Outcomes of Endoscopic Resection in Pediatric Skull Base Chordoma: A Systematic Review.

The endoscopic approach has been recommended as a primary option for treating chordomas, and it is associated with better resection rates and fewer surgical complications than transcranial surgery. This review aimed to assess the long-term consequences and evidence in the current literature regarding the endoscopic approach's efficacy in treating skull-base chordoma in children. A systematic review was conducted based on the PubMed, Web of Science, and EMBASE databases to examine the clinical outcomes of endoscopic endonasal surgery for pediatric skull base chordoma tumors. The review included studies published in English that employed specific research designs and reported on pediatric patients with skull base chordoma. Of the 268 studies initially considered, 25 met our eligibility criteria and were included in the final analysis. The average age of the patients was 11.5 years, with approximately equal number of males and females. The endoscopic endonasal approach (EEA) was the most commonly used modality. Gross total resection (GTR) was achieved in 62.7% of patients, while 18.09% had a subtotal resection (STR), and 13.83% had near-total resection only. Most patients showed significant to moderate improvement from their baseline condition and had no recurrence during their follow-up. Our findings further endorse that the endoscopic approach is a viable primary treatment option for pediatric skull base chordoma.

Acute Kidney Injury After Open Heart Surgery.

INTRODUCTION:  Acute kidney injury (AKI) is a term used to describe when the kidney loses its function rapidly. And it's associated with an increase in the level of serum creatinine by 0.5 to 1mg/dL. It can be diagnosed by a plethora of criteria such as the Kidney Disease Improving Global Outcomes (KDIGO) and the Risk, Injury, Failure, Loss, End-stage (RIFLE) criteria. Cardiac surgery-associated AKI (CSA-AKI) is the most prevalent complication in patients following cardiac surgery and is also linked to increased mortality and morbidity rates. In addition, exogenous and endogenous toxins, ischemia and reperfusion, inflammation, oxidative stress, metabolic factors, and neurohormonal activation may all play a role in the development of CSA-AKI. All these factors may be active at varying time intervals and with different degrees of intensity, or may function simultaneously.  Methods: In late 2019, a retrospective study was conducted by reviewing the health data of patients who underwent coronary artery bypass graft (CABG), valvular repairs, and other open cardiac surgeries at the King Abdulaziz University Hospital (KAUH), Jeddah, Saudi Arabia, between November 2014 and June 2019. Information was obtained from the Hospital information system, Jeddah, Saudi Arabia. Of the 159 patients who underwent open-heart surgery at KAUH, 126 (79.2%) were male and 33 (20.8%) were female. Patients below 15 years of age and those with poor renal function prior to open cardiac surgery were excluded. The KDIGO criteria were used to diagnose AKI for our patients. RESULTS:  In this study, 34% of the patients experienced AKI after open cardiac surgery, and the most frequent risk factor encountered was diabetes mellitus (DM), which was present in 97 (61%) patients, followed by angina pectoris in 93 (58.5%) patients. Hypertension was identified in 85 (53.5%) and acute myocardial infarction in 82 (51.6%) patients. There were only two (1.3%) patients with known cases of chronic obstructive lung disease (COPD). Of the surgeries, 131 (82.4%) were classified as elective and 28 (17.6%) were urgent. CONCLUSION:  The most common risk factor associated with AKI following open-heart surgery is DM, followed by angina pectoris. However, further studies are required to investigate all the cardiac procedures.

Anemia and Cost-Effectiveness of Complete Blood Count Testing Among Pregnant Women at King Abdulaziz University Hospital: A Single Tertiary Center Experience.

Background Iron deficiency is the most common etiology of anemia among pregnant women. Many studies showed that anemia during pregnancy had been associated with adverse outcomes such as intrauterine growth retardation, preterm delivery, and maternal mortality. However, screening for those pregnant remains controversial.  Objectives To find the prevalence of anemia among pregnant women and pregnancy outcomes. Also, to find the cost-effectiveness of running complete blood count (CBC) tests among them. Methods This is a retrospective record review done on pregnant women who delivered at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between January 1, 2018, and December 31, 2018. They were screened for eligibility, with the exclusion of those with hemoglobinopathies such as sickle cell anemia and thalassemia. Data were collected from their electronic medical records. Results A total of 5,120 pregnant women had delivered from January 1, 2017, to August 31, 2018, and 2,845 (55.6%) developed anemia during pregnancy. Out of 2,822, 2,301 were mild, 471 moderate, 50 severe, and 2,185 were normal. A total of 3,656 (71.4%) women were Saudis, and 1,464 (28.6%) were non-Saudis. The mean age was 29.85±6 years, and their first hemoglobin reading mean was 10.6±1.3g/dl. Out of 2,822, 546 developed undesired pregnancy outcomes. History of anemia, blood transfusion, intrauterine fetal demise, and stillbirth was significantly associated with abnormal hemoglobin levels (p<0.05). Complete blood count (CBC) testing for these pregnant women cost 422,990.92 US dollars. Conclusion Although the cut-off point of diagnosing anemia level during pregnancy isn't fully understood, pregnant women with mild to moderate levels appeared to have lesser adverse pregnancy outcomes in comparison to women with severe level. Therefore, screening during prenatal visits or antenatal for anemia should be tailored to each pregnant based on her condition and the overall clinical judgment.

Elective abdominal aortic aneurysm repair: does the aneurysm diameter influence long-term survival?

OBJECTIVES: The aim of this study was to investigate whether initial abdominal aortic aneurysm (AAA) diameter influences long-term survival after elective repair. DESIGN: Retrospective analysis of database. MATERIAL AND METHODS: Between March 1995 and December 2006, a consecutive series of 895 patients underwent elective treatment of an AAA either by open surgical or endovascular repair. An AAA diameter of 5.5cm was chosen as threshold to distinguish between small and large aneurysms, according to the definition given by the UK small aneurysm trial. Patient characteristics and distribution of basic risk factors were assessed. Survival estimates (Kaplan-Meier) and Cox proportional hazards regression results are reported. RESULTS: Patients with small aneurysms were more likely to survive the first 6 years after AAA repair, even after adjustment for treatment modality and baseline risk factors. After adjustment for age and sex aneurysms with smaller diameter were related to a lower risk of death (p<0.0016). CONCLUSIONS: Patients with small aneurysms (< or =5.5cm) have an improved long-term survival than patients with larger aneurysms.

Urinary GGT/creatinine ratio and fractional excretion of electrolytes in diarrhoeic calves.

The aim of this study was to monitor renal function in diarrhoeic calves and to determine the effectiveness of an applied fluid therapy. A total of 28 diarrhoeic (n = 18) and healthy (n = 10) Holstein-Friesian calves of different sexes, between 1 and 30 days of age, were used. Blood and urine samples were obtained from diarrhoeic calves before the treatment and then three more times at 24-h intervals during the treatment. From healthy calves, samples were taken only once. Therapy was started by the intravenous administration of 8.4% sodium bicarbonate and 0.9% sodium chloride solutions for the first 24 h, followed by the oral application of a commercial electrolyte solution (sodium chloride 3.5 g, trisodium citrate 2.9 g, potassium chloride 1.5 g and glucose anhydrous 20 g in 1 litre H2O) up to the 48th h of therapy. Before the therapy, the average levels of pH (7.10 +/- 0.12), bicarbonate (HCO3-) (16.48 +/- 3.80 mmol/l), base deficit (-12.65 +/- 5.97 mmo/l) and fractional excretion (FE) of sodium (0.16 +/- 0.11%) and potassium (15.07 +/- 8.56%) were significantly lower while serum urea (17.48 +/- 10.32 mmol/l) and creatinine (Cr) concentrations (169.72 +/- 98.12 micromol/l), haematocrit levels (45.13 +/- 13.60%) and urinary gamma glutamyl transferase (GGT)/Cr ratio (8.6 +/- 4.3 x 1/10(3) U/micromol) were significantly higher in diarrhoeic calves than in healthy calves. Alterations in parameters indicating the presence of renal dysfunction were normalised in the diarrhoeic calves that survived (83.3%). Three calves with severe metabolic acidosis and azotaemia died at the beginning of therapy. It was concluded that the FE of Na and K (FENa, FEK) and urine GGT/Cr ratio may have an important role in assessing renal function in diarrhoeic calves and in evaluating the effectiveness of an applied fluid therapy.

[Cryptosporidiosis in newborn calves in Ankara region: clinical, haematological findings and treatment with Lasalocid-NA]. / Cryptosporidien-lnfektionen bei neugeborenen Kälbern aus der Umgebung von Ankara: klinische und hämatologische Untersuchungen sowie Ergebnisse der Behandlung mit Lasalocid-Na.

In the first part of the present study, a total of 109 faeces samples collected from calves suffering from diarrhoea were examined for Cryptosporidium parvum oocytes and 39 (35.8%) of them were found to be positive. On the basis of oocyte counts, 14 (36%) samples were assessed as mildly infected and 25 (64%) samples as heavily infected. The occurrence of the disease was more common in winter (56.4%) than during other seasons (autuma 0%, summer 15.4% spring 28.2%. In the present study, the ionophore polyetherantibiotic Lasalocid-Na, that is licensed as a feed additive (Bovatec, 15% Lasalocid-Na, Roche AG) in Turkey, was administered to 11 calves naturally infected with Cryptosporidium and its therapeutic effect was evaluated. Lasalocid-Na (8 mg/ kg BW) was given once daily for 3 days added to the milk. The clinical parameters of infected calves were evaluated before and 3 days after the treatment in 24 hour intervals. The oocyst counts of faeces of calves with cryptosporidiosis were between 15 x 10(6) and 96 x 10(6)/mL before treatment. No oocystes were found in faecal samples of 3 calves (27.3%) after 48 hours and 4 (40%) calves after 72 hours of treatment, respectively. The number of oocytes in the faeces of the remaining calves varied between 90 and 1.2 x 10(6)/mL during the respective period. The number of oocystes before treatment was significantly higher than the number of oocytes after treatment. One of the calves died 56 h after the first treatment despite the treatment. The pH of venous blood was decreased prior to treatment as expected. The lowest pH was 6.83, the lowest bicarbonate concentration was 3.80 mmol/l and the lowest base excess was -31.2 mmol/l. After the treatment, pH, pCO2, HCO3- and BE values of the venous blood increased significantly and reached physiological values before discharge. The differences between the values assessed before the treatment and at the 2nd, 3rd, and 4th sampling time were statistically significant. Number of leucocyte and haemoglobin concentration before the treatment were significantly higher than the values after treatment (p < 0.01). These values returned back to physiological ranges 72 hours after first treatment. Lasalocid-Na was rather well tolerated. Side effects such as the decline of the suckling reflex and intoxication symptoms in respect to present administration form and dosage were found only in one calf (9%). Treatment procedure in the present study with Lasalocid-Na was found to be suitable in combination with an adequate infusion therapy for the treatment of calves on farms with problems related to cryptosporidiosis. Although the use of Lasolacid-Na for the treatment of Cryptosporidium infection in the EU is banned, it might be used as an alternative drug outside of the EU since it has a successful effect for preventing reinfections.

[Infusion therapy in newborn calves with diarrhea from the area of Ankara with special reference to acidosis (part 1)]. / Untersuchungen zur Infusionstherapie bei neugeborenen durchfälligen Kälbern aus der Umgebung von Ankara unter spezieller Berücksichtigung einer Azidose (1. Mitteilung).

Characteristic changes (hyperkalemia, metabolic acidosis and azotemia) occurred in the blood of 54 calves 1 to 15 days old with diarrhoea. Clinical signs of dehydration were observed. Average values were: Potassium 6.37 mmol/l, pH 7.17, bicarbonate 18.76 mmol/l, base excess (BE)-10.01 mmol/l, urea % 78.2 mg. The amount of 1.3% sodium bicarbonate solution to be given to calves with patent metabolic acidosis was determined according to the following formula: HCO3- (mmol/l = body weight (kg) x 0.5 x BE. In most of the cases with severe metabolic acidosis (pH < 7.0), a good compensating effect was obtained. Infusion treatment brought blood pH and base excess values near to normal, and bicarbonate concentration to within the physiological range. Balanced solutions were used in the regulation of electrolyte-fluid balance. Hematocrit, potassium and urea values, which had been pathologically high, returned to normal following infusion treatment. Apart from this, patients were given symptomatic treatment according to the important clinical findings. Forty-two animals recovered completely after intravenous infusion of buffer and electrolyte solutions. Twelve out the total of 54 animals died within 1-5 days despite infusion treatment.

Double aortic arch in a Siamese cat.

A double aortic arch is described in an 8-week-old female Siamese cat. In this case a vascular ring anomaly consistent with a double aortic arch is described in a cat. Stridor and dysphagia were noted in the cat. Radiography showed an esophageal dilation, with constriction at the fifth intercostal space. At necropsy, the esophagus and trachea were constricted at the base of the heart. The cause of the constriction of both the esophagus and trachea was a vascular ring formed by well-developed right and left aortic arches. The ascending aorta divided into two asymmetrical arches. The right aortic arch was larger than the left. The origin of the major arteries from the aortic arches were anomalous.

The impact of endovascular stent grafting on reducing mortality rates after surgical treatment of abdominal aortic aneurysms.

OBJECTIVES: to investigate whether appropriate selection in patients with infrarenal abdominal aortic aneurysms (AAA) for transfemoral endovascular aneurysm management (TEAM) or open graft replacement (OGR) may decrease in-hospital mortality rates (MR). DESIGN: analysis of a clinical series over three periods in an university vascular center. Conclusions of the second period were drawn and prospectively applied in a third period and compared. METHODS: during the period 1989-1994 only OGR was available (n=170). In the interval 1995-2000 either OGR or TEAM were carried out (n=454). During the period 01/2001-07/2002 the conclusions concerning selection of treatment modality were drawn and prospectively applied in 132 consecutive patients. MR were recorded and possible significant differences were checked. RESULTS: during the first period MR was 6.5%. Overall MR decreased to 3.7% in the second interval. Overall MR of the last period was improved to 1.5% (p<0.05). No patient died after OGR (0% vs 6.5%, p<0.04). As all patients with significant individual risk profiles were treated by TEAM, MR slightly increased (2.9%), but the difference remained insignificant (2.4% in period 2). CONCLUSIONS: risk adjusted selection of treatment modality influences the results after OGR significantly, thereby reducing overall MR of elective AAA treatment.