Factors associated with early postoperative mortality after total anomalous pulmonary venous connection repair: A retrospective cohort study.

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital defect where pulmonary venous plexus fails to connect with the left atrium (LA). Surgical repair is the primary treatment for TAPVC, but factors influencing outcomes are not fully understood. This study investigates the early outcomes of surgical repair for TAPVC and associated factors. A retrospective cohort analysis was conducted on TAPVC patients who underwent surgical repair between 2012 and 2022. Data were collected from medical records and supplemented with phone call validation. Demographic characteristics, surgical data, diagnostic tests, and outcomes were analyzed. Statistical analysis included chi-square, t-tests, and multivariate logistic regression using SPSS. A total of 88 patients underwent surgical repair for TAPVC, resulting in a mortality rate of 21.6%. Weight and bypass time were significantly associated with patient survival. Female patients had a higher likelihood of death. The anatomic type did not significantly influence mortality. Patients with pulmonary venous obstruction (PVO) experienced a higher mortality rate. Notably, ligation of the vertical vein in supracardiac and infracardiac types was associated with lower mortality. In conclusion, our study identifies several key factors contributing to higher mortality rates following TAPVC surgery, including low weight, female gender, prolonged bypass time, and preoperative vein obstruction. Highlighting the significance of surgical technique, particularly the sutureless approach, we advocate for its meticulous consideration to achieve improved outcomes. Furthermore, our findings indicate a potential decrease in mortality associated with vertical vein ligation, which may mitigate the risk of post-repair heart failure. We suggest further rigorous studies to gain comprehensive insights into TAPVC surgical interventions.

Lower limb preservation in pediatric trauma: a case study of Gustilo grade IIIC fracture in a 7-year-old.

This case report describes the intricate aspects of managing pediatric lower limb trauma. A 7-year-old patient had a severe compound fracture and significant soft tissue damage in the left lower limb, classified as Gustilo Grade IIIC. This necessitated the use of scoring systems such as the Mangled Extremity Severity Score and limb salvage index to assess the likelihood of limb preservation. Despite these high amputation risk indicators, a multidisciplinary approach has led to limb salvage surgery with internal fixation. Detailed postoperative monitoring revealed progressive recovery culminating in restored sensation, bone healing, and functional recovery. The discussion emphasizes the difficulties in deciding between limb salvage and amputation, stressing the importance of tailored care and cautious scoring system interpretation in pediatric cases. This conclusion advocates the prioritization of limb salvage in children owing to their unique healing capabilities while highlighting the need for further research to refine treatment protocols for pediatric lower limb trauma.

Challenges in diagnosing and managing cystic duct carcinoma: A case report from Syria.

INTRODUCTION AND IMPORTANCE: Primary cystic duct carcinoma, an uncommon and aggressive biliary cancer variant, poses a significant challenge in clinical practice. This study examines recent clinical cases, focusing on diagnostics, interventions, and implications in managing this disease, with a prevalence ranging from 0.03 % to 0.05 %, contributing to 2.6-12.6 % of extrahepatic biliary neoplasms. CASE PRESENTATION: A 57-year-old male, a smoker with hypertension and hyperuricemia, presented symptoms of severe upper right abdominal pain, jaundice, and altered stool color. Diagnosis revealed ulcerated papillary adenocarcinoma invading all gallbladder layers (2.5 cm). Surgical resection and Roux-en-Y anastomosis were performed. Histopathological examination showed invasive tumor proliferation, preserved lymph node architecture, and severe hepatic microsteatosis. Lymph nodes were tumor-free, and a benign hepatic biopsy (0.5 cm) displayed chronic portitis. The final diagnosis confirmed cystic duct carcinoma, emphasizing the complex diagnostic and therapeutic aspects in biliary cases. CLINICAL DISCUSSION: The clinical discussion unveils the complexities associated with primary cystic duct carcinomas. Emphasizing the necessity of a multidisciplinary approach, this case highlights the importance of efficient management strategies-from initial diagnosis to surgical intervention-in dealing with this challenging malignancy. CONCLUSION: In conclusion, this case underscores the intricate nature of primary cystic duct carcinomas. It accentuates the essential role of a multidisciplinary approach, urging the need for continuous research endeavors to further comprehend and enhance the treatment methodologies for this rare and complex malignancy.

Beyond the Operating Room: Exploring Gender Bias in Leadership Positions in German Plastic Surgery.

Background: Despite efforts to promote gender equity in medicine, gender disparities persist in various medical specialties, including plastic surgery. This study aimed to investigate the representation of female physicians in leadership positions in German plastic surgery departments. Methods: This cross-sectional study collected data about the physician workforce in the German plastic surgery field. The primary outcome was the proportion of female physicians in plastic surgery departments. Data were collected from 94 departments. The physician workforce was stratified based on gender and leadership. Results: We included 812 physicians working in different German plastic surgery departments. Of those, 76.8% were in leadership positions, and 35.1% were women. There was a significant association between being male sex and holding a leadership position (n = 158/188, 84% versus n = 30/188, 16%, P < 0.0001). This association persisted even after accounting for the academic grade of each physician in a multivariable regression model (OR 2.565; 95% confidence interval, 1.628-4.041). Conclusions: Women are significantly underrepresented in leadership positions in German plastic surgery, with only 16% of female physicians holding such positions. Furthermore, being male sex was significantly associated with holding a leadership position, even after adjusting for the academic grade. These findings emphasize the existence of gender bias in the selection process for leadership positions in plastic surgery.

Mediastinal liposarcoma: a case report and review of the literature.

BACKGROUND: Mediastinal Liposarcoma (ML) is an exceedingly rare neoplasm, accounting for less than 1% of all liposarcomas. Surgical resection is the most effective therapeutic modality, while adjuvant radiation therapy may be recommended for unresectable tumors. CASE PRESENTATION: This case report presents a rare case of a 52-year-old Syrian male patient with well-differentiated mediastinal liposarcoma (ML) who presented with exertional dyspnea, cough, and weight loss. Imaging studies revealed a large tumor causing extrinsic compression on the right lung, as well as compression of the heart and great vessels. CT-guided biopsy confirmed a diagnosis of well-differentiated liposarcoma, and the patient underwent surgical resection. The patient had a rapid postoperative recovery and was discharged on the fourth day post-operation, displaying an excellent postoperative status. The patient was followed up for 3 months postoperatively with no recurrence. CONCLUSION: This report highlights the significance of incorporating ML into the differential diagnosis of mediastinal masses, particularly in individuals presenting with exertional dyspnea and weight loss. Furthermore, this report provides a comprehensive review of previously reported cases of ML in the medical literature.

Acute hemorrhagic edema of infancy: a rare case report from Syria.

Acute hemorrhagic edema of infancy (AHEI) is a rare leukocytoclastic vasculitis clinically characterized by the classic triad (palpable purpuric skin lesions, edema, and fever) and is commonly misdiagnosed as Henoch-Schönlein purpura. AHEI frequently occurs after infections, drug treatment, or vaccination, even though its etiology is undetermined. Besides having a sudden onset, AHEI is also characterized by a self-limiting course with complete and spontaneous recovery within 1-3 weeks. Case Presentation: We report a rare case of a 1-year-old Syrian infant who presented to the clinic with an abnormal rash covering his entire body following a viral respiratory infection. On physical examination, he had many purpuric lesions across his body, and laboratory tests revealed that they were within the normal range. AHEI was determined based on clinical evaluation and laboratory analysis. Discussion and Conclusion: The authors focus on this entity as a differential diagnosis of his Henoch-Schönlein purpura. To prevent potentially serious complications, doctors should recognize purpura lesions in children exposed to respiratory infections, which received particular drugs or were given vaccinations. Furthermore, there is no danger associated with this disease, and it is benign.

Left diaphragmatic hernia after a mild blunt trauma in Syria: a case report.

Left side traumatic diaphragmatic hernias (DH) are very rare and usually present acutely. They might represent after years of minor trauma, and they should be considered among differentials to avoid complications. We present a 28-year-old female coming with acute epigastric pain radiating into the chest with dyspnea and vomiting. Her history was negative for trauma and other than very minor trauma two years earlier. Chest X-ray showed atelectasis with mild pleural effusion. Computed tomography scan showed several cavities, filling the left chest with a gaseous liquid level. Surgery was performed that demonstrated DH and the abdominal viscera were returned to the abdomen without any complications. Traumatic DHs can be easily overlooked with the absent of recent major trauma. They can represent years after the original trauma with acute symptoms, which can make it hard to diagnosis if not considered.

Ruptured hydatid cyst presenting with a hydropneumothorax in a 16-year-old boy: A case report from Syria.

INTRODUCTION AND IMPORTANCE: The rupture of the pulmonary hydatid cyst is a serious clinical problem because it causes significant local and systemic symptoms. Also, cyst rupture is not rare, but it is one of the most frightening and severe complications of hydatid cysts in the lung. CASE PRESENTATION: We report a 16-year-old male with a 15-x-15-cm cyst in the lower lobe of his left lung that had ruptured into the pleural space and bronchus, resulting in a fistula. The germinal layer was discovered within the fluid of the effusion inside the pleural cavity. The cyst was surgically excised and treated with albendazole. A three-month follow-up found the patient to be healthy and free of symptoms. CLINICAL DISCUSSION: The presented case highlights the importance of early detection and management of pulmonary hydatid cysts. The rupture of these cysts can lead to significant local and systemic symptoms, as well as the formation of fistulas. Echinococcus infection of the lung is relatively common, but hydatid cysts in general require special management due to their tendency to go undiagnosed until they are large and accompanied by cysts in other areas. The presented case highlights the importance of early detection and proper management of pulmonary hydatid cysts to prevent complications and ensure successful outcomes for patients. CONCLUSION: Infection of the left lung with Echinococcus is generally common, but hydatid cysts, in general, need special management because they usually are not detected early, are large, incidentally discovered, and are accompanied by cysts in other areas.