Pub Date : 2021-11-23DOI: 10.26420/austinjsurg.2021.1281
K. A, Kerima Ba, Imen B, Jalel K
Growing Skull Fracture (GSK) is a rare but significant complication of pediatric head trauma. It commonly develops after a head trauma with a linear skull fracture and an underlying dural tear. Delayed diagnosis and improper management can lead to severe complications. Few reports provide details on peropeartive findings and surgical management of GSF. Herein we report the case of a neglected growing skull fracture in a 2-year-old infant who suffered from an abuse head trauma at the age of three months. A progressive bulging at the site of the fracture was neglected by the family for months. CT scan of the brain showed gliotic brain tissue herniated through a large ragged skull defect. Surgery was indicated and the goals of operation were to remove safely nonviable herniated brain tissue and to protect the neural elements by restoring dural and bone defect. Surgery should be performed acutely in children with GSF to reduce the morbidity and improve outcome.
{"title":"Neglected Growing Skull Fracture: Details on Peroperative Findings and Surgical Repair","authors":"K. A, Kerima Ba, Imen B, Jalel K","doi":"10.26420/austinjsurg.2021.1281","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1281","url":null,"abstract":"Growing Skull Fracture (GSK) is a rare but significant complication of pediatric head trauma. It commonly develops after a head trauma with a linear skull fracture and an underlying dural tear. Delayed diagnosis and improper management can lead to severe complications. Few reports provide details on peropeartive findings and surgical management of GSF. Herein we report the case of a neglected growing skull fracture in a 2-year-old infant who suffered from an abuse head trauma at the age of three months. A progressive bulging at the site of the fracture was neglected by the family for months. CT scan of the brain showed gliotic brain tissue herniated through a large ragged skull defect. Surgery was indicated and the goals of operation were to remove safely nonviable herniated brain tissue and to protect the neural elements by restoring dural and bone defect. Surgery should be performed acutely in children with GSF to reduce the morbidity and improve outcome.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-11-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90178016","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-30DOI: 10.26420/austinjsurg.2021.1280
I. M
Diabetes is a major public health problem regionally and globally. In 2019, the International Diabetes Federation estimated that 465 million (9.3%) people worldwide had diabetes, and by 2045, the number may rise to 700 million (10.9%) [1]. The pooled prevalence of diabetes in the general population of Bangladesh is 7.8% and prevalence of pre-diabetes is 10.1% [2]. Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. The lifetime risk for foot ulcers in people with diabetes is estimated to be 15% [3]. Development of diabetic foot ulcer is attributed to many interacting factors, the most common ones being peripheral neuropathy and Peripheral Arterial Disease (PAD) [4]. PAD is an important precipitating factor in the outcome of diabetic foot ulcer [4]. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration [5]. Diabetic patients with PAD commonly show involvement of the arteries below the knee, especially at the tibial and peroneal arteries, and involvement of the profunda femoris [6]. Diabetic ulcers always require vascular evaluation, and when ischaemia is suspected the diagnostics should be organized rapidly to ensure revascularisation without delay. Foot ulcer in patients with diabetes is associated with an increased risk of lower limb amputation, and thus the primary aim of treatment for ischemic foot ulcer is limb preservation [4]. Invasive revascularization, including open reconstructive surgery and/or endovascular intervention, is the most effective treatment that may improve peripheral circulation and remedy symptoms [4]. The basic aim of any successful revascularization is to achieve pulsatile flow to the foot. The two methods currently available are peripheral bypass surgery and peripheral angioplasty [7]. Current literature shows that percutaneous transluminal angioplasty (PTA) is the first choice of procedures in revascularization of the lower limb [7].
{"title":"Revascularization in Diabetic Foot Ulcer and Outcome","authors":"I. M","doi":"10.26420/austinjsurg.2021.1280","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1280","url":null,"abstract":"Diabetes is a major public health problem regionally and globally. In 2019, the International Diabetes Federation estimated that 465 million (9.3%) people worldwide had diabetes, and by 2045, the number may rise to 700 million (10.9%) [1]. The pooled prevalence of diabetes in the general population of Bangladesh is 7.8% and prevalence of pre-diabetes is 10.1% [2]. Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. The lifetime risk for foot ulcers in people with diabetes is estimated to be 15% [3]. Development of diabetic foot ulcer is attributed to many interacting factors, the most common ones being peripheral neuropathy and Peripheral Arterial Disease (PAD) [4]. PAD is an important precipitating factor in the outcome of diabetic foot ulcer [4]. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration [5]. Diabetic patients with PAD commonly show involvement of the arteries below the knee, especially at the tibial and peroneal arteries, and involvement of the profunda femoris [6]. Diabetic ulcers always require vascular evaluation, and when ischaemia is suspected the diagnostics should be organized rapidly to ensure revascularisation without delay. Foot ulcer in patients with diabetes is associated with an increased risk of lower limb amputation, and thus the primary aim of treatment for ischemic foot ulcer is limb preservation [4]. Invasive revascularization, including open reconstructive surgery and/or endovascular intervention, is the most effective treatment that may improve peripheral circulation and remedy symptoms [4]. The basic aim of any successful revascularization is to achieve pulsatile flow to the foot. The two methods currently available are peripheral bypass surgery and peripheral angioplasty [7]. Current literature shows that percutaneous transluminal angioplasty (PTA) is the first choice of procedures in revascularization of the lower limb [7].","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73020602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-10-13DOI: 10.26420/austinjsurg.2021.1279
Bashar Ahm, Rahman Mm, Islam Mf, Ghosh Sk, Reza S, M. S, Ahmed Smp, Sabah Mn, Islam Mm, Jamil Ms, Hossain Sz
Objective: Covid-19 continues its negative impact on limb salvage in patients with limb ischemia and vascular trauma. Bangladesh fought the 1st and 2nd waves of the Covid-19 pandemic during April through August, 2020 and in April-May, 2021, respectively. Infections have been rising once again since early June 2021 to reach a positivity rate over 30%. With limited resources, vascular surgical care during the pandemic has been an unprecedented challenge for a developing country like Bangladesh. As a small vascular community, we have adopted a strategy focused on conserving essential resources including manpower while delivering essential vascular care. The present study evaluates the effectiveness of our pandemic-time guideline-based working strategy with a focus on limb salvage. Methods: Essential vascular services were provided by customized teams throughout the Covid-19 pandemic at two referral centers according to our working guidelines. Data were analyzed and key limb salvage outcomes compared between the two pandemic waves by chi-square test. Results: A total of 1792 vascular surgical cases were addressed during the pandemic- over 90% of which involved limb or life-saving procedures. Overall mortality was 0.6% and overall limb salvage rate for acute and Chronic Limb Threatening Ischemia (CLTI) were 95.3% and 76.8%, respectively. Limb salvage rate for CLTI was significantly higher in the 2nd wave compared with the 1st (P<0.05). Rate of Covid-19 infection among vascular workforce was about 20%. Conclusion: Emergency-focused altered working guideline has produced satisfactory results in terms of continuing emergency vascular services, improving limb salvage and safeguarding vascular workforce during Covid-19 pandemic in a developing country. Conservation of resources including manpower remains relevant in the context of a highly probable 3rd wave of infection.
{"title":"Vascular Care Services during the Covid-19 Pandemic in a South Asian Country: Implications for Limb Salvage","authors":"Bashar Ahm, Rahman Mm, Islam Mf, Ghosh Sk, Reza S, M. S, Ahmed Smp, Sabah Mn, Islam Mm, Jamil Ms, Hossain Sz","doi":"10.26420/austinjsurg.2021.1279","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1279","url":null,"abstract":"Objective: Covid-19 continues its negative impact on limb salvage in patients with limb ischemia and vascular trauma. Bangladesh fought the 1st and 2nd waves of the Covid-19 pandemic during April through August, 2020 and in April-May, 2021, respectively. Infections have been rising once again since early June 2021 to reach a positivity rate over 30%. With limited resources, vascular surgical care during the pandemic has been an unprecedented challenge for a developing country like Bangladesh. As a small vascular community, we have adopted a strategy focused on conserving essential resources including manpower while delivering essential vascular care. The present study evaluates the effectiveness of our pandemic-time guideline-based working strategy with a focus on limb salvage. Methods: Essential vascular services were provided by customized teams throughout the Covid-19 pandemic at two referral centers according to our working guidelines. Data were analyzed and key limb salvage outcomes compared between the two pandemic waves by chi-square test. Results: A total of 1792 vascular surgical cases were addressed during the pandemic- over 90% of which involved limb or life-saving procedures. Overall mortality was 0.6% and overall limb salvage rate for acute and Chronic Limb Threatening Ischemia (CLTI) were 95.3% and 76.8%, respectively. Limb salvage rate for CLTI was significantly higher in the 2nd wave compared with the 1st (P<0.05). Rate of Covid-19 infection among vascular workforce was about 20%. Conclusion: Emergency-focused altered working guideline has produced satisfactory results in terms of continuing emergency vascular services, improving limb salvage and safeguarding vascular workforce during Covid-19 pandemic in a developing country. Conservation of resources including manpower remains relevant in the context of a highly probable 3rd wave of infection.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79175154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-24DOI: 10.26420/austinjsurg.2021.1278
Scardina L, D. A, Sanchez Am, D’Archi S, Biondi E, Carnassale B, D’Alessandris N, Scaglione G, S. A, M. A, Masetti R, F. G.
Introduction: Granular cell tumor is a rare neoplasm of soft tissue and only in 1% of cases, it can shows a malignant behaviour. It is presumed to be a tumor originating from perineural or putative Schwann cells of peripheral nerves. Materials and Methods: We reviewed five patients affected by Granular cell tumor of the breast treated between January 2011 and January 2021 at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS of Rome, Italy. Results: All of the granular cell tumors presented as solitary, painless and firm lump, highly suggestive of malignancy. The radiological findings were heterogeneous and non-specific. All lesions presented as masses, more clearly evident on ultrasound as hypoechoic lesions, with irregular shape, blurred contours and borderline features. The tumors were composed of large polygonal cells with abundant eosinophilic granular cytoplasm and small, central nuclei, being immunohistochemically positive for S100, Vimentin (with variable staining), CD56; negative for HMB45, MelanA, AE1/AE3, EMA, and Desmin. Conclusion: Granular cell tumor is a rare, usually benign breast disease that can have very similar characteristics to breast cancer both clinically and radiologically. Treatment of choice consists in wide resection or lumpectomy with margin assessment (no ink on tumor).
{"title":"Granular Cell Tumor of the Breast: Clinical Presentation, Pathological Diagnosis and Treatment","authors":"Scardina L, D. A, Sanchez Am, D’Archi S, Biondi E, Carnassale B, D’Alessandris N, Scaglione G, S. A, M. A, Masetti R, F. G.","doi":"10.26420/austinjsurg.2021.1278","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1278","url":null,"abstract":"Introduction: Granular cell tumor is a rare neoplasm of soft tissue and only in 1% of cases, it can shows a malignant behaviour. It is presumed to be a tumor originating from perineural or putative Schwann cells of peripheral nerves. Materials and Methods: We reviewed five patients affected by Granular cell tumor of the breast treated between January 2011 and January 2021 at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS of Rome, Italy. Results: All of the granular cell tumors presented as solitary, painless and firm lump, highly suggestive of malignancy. The radiological findings were heterogeneous and non-specific. All lesions presented as masses, more clearly evident on ultrasound as hypoechoic lesions, with irregular shape, blurred contours and borderline features. The tumors were composed of large polygonal cells with abundant eosinophilic granular cytoplasm and small, central nuclei, being immunohistochemically positive for S100, Vimentin (with variable staining), CD56; negative for HMB45, MelanA, AE1/AE3, EMA, and Desmin. Conclusion: Granular cell tumor is a rare, usually benign breast disease that can have very similar characteristics to breast cancer both clinically and radiologically. Treatment of choice consists in wide resection or lumpectomy with margin assessment (no ink on tumor).","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75197083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-09-08DOI: 10.26420/austinjsurg.2021.1277
Goetz J, Renkawitz T, Meyer M, Woerner M, B. R., Grifka J, Weber M
Comparison of Functional and Clinical Outcomes between Minimally-Invasive and Conventional Approaches after Total Hip Replacement
全髋关节置换术后微创入路与常规入路的功能和临床效果比较
{"title":"Comparison of Functional and Clinical Outcomes between Minimally-Invasive and Conventional Approaches after Total Hip Replacement","authors":"Goetz J, Renkawitz T, Meyer M, Woerner M, B. R., Grifka J, Weber M","doi":"10.26420/austinjsurg.2021.1277","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1277","url":null,"abstract":"Comparison of Functional and Clinical Outcomes between Minimally-Invasive and Conventional Approaches after Total Hip Replacement","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87286372","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-26DOI: 10.26420/austinjsurg.2021.1276
A. Ws, Abulezz Ta, Ali-Riza Ae, el-Khoury Gy
Background: The objective of this study was to compare the pliability, the function, aesthetic outcome, complications and patient satisfaction between free anterolateral thigh flap and free medial sural artery perforator flap in reconstruction of post traumatic soft tissue defects of dorsum of the foot. Method: The study was conducted on forty patients with post traumatic soft tissue defects of the dorsum of the foot between August 2018 and August 2019. Patients were divided randomly into two groups. In group1 (20 patients), the defects were reconstructed with free anterolateral thigh perforator flap. In group 2 (20 patients), reconstruction was done by free medial sural artery perforator flap. Result: In group 1 (ALT flap), Complete flap survival was achieved in 100% of cases. Thirteen patients required secondary debulking procedures and scar revisions. In group 2 (MSAP Flap), Complete flap survival was achieved in 85% with one flap totally lost and two flaps had distal necrosis. One patient needed scar revision and another patient needed flap advancement. Conclusion: MSAP flap is superior to ALT flap. It has many advantages: it is thin, pliable, fitted to normal footwear, less hairy and there is no need for secondary procedures in most cases.
{"title":"Comparison between Free Anterolateral Thigh Flap and Free Medial Sural Artery Perforator Flap in Reconstruction of Post Traumatic Soft Tissue Defects of Dorsum of the Foot","authors":"A. Ws, Abulezz Ta, Ali-Riza Ae, el-Khoury Gy","doi":"10.26420/austinjsurg.2021.1276","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1276","url":null,"abstract":"Background: The objective of this study was to compare the pliability, the function, aesthetic outcome, complications and patient satisfaction between free anterolateral thigh flap and free medial sural artery perforator flap in reconstruction of post traumatic soft tissue defects of dorsum of the foot. Method: The study was conducted on forty patients with post traumatic soft tissue defects of the dorsum of the foot between August 2018 and August 2019. Patients were divided randomly into two groups. In group1 (20 patients), the defects were reconstructed with free anterolateral thigh perforator flap. In group 2 (20 patients), reconstruction was done by free medial sural artery perforator flap. Result: In group 1 (ALT flap), Complete flap survival was achieved in 100% of cases. Thirteen patients required secondary debulking procedures and scar revisions. In group 2 (MSAP Flap), Complete flap survival was achieved in 85% with one flap totally lost and two flaps had distal necrosis. One patient needed scar revision and another patient needed flap advancement. Conclusion: MSAP flap is superior to ALT flap. It has many advantages: it is thin, pliable, fitted to normal footwear, less hairy and there is no need for secondary procedures in most cases.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"85 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86514872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-26DOI: 10.26420/austinjsurg.2021.1275
Makrushin Av
It is proposed to study the mechanism of tumor regression from an evolutionary point of view. The proposal is based on the assumption that the evolutionary precursor of this mechanism is the resorption mechanism in sedentary modular invertebrates preparing for diapause in embryos. To understand how the tumor regression mechanism works, it is necessary to investigate the mechanism of resorption of these embryos in these invertebrates.
{"title":"Controlling Tumor Regression about the Physiological System","authors":"Makrushin Av","doi":"10.26420/austinjsurg.2021.1275","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1275","url":null,"abstract":"It is proposed to study the mechanism of tumor regression from an evolutionary point of view. The proposal is based on the assumption that the evolutionary precursor of this mechanism is the resorption mechanism in sedentary modular invertebrates preparing for diapause in embryos. To understand how the tumor regression mechanism works, it is necessary to investigate the mechanism of resorption of these embryos in these invertebrates.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"850 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91444156","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-08-05DOI: 10.26420/austinjsurg.2021.1274
E. D., Van der Veeken L, E. A, E. A, A. A., Deprest J
Congenital Diaphragmatic Hernia (CDH) is a rare congenital anomaly characterized by a defect in the diaphragm, which permits abdominal organs to herniate into the thorax. This causes lung hypoplasia and at birth, children with CDH experience respiratory distress and pulmonary hypertension. Despite optimal neonatal treatment, CDH is still associated with a high mortality and morbidity. In severe cases, Fetal Intervention (FETO) may alter the natural course of this disease. Herein we describe the rationale, action mechanism and technique to perform this intervention. Despite hope giving results, this technique remains investigational for left sided CDH. However, an increased survival may come at the cost of increased morbidity. Children born with CDH are at increased risk for long and short-term morbidity, including neurodevelopmental problems. Until now, there are still uncertainties about the severity and prevalence of neurologic morbidity. Furthermore, it remains uncertain if these problems are already present prenatally and if a prenatal intervention influence this.
{"title":"Congenital Diaphragmatic Hernia: More than Just a Lung Problem","authors":"E. D., Van der Veeken L, E. A, E. A, A. A., Deprest J","doi":"10.26420/austinjsurg.2021.1274","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1274","url":null,"abstract":"Congenital Diaphragmatic Hernia (CDH) is a rare congenital anomaly characterized by a defect in the diaphragm, which permits abdominal organs to herniate into the thorax. This causes lung hypoplasia and at birth, children with CDH experience respiratory distress and pulmonary hypertension. Despite optimal neonatal treatment, CDH is still associated with a high mortality and morbidity. In severe cases, Fetal Intervention (FETO) may alter the natural course of this disease. Herein we describe the rationale, action mechanism and technique to perform this intervention. Despite hope giving results, this technique remains investigational for left sided CDH. However, an increased survival may come at the cost of increased morbidity. Children born with CDH are at increased risk for long and short-term morbidity, including neurodevelopmental problems. Until now, there are still uncertainties about the severity and prevalence of neurologic morbidity. Furthermore, it remains uncertain if these problems are already present prenatally and if a prenatal intervention influence this.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"107 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85452174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-07-30DOI: 10.26420/austinjsurg.2021.1269
V. Erikçi
Normal portal pressure is between 0 and 10 mmHg and the pressure in the portal vein is slightly higher than that of the pressure in the inferior vena cava [1]. Portal Hypertension (PH) is usually defined as either a hepatice venous pressure gradient greater than 5mmHg or hepatic venous wedge pressure greater than 10mmHg [2]. It is usually encountered as a complication arising from chronic liver disease and cirrhosis. Common presentation of PH in children include catastrophic variceal hemorrhage usually from esophagus. Other common clinical features of PH include splenomegaly, hypersplenism, ascites, encephalopathy, and hepatopulmonary syndrome and portopulmonary hypertension. It has been reported that up to 15% of children with PH ultimately require shunt surgery [2]. Traditionally shunt surgery was a treatment option for children in whom control of variceal bleeding failed however; it was associated with relatively high rate of anastomotic stricture or thrombosis [1]. Nowadays it has also been reported that as the experience in vascular and transplant surgery together with microsurgical techniques have improved good success rates can be achieved even in small children [1]. In this review article, it is aimed to review the surgical treatment options in children with PH with special regard to shunt procedures under the light of relevant literature.
{"title":"Surgical Shunt Procedures in Childhood Portal Hypertension: A Review Article","authors":"V. Erikçi","doi":"10.26420/austinjsurg.2021.1269","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1269","url":null,"abstract":"Normal portal pressure is between 0 and 10 mmHg and the pressure in the portal vein is slightly higher than that of the pressure in the inferior vena cava [1]. Portal Hypertension (PH) is usually defined as either a hepatice venous pressure gradient greater than 5mmHg or hepatic venous wedge pressure greater than 10mmHg [2]. It is usually encountered as a complication arising from chronic liver disease and cirrhosis. Common presentation of PH in children include catastrophic variceal hemorrhage usually from esophagus. Other common clinical features of PH include splenomegaly, hypersplenism, ascites, encephalopathy, and hepatopulmonary syndrome and portopulmonary hypertension. It has been reported that up to 15% of children with PH ultimately require shunt surgery [2]. Traditionally shunt surgery was a treatment option for children in whom control of variceal bleeding failed however; it was associated with relatively high rate of anastomotic stricture or thrombosis [1]. Nowadays it has also been reported that as the experience in vascular and transplant surgery together with microsurgical techniques have improved good success rates can be achieved even in small children [1]. In this review article, it is aimed to review the surgical treatment options in children with PH with special regard to shunt procedures under the light of relevant literature.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87921933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-06-25DOI: 10.26420/austinjsurg.2021.1273
Yagel O, E. R., Planer D, Lipey A, Rudis E, N. H, Leibowitz D, Elitzur Y, Alcalai R, Elbaz-Greener G
Chest radiotherapy is a common treatment for mediastinal malignancy. The long-term effect of radiation can harm several of cardiovascular structures including pericardium, myocardium, valvular system, conduction system, and coronary arteries. Cardiovascular disease is the most common non-malignancy cause of death in radiation-treated patient, most often occurs many years after treatment. Valvular heart disease secondary to mediastinal radiation mainly affect the aortic and mitral valves. We present a unique case of 58 years old women with history of past mediastinal radiotherapy who presented with few episodes of true syncope, complete AV block, severe aortic stenosis and significant ostial left main and ostial right coronary artery disease.
{"title":"Combined Coronary Artery Bypass Grafting and Transcatheter Aortic Valve Replacement in a Patient with Severe Post-Radiation Damage","authors":"Yagel O, E. R., Planer D, Lipey A, Rudis E, N. H, Leibowitz D, Elitzur Y, Alcalai R, Elbaz-Greener G","doi":"10.26420/austinjsurg.2021.1273","DOIUrl":"https://doi.org/10.26420/austinjsurg.2021.1273","url":null,"abstract":"Chest radiotherapy is a common treatment for mediastinal malignancy. The long-term effect of radiation can harm several of cardiovascular structures including pericardium, myocardium, valvular system, conduction system, and coronary arteries. Cardiovascular disease is the most common non-malignancy cause of death in radiation-treated patient, most often occurs many years after treatment. Valvular heart disease secondary to mediastinal radiation mainly affect the aortic and mitral valves. We present a unique case of 58 years old women with history of past mediastinal radiotherapy who presented with few episodes of true syncope, complete AV block, severe aortic stenosis and significant ostial left main and ostial right coronary artery disease.","PeriodicalId":91056,"journal":{"name":"Austin journal of surgery","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88895826","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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