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Article in press
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Antegrade Versus Retrograde Cerebral Perfusion in Aortic Surgery: Systematic Review and Meta-Analysis of 19365 Patients
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Abstract [+]
Background
Since the risk of neurological injury and mortality can be mitigated with the appropriate choice of established brain protection strategies, we performed a meta-analysis of studies reporting cerebral perfusion strategy outcomes. Our focus was on surgeries that can be performed through a minimally-invasive approach, to support the decision-making process of adopting surgeons.
Methods
We searched the Excerpta Medica dataBASE (EMBASE), Medical literature analysis and retrieval system online (MEDLINE), and Cochrane databases, as well as ClinicalTrials.gov, Google Scholar, and the reference lists of relevant articles for studies reporting early mortality and/or stroke outcomes of both retrograde cerebral perfusion (RCP) and antegrade cerebral perfusion (ACP) strategies. The principal summary measures were odds ratio (OR) with 95% confidence interval (CI) and p values (statistically significant when <0.05). The pooled ORs were combined across studies that met the eligibility criteria. Results We identified and included seventeen eligible studies with a total of 19,365 patients undergoing ascending aorta and arch surgery from 2008-2019 by means of ACP (a total of 10,473 patients) or RCP (a total of 8,892 patients). Random effect model analyses found no increase in mortality (OR=1.03, 95%CI:0.80-1.32) or stroke (OR=1.04, 95%CI:0.81-1.32) associated RCP when compared to ACP (p>0.05).
Conclusion
In ascending aorta and arch surgery, requiring cerebral protection, ACP and RCP have similar rates of early mortality and stroke. While optimal application of cerebral protection strategies is both patient and surgeon specific, surgeons can comfortably adopt RCP in minimally invasive cases after accounting for factors that determine the outcomes of aortic surgery adequately.
Keywords
Antegrade; Retrograde; Cerebral protection; Aorta and great vessels; Minimally invasive cardiac surgery.
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Surgical Evolution in the Modern Era: From Quantity to Quality of Life to Surgical Innovation. The Paradigm of Esophageal Cancer Surgery
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Current Issue
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Idiopathic Primary Retroperitoneal Cyst: A Case Report
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Retroperitoneal cysts are rare; they are divided into neoplastic and non-neoplastic cyst. Incidences are 1 in 5750 to 1 in 250,000. They are often asymptomatic. Lymphangioma are benign cyst whereas 95% of them are found in the neck and axilla only 1% is in the abdomen. This is a case report describing the course of management for a 30-year-old male who presented to our outpatient
clinic with abdominal discomfort due to retroperitoneal cyst.
Keywords
Retroperitoneal Cyst; Ultrasound; Histopathology.
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A Clonorchis Sinensis in the Gallbladder: A Rare Case in Kuwait
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Clonorchis Sinensis is an important foodborne pathogen. It is actively transmitted in far-East countries and Asia, especially in China. It enters the biliary system via ingestion of infected cysts. It is exceedingly rare to encounter such a presentation in the Middle East, particular in Kuwait. The presence of liver fluke in the biliary system may lead to adverse complications. We are presenting a case report describing quite an unusual gallbladder finding in a 55-year-old Chinese lady.
Keywords
Clonorchis sinensis; Gallbladder; Acute cholecystitis; Liver fluke.
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Acute Mesenteric Ischemia in Severe Coronavirus (COVID19): Cases Report of 3 Patients
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Abstract [+]
Background
Coronavirus disease 2019 (COVID-19) is a respiratory disease with pulmonary infection, but some patients experiment gastrointestinal symptoms, in the literature only few cases of mesenteric ischemia in patients with severe COVID-19 infections have been described.
Cases
We present 3 cases of patient with severe COVID-19, with gastrointestinal manifestation in which bowel lesion was observed and which took benefits from bowel resections. No evidence available conclusively demonstrated a thrombotic or embolic event in our cases, therefore a precise knowledge of the mechanism of bowel lesion in COVID-19 patients is essential. Clinical managing patients with COVID-19 whom manifest gastrointestinal symptomatology should be aware of the mesenteric ischemia involvement.
Conclusion
In conclusion, patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may show atypical presentations, such as gastrointestinal symptoms, precise knowledge of the mechanism of bowel lesion in COVID-19 patients are essential.
Keywords
COVID-19; Mesenteric ischemia; Severe coronavirus.
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A Unique and Rare Presentation of Obstructed Choledochal Cyst in an Adult: A Case Report
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Choledochal cysts in adults are rare congenital abnormalities. Approximately 80% are found in childhood. Thus, their presentation in adults is always associated with complications, such as stone formation, inflammation and malignancies. The pathophysiology of this disease is yet uncertain. There are different types of choledochal cysts. Diagnosis can be challenging clinically; however, imaging techniques, such as ultrasound, magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT), can be helpful. We found several procedures performed in the extant literature, such as choledochoduodenostomy and choledochojejunostomy submucosal excision of the cyst; however, the best surgical option is excision with hepaticojejunostomy. We discuss the unusual presentation of a 33-year-old female patient with an obstructed choledochal cyst, despite having undergone a drainage procedure in childhood.
Keywords
Choledochal cyst; Hepato-jejunal anastomosis; Biliary system anomaly; Choledochal cyst in adults.
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Melorheostosis: A Rare Cause of Limb Pain
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Training of Future Surgeons in Minimally Invasive Surgery Needs Intensification: A Multicentre Study
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Melorheostosis: A Rare Cause of Limb Pain
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Melorheostosis is a rare skeletal dysplasia, and to date there are no reports of this condition in Australia. This is a case of a lady who presented with dull arm pain with a pathognomonic radiological findings. The plain radiographs obtained of the limb demonstrated a characteristic candle wax appearance in a monomelic distribution. The natural history, presentation, and management are discussed in detail.
Keywords
Melorheostosis; Skeletal dysplasia; Central Australia.
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