Single-Center Long-Term Results of Popliteal Artery Blunt Trauma Management Following Knee Dislocation - A Case Series Study.

OBJECTIVES: Injury to the popliteal artery after knee dislocation, if not promptly diagnosed and properly treated, can have devastating results. The purpose of this retrospective study was to describe the diagnostic and the treatment protocol we use, as well as provide long-term outcomes for a series of patients treated in our tertiary hospital, emphasizing on the importance of ankle-brachial index (ABI) measurement as an integral component of the diagnostic approach. METHODS: A retrospective analysis of all admissions to our hospital trauma center between November 1996 and July 2023, with a diagnosis of knee dislocation and the presence or absence of concomitant arterial injury resulting from blunt high energy trauma, was conducted. Before 2006, digital subtraction angiography (DSA) and/or computed tomography angiography (CTA) were part of the diagnostic approach (Group A). After 2006, the ankle-brachial index (ABI) was used as a first-line test to diagnose arterial damage (Group B). The Tegner and Lysholm scores were chosen to assess patients' postoperative impairment between groups, taking also in account the presence or absence of vascular injury. The Mann-Whitney U test and a univariate analysis of variance were used for the statistical analysis of scores. RESULTS: Overall, 55 patients were identified, and 21 of them (38.2%) had injuries to the popliteal artery, all of which were treated with a reversed great saphenous venous bypass. Out of the 21 patients, 4 (4.3%) developed compartment syndrome, which was treated with fasciotomies, and 1 leg (1.8%) was amputated above the knee. With no patients lost to follow-up, all but one (95%) of the vascular repairs are still patent, and the limbs show no signs of ischemia after a mean follow-up of 6 years. The Tegner and Lysholm score means were similar between groups A and B and independent of the presence of vascular injury and the diagnostic protocol used. Interestingly, an ABI below 0.9 proved to be predictive of arterial injury. CONCLUSION: A high level of awareness for the presence of popliteal artery injury should exist and an ABI measurement should be routinely performed in the management of all cases of knee dislocation. This way, less patients will undergo unnecessary CTA scanning, and hardly any popliteal artery injuries can go missing, as suggested by our study.

Laparoscopic Ligation of the Inferior Mesenteric Artery: A Systematic Review of an Emerging Trend for Addressing Type II Endoleak Following Endovascular Aortic Aneurysm Repair.

Background/Objectives: this systematic review aims to explore the efficacy and safety of the laparoscopic ligation of the inferior mesenteric artery (IMA) as an emerging trend for addressing a type II endoleak following endovascular aortic aneurysm repair (EVAR). Methods: A comprehensive literature search was conducted across several databases including Medline, Scopus, and the Cochrane Central Register of Controlled Trials, adhering to the PRISMA guidelines. The search focused on articles reporting on the laparoscopic ligation of the IMA for the treatment of a type II endoleak post-EVAR. Data were extracted regarding study characteristics, patient demographics, technical success rates, postoperative outcomes, and follow-up results. Results: Our analysis included ten case studies and two retrospective cohort studies, comprising a total of 26 patients who underwent a laparoscopic ligation of the IMA between 2000 and 2023. The mean age of the cohort was 72.3 years, with a male predominance (92.3%). The mean AAA diameter at the time of intervention was 69.7 mm. The technique demonstrated a high technical success rate of 92.3%, with a mean procedure time of 118.4 min and minimal blood loss. The average follow-up duration was 19.9 months, with 73% of patients experiencing regression of the aneurysmal sac, and no reports of an IMA-related type II endoleak during the follow-up period. Conclusions: The laparoscopic ligation of the IMA for a type II endoleak following EVAR presents a promising, minimally invasive alternative with high technical success rates and favorable postoperative outcomes. Despite its potential advantages, including reduced contrast agent use and radiation exposure, its application remains limited to specialized centers. The findings suggest the need for further research in larger prospective studies to validate the effectiveness of this procedure and potentially broaden its clinical adoption.

Endovascular Coil Embolization of a Large Ruptured Splenic Artery Aneurysm: A Case Report.

This case report aims to elucidate the current practices and efficacy of endovascular repair in managing splenic artery aneurysms (SAAs), particularly focusing on a case of a large, partially ruptured SAA. A 66-year-old female presented with severe abdominal pain and was later diagnosed with a 53mm saccular, degenerative SAA showing signs of partial rupture. The patient underwent successful endovascular repair using a combination of interlocking detachable coils and fibered coils. Despite the initial success, a follow-up CT angiogram revealed residual issues, necessitating additional embolization. The patient recovered well, with subsequent follow-ups indicating complete aneurysm closure and no complications. The successful management of this case aligns with current trends in SAA treatment, emphasizing the shift towards endovascular repair methods. This approach, highlighted in the literature, offers a minimally invasive alternative to open surgery, with lower morbidity and mortality rates. This case underscores the importance of individualized treatment planning and vigilant follow-up, particularly in light of the potential need for secondary interventions. This report contributes to the growing body of evidence supporting endovascular repair as a safe and effective treatment for SAAs, advocating for continued research into long-term outcomes and the development of advanced endovascular technologies.

Multiple non-syndromic basal cell carcinoma with the chest as primary site and lung metastases: A rare case.

Basal cell carcinoma (BCC) is the most commonly diagnosed cancer in humans, usually affecting elderly Caucasian men and skin regions mostly exposed to the sun, that rarely metastasizes. We report an unusual and aggressive case of multiple, non-syndromic metastatic BCC with an uncommon primary site in the chest and pulmonary metastases, treated successfully with surgery and vismodegib. A 51-year-old woman presented with a large pigmentary lesion of the chest, close to the sternum. She had the lesion for > 25 years and lately noticed multiple facial lesions. The diagnosis of multiple BCC was suspected and a punch biopsy of the primary lesion was performed. Diagnosis was confirmed by immunohistochemistry (BerEp4+, EMA- phenotype). After excision, staging with a thorax computed tomography scan revealed metastatic micro-nodules in the left lung, confirmed histologically after video-assisted thoracic surgical biopsy. Adjuvant chemotherapy with vismodegib was proposed and administered. At 30 days follow-up, thorax computed tomography scan was unaltered and her facial lesions showed significant regression. Although prognosis remains poor, early diagnosis and prompt management complimented by novel biological agents, like vismodegib, targeting disease pathogenesis, seems to bring promising results.

The influence of biphasic positive airway pressure vs. sham biphasic positive airway pressure on pulmonary function in morbidly obese patients after bariatric surgery.

BACKGROUND: The effect of biphasic positive airway pressure (BPAP) at individualized pressures on the postoperative pulmonary recovery of morbidly obese patients (MOP) undergoing open bariatric surgery (OBS) and possible placebo device-related effects (sham BPAP) were investigated. METHODS: Forty-eight MOP scheduled for OBS were initially enrolled. Subjects were randomly assigned to: A) the BPAP group in which BPAP, at individualized inspiratory positive airway pressure/expiratory positive airway pressure (IPAP/EPAP), was applied for 3 days postoperatively and B) the sham BPAP group in which sham BPAP was applied for the same time. Pulmonary function was assessed by spirometry 24 h prior to surgery and at 24, 48 and 72 h postoperatively and respiratory complications were recorded. RESULTS: Thirty-five subjects, 21 in the BPAP group and 14 in the sham BPAP group, completed the study. Baseline characteristics and pulmonary function were similar between groups preoperatively. Subjects in the BPAP group showed in general better spirometric performance and SpO2 values postoperatively and expedited pulmonary recovery. Atelectasis combined with respiratory distress syndrome (RDS) symptoms was observed in 21% of subjects in the sham BPAP group and one of these subjects developed lower respiratory tract infection. No respiratory complications were recorded in the BPAP group. Use of higher BPAP pressures was not associated with anastomosis leakage or disruption in any patient. CONCLUSION: Use of BPAP, at individualized pressures, expedites postoperative pulmonary recovery and eliminates respiratory complications in MOP who have undergone OBS.

Primary Amyloidosis Manifesting as Cholestatic Jaundice after Laparoscopic Cholecystectomy.

A 71-year-old female patient with cholelithiasis who had undergone laparoscopic cholecystectomy was admitted with obstructive jaundice (total bilirubin ~6 mg/dL) three months later. An ERCP was performed, in which a gallstone was found, followed by a sphincterotomy and cleansing of the bile duct. Due to deterioration of jaundice (>25 mg/dL), a new, unsuccessful ERCP and stent placement was carried out. Because of ongoing cardiac failure, she underwent an echocardiogram which revealed restrictive cardiomyopathy possibly due to amyloidosis. A liver biopsy was performed, which was positive for amyloid deposits in the liver, and the diagnosis was confirmed by the detection of monoclonal λ IgG protein in urine. The patient's jaundice gradually deteriorated and she died one week later from hepatic insufficiency.

Bacterial translocation in an experimental model of multiple organ dysfunctions.

BACKGROUND: In order to investigate the hypothesis that bacterial translocation from the intestine contributes to death after multiple organ dysfunction syndrome (MODS), a sterile MODS model was studied. METHODS: MODS was induced in 139 male C57BL/6 mice by lipopolysaccharide (LPS) (endotoxin) infusion followed by zymozan infusion in four groups: Α, sham-operation; Β, LPS; C, LPS + 0.8 g/kg zymozan; and D, LPS + 1.2 g/kg zymozan. Mice were sacrificed at 24 and 48 h for quantitative tissue cultures, isolation, and stimulation of splenocytes, measurement of apoptosis of lymphocytes and macrophages, and of serum LPS and survival. Some mice with MODS were treated with the antibiotic ertapenem. RESULTS: Enterobacteriaceae and Enterococcus spp were isolated from tissues. Group D had the highest bacterial load and the shortest survival. Release of interleukin-10, of interleukin-17, and of intgerferon-γ by splenocytes and the rate of apoptosis did not concur with immune paralysis. Serum LPS concentrations were higher in mice with MODS versus controls. Ertapenem prolonged survival and decreased the bacterial load. CONCLUSIONS: Bacterial translocation seems to be an important contributor leading from MODS to death and suggests a change in therapy towards adaptation of antimicrobial treatment upon early signs of MODS.

Clarithromycin modulates immune responses in experimental peritonitis.

Based on clinical data revealing a promising immunomodulatory effect of clarithromycin in sepsis due to ventilator-associated pneumonia, the efficacy of clarithromycin in experimental peritonitis and sepsis was assessed with particular emphasis on immune function. Cecal puncture and ligation was performed in rabbits assigned to the following groups: Group A, controls (n=12); Group B, intravenous clarithromycin treatment (n=15); Group C, piperacillin/tazobactam (TZP) treatment (n=10); Group D, clarithromycin+TZP combination treatment (n=12). Blood was sampled at serial time intervals and peripheral blood mononuclear cells (PBMCs) were isolated. Apoptosis of lymphocytes and monocytes was measured by flow cytometric analysis. PBMCs were stimulated with lipopolysaccharide (LPS) and Pam3Cys for the release of tumour necrosis factor-alpha (TNFα). Tissue bacterial growth was quantitatively measured after death or sacrifice. Survival in Group D after 10 days was prolonged compared with the other groups. Early apoptosis of lymphocytes in Group B was lower compared with Group D at 2h and compared with Group C at 4h. Early apoptosis of monocytes in Group B was lower compared with Group C at 24h. Following stimulation of PBMCs with LPS, release of TNFα was decreased in Group B compared with Groups A and D at 2h. Bacterial growth in tissues of Groups C and D was decreased compared with Group A. It is concluded that clarithromycin modulates the function of the immune response in experimental peritonitis by decreasing the rate of early apoptosis of lymphocytes and monocytes and by decreasing the ex vivo release of TNFα by blood monocytes.