Thoracoscopic excision of asymptomatic posterior mediastinal ganglioneuroma. A case series study

Background Posterior mediastinal ganglioneuroma is the most frequent type of neurogenic tumors, and usually it is asymptomatic. The surgical approach to excise it may differ from center to center based on the surgeon's experience as well as the size of tumor. We aim to present our center's experience and short-term outcomes in surgical excision of posterior mediastinal ganglioneuroma. Methods This retrospective case series study, from June 2019 till December 2022, included 9 asymptomatic patients with mean age of 31± 5 years who expressed lesion in the posterior mediastinum. The mean size of the tumor was   5.3±3.6 cm in maximal dimensions.  Results There were 7 males and 2 females with mean age was 31± 5 years,  the excision by video-assisted thoracoscopy (VATS)  was  employed in 8 patients and conventional thoracotomy was carried out in 1 case.  The mean operative time was 57±14 minutes with mean operative blood loss 50±10 ml. The mean postoperative chest tube drainage was 120±80 ml and no complications related to the procedures were observed. The average time of hospital stay after VATS treatment was 2 days, while after thoracotomy it was 5 days and patient suffered from ptosis that eventually recovered after 1 month with supportive treatment. Histopathological examination confirmed benign nature of ganglioneuroma in all cases. Conclusions Thoracoscopic excision of asymptomatic posterior mediastinal neurogenic tumor is safe, feasible and reduces postoperative pain, however, open technique might be considered for large-sized tumor to minimize the possible complications

Can a foreign body migrate against natural body barriers?

Pericardial foreign bodies (FBs) are a rare cause of chest pain in children. They can reach the pericardium through several routes including direct or iatrogenic implantation, transbronchial or transesophageal migration of inhaled or swallowed FBs. We reported a case of a 4-year-old girl presenting with persistent chest pain for 1 month. The child described the pain as ‘stitching’ in nature localized on the left side of the sternum. The child presented with increased pain intensity and a new onset of fever and cough. No history of chocking or swallowing of FB and no signs of trauma or child abuse were noted. Chest radiography revealed a needle in the left side of the chest. Computed tomography scan and echocardiography were used to precisely localize the needle and exclude intracardiac extension. ECG showed elevated ST segment and cardiac enzymes were normal. Removal of the needle was carried out surgically under fluoroscopic guidance. A small portion of the needle was found intrapericardially complicated by localized purulent pericarditis. The child had uneventful recovery and was discharged from the hospital on postoperative day 3.Keywords: foreign bodies, pain, pediatrics, pericardium, thoracic surger

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Detour technique, Dipping technique, or IIeal bladder flap technique for surgical correction of uretero-ileal anastomotic stricture in orthotopic ileal neobladder

ABSTRACTBackground:Uretero-ileal anastomotic stricture (UIAS) is a urological complication after ileal neobladder, the initial management being endourological intervention. If this fails or stricture recurs, surgical intervention will be indicated.Design and Participants:From 1994 to 2013, 129 patients were treated for UIAS after unsuccessful endourological intervention. Unilateral UIAS was present in 101 patients, and bilateral in 28 patients; total procedures were 157. The previous ileal neobladder techniques were Hautmann neobladder, detubularized U shape, or spherical shape neobladder.Surgical procedures:Dipping technique was performed in 74 UIAS. Detour technique was done in 60 renal units. Ileal Bladder flap was indicated in 23 renal units. Each procedure ended with insertion of double J, abdominal drain, and indwelling catheter.Results:Follow-up was done for 12 to 36 months. Patency of the anastomosis was found in 91.7 % of cases. Thirteen patients (8.3%) underwent antegrade dilatation and insertion of double J.Conclusion:After endourological treatment for uretero-ileal anastomotic failure, basically three techniques may be indicated: dipping technique, detour technique, and ileal bladder flap. The indications are dependent on the length of the stenotic/dilated ureteral segment. Better results for long length of stenotic ureter are obtained with detour technique; for short length stenotic ureter dipping technique; when the stenotic segment is 5 cm or more with a short ureter, the ileal tube flap is indicated. The use of double J stent is mandatory in the majority of cases. Early intervention is the rule for protecting renal units from progressive loss of function

Genetic susceptibility for insulin resistance among Egyptian women

The fat mass and obesity-associated (FTO) gene is recognized as the strongest predictor of obesity related traits such as insulin sensitivity and plasma glucose. The aim of this study was to investigate the association of the FTO rs17817449 genetic variant (G > T) polymorphism with risk of insulin resistance (IR) among Egyptian women. The variants in FTO rs17817449 were genotyped in 301 Egyptian women comprising two study groups, 150 women with IR and 151 healthy controls. The polymorphism of FTO rs17817449 was tested for association with IR. The frequencies of the FTO genotypes differed significantly between IR patients and healthy controls. Results revealed a significant association of TT genotype (OR, 2.33; 95% CI, 1.38–3.92; p = .001) and T-allele (OR, 1.55; 95% CI, 1.11–1.72; p .007) with IR. BMI, waist circumference, waist to hip and, body fat % were the highest in homozygotes TT genotype and the lowest in GG homozygotes in IR women but not observed in control subjects. Moreover, other abnormal metabolic risk parameters were significantly higher in TT carriers compared to GT and GG carriers in IR group. Association between FTO SNP (rs17817449) and IR was observed under recessive model. Conclusion: The present study suggests that FTO rs17817449 may have an important role in development of IR in Egyptian women

Upper Extremity Deep Vein Thrombosis in a Patient with Spontaneous Intracerebral Hemorrhage: A Case Report

Upper extremity deep venous thrombosis (UEDVT) is uncommon but may complicate intracerebral hemorrhage (ICH). A unique challenge arises when UEDVT is diagnosed and treated in situations of ICH. Case Report: We report a 43-year-old man developed edema in his hemiplegic arm 7 days after a spontaneous ICH. UEDVT was detected immediately despite pharmacotherapy with point-of-care compression ultrasound (POCUS). In addition to controlling thrombogenic factors, the dosage of enoxaparin was increased, yet it was subtherapeutic. Following this, the thrombosed veins recanalized and the hematoma diminished as well. Conclusion: A POCUS scan helps diagnose UEDVT, and the risk and benefits of treating UEDVT should be considered in patients with ICH