Surgery Case Reports最新文献

Acute emphysematous suppurative thyroid abscess is a potentially life threatening uncommon disease caused most commonly by gram positive organisms. It usually occurs in immunocompromised individuals with pre-existing multinodular goiter secondary to hematogenous spread of infection. The most characteristic feature of this disease is the presence of gas within the thyroid swelling seen on imaging, even though crepitus may be absent on examination. Surgical debridement and thyroidectomy are the procedure of choice in such cases and can lead to effective cure. We present an unusual and rare case of an acute emphysematous suppurative thyroid abscess caused by a gram negative (non-clostridial) organism in an immunocompromised patient after a fine needle aspiration cytology intervention.

Introduction

Extraskeletal osteosarcomas are rare tumors with poor overall survival and a high propensity for recurrence. It frequently arises in the lower extremities and has been reported to metastasize commonly in the lungs. Controversy exists as to whether it should be treated as a soft tissue sarcoma or an osteosarcoma. Various adjuvant treatment approaches have also been studied with conflicting results.

Case report

We present a 73-year-old female with a painless, gradually enlarging right upper arm mass for 2 months. She previously underwent a left mastectomy 5 years ago for a stage II breast cancer. Preoperative imaging showed a resectable, heterogenous right upper arm mass. She subsequently underwent radical excision with frozen section revealing spindle cell neoplasm. Final histopathology was consistent with extraskeletal osteosarcoma. The patient remains disease-free as of most recent follow-up.

Discussion

There are several proposed mechanisms for extraskeletal osteosarcomas. Based on the history and location of the tumor, we initially thought that this was metastatic breast cancer. Preoperative imaging determines resectability and surgical approach. Radical surgery is frequently performed which largely depends on the site of the tumor. Complete primary resection with adequate margins remains to be the treatment of choice to prevent recurrence or metastasis. The role of adjuvant radiotherapy or chemotherapy is still to be established.

Conclusion

This case highlights the various treatment options and the need for further research on its clinical behavior and potential targeted therapies.

We present the case of a patient with unexplained postural headaches who was found to have an atraumatic Cerebrospinal Fluid (CSF) leak from the foraminal and extraforaminal epidural spaces at the levels of C5-C6, C6-C7, C7-T1, and T1-T2, with contrast tracking along the brachial plexus elements as well as the bilateral scalene and paraspinal musculature. This is a rare presentation as the etiology was not connected to brachial plexus injury or surgical trauma but rather was a spontaneous occurrence. The patient was successfully treated with a CT-guided epidural blood patch that conferred complete resolution of the symptoms. We hope this case study offers clinical utility with the diagnosis and management of patients with orthostatic headaches.

Introduction

The anterior component separation (ACS) is a technique used for abdominal wall closure performed by dissecting and medially advancing the musculature to achieve tension-free closure.

Methods

and Materials:

This study reviewed our experience with this procedure as used for complex abdominal wall defects encountered during colorectal surgery in a 7-year period.

Results

Sixteen patients were included, with 12 having malignancies and the rest for infectious or inflammatory conditions. Defects ranged from 16–400 cm² and were mostly located at the midline (56%, n = 9). Five cases required additional flaps for closure, attributed either to the size or area of abdominal involvement where benefits of component separation is more limited. Complications include surgical site infection (n = 4), hematoma (n = 2), seroma (n = 1), and wound dehiscence (n = 2). None required ICU admission or assisted ventilation post-operatively. One patient died who had a preexisting cardiac pathology, and the rest were discharged improved.

Conclusion

This study demonstrates use of this modality for autologous reconstruction of complex appropriately sized abdominal wall defects from multiple etiologies. Adjunct flaps may be used to achieve reconstruction particularly in areas wherein the effectiveness of ACS is limited. While the study is able to describe immediate outcomes, long-term follow-up is recommended.

Background

Understanding the risks of performing open-heart surgery in patients with cirrhosis is of critical importance given increased risks of morbidity and mortality. We analyzed the variables and risk scoring systems associated with survival and postoperative outcomes among patients with cirrhosis after open-heart surgery.

Methods

This is a single-center retrospective study of 32 patients with cirrhosis who underwent open-heart surgery at our institution between August 2020 – September 2022. Patients were stratified by mortality status to compare demographic and clinical variables. Survival was assessed using Kaplan-Meier curves and log-rank tests for the following variables: Model for End-Stage Liver Disease (MELD) score (<11 vs ≥11), Child-Turcotte-Pugh (CTP) class (A vs B vs C), Society of Thoracic Surgeons (STS) score (predicted mortality <4 vs 4 to 8 vs ≥8), European System for Cardiac Operative Risk Evaluation (EuroSCORE) II (<3.3 vs ≥3.3), and cardiopulmonary bypass (off pump vs on pump).

Results

Overall survival for our patient cohort was 93.8% at 30 days, 81.3% at 1 year, and 78.1% at 2 years postoperatively. Increased preoperative creatinine (p = 0.049), preoperative total bilirubin (p = 0.017), intraoperative blood products (p = 0.016), and intensive care unit length of stay (p = 0.001) were significantly associated with decreased survival. Among the risk scoring systems, only CTP class was significantly associated with survival (p < 0.0001).

Conclusions

We demonstrated high short-term and long-term survival among patients with cirrhosis after open-heart surgery, suggesting that select patients may be operative candidates. Among risk-scoring systems, only CTP was significantly associated with survival, which may guide future risk stratification strategies.