Visceral Complications Research Articles

The accuracy of robot-assisted S2 alar-iliac screw placement at two different healthcare centers.

Current literature on robot-assisted S2 alar-iliac (S2AI) screw placement shows favorable outcomes and screw accuracy; however, the data is limited by a few retrospective, single-surgeon studies. To the author's knowledge, this is the first multicenter study which evaluates the accuracy of robot-assisted S2AI screws. Adult (≥18 years old) patients who underwent robot-assisted S2AI screw placement from 2017-2019 were reviewed. All surgeries used the same proprietary robotic guidance system, Mazor X (Mazor Robotics Ltd). A total of 65 screws were assessed in 31 patients. The mean follow-up ± standard deviation was 362±190 days (minimum was 90 days). The mean age was 61.1±11 years old, and 54.8% (n=17) of patients were female. Nearly half of the patients had a primary diagnosis of degenerative scoliosis (48.4%, n=15). Other diagnosis included pseudarthrosis (22.6%, n=7), degenerative disc disease (16.1%, n=5), and high-grade spondylolisthesis (12.9%, n=4). The mean length and diameter of screws were 84.6±6.1 mm and 8.4±0.7, respectively. The mean axial and sagittal angles were 50.0±6.3 and 24.0±10.5, respectively. The overall screw accuracy was 93.8% (n=61). There were four iliac cortex breaches (anterior =3, inferior 1) with a mean breach distance of 3.5±3.2. No statistically significant differences in screw length, diameter, axial angle, and sagittal angle were observed between screws with and without a breach. No intraoperative neurologic, vascular, or visceral complications from the S2AI screw were observed. No post-discharge wound complications, screw prominence issues, or revision of S2AI screws were observed during the study's follow-up period. Robot-assisted S2AI screw placement was found to be safe and accurate in this multicenter study. This is largely attributed to the versatility of the robotic guidance software that allows for detailed and precise preoperative and intraoperative planning.

Management of A Desmoid Tumor in Pregnancy: A Case Report

A desmoid tumor is a rare, non-metastasizing, locally aggressive, monoclonal proliferative disease of fibroblastic origin with a high recurrence rate. The etiology remains unclear. Desmoid tumors can be found in the abdominal wall, abdominal cavity, trunk and limbs. When sporadic, the abdominal wall is the most common site, particularly around the rectus abdominis muscle, with tumors tending to develop in young women of reproductive age or those who have suffered trauma, principally pregnant or postpartum women. Due to its unpredictable clinical course and high recurrence rate, the exclusive use of resection with a wide safety margin, the treatment of choice in cases of advanced tumors, has been questioned. This paper describes a case of a large desmoid tumor on the abdominal wall that developed in the 10th week of pregnancy in a 29-year-old patient with no history of familial adenomatous polyposis. Ultrasound showed that the tumor had increased around 158% during pregnancy. The patient underwent Cesarean section during which a mass of around 20 cm was detected between the anterior and posterior layer of the aponeurosis of the rectus abdominis muscle. Conservative management (no intervention) was adopted with follow-up imaging. Ultrasound-guided core biopsy was performed four and a half months after delivery, with histopathology revealing a spindle cell neoplasm, with possible musculoaponeurotic fibromatosis. Six months after childbirth, the tumor had decreased spontaneously by 40.5% in thickness and nine months following delivery the patient continues to be monitored under expectant management, with no complaints or symptoms. Although rare, obstetricians should be aware of the possibility of a desmoid tumor during pregnancy and should evaluate the best management option (surgery, pharmacological treatment or expectant management) according to the patient’s profile in order to avoid visceral complications, the need for extensive surgery with possible aesthetic and functional sequelae, and even iatrogenic complications.

Improved systemic AAV gene therapy with a neurotrophic capsid in Niemann-Pick disease type C1 mice.

Niemann-Pick C1 disease (NPC1) is a rare, fatal neurodegenerative disease caused by mutations in NPC1, which encodes the lysosomal cholesterol transport protein NPC1. Disease pathology involves lysosomal accumulation of cholesterol and lipids, leading to neurological and visceral complications. Targeting the central nervous system (CNS) from systemic circulation complicates treatment of neurological diseases with gene transfer techniques. Selected and engineered capsids, for example, adeno-associated virus (AAV)-PHP.B facilitate peripheral-to-CNS transfer and hence greater CNS transduction than parental predecessors. We report that systemic delivery to Npc1 m1N/m1N mice using an AAV-PHP.B vector ubiquitously expressing NPC1 led to greater disease amelioration than an otherwise identical AAV9 vector. In addition, viral copy number and biodistribution of GFP-expressing reporters showed that AAV-PHP.B achieved more efficient, albeit variable, CNS transduction than AAV9 in Npc1 m1N/m1N mice. This variability was associated with segregation of two alleles of the putative AAV-PHP.B receptor Ly6a in Npc1 m1N/m1N mice. Our data suggest that robust improvements in NPC1 disease phenotypes occur even with modest CNS transduction and that improved neurotrophic capsids have the potential for superior NPC1 AAV gene therapy vectors.

Mesh Migration into Sigmoid Colon after Inguinal Hernioplasty Presenting as Lower Abdominal Mass: A Case Report

Mesh related visceral complications are, in general, considered to be infrequent and rarely reported in literature, but in the last decade, incidence of such complications have increased. Our study highlights the case of an elderly patient, who developed rare complication of Mesh migration after laparoscopic inguinal hernioplasty.

Incidence of acute complications of herpes zoster among immunocompetent adults in England: a matched cohort study using routine health data.

SummaryBackgroundHerpes zoster can cause rare but serious complications; the frequency of these complications has not been well described.ObjectivesTo quantify the risks of acute non‐postherpetic neuralgia (PHN) zoster complications, to inform vaccination policy.MethodsWe conducted a cohort study among unvaccinated immunocompetent adults with incident zoster, and age‐, sex‐ and practice‐matched control adults without zoster, using routinely collected health data from the UK Clinical Practice Research Datalink (years 2001 to 2018). Crude attributable risks of complications were estimated as the difference between Kaplan–Meier‐estimated 3‐month cumulative incidences in patients with zoster vs. controls. We used Cox models to obtain hazard ratios for our primary outcomes in patients with and without zoster. Primary outcomes were ocular, neurological, cutaneous, visceral and zoster‐specific complications. We also assessed whether antivirals during acute zoster protected against the complications.ResultsIn total 178 964 incident cases of zoster and 1 799 380 controls were included. The absolute risks of zoster‐specific complications within 3 months of zoster diagnosis were 0·37% [95% confidence interval (CI) 0·34–0·39] for Ramsay Hunt syndrome, 0·01% (95% CI 0·0–0·01) for disseminated zoster, 0·04% (95% CI 0·03–0·05) for zoster death and 0·97% (95% CI 0·92–1·00) for zoster hospitalization. For other complications, attributable risks were 0·48% (95% CI 0·44–0·51) for neurological complications, 1·33% (95% CI 1·28–1·39) for ocular complications, 0·29% (95% CI 0·26–0·32) for cutaneous complications and 0·78% (95% CI 0·73–0·84) for visceral complications. Attributable risks were higher among patients > 50 years old. Patients with zoster had raised risks of all primary outcomes relative to controls. Antiviral prescription was associated with reduced risk of neurological complications (hazard ratio 0·61, 95% CI 0·53–0·70).ConclusionsNon‐PHN complications of zoster were relatively common, which may affect cost‐effectiveness calculations for zoster vaccination. Clinicians should be aware that zoster can lead to various complications, besides PHN.

Characterising the incidence and mode of visceral stent failure after fenestrated endovascular aneurysm repair (FEVAR).

BackgroundIn FEVAR, visceral stents provide continuity and maintain perfusion between the main body of the stent and the respective visceral artery. The aim of this study was to characterise the incidence and mode of visceral stent failure (type Ic endoleak, type IIIa endoleak, stenosis/kink, fracture, crush and occlusion) after FEVAR in a large cohort of patients at a high-volume centre.MethodsA retrospective review of visceral stents placed during FEVAR over 15 years (February 2003-December 2018) was performed. Kaplan-Meier analyses of freedom from visceral stent-related complications were performed. The outcomes between graft configurations of varying complexity were compared, as were the outcomes of different stent types and different visceral vessels.ResultsVisceral stent complications occurred in 47/236 patients (19.9%) and 54/653 stents (8.3%). Median follow up was 3.7 years (IQR 1.7–5.3 years). There was no difference in visceral stent complication rate between renal, SMA and coeliac arteries. Visceral stent complications were more frequent in more complex grafts compared to less complex grafts. Visceral stent complications were more frequent in uncovered stents compared to covered stents. Visceral stent-related endoleaks (type Ic and type IIIa) occurred exclusively around renal artery stents. The most common modes of failure with SMA stents were kinking and fracture, whereas with coeliac artery stents it was external crush.ConclusionVisceral stent complications after FEVAR are common and merit continued and close long-term surveillance. The mode of visceral stent failure varies across the vessels in which the stents are located.

Laparoscopic Total Extraperitoneal Repair and Open Prolene Hernia System for Inguinal Hernia Repair Have Similar Outcomes: A Retrospective Study.

To compare the results of Laparoscopic total extraperitoneal inguinal hernia repair (LTEPR) and the open prolene hernia system repair (OPHSR), in terms of complications, postoperative pain and quality of life. Background: Inguinal hernia repair is one of the most frequent surgeries made by general surgeons. Although, with the technological development and scientific advances even today it is not possible to define which is the gold standard procedure to hernia repair. Material and Methods: For this observational study, all 577 consecutive patients who underwent hernia repair were included in the study, 293 LTEPR, and 284 OPHSR. The average age for OPHSR was 62.49 years and for LTEPR 55.35 years. The average follow-up of 38.10 months, the mean operative time for OPHSR was 55.58 minutes and for LTEPR was 45.46 minutes, with a hospital stay of 1.1 and 1.08 respectively. Results: Each type of hernia was classified according to Gilbert/Rutcow-Robbins criteria, resulting in the OPHSR, 80.28 % were assigned to class 1 to 3 and only 19.72% in class 4 to 7. In the LTEPR, 52.22% of the patients are classified in degree 1 to 3 and 47.78% were class 4 to 7. In the LTEPR group there was more complications with 9 cases of bleeding controlled at the same time, one tear of the bladder, no other visceral complications; in the OPHSR group, there were fewer complications with significant differences (p= .014). The postoperative complications, principally hematoma, and seroma were the most common complication without statistic differences. The postoperative pain was in the OPHSR group, 77.46% of patients reported suffering from mild or pain-free pain, 21.47% reported moderate pain, and 1.05% reported severe pain, in the LTEPR group 74.4% of patients reported mild pain, 25.25% reported moderate pain and only one patient reported severe pain, without significant differences. In both groups, the patients reported a high index of satisfaction, and in the LTEPR group scare results were better than OPHSR (p .001). The outcomes of LTEPR are similar to OPHSR. However, LTEPR has shorter operative time, more intraoperative complications and better scar satisfaction.

Complications Following Total Laparoscopic Hysterectomies: A Cohort Study Analyzing One Vs. Two-Layer Laparoscopic Vaginal Cuff Closure

Study Objective To determine whether two-layer laparoscopic vaginal cuff closure during laparoscopic hysterectomies is associated with lower postoperative complications compared to standard one-layer closure. Design Retrospective cohort study. Setting Academic tertiary care center. Patients or Participants 2,973 patients. Interventions During a 6-year period, 1760 (59.2%) and 1213 (40.8%) patients underwent single (1-LVC) vs. two-layer (2-LVC) laparoscopic vaginal cuff closure, respectively. Factors influencing laparoscopic vaginal cuff complications including age, postmenopausal status, body mass index, tobacco use, immunosuppressant medications, and sexual activity were recorded. We compared total postoperative complications including visceral injury, blood transfusion, hematoma, thromboembolism, infection, and cuff complications. The latter were further examined for cuff dehiscence, mucosal separation, hematoma, cellulitis/abscess, granulation tissue and persistent vaginal bleeding. Statistical analyses included Chi-square and Wilcoxon rank sum testing. Measurements and Main Results 2-LVC closure was associated with decreased total postoperative complications (2-LVC: 3.38% vs. 1-LVC: 5.57%; p=0.006) without impacting intraoperative complications (1.40% vs. 1.25%; p=0.721) or emergency room/hospital readmissions (11.05% vs. 12.67%; p=0.181). 2.44% of 1-LVC patients experienced postoperative cuff complications compared to only 0.74% women in the 2-LVC group (p=0.002). No subjects in the 2-LVC cohort experienced a vaginal cuff dehiscence or mucosal separation compare to 0.63% and 0.23% of patients in the 1-LVC group, respectively. Granulation tissue (1-LVC: 0.40% vs. 2-LVC: 0.16%), persistent vaginal bleeding (0.57% vs. 0.16%), and cuff cellulitis (0.51% vs. 0.33%) were also more common in the 1-LVC cohort. Univariate analysis of total postoperative cuff complications revealed that a 2-LVC closure was protective of postoperative complications (OR=0.37, 95% CI: 0.188-0.712). Conclusion Although postoperative problems linked to laparoscopic hysterectomies are already exceptionally low, the added use of a 2-LVC closure further lowers postoperative total and vaginal cuff complications.

Lumbar Interbody Fusion: Techniques, Pearls and Pitfalls.

Lumbar interbody fusion (LIF) is an effective and popular surgical procedure for the management of various spinal pathologies, especially degenerative diseases. Currently, LIF can be performed with posterior, transforaminal, anterior, and lateral approaches by open surgery or minimally invasive surgery (MIS). Each technique has its own advantages and disadvantages. In general, posterior LIF is a well-established procedure with good fusion rates and low complication rates but is limited by the possibility of iatrogenic injury to the neural structures and paraspinal muscles. Transforaminal LIF is frequently performed using an MIS technique and has an advantage of reducing these iatrogenic injuries. Anterior LIF (ALIF) can restore the disk height and sagittal alignment but has inherent approach-related challenges such as visceral and vascular complications. Lateral LIF and oblique LIF are performed using an MIS technique and have shown postoperative outcomes similar to ALIF; however, these approaches carry a risk of injury to psoas, lumbar plexus, and vascular structures. Herein, we provide a detailed description of the surgical procedures of each LIF technique. We shall then consider the pearls and pitfalls, as well as propose surgical indications and contraindications based on the available evidence in the literatures.

Optically guided peritoneal access in pediatric laparoscopy: is it a good alternative for open access? A prospective comparative study

Background A minimally invasive approach has become the method of choice for treating many surgical cases. The superiority of open peritoneal access is owing to the low probability of visceral injury. Optically guided trocars were designed to decrease the injury risk to intra-abdominal contents by permitting the surgeon to see abdominal wall layers while traversing it and abdominal contents once access is complete. Materials and methods A prospective comparative study was done between optical trocar access using Fengh optical port, trocar model FLTC5 (Fengh medical Co. Ltd, Jiangsu, China), and open access using Hasson technique in pediatric patients. The study included 187 patients from the age of 1 year to the age of 16 years. Patients with previous open abdominal surgery, abdominal masses in the periumbilical region, and/or traumatic abdominal injury were excluded from the study. Access time and initial port insertion complications were reported to clarify safety and time for optical access. Results Optical access was done in 92 patients and open access in 95 patients. No visceral or major vascular complications were reported in both types of access. Access time in group IA (optical) was 58.06±16.1 s. in comparison with 175.7±54.7 s. in group IB (open) (P=0.0001*), and it was 49.7±9.4 s. in group IIA (optical) in comparison with 169.3±38.3 s. in group IIB (open) (P=0.0001*). Conclusions In selected cases, optical access is feasible, safe, and time-saving and avoids many problems in initial port insertion in pediatric laparoscopy.

Sequence variations of ACVRL1 play a critical role in hepatic vascular malformations in hereditary hemorrhagic telangiectasia

BackgroundHereditary Hemorrhagic Telangiectasia (HHT) is an autosomal dominant disorder characterized by multiple telangiectases and caused by germline disease-causing variants in the ENG (HHT1), ACVRL1 (HHT2) and, to a lesser extent MADH4 and GDF2, which encode proteins involved in the TGF-β/BMP9 signaling pathway. Common visceral complications of HHT are caused by pulmonary, cerebral, or hepatic arteriovenous malformations (HAVMs). There is large intrafamilial variability in the severity of visceral involvement, suggesting a role for modifier genes. The objective of the present study was to investigate the potential role of ENG, ACVRL1, and of other candidate genes belonging to the same biological pathway in the development of HAVMs.MethodsWe selected 354 patients from the French HHT patient database who had one disease causing variant in either ENG or ACVRL1 and who underwent hepatic exploration. We first compared the distribution of the different types of variants with the occurrence of HAVMs. Then, we genotyped 51 Tag-SNPs from the Hap Map database located in 8 genes that encode proteins belonging to the TGF-β/BMP9 pathway (ACVRL1, ENG, GDF2, MADH4, SMAD1, SMAD5, TGFB1, TGFBR1), as well as in two additional candidate genes (PTPN14 and ADAM17). We addressed the question of a possible genetic association with the occurrence of HAVMs.ResultsThe proportion of patients with germline ACVRL1 variants and the proportion of women were significantly higher in HHT patients with HAVMs. In the HHT2 group, HAVMs were more frequent in patients with truncating variants. Six SNPs (3 in ACVRL1, 1 in ENG, 1 in SMAD5, and 1 in ADAM17) were significantly associated with HAVMs. After correction for multiple testing, only one remained significantly associated (rs2277383).ConclusionsIn this large association study, we confirmed the strong relationship between ACVRL1 and the development of HAVMs. Common polymorphisms of ACVRL1 may also play a role in the development of HAVMs, as a modifying factor, independently of the disease-causing variants.

Free-hand technique of S(2) alar iliac screw placement for sacropelvic fusion in lumbar degenerative scoliosis

Objective: To evaluate the feasibility of placement of S(2) alar iliac screw (S(2)AI) using free-hand technique for sacrapelvic fusion in lumbar degenerative scoliosis. Methods: Eighteen patients with Lumbar Degenerative Scoliosis treated by S(2)AI screw fixation at Department of Orthopedics, General Hospital of Southern Theater Command of People's Liberation Army and Department of Orthopedics, 89th hospital of People's Liberation Army from August 2014 to October 2018 were analyzed retrospectively. There were 5 males and 13 females, aged 63.2 years old (range:55 to 71 years old).Parameters of spine including: Cobb Angle, C(7) plumb line -center sacral vertical line (C(7)PL-CSVL), lumbar lordosis(LL), sagittal vertical axis(SVA), pelvic incidence(PI), pelvic tilt(PT), sacral slope (SS) and pI-LL were measured on the whole spine X-ray before operation and at final follow-up. Pelvic CT scan was performed postoperatively to assess the accuracy of S(2)AI placement. Oswestry disability Index (ODI) was also recorded. The data were compared by paired t test or Wilcoxon tests. Results: All patients were followed up for 23.7 months (range: 12~62 months).At the last follow up, Cobb Angle decreased from (32.28±4.97) °preoperative to (6.56±3.20) ° (t=41.142, P<0.01) and C(7)PL-CSVL deceased from (1.11±2.07) cm preoperative to (0.18±1.08) cm (t=41.142, P=0.06) .LL improved from (-22.39±13.07) °preoperative to (-36.39±4.29) ° (t=4.470, P<0.01) , PI-LL decreased from (26.83±14.83)°preoperative to (13.72±8.3)° (t=4.396, P<0.01) , PT decreased from (27.94±4.26) °to (23.39±6.08) ° (t=2.680, P=0.02) , and SS increased from (22.22±6.36) °to (26.28±7.24) ° (t=-2.178, P=0.04) .SVA decreased from (6.54±4.51) cm preoperative to (2.62±1.29) cm (t=3.052, P=0.01) .ODI decreased from 0.58(0.40) (M(Q(R))) to 0.18 (0.15) (Z=-4.567, P<0.01) .No complications such as nerve and blood vessel injury occurred during the operation. A total of 32 S(2)AI screws were placed, 3 screws were placed with mild to moderate cortical breaches, 2 were perforated the pelvis ventrally, 1 was perforated posteriorly, with no clinically notable neurovascular or visceral complications. Eight patients finished the SRS-22 questionnaire, with mean score of 4.4 in terms of satisfaction with management. Conclusions: Free-hand technique of S(2)AI screw placement for sacrapelvic fusion in degenerative lumbar scoliosis is safe and feasible.S(2)AI fixation in DLS can provide great correction of deformity, maintain the stability of lumbo-pelvic area and improve the clinical symptoms.

Surgical Technique and Accuracy of S2 Alar-Iliac Screw Insertion Using Intraoperative O-Arm Navigation: An Analysis of 120 Screws

To evaluate the surgical technique and accuracy of S2 alar-iliac (SAI) screw placement using intraoperative O-arm-based 3-dimensional navigation (O-arm). This study involved 60 patients who underwent SAI screw placement using the O-arm system between September 2013 and September 2019. These surgeries were performed by 5 different surgeons. For O-arm-based SAI screw insertion, a reference frame was attached to the spinous process of the lower lumbar spine (usually L4) so as not to interfere with SAI screw insertion and to facilitate simultaneous L5-S posterior interbody fusion with navigation. The navigated probe, iliac tap, and screwdriver were used for SAI screw insertion. Screw placement accuracy and screw length were assessed using postoperative computed tomography. Perioperative complications were also evaluated. Mean age at surgery was 68.1 (range, 30-83) years. In total, 120 screws were inserted. Rate of accurate screw placement was 98.3% (118/120 screws). The 2 misplaced screws breached the anterior cortex of the sacrum. Mean screw length was 85.6 (range, 70-90) mm. There were no significant neurovascular or visceral complications perioperatively. SAI screw placement can be safely performed using the intraoperative O-arm system and our surgical technique.

Surgical management of neuromuscular scoliosis: approaches, pitfalls and outcomes

Background. Scoliosis is a common problem among neuromuscular disorders with increased incidence of morbidity and mortality. The management of neuromuscular scoliosis (NMS) is complex and requires a cooperative multi-disciplinary team to provide meticulous perioperative care. Conservative treatment, such as bracing, can delay but not replace surgical correction. However, surgery has the risk of higher perioperative complication rates in this patient population.&#x0D; Aim. It is a retrospective study to evaluate clinical outcome, approaches, pitfalls in management of NMS patients undergoing surgical correction.&#x0D; Materials and methods. We retrospectively evaluated patients with NMS who underwent surgery for scoliosis from 2004 to 2018. Sixty-eight patients were included in the study after meticulous preoperative checkup. In most cases an single-pedicle screw construct was used, but in a few others a hybrid construct was used. A follow up was performed to make a clinical and radiological assessment and recorded all measurements and any complications. A telephone questionnaire was used for functional evaluation and patient/parent satisfaction with surgery. Only 52 patients could participate in the questionnaire.&#x0D; Results. The mean follow up period was 43.28 months, and the mean age at the time of surgery was 14.29 years. The mean preoperative Cobbs angle was 71.7, while that of final follow-up was 34.6. The mean Cobbs correction percentage was 53.25%. For correction of fixed pelvic obliquity 15, a sacropelvic extension was done in 60.29% of cases. Complications occurred in 39.71% of operated cases; chest related in 36.11% (of all complications), hardware-related 16.67%, visceral complications (as paralytic ileus) in 13.89%, decubitus ulcer and delayed wound healing in 13.89%, deep wound infection in 8.33%, CNS complications (as status epilepticus) in 8.33%, and death in 2.78% (one case). The results of the questionnaire indicated favorable functional outcomes and patient/family satisfaction with surgery.&#x0D; Conclusion. Despite the perioperative difficulties seen in patients with NMS, patients who had relatively higher postoperative morbidity and mortality, most patients/parents were satisfied with the results of the spinal deformity surgery. The patients/parents would recommend surgery to other patients with similar disorders.

MULTIPLE HEMANGIOMATOSE DISEASE INVOLVING GASTROINTESTINAL TRACT: A CASE REPORT.

Hemangiomas are a type of benign vascular tumor, originated from angiogenesis disorders and prevalent in approximately 4% to 5% of the population. Among the most common complications are: ulcerations and bleeding, in cases of those located in the gastrointestinal tract; impairment of airways and vision; visceral complications; obstruction of the ear canal causing deficit in hearing; or problems in eating or in the emission of sounds due to its presence in the oral cavity. Colon and rectum hemangiomas are a rare cause of lower digestive hemorrhage. The aim of this study is to demonstrate the case of multiple hemangiomatose disease in an inpatient undergoing treatment at the Palmas General Public Hospital (HGPP).

Status of human toxocariasis, a neglected parasitic zoonosis in Iran: a systematic review from past to current

Although human toxocariasis can lead to serious complications including neurological, ocular and visceral complications, there is a lack of comprehensive epidemiological information about the seroprevalence of Toxocara species in humans. In the present study, we analysed and reviewed the overall seroprevalence of human toxocariasis in Iran. The data collection was systematically undertaken on published articles using the PubMed, Google Scholar, ScienceDirect and Scopus databases. A total of 27 studies from the past two decades reporting seroprevalence of human toxocariasis met our eligibility criteria. The pooled proportion of Toxocara infection was estimated as 6.58% (95% confidence interval = 3.98-9.77). A wide variation between different studies was observed (Q statistic = 799.37, df = 26, P < 0.0001, and I2 = 96.7%). The seroprevalence rate of toxocariasis in the Iranian population is relatively high; contamination of the environment by eggs from the host as well as from household dogs and cats should be blamed.

Arteriomesenteric compression of the duodenum as a complication of the surgical correction of typical idiopathic scoliosis: clinical case

The presented rare clinical case of the development of arteriomesenteric compression of the duodenum is described with the aim of informing a wide audience of specialists (orthopedic trauma surgeons, vertebrologists, neurosurgeons, surgeons, neurologists and pediatricians) about a rare complication of surgical correction of typical adolescent idiopathic scoliosis intestinal obstruction due to compression of the lower horizontal part of the duodenum by the superior mesenteric artery. Publications answering two posed questions were analyzed: is there a correlation between surgical correction of scoliosis and development of abdominal pathology in a patient in the immediate postoperative period, and should the instrumentation be completely or partially removed at the level of the thoracolumbar junction in the case of formation of duodenal arteriomesenteric compression in a patient operated on the spine? Abdominal visceral complications are extremely rare and represented by a very few publications even in modern electronic databases of medical information, therefore we consider it important to bring a case from our practice to the attention of readers.

Outcomes of Arterial Conduits in Vascular Reconstruction After Oncologic Resection of Locally Advanced Pancreatic Malignancies

To determine early and midterm outcomes of various conduit types for visceral artery reconstruction after resection of locally advanced pancreatic malignancies. Retrospective review of all patients who underwent resection for pancreatic malignancy with visceral reconstruction using superficial femoral artery (SFA), great saphenous vein (GSV), splenic artery (SA), cryopreserved allograft, or prosthetic graft (PG) between 2000 and 2019. The SFA donor limbs were revascularized with expanded polytetrafluoroethylene interposition grafts. End points for visceral and donor limb arterial reconstructions are primary and secondary patency, vascular complications, and mortality. Visceral reconstruction for oncologic resection was performed in 57 patients. Reconstructed arteries included proper hepatic (n = 24), common hepatic (n = 17), superior mesenteric (n = 22), right hepatic (n = 5), and left hepatic (n = 2) with multivessel reconstructions performed in 13 patients. Of 57 visceral reconstructions, 30 were performed with autogenous SFA; 27 had no preoperative evidence of peripheral arterial disease. Median follow-up for all patients was 9 months. The 30-day visceral reconstruction complications included pseudoaneurysms in one SFA conduit (requiring gastroduodenal artery coiling and covered stent placement) and one GSV conduit (requiring covered stent placement), thrombosis in one PG conduit and one GSV conduit (both requiring open thrombectomy), and anastomotic bleed from one SA conduit (requiring operative repair). The 30-day SFA harvest donor limb complications included one hematoma, one lymphocele, and one symptomatic edema. Early mortality occurred in three patients including one SA conduit with multiorgan failure, one GSV conduit pseudoaneurysm rupture secondary to pancreatic leak and one SFA conduit of unknown cause. Midterm visceral reconstruction complications included pseudoaneurysm in 6 patients (3 SFA conduits with 2 treated, 3 GSV conduits with all treated), and graft occlusion in 10 patients (3 SFA, 4 GSV, 1 cryopreserved allograft and 2 PG). One patient underwent percutaneous angioplasty for high-grade stenosis of a SA graft. This gave a primary and secondary patency for all visceral arterial reconstructions of 81% and 84%, respectively. Midterm SFA donor limb patency was 100% with median follow-up of 8 months. Late mortality occurred in 19 patients (33%) with 11 cancer-related deaths and 5 of unknown cause or unrelated to the primary cancer. Three late mortalities occurred secondary to mycotic graft pseudoaneurysm ruptures in the setting of bile and pancreatic leaks (1 GSV, 1 PG secondary reconstruction in SFA conduit patient and 1 SFA conduit). This preliminary study suggests that superficial femoral artery can be considered feasible conduit in oncologic reconstructions with low morbidity of the donor limb. Long-term follow-up is needed to identify oncologic and patency-related outcomes.TablePrimary end points by conduit choiceConduitNo. of patientsPrimary patencySecondary patencyMajor early visceral graft complicationsAll-cause mortality, % (vascular-related, %)Median follow-up, months (range)Superficial femoral artery3090%90%n = 1 pseudoaneurysm30 (7)8 (2-39)Cryopreserved allograft988%88%n = 00 (0)4 (1-23)Great saphenous vein838%38%n = 2 (1 pseudoaneurysm, 1 thrombosis)75 (25)11 (0-25)Prosthetic graft667%83%n = 1 thrombosis67 (0)12 (1-107)Splenic artery450%50%n = 1 anastomotic bleed50 (0)26 (1-52) Open table in a new tab

Re-do surgery after prosthetic abdominal wall repair: intraoperative findings of mesh-related complications.

Mesh repair is one of the most popular technique for the treatment of abdominal wall hernias, resulting in lower recurrence rates. However, it is associated with a high risk of mesh-related complications. The aim of the present study is to assess the impact of biomaterials on the intra-abdominal organs, in terms of adhesions and visceral complications, in a series of patients undergoing re-do surgery at our abdominal wall unit. We reviewed the clinical records of 301 patients who undergone laparotomy between June 2008 and May 2018, selecting 67 patients with one or more previous prosthetic abdominal wall repair (AWR). The average number of previous repairs was 1.6 with a mean time interval of 66months from the last repair. Clinical presentation included hernia recurrence (69%), mesh infection (26%), infection and recurrence (10%), and fistula (1%). Adhesions were intraoperatively observed in all patients, except for eight cases. Mesh was completely removed in 43 patients, partially in four. Postoperative complications were observed in 39% of cases, including wound dehiscence, hematoma, seroma, and mesh infection. Long-term implant results in abdominal wall repair and are not completely known, and literature is still lacking on this topic. Re-do surgery for subsequent pathological events may represent a way to increase our knowledge.

Recurrent pneumothorax and intrapulmonary cavitary lesions in a male patient with vascular Ehlers-Danlos syndrome and a novel missense mutation in the COL3A1 gene: a case report

BackgroundVascular Ehlers-Danlos syndrome (vEDS) is a rare autosomal dominant hereditary collagen disease caused by a defect or deficiency in the pro-α1 chain of type III procollagen encoded by the COL3A1 gene. Patients with vEDS rarely present with multiple pneumothoraces. The clinical features of this disease are not familiar to clinicians and are easily missed. We report a patient with a novel missense mutation in the COL3A1 gene (NM_000090.3: c.2977G > A) and hope to provide clinicians with valuable information.Case presentationWe reported the case of a young man presenting with frequent episodes of pneumothorax and intrapulmonary cavities and nodular lesions without arterial or visceral complications. His skin was thin and transparent, and the joints were slightly hypermobile. Whole-exome sequencing (chip capture high-throughput sequencing) revealed a heterozygous missense mutation in exon 41 of the COL3A1 gene (NM_000090.3: c.2977G > A), confirming the diagnosis of vEDS. vEDS remains a very rare and difficult diagnosis to determine.ConclusionWhen a patient presents with recurrent pneumothorax, intrapulmonary cavities and nodular lesions, thin and transparent skin, and hypermobile joints, clinicians should consider the diagnosis of vEDS.