Search

Objective: The bilateral presentation of Carotid Body Tumors (CBT) is rare; the surgical resection of these masses remains the mainstay management due to the malignant potential. We aim to describe, classify, and quantify baroreceptor failure (BRF) after the surgical management of patients with bilateral CBT to better understand the clinical consequences., Methods: Retrospective review of patients that underwent bilateral CBT resection to assess the changes in baroreceptor function. We describe the clinical events associated to BRF after surgery, baseline patient's demographics, characteristics, comorbidities. Additionally, clinical and a quantitative evaluation of baroreceptor sensitivity were conducted using the Composite Autonomic Severity Score (CASS)., Results: From 1986 to 2020, a total 146 CBT resections were performed in 132 patients in our institution. Tumors were removed bilaterally in staged procedures in seven patients with a mean age of 61 years (Standard Deviation 11), six (85%) were females, and there was no family history of paragangliomas. The clinical presentation were palpable masses in 5 (71%), and odynophagia in 2 (29%) cases; malignant histopathology following surgery was found in one case. BRF occurred in one patient after unilateral CBT resection, consisting of bradycardia and a 40 s asystole that was not previously associated to BR sensitivity. Three (43%) patients presented BRF in the immediate postoperative period of the contralateral CBT excision, consisting of volatile hypertensive crisis in two cases, and supraventricular tachycardia in one. All the patients developed (100%) chronic baroreceptor sensitivity symptoms consisting in syncope, vertigo and fatigue in 4 (57%), tachycardia in 2 (28%), and orthostatic headache in one (14%). Autonomic testing showed mixed sympathetic and parasympathetic failure in five (71%), severe sympathetic failure in 1 (14%), and parasympathetic dysfunction in one patient (14%)., Conclusions: Postoperative autonomic assessment confirmed BRF in all studied patients that underwent staged bilateral CBT resection with mixed, sympathetic, and parasympathetic dysfunction. Further studies are necessary to evaluate the incidence and physiological mechanisms of these sequelae to anticipate possible complications and offer the appropriate perioperative management., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: The increased survival rates of end-stage renal disease (ESRD) patients have impacted directly in the proportion of elderly patients requiring a reliable hemodialysis (HD) access; this group clearly demands an individualized approach. We aim to analyze maturation and patency rates of arteriovenous fistulas (AVF) in elderly patients., Methods: This was retrospective review of a database of patients that underwent AVF creation in our institution. The maturation and patency rates were analyzed divided in groups based on age (equal and greater of 65 years, and patients under 65 years). Patency rates were compared using Kaplan-Meier analysis., Results: Twenty patients ≥ 65 years old (mean 73, SD ± 5.4) were analyzed. The overall maturation rate in this group was 75% compared to 84.1% (p = 0.33) in the younger group (mean age 48 years, SD ± 17). The primary patency at 6 and 12 months for the ≥ 65 years group was 93% and 86%, respectively, compared with 85% and 81% for the younger group (p = 0.77)., Conclusion: Autogenous AVF remains the preferred and durable option for elderly patients. We found no difference in terms of maturation and patency rates compared to younger patients. Standardized protocols are needed to optimally select vascular accesses., (Copyright: © 2023 Permanyer.)

Aortopathies associated to Marfan syndrome (MFS) are important causes of maternal death during pregnancy. We present a 27-year-old and 24-week pregnant MFS woman who arrived to the emergency department with increasing abdominal pain; an obstetric ultrasound showed an Abdominal Aortic Aneurysm (AAA), a multislice computed tomography angiography (CTA) confirmed and demonstrated a 7.3 centimeter (cm) infrarenal AAA without evidence of dissection. A multidisciplinary committee determined that an open repair would lead to a significantly high maternal-fetal morbidity and mortality. Although endovascular repair (EVAR) in MFS patients remains controversial, an urgent bridge therapy was considered to be the best option. She was transferred to the angiography suite for EVAR to prevent AAA rupture and ensure a satisfactory pregnancy. The patient and fetus presented no complications during the procedure and were discharged 3 days later. She continued her pregnancy without eventualities and an elective C-section was performed on week 36. A CTA imaging at 12 months revealed type 1A and 3 endoleaks, we decided to perform endograft explant and a definitive open repair, there were no complications during the procedure, the patient is currently asymptomatic. Our case illustrates a complex decision and management that successfully avoid morbidity and mortality of a MFS mother and her product; additionally, this experience reinforces the need for lifelong and close surveillance in these patients.

Primary aortitis (PA) secondary to Listeria monocytogenes is extremely rare with only a few cases reported in the literature. Presently, there is no consensus concerning the best treatment when no complications are found in the thoracic computed tomography (CT) imaging. This report illustrates the clinical presentation and favorable clinical course of a rare case of PA secondary to Listeria monocytogenes in an 82-year-old diabetic woman, successfully treated with conservative management with 18 months of follow up. Included in this article, we additionally present a review of the literature of this uncommon etiology of infectious aortitis.

Introduction: Esophageal Schwannoma is a rare tumor that represents the least frequent mesenchymal tumor of the esophagus and represents a condition with only a few cases reported in the literature PRESENTATION OF A CASE: We report a 40-year-old female with a 5 years history of gastroesophageal reflux, repeated history of pharyngitis, odynophagia that culminated in progressive oropharyngeal dysphagia to solids. A barium esophagogram revealed a filling defect in the superior and middle thirds of the esophagus. Upper gastrointestinal endoscopy showed a smooth elevated lesion in the upper third of the esophagus, impossible to resect by this mean. An open left cervical approach revealed an 80 × 45 × 20 mm large tumor, which was resected., Discussion: In general, Schwanommas are rarely found in the gastrointestinal tract (GI), while the great majority occur in the stomach, esophagic is the least common GI form of presentation., Conclusion: The knowledge about a new case, impacts in obtaining more information about the clinical course and surgical treatment of this tumor., (Copyright © 2019 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: The open abdomen is a useful resource for treating patients with abdominal hypertension and abdominal compartment syndrome. Currently, early closure assisted with negative pressure devices is considered standard of treatment, and its use has demonstrated favorable outcomes and a decreased rate of complications., Presentation of a Case: We present a case of a 32-year-old male patient with diagnosis of non-seminomatous germinal testicular tumor (Stage IIIB (T3-N3-M1), which was summited to surgery, as a complication he presented massive bleeding, that culminated in acute compartment syndrome. With the aforementioned findings the patient re entered the operating room and was managed with open abdomen combined with a medial retraction technique of the abdominal fascia. Currently, the patient has not presented recurrence or late complications after a year., Discussion: The use of negative pressure techniques for open abdomen management began to be generalized in 1995. Subsequently, this technique evolved to V.A.C therapy (Vacuum-assisted closure therapy). Currently, these negative pressure techniques have become the most used method for the temporary closure and management of open abdomen. Controversies continue to limit its widespread use and effectiveness., Conclusion: Adequate application of negative pressure therapy in combination with techniques of medial retraction of the abdominal fascia, have proved to be useful in management for patients with open abdomen., (Copyright © 2019 The Authors. Published by Elsevier Ltd.. All rights reserved.)