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Background: As a result of increased life expectancy and improved care for patients suffering from chronic disease, the number of patients with multimorbidity requiring surgical intervention is increasing. For complex surgical patients, it is essential to balance the potential benefits of surgical treatment against the risk of permanent loss of functional capacity and quality of life due to complications. European and US guidelines on perioperative care recommend preoperative multidisciplinary team (MDT) discussions for high-risk noncardiac surgical patients. However, the evidence underlying benefits from preoperative MDT meetings with all relevant perioperative specialties present is limited. The current study aims to investigate the effect of implementation of preoperative MDT discussions for high-risk patients undergoing noncardiac surgery on serious adverse events., Methods/design: PREPARATION is a stepped-wedge cluster randomized trial in 14 Dutch hospitals without currently established preoperative MDT meeting. The intervention, preoperative MDT meetings, will be implemented sequentially with seven blocks of 2 hospitals switching from control (preoperative screening as usual) to the intervention every 3 months. Each hospital will be randomized to one of seven blocks. We aim to include 1200 patients. The primary outcome is the incidence of serious adverse events at 6 months. Secondary outcomes include (cost)effectiveness, functional outcome, and quality of life for up to 12 months., Discussion: PREPARATION is the first study to assess the effectiveness of a preoperative MDT meeting for high-risk noncardiac surgical patients in the presence of an anesthesiologist. If the results suggest that preoperative MDT discussions for high-risk patients are (cost)-effective, the current study facilitates implementation of preoperative MDT meetings in clinical practice., Trial Registration: ClinicalTrials.gov NCT05703230. Registered on 11/09/2022., (© 2023. BioMed Central Ltd., part of Springer Nature.)

Introduction: Primary prophylaxis has significantly reduced the number of orthopedic surgical procedures performed on patients with hemophilia (PWH) worldwide. However, studies on orthopedic surgery in PWH are still being published in the medical literature., Areas Covered: The aim of this article is to determine the types of orthopedic surgical interventions in PWH published between 2020 and 2023 and the countries in which they are published., Expert Opinion: The following orthopedic surgical procedures are still performed on PWH: total knee, ankle, elbow and hip arthroplasty, ankle fusion, ankle distraction, and the surgical removal of hemophilic pseudotumors. The countries in which articles on orthopedic surgery in hemophilia have been published in the period 2000-2023 include China (14 articles); Republic of Korea and U.S.A. (3 articles each); Germany, Italy, Japan, Poland and Turkey (2 articles each); and 1 article each in the following countries: Austria, Belgium, Chile, France, Ireland, New Zealand, Russia, and The Netherlands. These data suggest that primary prophylaxis should be improved and extended to all patients globally.

Objective: To evaluate the impact of the specialty (urologist vs radiologist) of the physician obtaining percutaneous renal access (RA) on perioperative outcomes, complications, and costs of percutaneous nephrolithotomy (PCNL)., Materials and Methods: We used data from a national hospital discharge database to identify patients undergoing PCNL between 2003 and 2015. Procedure codes related to RA were linked to physician specialty. We examined patient demographics, Charlson comorbidity index, postoperative complications, length of stay (LOS), and direct hospital costs, as well as hospital and surgeon characteristics stratified by specialty of the physician obtaining RA. A multivariable regression model was created adjusting for potential confounders., Results: We identified 40,501 patients undergoing PCNL between 2003 and 2015. Urologists obtained access in 17.0% of cases. RA by urologists was associated with a lower 90-day complication rate (5.0% vs 8.3%, p < 0.001) and lower rates of prolonged hospitalization ≥4 days (22.5% vs 42.1%, p < 0.001). On multivariable analysis, RA by urologists was associated with lower rates of any complication (Clavien 1-5) (odds ratios [OR] 0.70, p ≤ 0.001), shorter LOS (OR 0.67, p < 0.001), and lower direct hospital costs (OR 0.65, p < 0.001)., Conclusion: In the United States, radiologists obtain percutaneous RA in the majority of PCNLs. Access by urologists is associated with lower overall complications, shorter hospitalizations, and lower direct hospital costs. Coding errors and absence of stone complexity information may limit the cogency of our findings and requires further investigation.

Abstract The relative risk and benefits of Laparoscopic liver resection (LLR) are still controversial. This study aimed to evaluate perioperative and survival outcomes for three primary malignant liver tumors related outcomes following LLR. Data from three Homogeneous-High-Volume-Expert-Centers were collected. Multivariable logistic regression analysis was performed for the association between LLR, and major complications defined as Clavien-Dindo Classification grade ≥ II. Multivariable Cox proportional hazards regression was used to explore the impact of LLR on primary malignant liver tumor survival. Overall, 5886 patients underwent liver resection, of which 1991 underwent LLR. After adjusting for covariables, LLR had significantly lower rate of CDC grade ≥ II (OR = 0.56, 95% CI: 0.48–0.67, P 0.05). LLR was associated with lower rate of major complications, especially in women, non-drinkers, those without a history of abdominal surgery, and those with normal platelet. For primary malignant liver tumors, the survival outcomes did not differ significantly between LLR and OLR.

Abstract Introduction Kirschner wires are frequently employed in orthopedic procedures. While most complications are minor, rare instances of distant pin migration can occur. Such migration is more prevalent in the shoulder region but has been reported elsewhere. Case presentation A 50-year-old Persian male with a right femoral neck fracture (Garden type IV) underwent closed reduction and internal fixation with three cannulated screws. During the procedure, a guide pin broke and remained lodged. Follow-up radiographs revealed the migrated pin in the patient’s chest wall near the 11th rib, necessitating surgical removal via thoracotomy. Conclusion This case underscores the potential for orthopedic implant migration. While often associated with smaller pins, the risk exists for all sizes. The timeframe for diagnosis varies significantly and in some cases it can be asymptomatic and discovered incidentally.

Abstract To analyze the clinical features, epidemiological characteristics, risk factors, and complication characteristics of pulmonary tuberculosis (PTB) combined with extrapulmonary tuberculosis (EPTB) in elderly patients (aged > 60 years). Clinical data were collected from pathogen positive elderly patients with PTB hospitalized in a teaching hospital in Zhejiang from 2017 to 2023. We retrospectively analyzed the risk factors for complications of EPTB in elderly patients with PTB by univariate and multivariate logistic regression models. We also described the characteristics of complications in PTB with EPTB. A total of 781 PTB elderly patients were enrolled, of whom 86 (11.01%) had complicated EPTB. The most commonly invasive sites for EPTB were thoracic spine (17.53%), cervical lymph nodes (13.40%), and meninges (12.37%). 60

Abstract We sought to identify long-term associations of medical complications and healthcare utilization related to polypharmacy following spinal surgery for degenerative lumbar pathology. The IBM MarketScan dataset was used to select patients who underwent spinal surgery for degenerative lumbar pathology with 2-year follow-up. Regression analysis compared two matched cohorts: those with and without polypharmacy. Of 118,434 surgical patients, 68.1% met criteria for polypharmacy. In the first 30 days after discharge, surgical site infection was observed in 6% of those with polypharmacy and 4% of those without polypharmacy (p

Abstract This research explores the challenges posed by variations in cystic duct anatomy during laparoscopic cholecystectomy and the potential use of stapler devices to address such complexities. It aims to assess the safety and efficacy of stapler devices, particularly in cases involving short, and wide cystic duct. The study, conducted at King Abdulaziz Medical City in Riyadh, Saudi Arabia, between 2021 and 2023. The study design involved a retrospective cohort approach, and the sample size encompassed all cases meeting the inclusion criteria during the study period. Data was analyzed using SPSS program. The study involving 568 patients, with the predominant technique for ligation being clipping (89.3%). The primary indication for using the Endo GIA stapler was a wide cystic duct (6.2%). Analysis revealed a significant association between stapler device use and hypertension (p = 0.042), diabetes (p = 0.001), CKD (p = 0.011), and obstructive jaundice (p = 0.006). Multivariate regression demonstrated that older patients were 2.1 times more likely to use stapler devices (AOR = 2.125; p = 0.039), while those with obstructive jaundice had a 2.2 times higher likelihood (AOR = 2.168; p = 0.049). Throughout the years, metal clips have shown the best prognosis compared to any other method for securing the cystic duct during closure in laparoscopic cholecystectomy. However, to avoid incomplete sealing of wide, short, or inflamed ducts, other instruments have emerged as possible alternatives for such conditions. Use of Endo-GIA is a safe and effective method for patients with wide, short cystic duct. Selective usage of endo-GIA is considered cost effective and may add a positive impact in decreasing post operative biliary leak.

Background/Objectives: Periprosthetic joint infection (PJI) is one of the most common complications after joint replacement. Two-stage revision remains the standard of care in chronic infections. The aim of this systematic review was to investigate the outcomes, complications, and eradication rates of two-stage revision surgery to treat PJI of the shoulder, elbow, hip, and knee. Methods: A total of 36 studies were included. Patient demographics, follow-up, the visual analog scale (VAS) for pain, the Constant–Murley score (CMS) for shoulder, the Harris Hip Score (HHS) for hip, the Knee Society Score (KSS) for knee, the range of motion (ROM), number and types of complications, and eradication rate were recorded. Results: A total of 2484 patients were identified, of whom 145, 29, 1269, and 1041 underwent two-stage revision surgery for shoulder, elbow, hip, and knee infections, respectively. The overall mean follow-up was 5.7 ± 4.5 years. The overall mean time of re-implantation was 20.8 ± 21.3 weeks. The most common causative bacteria were Cutibacterium acnes (32.7%) for shoulder, Methicillin-Sensitive Staphylococcus aureus (44.4%) for elbow, and Staphylococcus coagulase negative (CNS) (31.3% and 23%) for hip and knee infection, respectively. The mean overall preoperative VAS score was 6.7 ± 2.3, while, postoperatively, the mean score was 4.5 ± 2.7 (p < 0.001). A total of 2059 out of 2484 patients (82.9%) experienced eradication. Conclusions: Two-stage revision is an effective procedure to treat PJI with an overall eradication rate of 83%. A significant recovery of functionality and a decrease in residual pain can be achieved after surgery. Aseptic loosening and re-infection were the most common complications in shoulder and hip infections. Death rate was high in knee infections.

The aim of the study to assess the resistance of infectious complication pathogens to antibacterial drugs in patients after major liver resection (MLR) with or without biliary obstruction. Material and methods. A total of 105 patients were assigned to 2 groups: group 1 consisted of 53 patients (7 – with hepatocellular carcinoma (HCC), 28 – with cholangiocarcinoma (CC), 18 – with metastases of colorectal cancer) with biliary obstruction; group 2 – 52 patients (25, 10 and 17, respectively) without biliary obstruction. Results. A microbiological examination of urine, blood, sputum, bile, pharyngeal and wound samples was performed after MLR. Conclusions. Patients with HCC and CC with biliary obstruction after MLR had infectious complications in 100.0 % of cases, patients without biliary obstruction – in 25.7%; Gram-positive microorganisms were statistically significantly more often isolated from them: Enterococcus faecalis in 17.1 % (р1,2 = 0.01); gram-negative microorganisms: Escherichia coli in 5.7 % (р1,2 = 0.05), hemolytic Escherichia coli in 5.7 % (р1,2 = 0.05), Pseudomonas aeruginosa in 5.7 % (р1,2 = 0.05); fungi in 8.6 % (р1,2 = 0.04); significantly more often, Enterococcus faecalis was isolated from blood in 5.7 % (р1,2 = 0.05), Enterococcus faecium – from urine in 8.6 % (р1,2 = 0.05), Candida albicans – from wounds in 5.7 % (р1,2 = 0.05) and sputum in 8.6 % (р1,2 = 0.02).

Introduction: Surgical treatment for Benign Prostatic Hyperplasia (BPH) has advanced significantly in recent years. Transurethral Resection of the Prostate (TURP) is a minimally invasive procedure associated with a low risk of complications and clinical limitations, including life-threatening Transurethral Resection (TUR) syndrome, as, well as higher costs due to longer hospital stays and challenges in managing large glands. Aim: To compare the safety and effectiveness of prostate enucleation using Holmium Laser Enucleation of the Prostate (HoLEP) with bipolar resection of the prostate in cases of BPH. Materials and Methods: A hospital-based prospective interventional study was conducted in the Department of Urology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, Maharashtra, India, from January 2020 to July 2022. The study included 60 patients, divided into two groups of 30 each. Males aged ≥45 years with recurrent Lower Urinary Tract Symptoms (LUTS) secondary to BPH, with or without Acute Urinary Retention (AUR) (drug-refractory) or with failed medical therapy (alpha-blockers, 5-alpha reductase inhibitors), were included in the study. In the first group, HoLEP was performed (Group I), while in the second group (Group II), patients underwent bipolar resection. Data were analysed and statistically evaluated using Statistical Package for the Social Sciences (SPSS) software version 21.0. A p-value of less than 0.05 was considered statistically significant. Results: The mean age of patients in the HoLEP group was 60.25 years, while in the Bipolar TURP (B-TURP) group, it was 59.67 years. Both groups had similar proportions of patients with moderate urinary symptoms {International Prostate Symptom Score (IPSS)} and large prostates (>80 grams). The mean amount of irrigation fluid used (40.83±9 litres vs. 21.2±5.9 litres) and the duration of surgery (106.33±14.24 min vs. 67.4±9.73 minutes) were significantly higher in the HoLEP group compared to the B-TURP group (p-value

The interventional cardiac catheterization for treating congenital heart disease has evolved. Complications following interventional procedures might need emergency surgery as a bailout. Here, we report a case of cardiac perforations in three different sites following device closure of atrial septal defect (ASD). In literature, the major sites of ASD device erosion are at the roof of the right atrium (RA), left atrium (LA), or at the atrial junction with the aorta. In our patient, the device eroded at all three sites: the roof of the LA, RA, and the aorta, causing hemopericardium.

Non-Hodgkin’s lymphoma (NHL) is the most common type of Gastrointestinal (GI) lymphoma with known complications such as bleeding, obstruction and perforation. In this article we present a 59-year-old male patient diagnosed with Peripheral T cell Lymphoma – Not Otherwise Specified (PTCL-NOS) with GI involvement was started on chemotherapy. On day 2 post completion of first cycle of chemotherapy, patient had presented to the emergency department with sudden onset abdominal pain and distension. On evaluation, he was diagnosed with multiple perforations in the small bowel. Patient underwent exploration with primary repair of few perforations and ileal resection with double barrel ileostomy. Chemotherapy plays an important role in the management of NHL. One well-known NHL consequence, intestinal perforation, can happen at the time of initial presentation or after starting chemotherapy. Surgeons should be aware of possibility of such complications and high-risk factors for perforation. At present, there is no role for elective surgery in GI lymphoma and is mainly reserved for complications like uncontrolled bleeding, obstruction or perforation.

Introduction: Syndactyly is a common congenital deformity with an incidence of 1/2000–3000 with a male predominance. Several surgical approaches were described for various clinical presentations. Despite well-documented techniques in current literature, causes, and management of complications remain a topic of debate and often vary based on clinical experience. This study aims to outline our surgical outcome and compare the related complications to those reported in the literature. Materials and Methods: Patient data were extracted from the clinical database and a retrospective study was conducted on 55 patients who underwent syndactyly release. Standardized surgical interventions were performed and early postoperative complications were recorded. Results: Of 55 patients, 39 patients were male and 16 were female. The surgical release of 102 webs (63 hands-71 webs, 21 feet-31 webs) was performed. Gender is not a factor that affects the complication rates (P = 0.062, P > 0.05). Age at surgery over 2 years is associated with increased postoperative complications (P = 0.032, P < 0.05). During the follow-up period, the most frequent complication was web creep (7%). Conclusion: Our retrospective study, despite its limitations, provides valuable insights into achieving successful outcomes and guides future research.

COVID-19 is characterized by various adverse consequences and complications, the prevention of which affects the outcome of the disease. Aim of the study was to investigate the thrombohemorrhagic events of COVID-19 infection. Material and methods. This study involved 403 patients with novel coronavirus infection; the patients were divided into 2 groups: 75 with COVID-19 complications and 328 patients without complications. Metabolic disorders, features of lung damage, comorbidity, signs of inflammation and coagulation, treatment outcomes, peculiarities of thrombotic events and hemorrhages development were studied. Results and its discussion. Thrombohemorrhagic complications of COVID-19 occurred mostly in patients with angina pectoris, coronary artery sclerosis and chronic heart failure of functional class II–III, as well as decompensated diabetes mellitus and obesity. These coronavirus infection effects are often accompanied by an increase in content of inflammatory markers such as CRP and ferritin, as well as of hypercoagulability (D-dimers). Conclusions. Manifestations of inflammatory coagulopathy in patients infected by COVID-19 increases risk of thrombohemorrhagic complications.

In the structure of total mortality, cardiovascular diseases are in the first place in the world. The main and most common reason for this is the incidence of myocardial infarction (MI). The basis of the pathogenesis of MI with ST elevation is persistent and complete thrombotic occlusion of the large epicardial branch of the coronary artery, leading to extensive necrosis of the heart muscle with the development of life-threatening complications, including death, the frequency of which is 8–10 %. The prognosis for MI is influenced by the presence of risk factors, complications, hemodynamic status, polymorbidity, as well as tactics for restoring coronary blood flow. To eliminate acute coronary artery occlusion, conservative treatment is used – thrombolytic therapy, surgical – primary percutaneous intervention, thromboextraction, coronary bypass surgery, as well as their combination. Today, there are scattered and isolated studies characterizing the approach to treatment in patients with MI with ST elevation in various diseases and with polymorbid pathology, the relationship with risk factors and laboratory and instrumental data has not been established, among which predictors of rapid response and death in patients with polymorbid pathology for emergency physicians have not been determined. It can be assumed that the chosen optimal patient management tactics in a specific clinical situation, taking into account the above-mentioned factors, will reduce the development of complications and increase the survival rate of patients with MI.

Objective: Type 2 Diabetes mellitus (T2DM) is the most prevent metabolic disease. Gender differences are important in the epidemiology, pathophysiology, and treatment of many diseases. The aim of this study is to investigate the gender effect on laboratory variables and complications in patients with T2DM. Materials and Methods: In this descriptive cross-sectional study, patients with T2DM between 35 -65 years old who referred to Diabetes Research Center, Yazd, Iran during 2018-2019 were studied. Demographic features and clinical information of patients were extracted from patients' medical records. All information and variables were examined in two groups according to gender and the data were analyzed using SPSS 19. Results: Totally, 1931 patients were enrolled in the study (988 females and 943 males). Most of the patients (68.6%) were treated with insulin. Body mass index was higher in women than in men. The variables of LDL (P= 0.029), triglyceride (P< 0.001) and retinopathy (P= 0.021), were significantly different between men and women. Conclusion: The results of this study showed there are significant differences between male and female patients with T2DM in terms of lipid profiles and retinopathy.

Abstract This study aimed to analyse the treatment and outcomes of traumatic hip dislocation (THD) in children. Clinical data of children with THD were collected at our clinical centre from 1 June 2012 to 1 January 2023. Demographic data, injury mechanism, type of dislocation, combined injuries, reduction time, reduction method, and radiographs were analysed. The Merle d’Aubigné–Postel hip score was used to evaluate hip function and complications at the final follow-up. A total of 19 children with THD were enrolled, including 12 male and seven female patients, with an average age of 8.28 ± 0.99 years. Posterior dislocation was the main type of dislocation (89.47%). Fifteen patients (78.95%) had experienced high-energy injuries and traffic accidents were the main causes of injury (47.37%). Closed reduction was performed as soon as possible, and open reduction was performed if necessary. The hip scores of 18 patients (94.74%) were excellent. One patient had osteonecrosis of the femoral head, with a hip function score of 10 (moderate). High-energy injuries, such as traffic accidents, have gradually become the main cause of injury. The prognosis for THD in children is generally good.

Background: The incidence of scule glomeruloneplaritis (AGN) is iodalinc in developed countries and usually runs an complications. To class study we aim to determine the cutore complications and outcome of childhood AG in Port Harcourt, Nigeria. Patients and Methods: A prospective study of children with acute glomerulonephritis (AGN) aurulled to the children's wador Emergency ward of the dearment of Paediatrics, Triversity of Text Harcourt Teaching Hospital (UITH) from June 2006 to June 2007, was carried out. The complications, investigations, treatment (conservative with or without dialysis) and outcome were document and analyzed Results: The 31 patients with AGN1epresenter 38.5 percent of the 81 renal cases (excluding urinary tract infection) seer during the study period. They consisted of 16 (51.6 percent) males and 15 (18.4 percent) females, and were aged 3-16 years with a mean age of 3+ 4.2 years. Toenry (64.5 percent) patients had at least, the complication, and six (19.4pxecent) had more than one complication. There were more less [11: 55. TCETA] with complications ibuujemales [nine: 45.0 PETLET although the inference was not significant (p > 0.80). There was also the significant difference local patients will and without complications (p > 0.96). Acute Tenud Trul.rc (ARD) was the soonest complication serial 12 (38.7 percent) paticuts. Hypertensive encephalopathy will seizure occurred in five patients. Others included pulmonary vedere in five, nephrotic syndrome in four, axemia in four, while congestive. cardiac failure and chronic renal failure occurred in two parties each live patents with ARF underwood dialysis due to failure of conservative measures within traceable hypertension (2) and uncmis (3). The mean duration of admission was 12.3 1 9.6 days (raniye 7- 16 days). Three patients, comprising two with intocable hypertension and one with waertia died in the hospital. Conclusion: Most cases of acute glomerulonephritis in this study the complications, with morality mainly from hypertensive encephalopulliy and uraccia.

Abstract The current study aimed to evaluate the effect of lymph node ratio (LNR) on the short-term and long-term outcomes of colorectal cancer (CRC) patients who underwent radical CRC surgery. We retrospectively collected CRC patients who underwent radical surgery from Jan 2011 to Jan 2020 in a single-center hospital. The patients were divided into the high LNR group and the low group according to the median. The baseline information and the short-term outcomes were compared between the high group and the low group. Univariate and multivariate logistic regression was performed to analyze the independent predictors for overall survival (OS) and disease-free survival (DFS). A 1:1 proportional propensity score matching (PSM) was used to reduce the selection bias between the two groups. Kaplan–Meier method was used to estimate the OS and DFS between the two groups in different T stages. A total of 1434 CRC patients undergoing radical surgery were enrolled in this study, and there were 730 (50.9%) patients in the low LNR group and 704 (49.1%) patients in the high LNR group. After the PSM, there were 618 patients in both groups, the baseline characteristics between the two groups had no significant difference (p > 0.05). After comparing the Surgery-related information and The Short-term outcomes, the high LNR group had a longer hospital stay (after PSM, p

Introduction: Lymphatic cystic malformations occur in the mesentery of the small and large bowel, omentum and retroperitoneal area and are rare, benign, intra-abdominal cystic lesions. Aim: To review the demographics, clinical presentation and surgical outcomes of children’s mesenteric and omental lymphatic cystic lesions. Materials and Methods: A single-institution, retrospective descriptive study was conducted in the Department of Paediatric Surgery, Gandhi Medical College and Associated Hospitals, Bhopal, India, from January 1, 2000, to December 31, 2023. It included cases of lymphatic cystic lesions in infants and children below 12 years of age involving the mesentery of the small and large bowel and omentum. The details collected from the case records were the age, sex, clinical presentation, radiological investigations carried out, operative findings and the outcome of the operative intervention executed for mesenteric and omental lymphatic cysts in children. The results obtained from the present study are expressed in numbers and percentages. Results: The present study analysed 18 children aged ≤12 years who underwent surgery for lymphatic cysts of the mesentery of the small bowel (n=14), large bowel/mesocolon (n=1) and omentum (n=3) during the study period. There were 11 boys and 7 girls. More than four-fifths (n=15) of the children were ≤5 years old at the time of diagnosis and operative therapy provided. One-third (n=7) of the cases clinically presented with the clinical features of intestinal obstruction. The cysts involved the mesentery of the small bowel in three-fourths (n=14) of the cases. The complete excision of the lymphatic cysts was possible in three-fourths (n=14) of the cases. In 10 children, resection of the adjacent/involved small bowel segment was also required during the operative procedures. Fifty percentage of the cases revealed volvulus of the small bowel caused by mesenteric cysts involving the small bowel. More than half of the cases required resection of the adjacent/involved segment of the small bowel along with excision of the mesenteric cysts. Conclusion: Mesenteric cysts are rare abdominal pathology with diverse clinical presentations ranging from vague abdominal pain and lump to an acute abdomen. Early referral to higher centres, diagnosis and prompt surgical excision of the mesenteric cysts can prevent volvulus, one of the most common complications and requirements of an emergency surgical procedure.

Often premature birth is accompanied by preterm premature rupture of membranes (PPROM). PPROM is a complication of the course of pregnancy in 2–3 % cases and is the most common in premature birth. As a rule, the protocols for the management of such patients vary greatly and are mainly individual. In practical obstetrics, there is an urgent need to decide whether the risk of complications resulting from previous PPROM exceeds the risk of intrauterine infection. Of course, the need for further research in this area is necessary, which will help to choose the tactics of the maximum allowable period that would be optimal for reducing perinatal morbidity and mortality, as well as to identify factors that improve the prognosis for the mother and fetus. The review analyzes and summarizes the results of studies on PRPO in premature pregnancy complicated by chorioamnionitis. The advantages and disadvantages of various approaches in the management of such patients are considered. The modern medical literature presented in eLibrary and CyberLeninka electronic libraries, PubMed database of medical and biological publications has been studied.

Background: Birth injuries to the brachial plexus are highly rare; however, they necessitate treatment and follow-up from infancy until skeletal maturity. Many complications may arise as a result of primary nerve surgery. Objectives: To study the long-term complications of nerve repair procedures in patients with obstetric brachial plexus palsy. Patients and methods: This was retrospective research that was performed on 8 cases having obstetric brachial plexus palsy and underwent nerve surgery procedure. The ages ranged from 3 to 20 months. The assessment of the surgical procedure outcomes involves post-operative evaluation of both short and long-term complication. Results: Our study showed that the most frequent long-term complications were decreased innervation (25%), followed by decreased strength and stamina and balanced discoordination (12.50%) while there were no complications encountered in 50% of cases. The short-term complications included wound infection, seroma and hematoma. Conclusion: The nerve surgery procedure is an efficient primary approach in the management of cases with brachial plexus injury. However, a long-term follow-up is usually associated with late squeal such as reduced innervation and decrease in the overall strength and stamina.

The development of new local treatment methods of peritoneal carcinomatosis in ovarian cancer is an urgent task due to the fact that in most cases complete surgical cytoreduction is technically impossible, and systemic cytostatic therapy does not provide a stable therapeutic effect. The pressurized intraperitoneal aerosolized chemotherapy (PIPAC) is a local method of treating peritoneal carcinomatosis in ovarian cancer, which allows for uniform distribution of medicinal aerosol over the peritoneum and is used together with standard combined treatment in order to improve its outcomes.Purpose of the study. To analyze the effect of PIPAC, used in addition to the standard combined treatment of ovarian cancer with peritoneal carcinomatosis, on the clinical outcome of surgical treatment and long-term results.Patients and methods. Our prospective randomized open-label controlled trial included 169 patients with newly diagnosed ovarian cancer with peritoneal carcinomatosis. The main group included 84 patients and 85 in the control group. Randomization was performed intraoperatively using a digital randomizer. The distribution was homogeneous according to the stages of ovarian cancer (Barnard's criterion = 0.292) and the peritoneal carcinomatosis index (PCI) (Mann-Whitney U test = 0.625). We used a combination of surgical cytoreduction with a one-time PIPAC session and subsequent systemic chemotherapy within the framework of one hospitalization, further PIPAC sessions were performed 2 more times with an interval of 42 days in combination with systemic chemotherapy within the framework of one hospitalization. All patients were operated on at the first stage in the volume of extirpation of the uterus with appendages and removal of the large omentum, all underwent systemic cytotoxic therapy scheme: paclitaxeln 175 mg/m2 , carboplatin AUC 5–7) (6 courses with an interval of 21 days). In the main group, 3 sessions of PIPAC were added to the standard treatment. To study the surgical safety profile of PIPAC, all adverse events of a surgical profile were recorded at each hospitalization. The duration of life without relapse was estimated as the main outcome, the median relapse-free survival was the main indicator. The total duration of the study was 36 months.Results. During statistical processing, it was found that the median disease-free survival in the group with the use of PIPAC was 8 months higher. Thus, in the control group, the median disease-free survival was 13 months in the 95 % confidence interval (in the range of values from 12 to 14 months), in the main group – 21 months (95 % confidence interval, range from 18 to 22 months). Surgical adverse events were reported in 1.2 % after 252 sessions of PIPAC over the entire study period. These phenomena didn’t require additional medical interventions, didn’t increase the duration of hospitalization and didn’t lead to the exclusion of patients from the clinical trial protocol.Conclusion. The use of the PIPAC technique as an additional method of standard regional treatment has demonstrated an improvement in the results of treatment of newly diagnosed ovarian cancer with peritoneal carcinomatosis. PIPAC has a favorable surgical safety profile and is a promising method of local exposure to peritoneal carcinomatosis in both clinical and research work.

Retention (delayed eruption) of the third molar is one of the most common pathologies in the outpatient practice of a dentist-surgeon. Such a pathology can very often be complicated by inflammatory diseases, such as pericoronitis, periostitis and other more serious diseases. Therefore, early warning and most gentle removal of the causative tooth determines the professionalism of the dental surgeon. A large number of indexes of difficulty of removal of the third molar have been proposed by different authors, but none of them is considered universal and optimal for different clinical cases. The level of complexity is most clearly characterized by a scale that takes into account not only radiological but also clinical and demographic indicators. Such scales exist in modification or in more recent literary sources. Having chosen the most clear and correct scale, it is possible for the surgeon to clearly assess the entire level of complexity and responsibility for surgical intervention on removing the third molar, thereby obtaining the most effective result, minimizing complications both during the operation and after a while. The purpose of the study: justification of the selection of the difficulty rating scale for the removal of the third molar of the lower jaw, depending on its position. The study analyzed and compared 18 basic scales of complexity that are most often used by surgeons before removing the impacted third molar of the lower jaw. Data sources that were used for the search were taken from Medline, PubMed, Google Scholar, Minerva library databases. Each of the difficulty scales was presented and translated into Ukrainian for convenient use in the practice of a dental surgeon. A general table was provided where a comparative analysis of the difficulty scales was made according to thirty parameters. It is shown that the Cosme Gay-Escoda C. scale has the most indicators for preoperative assessment of complexity. There are many difficulty scales for preoperative assessment for the removal of impacted third molars of the lower jaw. Some of them have radiological evaluation criteria, some have clinical criteria, and only the Pernumbuco index (2017), Zhang X. (2019), and Cosme Gay-Escoda C. (2022) scales also have demographic indicators. However, the latter has the largest number of criteria, according to which the difficulty of removing the third molar of the lower jaw is calculated.

Ventriculoperitoneal shunt malfunction is frequently observed, with the ventriculoperitoneal shunt fracture being a prevalent etiology. The occurrence of ventriculoperitoneal shunt malfunction is approximately 40% in the first year after implantation and increases to 50% in the second year. Ventriculoperitoneal shunt fracture accounts for 15% of total ventriculoperitoneal shunt malfunction incidents. Ventriculoperitoneal shunt fractures commonly occur due to calcification, immune reactions, and abrasions. The report describes a 5-year-old child who exhibited ventriculoperitoneal shunt malfunction based on clinical examination and CT scan findings. The patient presented with fever and pain in the postoperative wound located posteriorly to the left ear. Radiographic imaging of the cranium and thoracoabdominal region revealed the presence of a ventriculoperitoneal shunt fracture and a C5 spinal disconnection. Additionally, it was demonstrated that the distal catheter had relocated to the abdominal cavity. The laboratory examination and cerebrospinal fluid analysis yielded normal results. The fractured ventriculoperitoneal shunt was subsequently removed and replaced with a new one. It is important to thoroughly investigate and comprehend ventriculoperitoneal shunt malfunctions, even during routine follow-ups.

Relevance. The high primary incidence of peptic ulcer in people of working age and frequent relapses with a complicated course are accompanied by temporary but quite long-term loss of ability to work, a decrease in labor productivity and quality of life of patients, as well as disability and mortality, which determines the important medical, social and economic status of this disease. In addition, a significantly increasing contribution of primary morbidity to the overall morbidity is made by pediatric patients, and the morbidity of elderly and senile people is growing. In the Russian Federation in 2019, 1,188,551 cases of peptic ulcer disease were registered, 101,680 (8.5 %) of which were diagnosed for the first time in life. According to recent studies, the lifetime prevalence of peptic ulcer disease in the general population of the Russian Federation is 5–10 %, and the annual incidence is 0.1–0.3 %.In the Russian Federation, the incidence of ulcer in children in the last decade is 1100–1500 cases per 100,000 children. In 81–87 % of children, the localization of a newly detected ulcerative defect is determined in the duodenal zone, in 11–13 % — in the stomach wall, and in 4–6 % of children, a combination of ulcer localization in the stomach wall and duodenal zone is noted. The number of complications in the form of bleeding is recorded with an annual frequency of 19 to 57 per 100,000 people. (from 0.02 to 0.06 %). The number of complications in the form of perforation ranges from 4 to 14 cases per 100,000 people. (from 0.004 to 0.014 %). Mortality from complications of peptic ulcer and erosive and ulcerative lesions of the stomach and duodenum is 7.7 % of all deaths caused by diseases of the digestive system. Conclusion. Peptic ulcer disease currently remains one of the diseases of the human digestive system that requires studying the accumulated experience of domestic and foreign medicine and further multidisciplinary research to improve treatment results for this category of patients, and the epidemiology of gastric and duodenal ulcers continues to be of interest, both scientifically and from a practical point of view.

Abstract Although bilateral simultaneous total knee arthroplasty (BSTKA) is an effective treatment for bilateral knee osteoarthritis, safety concerns and lack of precise patient selection criteria persist. The purpose of this retrospective study was to determine the complication rate and the role of frailty in patient selection for BSTKA. We analyzed data from 434 patients who underwent BSTKA between February 2012 and January 2021, examining demographic factors and preoperative blood test results. Complications occurred in 77 patients (18%), with anemia requiring transfusion being the most common (26 patients, 5.9%). In the univariate analysis, age ≥ 75 years, age-adjusted Charlson Comorbidity Index ≥ 5, age-adjusted 5-factor modified Frailty Index (aamFI-5) ≥ 3, hemoglobin ≤ 11.0 g/dL, albumin ≤ 3.5 g/dL, estimated glomerular filtration rate

Background. An introduction of minimally invasive technologies contributes to annual increase in the number of surgical interventions for hiatal hernia. However, the rate of major complications (pain syndrome, dysphagia and recurrence of gastroesophageal reflux) inevitably reaches 32%. 19% of the patients need re-surgery, 60‒70% of them fail to recover, and 45% undergo surgical interventions for the third time.Aim. To specify the major complications of surgical treatment for hiatal hernia and to substantiate the optimal techniques of reconstructive interventions for its elimination.Methods. An observational non-randomized study involved 78 patients diagnosed with hiatal hernia without obstruction or gangrene. Patients were categorized into three groups depending on the performed surgical intervention — primary or reconstructive. Group 1 included 31 patients who underwent surgical treatment by means of traditional tactics and techniques (Nissen, Dor procedures); Group 2 enrolled 35 patients after incomplete selective proximal vagotomy with fundoplication according to Chernousov; Group 3 consisted of 12 patients who underwent reconstructive re-surgey for complications of surgical treatment of hiatal hernia. Surgical interventions were performed in five city and district general surgical hospitals of Belgorod Oblast, Russia. The hospitals were considered equally equipped and had surgeons of similar qualification. Patients were included in the study from 2015 to 2023, the follow-up of each patient lasted from 3 months to 8 years. The results of surgical treatment were evaluated by a questionnaire survey. Presence and severity of the major complications of surgical treatment for hiatal hernia were assessed according to the Dakkak scale and Gastro Esophageal Reflux Disease (GERD) questionnaire, evaluating patient outcomes as excellent, good, satisfactory, and unsatisfactory. Statistical data processing was carried out by means of Microsoft Excel 2019 (Microsoft, USA). A statistical level with p ≤ 0.05 was considered statistically significant.Results. The major complications of surgical interventions for hiatal hernia include recurrence of gastroesophageal reflux, pain syndrome and dysphagia, which made up 54.8, 48.4 and 61.3% in Group 1, respectively. In total, the shares of all types of complications exceed 100%, as three patients were recorded with all three complications, 12 patients — with two types of complications, and 15 patients had one complication. The results evaluating the patient’s condition were expressed as good in 19.4% of patients, satisfactory — in 22.6%, and unsatisfactory — in 58.0%. In Group 2, the results evaluating the patient’s condition appeared only good (22.9%) and excellent (77.1%). The reconstructive interventions in Group 3 included: elimination of cruroraphia; incomplete selective proximal vagotomy with modified gastroesophageal refundoplication and fundoplication according to Chernousov; formation of the esophageal hiatus in the diaphragm adequate to the parameters of the fundoplication cuff. The results evaluating the patient’s condition appeared only good (22.2%) and excellent (77.8%).Conclusion. The major complications of surgical treatment for hiatal hernia include pain syndrome, dysphagia and recurrence of gastroesophageal reflux and can be eliminated by the reconstructive interventions composed of the following techniques: elimination of cruroraphia, removal of the cuff, incomplete selective proximal vagotomy, refundoplication by the modified method according to Chernousov, formation of the esophageal hiatus in the diaphragm with adequate parameters of the fundoplication cuff.

Background. Intussusception of the small intestine loop through gastroenteroanastomosis is considered a rare but potentially dangerous complication that can occur after gastroenteroanastomosis surgery. This complication is extremely seldom associated with pancreaticoduodenectomy.Case description. A 44-year male patient underwent pancreaticoduodenectomy for common bile duct cancer on 07.10.2019, followed by adjuvant chemotherapy. On April 14, 2021 he was admitted for the next course of chemotherapy and complained of pain in the epigastric region and nausea, that appeared a few days ago, thus, he was appointed an urgent additional examination. Gastroscopy revealed a loop of small intestine, prolapsing into the lumen of the gastric remnant through the gastroenteroanastomosis. The fixed loop of intestine precluded endoscopic disinvagination from being performed. Computed tomography confirmed intussusception of the small intestine loop through gastroenteroanastomosis. The patient underwent emergency surgery. Laparotomy revealed a 40 cm intussusception of the small intestine loop through gastroenteroanastomosis into the gastric remnant. The intestine loop was accurately disinvaginated and proved to be viable. The intestine loop was additionally fixed to prevent re-intussusception. After the complication-free postoperative period, the patient was discharged on day 6. The follow-up examination in 6 months revealed no signs of intussusception recurrence according to computed tomography. The paper reviewed the internationally published cases of jejunogastric intussusception after pancreaticoduodenectomys.Conclusion. Jejunogastric intussusception refers to an extremely rare complication after a previously performed pancreaticoduodenectomy. A risk of the complications is to be recognized, since their timely diagnosis and surgical treatment enable successful outcome to be achieved.

Aims. Mucosal Associated Invariant T (MAIT) cells are unconventional T cells with anti-infective potential. MAIT cells detect and fight against microbes on mucosal surfaces and in peripheral tissues. Previous works suggested that MAIT cells survive exposure to cytotoxic drugs in these locations. We sought to determine if they maintain their anti-infective functions after myeloablative chemotherapy. Methods. We correlated the amount of MAIT cells (measured by flow cytometry) in the peripheral blood of 100 adult patients before the start of myeloablative conditioning plus autologous stem cell transplantation with the clinical and laboratory outcomes of aplasia. Results. The amount of MAIT cells negatively correlated with peak C-reactive protein level and the amount of red blood cell transfusion units resulting in earlier discharge of patients with the highest amount of MAIT cells. Conclusion. This work suggests the anti-infectious potential of MAIT cells is maintained during myeloid aplasia.

Abstract Cosmetic filler injections have gained popularity in recent years, but the rise in complications has led to an increase in legal disputes. This study analyzes civil court rulings related to cosmetic filler injection lawsuits in South Korea from 2007 to 2023. A retrospective case analysis was performed using a systematic database search, and a mixed-methods approach was employed for data analysis. The study examined 27 cases, revealing a high rate of liability findings against medical practitioners. Skin necrosis and blindness were the most common complications, and intravascular filler injection was recognized as negligence. Violation of informed consent was found in most cases, with mean compensation awards of ￦193,019,107 KRW ($142,831 USD) for first instance cases and ￦81,845,052 KRW ($60,564 USD) for second instance cases. The findings emphasize the importance of practitioner awareness, adherence to precautionary measures, and proactive prevention and management of complications. Collaboration among stakeholders is crucial for developing strategies that prioritize patient safety and minimize legal disputes in the aesthetic medicine industry. This study provides valuable insights for enhancing medical practices and safeguarding patient well-being in the field of cosmetic filler injections.

Abstract Kidney transplantation (KT) is associated with a substantial risk of postoperative complications (POC) for which performant predictors are lacking. Data showed that a perioperative gain of weight (ΔWeight) was associated with higher risk of POC, but it remains unexplored in KT. This retrospective study aimed to investigate the association between ΔWeight and POC after KT. ΔWeight was calculated on postoperative day (POD) 2. POC were graded according to the Dindo-Clavien classification. Primary endpoint was overall POC. A total of 242 patients were included and 174 (71.9%) complications were reported. Patients showed a rapid gain of weight after KT. Mean ΔWeight was 7.83 kg (± 3.20) compared to 5.3 kg (± 3.56) in patients with and without complication, respectively (p = 0.0005). ΔWeight showed an accuracy of 0.74 for overall POC. A cut-off of 8.5 kg was determined. ΔWeight ≥ 8.5 kg was identified as an independent predictor of overall POC on multivariable analysis (OR 2.04; 95% CI 1.08–3.84; p = 0.025). ΔWeight ≥ 8.5 kg appeared as an independent predictor of POC after KT. These results stress the need to monitor weight in KT and to further investigate this surrogate with future studies assessing its clinical relevance.

Objectives: The study aims to compare the success rate, time for cannulation and complications of ultrasound-guided internal jugular venous cannulation versus blind landmark-based technique in adult cardiac surgical patients. The primary objective is to compare the success rate between USG group and landmark group. The secondary objectives are to determine the complications, time for cannulation and compare between the two groups. Materials and Methods: In a prospective randomized controlled doubleblinded trial, 122 adult patients undergoing elective cardiac surgery were split up into two pairs. Group U (ultrasound-guided technique) and Group N (non-ultrasound-based technique). We assessed first attempt success rate, number of attempts required, time for cannulation and complications (e.g., carotid artery puncture, hematoma, pneumothorax). Results: Demographics between Group U and N were similar. Ultrasound-guided technique exhibited higher first attempt success rate (91.8% vs. 75.4%, p=0.014), fewer attempts (1.10 vs. 1.61, p=0.017) and fewer complications (carotid artery puncture: 1.6% vs. 6.6%, p=0.042; hematoma: 1.6% vs. 6.6%, p=0.042) compared to the non-ultrasound-based technique. Group N had a higher failure rate (6.6% vs. 0%, p=0.042). No significant difference in cannulation time was observed (U: 217.02 seconds vs. N: 214.31 seconds, p=0.92). Conclusion: Ultrasound-guided internal jugular venous cannulation yields better first attempt success, fewer attempts, and fewer complications than nonultrasound-based IJV cannulation. But there wasn't any obvious distinction in cannulation time between the two sets.

Abstract Background Breast cancer is the most common malignancy among women in the UK. Following mastectomy, reconstruction is now integral to the surgical management of breast cancer, of which implant-based reconstruction (IBBR) is the most common type. IBBR initially evolved from pre-pectoral to post-pectoral due to complications, but with developments in oncoplastic techniques and new implant technology, interest in pre-pectoral IBBR has increased. Many surgeons use acellular dermal matrices (ADM); however, there is little evidence in literature as to whether this improves surgical outcomes in terms of complications, failure and patient satisfaction. This review aims to assess the available evidence as to whether there is a difference in surgical outcomes for breast reconstructions using ADM versus non-use of ADM. Methods A database search will be performed using Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews and Clinicaltrials.org. The search timeframe will be 10 years. Studies will be screened using inclusion and exclusion criteria and data extracted into a standardised spreadsheet. Risk of bias will be assessed. Screening, extraction and risk-of-bias assessments will be performed independently by two reviewers and discrepancies discussed and rectified. Data analysis and meta-analysis will be performed using Microsoft Excel and R software. Forest plots will be used for two-arm studies to calculate heterogeneity and p-value for overall effect. Discussion With the renaissance of pre-pectoral IBBR, it is important that surgeons have adequate evidence available to assist operative decision-making. Assessing evidence in literature is important to help surgeons determine whether using ADM for IBBR is beneficial compared to non-use of ADM. This has potential impacts for patient complications, satisfaction and cost to healthcare trusts. Systematic review registration PROSPERO 2023 CRD42023389072.

Abstract This study explores 15-year urological complications in chronic spinal cord injury (SCI) patients and investigates the predictive factors from video-urodynamic study (VUDS) and bladder management. Analyzing 864 SCI patients with a mean 15.6-year follow-up, we assessed complications and utilized multivariate logistic regression for risk evaluation. VUDS factors such as autonomic dysreflexia, detrusor sphincter dyssynergia, vesicourethral reflux (VUR), contracted bladder, and high voiding detrusor pressure significantly increased the likelihood of recurrent urinary tract infections (rUTI). Low bladder compliance, VUR, and contracted bladder notably raised the risk of hydronephrosis, while contracted bladder and detrusor overactivity with detrusor underactivity heightened chronic kidney disease risk. Volitional voiding reduced rUTI and VUR risk, whereas Valsalva maneuver-assisted voiding increased hydronephrosis risk. In conclusion, a contracted bladder identified in VUDS is associated with long-term urological complications in SCI, we propose that patients already experiencing a contracted bladder should prioritize volitional voiding as their preferred bladder management strategy to minimize the risk of additional complications such as rUTI and VUR. These findings unveil previously unexplored aspects in research, emphasizing the need for proactive management strategies in this patient population.

The use of ultrasound for pleural procedures is associated with a decreased risk of complications. Handheld ultrasounds allow for easier evaluation of the pleural space. Limited data exists for the use of such devices for pleural procedures. The primary objective of our study was to assess the effectiveness and safety of handheld ultrasound for pleural procedures. We performed a prospective observational study, including all consecutive patients who underwent pleural procedures using the handheld ultrasound between September 2021 and November 2023. A total of 332 pleural procedures were attempted with handheld ultrasound, of which 329 pleural procedures (99.1%) were successfully performed. The median volume of fluid drained was 500 (interquartile range: 300-800). Thoracentesis was performed in 127 patients (38.5%), tube thoracostomy in 179 patients (54.4%), and medical thoracoscopy in 23 patients (7.0%). Exudative pleural effusions were found in 264 patients (80.0%), of which 152 (46.2%) were determined to be due to infectious etiologies. A total of 4 (1.2%) patients had a complication due to the procedure. 2 patients (0.6%) had a pneumothorax, while 2 patients (0.6%) developed a hemothorax. A total of 101 patients had either low platelets (

Objective To compare the clinical outcomes between ceramic-on-ceramic (CoC) and ceramic-on-polyethylene (CoP) bearing surfaces in patients undergoing total hip arthroplasty (THA) through a pooled analysis and evidence update. Methods We performed a systematic literature search using PubMed, Embase, Cochrane Library and Web of Science up to March 2023 for studies that compared the bearing surfaces of CoC and CoP in patients undergoing THA. The primary outcomes were the incidence of common postoperative complications and the rate of postoperative revision. The secondary outcome was the Harris Hip Score. Results A total of 10 eligible studies involving 1,946 patients (1.192 CoC-THA versus 906 CoP-THA) were included in the evidence synthesis. Pooled analysis showed no significant difference in the rates of common postoperative complications (dislocation, deep vein thrombosis, infection, wear debris or osteolysis) and of revision. After eliminating heterogeneity, the postoperative Harris Hip Score was higher in the CoC group than in the CoP group. However, the strength of evidence was moderate for the Harris Hip Score. Conclusion CoC articulations are more commonly used in younger, healthier, and more active patients. While the performance of conventional polyethylene is indeed inferior to highly cross-linked polyethylene, there is currently a lack of sufficient research comparing the outcomes between highly cross-linked polyethylene and CoC bearing surfaces. This area should be a focal point for future research, and it is hoped that more relevant articles will emerge. Given the limited number of studies included, the heterogeneity and potential bias of those included in the analysis, orthopaedic surgeons should select a THA material based on their experience and patient-specific factors, and large multicentre clinical trials with >15 years of follow-up are needed to provide more evidence on the optimal bearing surface for initial THA.

Key Clinical Message Destroyed lung syndrome is a recognized devastating complication of pulmonary tuberculosis (TB) that affects the quality of life of patients. Clinicians in TB‐endemic countries should be aware of this complication aiming at prevention. TB control programs should intensify efforts at early detection and treatment and also provide interventions for post‐TB complications.

Primary brain tumours are rare but carry a significant morbidity and mortality burden. Malignant gliomas are the most common subtype and their incidence is increasing within our ageing population. The diagnosis and treatment of gliomas involves substantial interplay between multiple specialties, including general medical physicians, radiologists, pathologists, surgeons, oncologists and allied health professionals. At any point along this pathway, patients can present to acute medicine with complications of their cancer or anti-cancer therapy. Increasing the awareness of malignant gliomas among general physicians is paramount to delivering prompt radiological and histopathological diagnoses, facilitating access to earlier and individualised treatment options and allows for effective recognition and management of anticipated complications. This article discusses evidence-based real-world practice for malignant gliomas, encompassing patient presentation, diagnostic pathways, treatments and their complications, and prognosis to guide management outside of specialist centres.

Hereditary Multiple Exostoses (HME) is a rare autosomal dominant bone disease. It is characterized with numerous benign osteochondromas, which grow outward from the metaphyses of long bones. In many cases it is asymptomatic but can lead to considerable number of complications, like pressure symptoms, limb deformities, and can cause psychosocial problems. Malignant transformation is rarely seen. Surgery is the main modality of treatment.This paper aims to highlight the role of FNAC in diagnosis of HME.

Aim – to conduct a comparative assessment of the accuracy of the developed method of preoperative planning for primary hip arthroplasty. Material and methods. The "Method of preoperative planning in hip arthroplasty" and special device were developed to improve the accuracy of preoperative planning and reduce the number of complications. A clinical study was conducted in the comparison groups. In the main group (50 patients), we used the proposed method in the pre-operative planning; in the control group the patients were prepared for the operation using a standard planning method. The accuracy of evaluation of implant sizes, limb length and offset were registered in the post-operative period. The preoperative planning data were compared with the results obtained. Results. The accuracy of offset estimation in the main group was higher than in the control group (T-criterion = -2.6; p = 0.01). The average difference between the estimated offset and the one obtained in the main group was 1.4±1.5 mm, in the control group it was 2.2±1.7 mm. The error in head size estimation in the main group was less than in the control group (odds ratio = 3.02). No significant differences were registered in determining the size of components of the endoprosthesis, and there were no differences in the leg length in the study groups. Conclusion. The developed method allows for improving the accuracy of preoperative planning in hip arthroplasty. The proposed device ensures the correct placement of patients when performing pelvic radiography, and also makes it easy to change it when performing this procedure.

Abstract The global obesity problem is becoming increasingly serious, with eight of the top ten causes of death in Taiwan in 2020 being related to obesity. Morbid obesity poses a significant threat to one’s health and well-being. In recent years, bariatric surgery has emerged as a more effective treatment option for patients with morbid obesity. However, the procedure is not without risks. This study aims to examine the factors that impact the postoperative efficacy evaluation of patients with morbid obesity. This study uses a retrospective cross-sectional design, with medical records being collected retrospectively. The data was collected from patients who underwent bariatric surgery between July 1, 2017 and June 30, 2020 at a hospital in southern Taiwan. A total of 663 patients were included in the study and were observed for 1 year after the surgery. The independent variables included demographic variables, perceived symptoms variables, perceived lifestyle variables, and surgery-related variables, while the dependent variables included weight loss outcomes and complications. The prognostic factors affecting the postoperative efficacy evaluation of patients with pathological obesity were determined using multiple regression analysis and binary regression analysis. The study found that 65.6% of the participants were female, with an average age of 36.8 years. The results of the multiple regression and binary logistic regression showed that gender, age, BMI, diabetes, and smoking habit were the predictors of postoperative weight loss. Hypertension, diabetes, liver disease, kidney disease, smoking habit, drinking habit, and operation time were the predictors of postoperative complications. The study found that the presence of the aforementioned 12 significant factors can affect the success of weight loss after surgery and the incidence of postoperative complications. This information can serve as a reference for clinical care institutions and patients to improve the postoperative efficacy evaluation.

Abstract To investigate the significance of atherosclerotic plaque location in hybrid surgery comprising both endovascular recanalization approaches and carotid endarterectomy for symptomatic atherosclerotic non-acute long-segment occlusion of the internal carotid artery (ICA), 162 patients were enrolled, including 120 (74.1%) patients in the proximal plaque group and 42 (25.9%) in the distal plaque group. Surgical recanalization was performed in all patients, with successful recanalization in 119 (99.2%) patients in the proximal and 39 (92.9%) in the distal plaque group. The total successful recanalization rate was 97.5% (158/162) with a failure rate of 2.5% (4/162). Periprocedural complications occurred in 5 (4.2% or 5/120) patients in the proximal plaque group, including neck infection in two (1.7%), recurrent nerve injury in 1 (0.8%), and laryngeal edema in 2 (1.7%), and 2 (4.8%) in the distal plaque group, including femoral puncture infection in 2 (4.8%). No severe complications occurred in either group. Univariate analysis showed plaque location was a significant (P = 0.018) risk factor for successful recanalization, and multivariate analysis indicated that the plaque location remained a significant independent risk factor for recanalization success (P = 0.017). In follow-up 6–48 months after the recanalization surgery, reocclusion occurred in two (2.8%) patients in the proximal plaque group and 4 (13.3%) in the distal plaque group. In conclusion, although hybrid surgery achieves similar outcomes in patients with ICA occlusion caused by either proximal or distal atherosclerotic plaques, plaque location may be a significant risk factor for successful recanalization of symptomatic non-acute long-segment ICA occlusion.

Abstract Although tension band wiring (TBW) is popular and recommended by the AO group, the high rate of complications such as skin irritation and migration of the K-wires cannot be ignored. Ding’s screw tension band wiring (DSTBW) is a new TBW technique that has shown positive results in the treatment of other fracture types. The objective of this study was to evaluate the stability of DSTBW in the treatment of olecranon fractures by biomechanical testing. We conducted a Synbone biomechanical model by using three fixation methods: DSTBW, intramedullary screw and tension band wiring (IM-TBW), and K-wire TBW, were simulated to fix the olecranon fractures. We compared the mechanical stability of DSTBW, IM-TBW, and TBW in the Mayo Type IIA olecranon fracture Synbone model using a single cycle loading to failure protocol or pullout force. During biomechanical testing, the average fracture gap measurements were recorded at varying flexion angles in three different groups: TBW, IM-TBW, and DSTBW. The TBW group exhibited measurements of 0.982 mm, 0.380 mm, 0.613 mm, and 1.285 mm at flexion angles of 0°, 30°, 60°, and 90° respectively. The IM-TBW group displayed average fracture gap measurements of 0.953 mm, 0.366 mm, 0.588 mm, and 1.240 mm at each of the corresponding flexion angles. The DSTBW group showed average fracture gap measurements of 0.933 mm, 0.358 mm, 0.543 mm, and 1.106 mm at the same flexion angles. No specimen failed in each group during the cyclic loading phase. Compared with the IM-TBW and TBW groups, the DSTBW group showed significant differences in 60° and 90° flexion angles. The mean maximum failure load was 1229.1 ± 110.0 N in the DSTBW group, 990.3 ± 40.7 N in the IM-TBW group, and 833.1 ± 68.7 N in the TBW group. There was significant difference between each groups (p

Abstract Albumin, a key protein in human blood plasma, has been linked to various health conditions. However, its association with malaria, particularly in assessing disease severity, remains inadequately understood. This comprehensive systematic review and meta-analysis aimed to elucidate the relationship between albumin levels and malaria severity. A comprehensive literature search was conducted across multiple databases, including Embase, Scopus, PubMed, MEDLINE, Ovid, and Google Scholar, to identify studies examining albumin levels in malaria patients. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Data were pooled using a random-effects model, and heterogeneity was assessed using I 2 statistics. Subgroup and meta-regression analyses were performed based on publication year, study location, and Plasmodium species. A total of 37 studies were included in this review. The thematic synthesis indicated that albumin levels in malaria patients varied significantly based on geographical location. A meta-analysis of 28 studies found that albumin levels were significantly lower in malaria patients compared with non-malarial controls (P

Background: Ultrasound has become the standard of care for the insertion of central venous catheters (CVCs) in the intensive care unit. With the introduction of ultrasonography in CVC insertion, there has been an improvement in the success rate and a dramatic decrease in the rate of complications. Aims and Objectives: The aim of this study was to compare the safety and ease of insertion of ultrasonically guided cannulation of the internal jugular vein (IJV) with that of the supraclavicular subclavian vein (SCV) in adult patients undergoing various surgical procedures. Materials and Methods: All the patients in whom central venous cannulation was planned were assigned to two groups. Group I underwent ultrasound-guided IJV while as Group II underwent cannulation ultrasound-guided SCV cannulation. A comparison was made between the two groups, of the success rates, durations of procedure, number of attempts at needle redirections, difficulties if any during insertion of guidewires, and the complications encountered. Results: The IJV group had a higher proportion of first-attempt success (93.2% versus 62.7%). The IJV group had a lesser incidence (3.2%) of complications such as guidewire progression and needle redirections compared with SCV (15.2%). The frequency of adverse events did not differ between the two study groups with an incidence in 3.2% in IJV group and 9.6% in the subclavian group. Higher first-attempt success rates and fewer procedural complications were seen with ultrasound-guided IJV. Conclusion: IJV central venous catheterization is an easier and less invasive and less risky procedure for patients.

Introduction. Bariatric surgery is one of the most effective methods of treating morbid obesity, which allows for a long-lasting result. Along with the increase in the number of operative methods of obesity treatment, the relevance of issues related to postoperative complications is increasing. In recent years, the issue of using special checklists after surgery has been actively investigated. This will help optimize the process of monitoring patients' condition in the postoperative period. The aim of the study: to develop a check-list model to prevent the detection of complications after laparoscopic gastric bypass in obese patients. Materials and methods. On the basis of the developed checklist, a study of the condition of obese patients, who underwent laparoscopic gastric bypass during 2019-2023, was conducted on the basis of the Department of General Surgery No. 2 of the Bogomolets National Medical University. The checklist included the following criteria: the level of pain on the VAS scale, the level of nausea, eating, mobility, whether there is a desire to be discharged home, abdominal muscle tension, pain in the calf muscles, heart rate, oxygen saturation in the blood, the number drainage discharge within 24 hours, temperature, systolic blood pressure, central venous pressure, laboratory diagnosis, decrease in hemoglobin concentration, leukocyte level after surgery, C-reactive protein level after surgery, blood procalcitonin level, erythrocyte sedimentation rate level, the presence of a shift in the leukocyte formula to the left. The presence of complications was assessed, the parameters of the checklist were analyzed using univariate logistic regression and ROC analysis for early detection of complications and determination of the chance of complications in the future. Results. Complications occurred in 18/218 (8.2%). The most frequent complication was bleeding in 6/18 (33.3%). Reoperation was performed in 12 cases of 12/18 (66.6%), endoscopic treatment was performed in 1 case, and conservative methods were used in 5 cases. According to the checklist, 31.81% had a positive predictive value (PPV) and 99.56% had a negative predictive value (NPV). The optimal cut-off point of the total score of the checklist was 6. Patients with a positive prognosis of the checklist have a higher chance of developing complications of VSH – 4.5 (95% CI 1.8-9.72), p

Abstract Introduction Pituitary surgery involves special conditions for the anaesthetist due to the anatomical localisation and the role of the pituitary gland in hormonal balance. The aim of this study was to retrospectively investigate the effect of TSH levels on perioperative complication rates in patients undergoing pituitary surgery. Methods In this study, patients who underwent pituitary surgery at Izmir Katip Celebi University Ataturk Training and Research Hospital between January 2017 and November 2022 were retrospectively screened. Two patients out of the 137 were excluded from the study as they underwent simultaneous aneurysm surgery along with pituitary tumor surgery. A total of 135 patients meeting the criteria were analyzed. Patients were divided into three groups according to TSH levels. Perioperative complication rates and mortality rates were compared between the three groups. Findings The study included a total of 135 patients, with an age range of 16–76 years. Among the groups with low–normal–high TSH levels, there were no statistically significant difference observed, in postoperative complications, such as epistaxis, rhinorrhea, postoperative nausea/vomiting, seizures, hypertension, and hypotension. When looking at the incidence of postoperative diabetes insipidus, a significant difference was found between the groups. When examining the mortality rates on the 28th day, a significant difference was found between the groups, with a mortality rate of 25% in the high TSH group (p