Unusual presentation of aneurysmal bone cyst (ABC) in children: pediatric intracranial osteosarcoma with secondary ABC.

A 13-year-old female patient presented with painless vision loss and proptosis for 18 months. Imaging findings were highly suggestive of a supraorbital aneurysmal bone cyst (ABC) for which she underwent complete surgical excision. Postoperatively, she developed left hemiparesis. Computed tomography angiography (CTA) revealed right complete internal carotid arterial (ICA) thrombosis. This was managed conservatively, and she improved in hemiparesis over the next 3 weeks. Histopathology report revealed osteosarcoma with secondary ABC, for which she was referred for radiotherapy. At 1.5 months follow-up, the patient's left lower limb power improved to 4 + /5. She was walking without support, and her left upper limb power was 4/5.

Endoscopic Endonasal Approach for Giant Pituitary Adenoma Occupying the Entire Third Ventricle: Surgical Results and a Review of the Literature.

BACKGROUND: Pituitary macroadenomas occasionally disrupt the sellae diaphragma and extend directly to the third ventricle causing hydrocephalus. We present the results of a single-stage extended endoscopic approach for managing giant pituitary adenomas (GPAs) occupying the entire third ventricle. METHODS: A retrospective study of all GPAs occupying the entire third ventricle operated on via the endoscopic endonasal approach between January 2016 and December 2020 was performed. RESULTS: The study included 8 cases of GPA occupying the entire third ventricle, of which 2 (25%) were functioning adenomas. Of 8 patients, 4 (50%) presented with hydrocephalus, 2 underwent preoperative ventriculoperitoneal shunt, and 2 had an intraoperative external ventricular drain. No patients had postoperative cerebrospinal fluid rhinorrhea. Complete resection of the third ventricular component could be achieved in all cases radiologically; minimal residual tumor was present either in the lateral compartment of the cavernous sinus or over the anterior cerebral artery complex in 5 of 8 (62.5%) patients. Complete resolution of temporal hemianopia was seen in 8 of the 12 eyes (66.67%), and partial resolution was seen in 4 of 12 (33.3%) eyes. At a mean follow-up of 24.62 ± 10.01 months, none of the patients needed another surgical procedure. CONCLUSIONS: The extended endonasal endoscopic approach can be safely and efficiently used for single-stage excision of GPAs that disrupt the diaphragm and occupy the third ventricle. Preoperative cerebrospinal fluid diversion may be used to manage associated acute hydrocephalus in these cases.

Clinical Profile of Surgical Diseases with Emergence of New Problems in HIV+ Individuals.

North Karnataka is one of the regions with the high prevalence of HIV+ individuals. Bijapur is a district in North Karnataka with high prevalence as per fact sheets of NACO of March 2012. Better awareness, access to health care, and antiretroviral therapy have improved survival and increase in number of people living with HIV/AIDS (PLHA). Improved survival has increased their attendance to hospitals with variety of surgical problems, some known and some less known. The percentage of HIV+ individuals was 1.64 % among all admissions. Of these individuals, 13.65 % (272) had surgical problems. Abscesses were the commonest. Abscesses at uncommon sites also were encountered. Anorectal pathologies, tuberculosis, lymphadenopathy, appendicitis, etc. commonly seen in HIV+ individuals were seen. Drug-induced pancreatitis due to anti retroviral therapy was one of the common problems encountered. Uncommon conditions like ureteric calculi, external iliac artery thrombosis, diaphragmatic eventration, and few more were observed. Even though literature on AIDS/HIV is abundant, there is less information on surgical conditions encountered more so from this part of the subcontinent. Hence, it was decided to report the profile of the conditions encountered.

Rational Hyperoxia in the Perioperative Period: a Safe and Effective Tool in the Reduction of SSI.

Oxygen supplemented at a concentration higher than 40-50 % for at least 2 h perioperatively is expected to reduce surgical site infections (SSI). Although supplementation of 80 % of oxygen perioperatively has shown to reduce SSI in various studies, this concentration is known to be associated with airway complications. This study was taken up to assess the efficacy of 60 %, i.e. <80 and >50 %, inspired oxygen supplemented perioperatively in reducing SSI. One hundred and eighty-eight patients who underwent elective class I and II surgeries were studied. Patients were divided equally into two groups and subgroups and matched for age, sex, type of surgeries, etc. The control group received 30 % and the study group received 60 % oxygen supplementation perioperatively for 2 h. Wounds were observed for the development of SSI. 8/94 patients in the study group and 13/94 patients in the control group developed SSI (p < 0.01). The results indicate a relative risk of 1.62, risk difference of 0.0531 and attributable risk of 38.42 %. Hence, it may be concluded that perioperative oxygen supplementation at 60 % concentration reduces SSI.