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Children (Basel, Switzerland) Jun 2024Pressure ulcers pose significant challenges in terms of treatment, often exhibiting a low success rate and a propensity for recurrence. Children with neurological...
BACKGROUND
Pressure ulcers pose significant challenges in terms of treatment, often exhibiting a low success rate and a propensity for recurrence. Children with neurological impairments such as myelomeningocele and those with spinal injuries are particularly vulnerable to developing pressure ulcers. Despite advancements, achieving successful reconstruction remains a formidable task. Common sites prone to pressure ulcer formation include the sacral and ischial regions, as well as areas over bony prominences. Additionally, pressure ulcers attributable to medical devices facilitating ambulation are observed. While many pressure sores resolve spontaneously, conservative management may prove ineffective for some, especially in cases of stage 3 and 4 ulcers, necessitating surgical intervention. Various surgical techniques are employed for the treatment of decubitus ulcers, yet there exists no universally accepted gold standard for their management. This paper presents our institutional experience in this domain, highlighting differences in surgical approaches, treatment outcomes, complication rates, and long-term follow-up.
METHODS
This study involved a retrospective analysis of medical records from 11 children, ranging in age from 10 to 17 years, who presented with extensive pressure ulcers that were unresponsive to conservative treatment measures. Data collection spanned from February 2017 to June 2022. The pressure ulcers affected various anatomical regions, including the ischial area (5/11 patients), sacral region (3/11 patients), lower limb (1/11 patients), elbow (1/11 patients), and perineal area (1/11 patients). Surgical intervention was the chosen approach for all cases, employing techniques such as reconstructive surgery utilizing perforator, pediculated flaps, and locoregional flaps.
RESULTS
Eleven patients with sore ulcers (stage 3 and 4) were treated surgically. We present our experience of using surgical methods, including pedicled anterolateral flaps, pedicled gracilis musculocutaneous flaps, propeller flaps and locoregional flaps. In some cases, surgery was performed after 60 days of hospitalization or ten years after ulcer occurrence. We reviewed the length of hospital stay, surgical management and patient satisfaction. Patients were followed up to 5 years post-surgery. All flaps survived except for one flap where partial necrosis was observed. The recurrence rate was 9.01% (1/11). One patient underwent another surgery. The general outcome was satisfactory.
CONCLUSIONS
Conclusions: Our findings underscore the efficacy of flap reconstruction surgical techniques in the management of pressure ulcers among pediatric patients. Based on our experience and the outcomes observed, we advocate for considering reconstructive surgery as a viable therapeutic option early in the treatment course, particularly for stage 3 and 4 ulcers. This approach not only addresses the immediate needs of patients but also holds promise for long-term wound healing and prevention of recurrence.
PubMed: 38929270
DOI: 10.3390/children11060691 -
Children (Basel, Switzerland) May 2024This study aims to analyze the impact of the COVID-19 pandemic on the clinical, pathological, and surgical characteristics of acute appendicitis (AA) at the University...
BACKGROUND
This study aims to analyze the impact of the COVID-19 pandemic on the clinical, pathological, and surgical characteristics of acute appendicitis (AA) at the University Hospital Centre (UHC) Zagreb.
METHODS
This retrospective study analyzed demographic, clinical, and surgical data from consecutive AA patients. Data were collected from an electronic database for two periods: 1 January to 31 December 2019 (pre-COVID-19), and 11 March 2020, to 11 March 2021 (COVID-19 pandemic).
RESULTS
During the two study periods, 855 appendectomies were performed, 427 in the pre-pandemic, and 428 during the pandemic. Demographic data were comparable between groups. There was statistically no significant difference in the type of appendectomy ( = 0.33) and the median hospital length of stay (3; (2-5) days, = 0.08). There was an increase in the conversion rate during the pandemic period (4.2% vs. 7.7%, = 0.03). The negative appendectomy rate and the incidence of perforated AA did not differ significantly ( = 0.34 for both).
CONCLUSIONS
We did not observe a significant increase in the rate of AA complications during the COVID-19 pandemic at the UHC Zagreb. This may be attributed to two factors: (1) AA was diagnosed and treated as an emergency, which remained available during the pandemic, and (2) diagnostic and therapeutic protocols remained unaltered. We recommend a laparoscopic approach even during the COVID-19 pandemic.
PubMed: 38929221
DOI: 10.3390/children11060641 -
Children (Basel, Switzerland) May 2024Gastrointestinal tract perforation is uncommon in children, accounting for <10% of cases of blunt abdominal trauma. Diagnosis of bowel perforation in children can be... (Review)
Review
Gastrointestinal tract perforation is uncommon in children, accounting for <10% of cases of blunt abdominal trauma. Diagnosis of bowel perforation in children can be challenging due to poor diagnostic imaging accuracy. Intra-abdominal free air is found only in half of the children with bowel perforation. Ultrasound findings are nonspecific and suspicious for perforation in only two-thirds of cases. A computer tomography (CT) scan has a sensitivity and specificity of 50% and 95%, respectively. Surgical decisions should be made based on clinical examination despite normal CT results. Management of bowel perforation in children includes primary repair in 50-70% and resection with anastomosis in 20-40% of cases.
PubMed: 38929192
DOI: 10.3390/children11060612 -
Foods (Basel, Switzerland) Jun 2024Poly-(Lactic Acid) (PLA) is regarded as one of the most promising bio-based polymers due to its biocompatibility, biodegradability, non-toxicity, and processability. The...
Poly-(Lactic Acid) (PLA) is regarded as one of the most promising bio-based polymers due to its biocompatibility, biodegradability, non-toxicity, and processability. The investigation of the potential of PLA films in preserving the quality of strawberries is fully in line with the current directives on the sustainability of food packaging. The study aims to investigate the effects of PLA films on strawberries' physical and chemical properties, thereby determining whether they can be used as a post-harvest solution to control antioxidant loss, reduce mold growth, and extend the shelf-life of strawberries. Well-designed PLA films with different-sized holes obtained by laser perforation (PLA, PLA and PLA) were tested against a conventional packaging polypropylene (PP) tray for up to 20 days of storage. Weight loss and mold growth were significantly slower in strawberries packed in PLA films. At the same time, PLA-based films effectively preserved the deterioration of vitamin C content, polyphenols and antioxidant activity compared to the control. Furthermore, among all, the micro-perforated PLA film (PLA) showed better preservation in the different parameters evaluated. These results could effectively inhibit the deterioration of fruit quality, showing promising expectations as an effective strategy to extend the shelf-life of strawberries.
PubMed: 38928785
DOI: 10.3390/foods13121844 -
Diagnostics (Basel, Switzerland) Jun 2024Acute appendicitis is a common abdominal emergency observed in emergency departments (ED). Distinguishing between uncomplicated and complicated appendicitis is important...
BACKGROUND
Acute appendicitis is a common abdominal emergency observed in emergency departments (ED). Distinguishing between uncomplicated and complicated appendicitis is important in determining a treatment strategy. Serum soluble vascular cell adhesion molecule-1 (VCAM-1) is an inflammatory biomarker. We aimed to determine the role of VCAM-1 in predicting complicated appendicitis in children.
METHODS
Pediatric patients with suspected appendicitis admitted to the ED were enrolled in this prospective study. Pre-surgical serum VCAM-1 was tested in children with acute appendicitis within 72 h of symptoms (from day 1 to day 3). Serum VCAM-1 levels were further analyzed and compared between patients with and without complicated appendicitis.
RESULTS
Among the 226 pediatric appendicitis patients, 70 had uncomplicated appendicitis, 138 had complicated appendicitis, and 18 had normal appendices. The mean serum VCAM-1 levels in patients with perforated appendicitis were higher than in those with simple appendicitis ( < 0.001). On day 1 to day 3, the mean VCAM-1 levels in patients with complicated appendicitis were all significantly higher than in those with uncomplicated appendicitis (all < 0.001).
CONCLUSION
Serum VCAM-1 levels may be helpful in differentiating uncomplicated and complicated appendicitis in children and could predict appendiceal perforation.
PubMed: 38928671
DOI: 10.3390/diagnostics14121256 -
Diagnostics (Basel, Switzerland) Jun 2024Tooth loss in the posterior maxilla often necessitates dental implant placement, but the maxillary sinus anatomy poses challenges, especially during sinus floor...
BACKGROUNDS
Tooth loss in the posterior maxilla often necessitates dental implant placement, but the maxillary sinus anatomy poses challenges, especially during sinus floor elevation. Mesially angled implants are an alternative for total edentulism, but for single tooth deficiencies, palatally angled implants may offer a solution. This study evaluates the prevalence of avoiding sinus floor elevation by placing palatally angled implants in cases with a single missing tooth.
METHODS
A retrospective study at Ahmet Keleşoğlu Faculty of Dentistry involved 100 participants with a single missing tooth and prior CBCT scans. Virtual implants were placed using OnDemand3D (version 1.0.7462) software. On CBCT sections, implants were angled palatally to avoid sinus or nasal cavity perforation. Statistical analysis was conducted using R and MedCalc (version 4.3.2) software.
RESULTS
Of the participants (60% female, average age 50.45), 76 edentulous regions required sinus elevation. The implant placeability rates varied across zones (second molar: 39.3%, first molar: 63.1%, second premolar: 78.5%). Implant placement at a palatal angle was significantly higher in the second premolar and first molar regions. Statistically significant differences were observed in the implant placeability between regions.
CONCLUSIONS
This study supports the feasibility of avoiding sinus floor elevation through palatally angled implants in specific cases, reducing the associated complications.
PubMed: 38928657
DOI: 10.3390/diagnostics14121242 -
Cancers Jun 2024Patients with advanced vulvoperineal cancer require a multidisciplinary treatment approach to ensure oncological safety, timely recovery, and the highest possible... (Review)
Review
BACKGROUND
Patients with advanced vulvoperineal cancer require a multidisciplinary treatment approach to ensure oncological safety, timely recovery, and the highest possible quality of life (QoL). Reconstructions in this region often lead to complications, affecting approximately 30% of patients. Flap design has evolved towards perforator-based approaches to reduce functional deficits and (donor site) complications, since they allow for the preservation of relevant anatomical structures. Next to their greater surgical challenge in elevation, their superiority over non-perforator-based approaches is still debated.
METHODS
To compare outcomes between perforator and non-perforator flaps in female vulvoperineal reconstruction, we conducted a systematic review of English-language studies published after 1980, including randomized controlled trials, cohort studies, and case series. Data on demographics and surgical outcomes were extracted and classified using the Clavien-Dindo classification. We used a random-effects meta-analysis to derive a pooled estimate of complication frequency (%) in patients who received at least one perforator flap and in patients who received non-perforator flaps.
RESULTS
Among 2576 screened studies, 49 met our inclusion criteria, encompassing 1840 patients. The overall short-term surgical complication rate was comparable in patients receiving a perforator ( = 276) or a non-perforator flap ( = 1564) reconstruction (* > 0.05). There was a tendency towards fewer complications when using perforator flaps. The assessment of patients' QoL was scarce.
CONCLUSIONS
Vulvoperineal reconstruction using perforator flaps shows promising results compared with non-perforator flaps. There is a need for the assessment of its long-term outcomes and for a systematic evaluation of patient QoL to further demonstrate its benefit for affected patients.
PubMed: 38927919
DOI: 10.3390/cancers16122213 -
Cancers Jun 2024This study introduces a free-style perforator based island flap (PBIF) for the reconstruction of skin defects. From March 2012 to December 2022, a retrospective...
This study introduces a free-style perforator based island flap (PBIF) for the reconstruction of skin defects. From March 2012 to December 2022, a retrospective investigation was conducted on patients who underwent reconstruction for facial defects due to skin cancer. Data on the patients' gender, age, anesthesia method, diagnosis, defect location, flap size, complications, and follow-up periods were collected. There are several principles for designing the PBIF: finger-pinching method, alignment with the direction of wrinkles, the smaller width and longer length of the flap, and proximal attachment to the muscle. A total of 32 patients were included, with an average age of 63.6 years. Surgeries were performed in various regions, such as the infraorbital area, nose, cheek, philtrum, and the anterior/posterior/inferior auricular regions, with an average flap size of 7.63 cm. There were no complications, such as venous congestion or vascular insufficiency in the skin flaps, although one case required revisional closure due to flap disruption. The PBIF is a useful and effective method for the restoration of facial defects. This method can provide simple yet aesthetically satisfying results, showing stable outcomes without complex surgeries or complications. This study indicates the potential for this method to be more widely employed in reconstructive surgeries in the future.
PubMed: 38927912
DOI: 10.3390/cancers16122206 -
Bioengineering (Basel, Switzerland) Jun 2024(1) Background: When placing implants in the maxillary posterior region with insufficient alveolar bone, a maxillary sinus elevation is necessary. Autogenous bone,...
(1) Background: When placing implants in the maxillary posterior region with insufficient alveolar bone, a maxillary sinus elevation is necessary. Autogenous bone, though biologically ideal, poses risks and discomfort due to donor site harvesting. Block-type autogenous tooth bone graft material, made from the patient's own extracted tooth, offers similar biological stability without these drawbacks. (2) Methods: This study observed the progress of 19 implant patients who were treated with maxillary sinus elevation procedures using block-type autogenous tooth bone graft material at the Daegu Catholic University Medical Center. Extracted teeth were processed into demineralized tooth block bone. After elevating the sinus membrane, implants and the tooth bone graft material were placed in the space, and the bony window was repositioned. Postoperative evaluations through clinical observation and radiographic imaging assessed sinus membrane elevation, alveolar bone height increase, and implant osseointegration. (3) Results: Results showed proportional increases in alveolar bone height to the graft material size, with long-term stability. No postoperative complications occurred, even with sinus membrane perforation, and implants remained stable. (4) Conclusions: The study concludes that maxillary sinus lifts using block-type autogenous tooth bone graft material provide excellent bone induction and biocompatibility, making this a highly beneficial method for both dentists and patients.
PubMed: 38927869
DOI: 10.3390/bioengineering11060633 -
Emergency Radiology Jun 2024Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent... (Review)
Review
Intestinal obstruction is a common surgical emergency with high morbidity and mortality. Patients presenting with features of small bowel obstruction need urgent evaluation to avoid complications such as bowel gangrene, perforation, or peritonitis. Imaging is necessary in most cases of suspected bowel obstruction, to take an appropriate decision, for apt patient management. Among the common causes of small bowel obstruction, adhesions, external herniae, malignancies, and Crohn's disease top the chart. Imaging helps in determining the presence of obstruction, the severity of obstruction, transition point, cause of obstruction, and associated complications such as strangulation, bowel gangrene, and peritonitis. This review is based on the cases with unusual causes of bowel obstruction encountered during our routine practice and also on the extensive literature search through the standard textbooks and electronic databases. Through this review we want our readers to have sound knowledge of the imaging characteristics of the uncommon yet important causes of bowel obstruction. We have also revisited and structured a checklist to simplify the approach while reporting a suspected case of small bowel obstruction. Imaging plays a key role in the diagnosis of small bowel obstruction and in determining the cause and associated complications. Apart from the common causes of small bowel obstruction, we should also be aware of the uncommon causes of small bowel obstruction and their imaging characteristics to make an accurate diagnosis and for apt patient management.
PubMed: 38926239
DOI: 10.1007/s10140-024-02256-8