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Surgical Endoscopy Jun 2023There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended...
AIMS
There is considerable controversy regarding optimal management of patients with paraesophageal hiatus hernia (pHH). This survey aims at identifying recommended strategies for work-up, surgical therapy, and postoperative follow-up using Delphi methodology.
METHODS
We conducted a 2-round, 33-question, web-based Delphi survey on perioperative management (preoperative work-up, surgical procedure and follow-up) of non-revisional, elective pHH among European surgeons with expertise in upper-GI. Responses were graded on a 5-point Likert scale and analyzed using descriptive statistics. Items from the questionnaire were defined as "recommended" or "discouraged" if positive or negative concordance among participants was > 75%. Items with lower concordance levels were labelled "acceptable" (neither recommended nor discouraged).
RESULTS
Seventy-two surgeons with a median (IQR) experience of 23 (14-30) years from 17 European countries participated (response rate 60%). The annual median (IQR) individual and institutional caseload was 25 (15-36) and 40 (28-60) pHH-surgeries, respectively. After Delphi round 2, "recommended" strategies were defined for preoperative work-up (endoscopy), indication for surgery (typical symptoms and/or chronic anemia), surgical dissection (hernia sac dissection and resection, preservation of the vagal nerves, crural fascia and pleura, resection of retrocardial lipoma) and reconstruction (posterior crurorrhaphy with single stitches, lower esophageal sphincter augmentation (Nissen or Toupet), and postoperative follow-up (contrast radiography). In addition, we identified "discouraged" strategies for preoperative work-up (endosonography), and surgical reconstruction (crurorrhaphy with running sutures, tension-free hiatus repair with mesh only). In contrast, many items from the questionnaire including most details of mesh augmentation (indication, material, shape, placement, and fixation technique) were "acceptable".
CONCLUSIONS
This multinational European Delphi survey represents the first expert-led process to identify recommended strategies for the management of pHH. Our work may be useful in clinical practice to guide the diagnostic process, increase procedural consistency and standardization, and to foster collaborative research.
Topics: Humans; Hernia, Hiatal; Delphi Technique; Fundoplication; Laparoscopy; Herniorrhaphy; Surgical Mesh; Treatment Outcome
PubMed: 36849562
DOI: 10.1007/s00464-023-09933-8 -
Northern Clinics of Istanbul 2022Ovarian tumors are the most common gynecological tumors seen in girls. Approximately 60-70% of them are germ cell tumors. Pseudo-Meigs syndrome is characterized by the...
Ovarian tumors are the most common gynecological tumors seen in girls. Approximately 60-70% of them are germ cell tumors. Pseudo-Meigs syndrome is characterized by the presence of pelvic tumoral mass (benign or malign), pleural effusion, and massive acid. If the tumor is removed, acid and hydrothorax disappear. Endodermal sinus (yolk sac) tumor is a very rare cause in the diagnosis of Pseudo-Meigs syndrome, and only a few cases have been reported. This case is one of the rare cases presenting with Pseudo-Meigs syndrome and pathologically diagnosed as yolk sac tumor.
PubMed: 36530560
DOI: 10.14744/nci.2020.45452 -
Case Reports in Rheumatology 2022Pericardial effusion or the accumulation of fluid in the pericardial sac, can result from infectious, malignant, or autoimmune processes such as systemic lupus...
Pericardial effusion or the accumulation of fluid in the pericardial sac, can result from infectious, malignant, or autoimmune processes such as systemic lupus erythematous (SLE). However, pericardial effusion is infrequently the first presentation of SLE. Here, we describe the case of a 54-year-old African American woman who presented with hypertensive emergency and was found to have pericardial effusion on echocardiogram. Her hypertensive symptoms resolved with medical management and a work up were positive for serum markers of SLE and mesothelioma cell markers (calretinin, CK 5/6) and adenocarcinoma marker MOC31 in the pericardial fluid. Her effusion ultimately improved on high-dose steroid therapy and has not recurred in one year. Given normal pleura and pericardium on computed tomography (CT) imaging and long-term clinical improvement in SLE therapy, we hypothesize that she had false-positive mesothelioma markers in the setting of SLE.
PubMed: 36387931
DOI: 10.1155/2022/8081055 -
Journal of Infection in Developing... Sep 2022Sepsis is a serious problem in felines with a mortality rate ranging from 29-79%. Neisseria spp. is considered a commensal microorganism of the oral cavity of dogs and...
INTRODUCTION
Sepsis is a serious problem in felines with a mortality rate ranging from 29-79%. Neisseria spp. is considered a commensal microorganism of the oral cavity of dogs and cats and is usually isolated from human wounds resulting from bites of these animals.
CASE REPORT
The present report describes clinical, imaging and laboratory findings of a feline with sepsis wherein commensal and multidrug-resistant (MDR) Neisseria spp. was isolated. The feline presented a history of four days of anorexia, dyspnea, prostration, and, pericardial, pleural and abdominal effusions. Pericardiocentesis was performed and hemorrhagic exudate was observed. The animal died after 11 days of treatment with gentamicin and amoxicillin combined with clavulanic acid. During necropsy, the abdominal cavity was found to be filled with greenish-yellow content and the pericardial sac was thickened with a large amount of purulent secretion. Histopathology revealed sepsis with necrotizing suppurative pericarditis, diffuse mononuclear pneumonia and necrotic pleuritis, leading to secondary bacterial infection.
CONCLUSIONS
Commensal Neisseria spp. are important zoonotic bacteria, which trigger a serious disease in felines. However, it has not been reported to cause sepsis with pneumonia, suppurative necrotizing pericarditis and pericardial effusion.
Topics: Amoxicillin; Animals; Cat Diseases; Cats; Clavulanic Acid; Dog Diseases; Dogs; Gentamicins; Humans; Neisseria; Pericarditis; Pneumonia; Sepsis
PubMed: 36223630
DOI: 10.3855/jidc.13165 -
Monaldi Archives For Chest Disease =... Sep 2022Thoracic endometriosis is very rare. Usually, the thorax is the most frequent affected site outside the pelvis. Common symptoms include chest pain, dyspnea, and...
Thoracic endometriosis is very rare. Usually, the thorax is the most frequent affected site outside the pelvis. Common symptoms include chest pain, dyspnea, and hemoptysis. Common manifestations include pneumothorax, hemothorax, and pulmonary or pleural nodules. In addition, symptoms and manifestations can be "catamenial" happening a few days after menstruation onset. This disease can be debilitating, causing a significant impact on the quality of life of young women. We present a case of a young female who was referred to our hospital with recurrent right-sided pleural effusions and pneumothoraces. Pleural fluid drainage was consistent with hemothorax. Transvaginal ultrasound showed mild intraperitoneal fluid in the Cul-de-Sac. Due to concerns for thoracic endometriosis, video-assisted thoracoscopic surgery was performed confirming the diagnosis by pathology. Therapeutic pleurectomy with diaphragmatic repair and pleurodesis was performed. The patient was started on medroxyprogesterone acetate injections two weeks after with great clinical response.
Topics: Female; Humans; Endometriosis; Hemothorax; Hemopneumothorax; Quality of Life; Pneumothorax; Thoracic Surgery, Video-Assisted
PubMed: 36172717
DOI: 10.4081/monaldi.2022.2401 -
BMC Surgery Jul 2022Laparoscopic large hiatal hernia (LHH) repair remains a challenge despite three decades of ongoing attempts at improving surgical outcome. Its rarity and complexity,...
BACKGROUND
Laparoscopic large hiatal hernia (LHH) repair remains a challenge despite three decades of ongoing attempts at improving surgical outcome. Its rarity and complexity, coupled with suboptimal initial approach that is usually best suited for small symptomatic herniae have contributed to unacceptable higher failure rates.
RESULTS
We have therefore undertaken a systematic appraisal of LHH with a view to clear out our misunderstandings of this entity and to address dogmatic practices that may have contributed to poor outcomes.
CONCLUSIONS
First, we propose strict criteria to define nomenclature in LHH and discuss ways of subcategorising them. Next, we discuss preoperative workup strategies, paying particular attention to any relevant often atypical symptoms, indications for surgery, timing of surgery, role of surgery in the elderly and emphasizing the key role of a preoperative CT imaging in evaluating the mediastinum. Some key dissection methods are then discussed with respect to approach to the mediastinal sac, techniques to avoid/deal with pleural breach and rationale to avoid Collis gastroplasty. The issues pertaining to the repair phase are also discussed by evaluating the merits of the cruroplasty, fundoplication types and gastropexy. We end up debating the role of mesh reinforcement and assess the evidence with regards to recurrence, reoperation rate, complications, esophageal dilatation, delayed gastric emptying and mortality. Lastly, we propose a rationale for routine postoperative investigations.
Topics: Aged; Fundoplication; Gastroplasty; Hernia, Hiatal; Herniorrhaphy; Humans; Laparoscopy
PubMed: 35804332
DOI: 10.1186/s12893-022-01705-w -
Clinical Case Reports Feb 2022Extramedullary multiple myeloma is seen in advanced and aggressive disease and occurs due to plasma cell infiltration of sites other than the bone marrow. Myelomatous...
Extramedullary multiple myeloma is seen in advanced and aggressive disease and occurs due to plasma cell infiltration of sites other than the bone marrow. Myelomatous ascites or pleural effusion is seen in less than 1% of cases and can be differentiated from infectious etiologies based on fluid cytology.
PubMed: 35140947
DOI: 10.1002/ccr3.5329 -
Cureus Nov 2021Perioperative acute cardiac tamponade associated with perforation from pulmonary vein isolation (PVI) and radiofrequency catheter ablation (RFCA) for the treatment of...
Perioperative acute cardiac tamponade associated with perforation from pulmonary vein isolation (PVI) and radiofrequency catheter ablation (RFCA) for the treatment of refractory atrial fibrillation (AF) is rare. If not identified early and managed promptly, it can lead to decreased ejection fraction, hypotension, and ultimately death. We report a case of acute tamponade that was diagnosed and successfully managed following PVI and RFCA. A 49-year-old woman with a past medical history of paroxysmal AF and sick sinus syndrome presented to our hospital with intermittent episodes of palpitations and recurrent episodes of syncope. Given the drug-refractory AF, our patient underwent PVI and RFCA. A loop recorder was implanted for recurrent episodes of syncope, which revealed that she had sick sinus syndrome. During the current visit, transthoracic ECG revealed mild tricuspid regurgitation and trace pericardial effusion. Her left ventricle (LV) ejection fraction was 60%. A CT angiography of the pulmonary vessels and the aorta showed no evidence of pulmonary embolism, aortic aneurysm, or aortic dissection. However, there was an enlarged heart size and small bilateral pleural effusions. During a second PVI and RFCA, while in the operating room, the patient became hypotensive. A transesophageal echocardiogram (TEE) showed diastolic volume reduction in the right atrium and right ventricular and pericardial effusion. Intravenous (IV) resuscitation with lactated Ringer's solution and saline solution was rapidly given to the patient while performing percutaneous pericardiocentesis. In addition, packed red blood cells were transfused into the patient, and phenylephrine was given IV. There was 400 mL of blood drained from the pericardial sac, confirming the presence of acute cardiac tamponade. Following the pericardiocentesis, the patient became normotensive. A drainage tube was inserted into the pericardial space, which drained a total of 250 mL of sanguineous fluid over the next 48 hours after the procedure, after which it was removed without signs of persistent bleeding, and the patient was discharged. We conclude that her previous PVI and RFCA, and the anatomical distortion that might have resulted from her enlarged heart size, may have predisposed her to perforation and thus acute cardiac tamponade in this PVI and RFCA. Although perforation leading cardiac tamponade is rare during PVI and RFCA, the future focus when performing this procedure should be to (i) have a high index of suspicion for acute cardiac tamponade, (ii) use TEE and intracardiac echocardiography for early detection, and (iii) promptly manage the acute cardiac tamponade with pericardiocentesis, while giving IV fluid resuscitation and positive inotropes to hemodynamically stabilize the patient.
PubMed: 34926044
DOI: 10.7759/cureus.19572 -
European Heart Journal. Case Reports Nov 2021Pyopneumopericarditis is a very rare diagnosis that requires prompt recognition and urgent treatment. It denotes the presence of pus and air in the pericardium with...
BACKGROUND
Pyopneumopericarditis is a very rare diagnosis that requires prompt recognition and urgent treatment. It denotes the presence of pus and air in the pericardium with associated inflammation of the fibrous pericardial sac.
CASE SUMMARY
A 49-year-old gentleman was admitted with pyopneumoperciarditis on a background of a previous uncomplicated Roux-en-Y gastric bypass surgery performed 7 years prior. He underwent emergency surgery for an omental patch repair of an ulcer perforation involving the diaphragm and pericardium. His inpatient stay was complicated by persistent seropurulent output from the pericardial drain, loculated pleural effusion, and deconditioning.
DISCUSSION
Management is extrapolated from the literature regarding purulent pericarditis. This condition albeit rare, requires swift recognition as without treatment mortality approaches 100%. Colchicine is an important adjunctive therapy postoperatively to prevent constrictive physiology.
PubMed: 34870085
DOI: 10.1093/ehjcr/ytab408