results in 139 incisional hernia repairs with a high percentage of moderate-to-high complex cases.

Abstract Aims Presenting 139 repairs by 4 specialised surgeons, mostly of moderate/high complexity. Material &amp; Methods Prospective study (EVEREG registry). Results 65 men. 65.49 (35–93) year-old. Middle BMI 30.31 kg/m2 (52%≥30). 96.4% ASA II/III. Hernias: 113 midline, 15 lateral, 11 combined. Mean defects 86.25cm2 (2–480). 29 W3, 92 W2, 4 paraostomal, 34 recurrent. 9 received botulinum toxin. Surgeries: 132 elective. 89.9% open. 30 components separations (21.6%, 23 TAR). 23 (16.5%) received two meshes. Principal mesh position: 55.4% retromuscular, 34.5% preperitoneal, 6.5% intraperitoneal, 3.6% others. Defect closure: 87.1%. Mean overlap 8.3cm (1–23). 61 associated procedures highligthing 18 dermolipectomies, 10 colorectal surgeries, 8 diffuse adhesiolysis, 8 mesh explants (2 infected). Intraoperative complications: 9 patients (6.5%). 8 bowel injuries (5 serosal tears), 1 muscular bleeding, 1 bladder injury. Postoperative complications: 22.3% patients. 21 grade I, 6 II, 3 III, one IV. Highlighting: ileum (9), hematoma/anemia (9), general (6), seroma (4), 4 surgical site infections (SSI, 1 deep, 2 organ/space, 1 superficial), 1 bowel perforation. 4 reinterventions (2.9%), 2 due to visceral complications. No exitus. Mean stay: 4.46 days. 1 month: 36 patients complicated (25.9%); highlighting 21 seromas (76% types 0-I), 6 superficial SSIs and 3 bowel obstructions (1 required surgery). 6, 12, 24 months: complications stabilized at 8–10%. 4 bulging, 2 late seromas, 1 temporal SSI (1 year), 1 chronic SSI, 6 chronic pains (4 at 24 months), 8 recurrences (5.75%, 7 in mesh border, 1 complete; 6 in highly-complex). Conclusions Specialised surgeons obtained comparable to accreditation standards outcomes even the high complexity.

Clinical case of severe visceral complications with atypical localization in a patient with gout

The diagnosed gout is a signal to search for unrecognized concomitant conditions and their underlying causes and mechanisms of development. Due to the fact that gout is a common metabolic disorder with symptoms of localized inflammation caused by chronic and/or episodic deposition of monosodium urate crystals (MSU) in joints and soft tissues, the understanding of the inflammation interaction in metabolic disorders has changed. In cases of severe visceral complications of gout, the most common sites of tophl are kidneys, liver, spleen, lungs, pericardium, subcutaneous tissue and other soft tissues. The aim of this study was to outline the features of severe visceral complications with atypical localization in a patient with gout (identification of MSU crystals with polarization microscopy) and to determine the role of videothoracoscopy in this case. Patient N., 55 years old, complained of moderate chest pain, shortness of breath during exercise, general weakness and occasional cough. The patient was hospitalized in a multidisciplinary clinical institution. Examinations were performed, including polarization microscopy, spiral computed tomography (polytopic foci, formations), videothoracoscopy. Endoscopic resection of SVII of the lower lobe of the left lung with a biopsy of the lungs formations and mediastinal lymph nodes was performed. Results of histologic examination: amorphous masses are presented in combination with the organized chronic giant cell granulomatous structure (tophus), which contains clusters of crystals of MSU. Cytological examination of pleural cavity fluid revealed the presence of crystals of MSU. The presence of crystals of MSU was confirmed by polarization microscopy. From the anamnesis of the disease it became known that at the age of 38 the patient consulted a rheumatologist for moderate joint syndrome. On the basis of anamnesis, laboratory and instrumental data (X-ray, ultrasound examination) the diagnosis of gout, chronic gouty arthritis was established. Urate lowering therapy was prescribed. The patient took the drugs periodically without re-consultation with the doctor. The presented case of untreated gout has led to significant structural disorders in organs such as lungs, pleura. Endoscopic resection of the lower lobe of the left lung and revision of the thoracic cavity revealed atelectasis, hemorrhage, inflammatory infiltration, fibrous changes in tissues, amorphous masses with organized chronic giant cell granulomatous structure, presented by crystals of MSU. During the surgery, a powdery substance was found on the pleura surfaces. A video thoracoscopy in this case was a means to present a visceral damage in gout. The search for diagnostic tools to diagnose a severe visceral complications with atypical localization in gout still remains unsolved. Undoubtedly, the central role in the development of gout is played by the deposition of numerous crystals of MSU. In the patient under observation, crystals of MSU were found in pleural fluid and sputum consisting of sodium urate, like the known facts of their appearance in the joint fluid and urine. Uric acid salt crystals were also detected in the areas of pulmonary fibrosis formation according to the results of radiological examination, as well as endoscopic intervention in the lower lobe of the left lung.

The Evaluation and Management of Visceral Complications in Radiation Fibrosis Syndrome Part 1.

External beam ionizing radiation is a fundamental component of cancer treatment and is incorporated into approximately 50% of cancer treatments. Radiation therapy causes cell death directly by apoptosis and indirectly by disruption of mitosis. This study aims to inform rehabilitation clinicians of the visceral toxicities of radiation fibrosis syndrome and how to detect and diagnose these complications. Latest research indicates that radiation toxicity is primarily related to radiation dose, patient co-morbidity, and concomitant use of chemotherapies and immunotherapies for the treatment of cancer. While cancer cells are the primary target, surrounding normal cells and tissues are also affected. Radiation toxicity is dose dependent, and tissue injury develops from inflammation that may progress to fibrosis. Thus, radiation dosing in cancer therapy is often limited by tissue toxicity. Although newer radiotherapeutic modalities aim to limit delivery of radiation to non-cancerous tissues, many patients continue to experience toxicity. To ensure early recognition of radiation toxicity and fibrosis, it is imperative that all clinicians are aware of the predictors, signs, and symptoms of radiation fibrosis syndrome. Here, we present part 1 of the visceral complications of radiation fibrosis syndrome, addressing radiation-related toxicity in the heart, lungs, and thyroid gland.

Fractured Sealing Rings in a Fenestrated Anaconda Stent-Graft

An 81 year-old man presented with an asymptomatic juxtrarenal abdominal aortic aneurysm and was subsequently treated with a fenestrated endovascular Anaconda stent-graft. Surveillance imaging within the first postoperative year demonstrated a lower proximal sealing ring fracture. In the second postoperative surveillance year, the upper proximal sealing ring was also fractured with extension of the wire into the right paravertebral space. Despite these sealing ring fractures, there were no endoleak nor visceral stent complications and the patient continued on standard surveillance protocols. There are an increasing number of reports of fractured proximal sealing rings with the fenestrated Anaconda platform. Those analysing the surveillance scans of patients treated with this device should stay vigilant for the development of this complication.

Modified Iliac Screw in Lumbopelvic Fixation After Sacral Tumor Resection: A Single-Center Case Series.

Traditional iliac screw, S2-alar iliac screw, and modified iliac screw are the 3 common techniques for lumbopelvic fixation. The application of the modified iliac technique in sacral spinal tumors has been rarely reported. To report the feasibility and safety of modified iliac screws after sacral tumor resection and their preliminary clinical outcomes. Twenty-seven patients who underwent sacral tumor resection with modified iliac screw fixation between August 2017 and August 2021 at our center were clinically and radiographically evaluated. A total of 59 iliac screws were inserted by freehand according to the anatomic landmarks. The mean operation time was 207 minutes (range, 140-435 minutes). The average estimated blood loss was 1396 mL (300-4200 mL). Computed tomography scans showed that 2 (3.4%) screws penetrated the iliac cortex, indicating a 96.6% implantation accuracy rate. There were no iatrogenic neurovascular or visceral structure complications observed. The mean minimal distances from the screw head to the skin were 24.9 and 25.8 mm on the left and right sides, respectively. The mean minimal distances from the screw head to the horizontal level of the posterior superior iliac spine were 7.9 and 8.3 mm on the left and right sides, respectively. Two patients (7.4%) underwent reoperation for wound infection. At the latest follow-up, no patient had complications of screw head prominence, pseudarthrosis, or instrument failure. The modified iliac screw is characterized by its minimal invasiveness and simplicity of placement. It is an ideal alternative for lumbopelvic fixation after sacral tumor resection.