Acta Chirurgica Belgica最新文献

Background: Tibial fractures, with an annual incidence of 51.7 per 100.000 adults, often result in complications like non-union and infection, particularly in open fractures. Non-union rates after intramedullary nailing are 9.7%. Hypertrophic non-union stems from unstable fracture sites, while atrophic non-union arises from inadequate biological environments. Treatment involves rigid bone fixation for hypertrophic non-union and combining biological tissue supply with mechanical stability for atrophic non-unions. This case report outlines a complex tibial non-union post-high-impact injury, detailing the surgical technique and TRUMATCH^TM Graft Cage-Long Bone usage. In addition, we outlined the current literature on this topic.

Case report: A male patient suffered a traumatic Gustilo II comminuted tibia and fibula fracture, Lisfranc injury and a Schatzker I tibial plateau fracture of the right leg. During follow-up the patient developed an aseptic non-union with eight-centimeter anterolateral bone defect after primary surgery. Surgical intervention was performed using the three-dimensional printed TRUMATCH^TM Graft Cage-Long Bone. At one year follow-up, clinical and radiological consolidation of the right tibia was seen.

Conclusion: This case report describes a challenging case of aseptic traumatic non-union of the tibia with a critical-sized defect treated with a novel patient-specific implant in a one-stage procedure. The application of the TRUMATCH^TM Graft Cage-Long Bone is promising and warrants further investigation in larger, more controlled studies to substantiate our findings.

Background: In noncardiac surgery, several biomarkers are known to play a role in predicting long-term complications, such as major adverse cardiovascular events (MACE), myocardial infarction, or death. Carotid endarterectomy (CEA) is considered a low to medium-risk surgery for carotid stenosis aimed at preventing stroke events. Brain natriuretic peptide (BNP) is a biomarker with potential prognostic value regarding MACE. Since its role in patients undergoing CEA is unknown, this study aims to assess the potential role of BNP as a short and long-term predictor of all-cause mortality and MACE in patients undergoing CEA.

Methods: From a prospective database, patients who underwent CEA under regional anesthesia (RA) at a tertiary hospital center were enrolled, and a post hoc analysis was conducted. Patients on which BNP levels were measured up to fifteen days before surgery, and two groups based on the BNP threshold (200 pg/mL) were defined and compared. Kaplan Meier survival curves and adjusted hazard ratios (aHR) were assessed by multivariable Cox regression. The primary outcome was the incidence of long-term MACE and all-cause mortality. Secondary outcomes included the incidence of AMI and AHF.

Results: A total of 89 patients were evaluated. The mean age of the cohort was 71.2 ± 8.7 years, with 71 (79.8%) males, and presented a median follow-up of 30 [13.5-46.4] months. BNP > 200 pg/mL has demonstrated positive predictive value for MACE (aHR: 5.569, confidence interval (CI): 2.441-12.7, p < 0.001) and all-cause mortality (aHR: 3.469, CI: 1.315-9.150, p = 0.018).

Conclusion: BNP has been demonstrated to independently predict long-term all-cause mortality, MACE and AMI following CEA. It serves as a low-cost, ready-to-use biomarker, although further studies are necessary.

Asbestos exposure is a well-documented cause of pulmonary diseases. However, its systemic effects, particularly on the cardiovascular system, are less understood. We expose a case that highlights an unusual cardiovascular manifestation in a patient with a history of pleural asbestosis compressing the aorta and clinically manifested as lower limb claudication. A 65-year-old individual presented with bilateral short-distance lower extremity claudication. The patient's clinical presentation prompted advanced imaging studies, including CT angiography, to assess the extent of vascular involvement. The imaging confirmed the presence of substantial calcification and narrowing of the thoracic aorta. The patient had a documented history of pleural asbestosis. This case underscores the potential for asbestos-related diseases to extend beyond pulmonary manifestations, affecting cardiovascular health. The observed aortic calcification and coarctation represent an atypical progression of asbestosis related pathology.

Background: Mesenteric cystic lymphangiomas (MCLs) are rare benign tumours seen in adults. The clinical presentation may vary from asymptomatic to acute abdominal pain with inexplicable abdominal pain, nausea and vomiting.

Case presentation: In the current case report, a 22-year old, healthy women presented to the emergency room with acute abdominal pain in need of urgent surgical exploration. Histopathological examination revealed an mesenteric cystic lymphangioma.

Conclusion: In patients with inexplicable abdominal pain, the suspicion of MCLs and proper diagnostic strategies are important. The primary treatment of MCLs consists of radical surgical resection to prevent invasion in surrounding tissue. Tertiary referral centres should be consulted to support in the diagnosis, treatment and follow-up of MCLs.

Introduction: Tunneled dialysis catheters (TDCs) are important for hemodialysis in patients awaiting a permanent surgical solution, kidney transplantation or without feasible surgical access. Infection of a TDC is a common and severe complication, which often requires removal of the TDC and causes high morbidity and mortality. To date, several risk factors for TDC infections have been reported. This systematic review and meta-analysis aim to provide an overview of currently known risk factors.

Methods: A systematic literature search was conducted, including all studies describing patient-, catheter-, and dialysis-related risk factors for TDC infections. In case sufficient data was available for a risk factor, a meta-analysis with random effects model was performed.

Results: Out of 1273 studies, 30 were included describing a total of 71 risk factors. A meta-analysis was conducted for 26 risk factors. The average incidence of TDC infections was 1.16 ± 0.70/1000 catheter days. Diabetes (odds ratio, OR 1.96), coronary artery disease (OR 2.16), peripheral artery disease (OR 2.28), history of sepsis (OR 2.79), and the number of prior TDCs (OR 1.24) were the most significant risk factors for infection.

Conclusion: Several risk factors are associated with increased TDC infection rates. Most of these risk factors are also linked with infection in other populations and most likely reflect the general frailty of hemodialysis patients. The association between many risk factors and TDC infections was often unclear due to the low number of studies available. Additional large cohort studies are necessary to demonstrate the relevance of these risk factors.

Background: With the progress achieved in transplant surgeries an improved long-term survival of patients is obtained due to more effective immunosuppressant therapy. De novo malignancy (DNM) has gained interest in this group of patients. DNM is a major cause of late mortality after liver transplantation.

Methods: We report the case of a patient who underwent orthotopic liver transplantation with right hemiliver (right split) 18 years ago who came to our attention for gastric cancer. We performed a robotic subtotal gastrectomy D2 lymphadenectomy with manual latero lateral trans mesocolic BII gastro jejunal anastomosis using da Vinci robotic surgery system at our hospital.

Results: The operation was successful, the operative time was 230 min, the intraoperative blood loss was 100 ml. The patient was discharged on day 8 after surgery, and no complications occurred. Postoperative pathological stages were pT2 N0 (0/25). During the follow-up period, the patient was in good health without long-term complications.

Conclusion: Robotic approach is feasible in patients after liver transplantation.

Background: The syndrome of Loeys-Dietz (LDS) is a rare connective tissue disorder. A classic triad of symptoms is seen: hypertelorism, atypical uvula or clef palate, and multiple tortuous arteries and aneurysms of the aorta and main arterial branches. Mutations in genes involving the transforming growth factor-beta (TGFB) signaling pathway are the cause of this syndrome. There are six subtypes of LDS, categorized based on the gene mutation that is involved. LDS type V and VI, concerning the TGFB3 and SMAD2 gene respectively, are the two subtypes that are least frequently seen. Mostly, in the patients with LDS type V non-cardiovascular symptoms are most prominent and there is a lower prevalence of vascular abnormalities.

Methods and results: This case report illustrates extensive vascular disease in Loeys-Dietz syndrome type V. We present open repair of a true deep femoral artery aneurysm and two-staged repair of a giant common iliac aneurysm with coiling of an ipsilateral internal iliac artery aneurysm and subsequent endovascular aortic repair (EVAR).

Conclusion: Loeys-Dietz syndrome type V is a rare connective tissue disorder, that was thought to have non-cardiovascular symptoms at the forefront. However, this case represents multiple vascular abnormalities, including arterial tortuosity and iliac and femoral artery aneurysms, as the main symptom in LDS type V, presents our multi-stage treatment and discusses the different therapeutic strategies.

Background: This article examines the surgical techniques used for the treatment of neuralgia and dystonia in Greece during the late 19th to the middle of the twentieth century. It emphasizes on the Greek contribution to neurosurgery.

Methods: The aim of this study is achieved by examining unpublished archives as well as historical documents collected from both the National Library of Greece and the Library of the Hellenic Parliament.

Results: Greek medicine of the nineteenth century emerged through the practice of Greek physicians who have studied abroad. Many important figures on surgery, like Theodoros Aretaios, Nikolaos Taptas and Konstantinos Mermigas attempted myotomies, neurectomies, trasoraphies, and injections according the European protocols, though introducing some variants on well established procedures. This article also refers to the early stereotactic neurosurgery in Greece, especially in the treatment of Parkinson's Disease and extrapyramidal syndromes by Aggelos Karakalos, ultimately contributing toward a better understanding of the evolution of Greek surgery, highlighting its pivotal role in the international development of neurosurgical techniques. Greek school of surgery avoided brutal operations like trephination and proved worthy among most advanced school of the 19^th and 20^th centuries.

Conclusion: Neuralgias and dystonias constituted for the physicians of the past a riddle connected with the mystery of the central and peripheral neural system. Surgical procedures were proposed, finding ways of implication mainly in the cases of neuralgias. Gradually drug administration of simple substances like alcohol demonstrated some results. The study of Greek medical archives dated back to 19^th and early twentieth century allow us to have a comprehensive idea about the therapeutical approaches and especially the operative ones used by the Greek physicians of the time to fight dystonias and neuralgias unveiling their capabilities and theoretical medical knowledge.