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Journal of Neurosurgery. Case Lessons Mar 2024Myelomeningocele (MMC) is the most serious form of spina bifida, a congenital defect in neural tube development. Defect closure in a patient with an extremely low birth...
BACKGROUND
Myelomeningocele (MMC) is the most serious form of spina bifida, a congenital defect in neural tube development. Defect closure in a patient with an extremely low birth weight presents unique challenges and risks; lower birth weight is associated with multiple organ system concerns, homeostasis is difficult, and local tissue is underdeveloped. To the authors' knowledge, the present case is the lowest reported weight (490 g) for a neonate with postnatal MMC repair.
OBSERVATIONS
A preterm male with a prenatally diagnosed lumbosacral MMC and associated Chiari malformation type II was born at 23 weeks 1 day to a 29-year-old mother, gravidity 6 parity 4. The patient was medically stabilized and underwent MMC closure on day of life 5. His weight was 490 g at the time of this repair, and he did not have any surgical complications. At age 16 months, he underwent endoscopic third ventriculostomy with choroid plexus cauterization; he has not required any further hydrocephalus treatments since the last follow-up at 30 months of age.
LESSONS
To the authors' knowledge, this case is the lowest birth weight ex utero MMC closure reported in the literature. Challenges of prematurity and size required appropriate preoperative stabilization, careful hemostasis and temperature regulation, and meticulous surgical technique.
PubMed: 38437685
DOI: 10.3171/CASE23556 -
Journal of Orthopaedic Case Reports Feb 2024Distal tibia fractures are a common cause of physeal injuries that can subsequently cause deformity in pediatric populations. Limited literature exists supporting...
INTRODUCTION
Distal tibia fractures are a common cause of physeal injuries that can subsequently cause deformity in pediatric populations. Limited literature exists supporting treatment strategies for varus deformities. In this study, we illustrate a unique case of premature physeal closure complicated by development of a varus ankle deformity treated with navigation guided physeal bar resection that spontaneously resolved without the requirement for guided growth.
CASE REPORT
A 6-year-old female presented to our clinic after development of a right ankle varus deformity measuring 14°. She had sustained a right Salter Harris type 3 distal tibia fracture 10 months prior and underwent fixation at an external facility. After undergoing navigation guided physeal bar resection, resolution of her deformity occurred without the use of guided growth.
CONCLUSION
Spontaneous resolution of an ankle deformity is possible after a physeal bar resection. However, in these technically demanding procedures, it is important to optimize accuracy and results using preoperative bar mapping and intraoperative three-dimensional navigation.
PubMed: 38420249
DOI: 10.13107/jocr.2024.v14.i02.4212 -
Journal of AAPOS : the Official... Apr 2024We present the case of a patient with a history of laser-treated retinopathy of prematurity (ROP) who developed narrow angles and intermittent angle closure. Despite...
We present the case of a patient with a history of laser-treated retinopathy of prematurity (ROP) who developed narrow angles and intermittent angle closure. Despite laser peripheral iridotomy/iridoplasty, 1 year later, the patient had recurrent narrowing that resolved following clear lens extraction with intraocular lens placement. This case highlights the importance of continued monitoring for narrow angles in patients with ROP history.
Topics: Infant, Newborn; Humans; Glaucoma, Angle-Closure; Iris; Retinopathy of Prematurity; Laser Therapy; Iridectomy; Intraocular Pressure
PubMed: 38412916
DOI: 10.1016/j.jaapos.2024.103854 -
Advances in Medical Education and... 2024Literature suggest that physicians' high level of confidence has a negative impact on medical decisions, and this may lead to medical errors. Experimental research is...
BACKGROUND
Literature suggest that physicians' high level of confidence has a negative impact on medical decisions, and this may lead to medical errors. Experimental research is lacking; however, this study investigated the effects of high confidence on diagnostic accuracy.
METHODS
Forty internal medicine residents from different hospitals in Saudi Arabia were divided randomly into two groups: A high-confidence group as an experimental and a low-confidence group acting as a control. Both groups solved each of eight written complex clinical vignettes. Before diagnosing these cases, the high-confidence group was led to believe that the task was easy, while the low-confidence group was presented with information from which it could deduce that the diagnostic task was difficult. Level of confidence, response time, and diagnostic accuracy were recorded.
RESULTS
The participants in the high-confidence group had a significantly higher confidence level than those in the control group: 0.75 compared to 0.61 (maximum 1.00). However, neither time on task nor diagnostic accuracy significantly differed between the two groups.
CONCLUSION
In the literature, high confidence as one of common cognitive biases has a strong association with medical error. Even though the high-confidence group spent somewhat less time on the cases, suggesting potential premature decision-making, we failed to find differences in diagnostic accuracy. It is suggested that overconfidence should be studied as a personality trait rather than as a malleable characteristic.
PubMed: 38410282
DOI: 10.2147/AMEP.S442689 -
Journal of Clinical Ultrasound : JCU May 2024We aimed to investigate the role of lung ultrasound (LUS) score in the closure of hemodynamically insignificant patent ductus arteriosus (PDA) and the clinical findings...
PURPOSE
We aimed to investigate the role of lung ultrasound (LUS) score in the closure of hemodynamically insignificant patent ductus arteriosus (PDA) and the clinical findings of the patients before and after closure.
METHODS
The study groups (107 preterm neonates under 34 gestational weeks) were classified as hemodynamically significant PDA (group 1), hemodynamically insignificant PDA with closure therapy (group 2), hemodynamically insignificant PDA without closure therapy (group 3), and no PDA group (group 4) based on the echocardiography. 6- and 10-region LUS scores were compared for each group.
RESULTS
There was a significant difference between groups 1 and 3 on first, third, and seventh days. In contrast, groups 1 and 2 had similar LUS scores on the first, third, and seventh days. There was a negative correlation between LUS scores on the first and third days and gestational age, birth weight, the first- and fifth-minute APGAR scores, and there was a positive correlation between aortic root to left atrium ratio, and PDA diameter/weight ratio.
CONCLUSION
We observed that LUS scores in patients with hemodynamically insignificant PDA treated with closure therapy were similar to in patients with hemodynamically significant PDA. Thus, LUS score can have role in PDA closure in preterm neonates. However, more comprehensive studies are needed.
Topics: Humans; Ductus Arteriosus, Patent; Infant, Newborn; Female; Male; Lung; Infant, Premature; Echocardiography; Ultrasonography; Treatment Outcome
PubMed: 38385619
DOI: 10.1002/jcu.23653 -
European Journal of Pediatrics May 2024Transcatheter patent ductus arteriosus (PDA) closure is a safe and effective alternative to surgical ligation in low-body-weight infants. Post-ligation cardiac syndrome... (Comparative Study)
Comparative Study
Post-ligation cardiac syndrome after surgical versus transcatheter closure of patent ductus arteriosus in low body weight premature infants: a multicenter retrospective cohort study.
Transcatheter patent ductus arteriosus (PDA) closure is a safe and effective alternative to surgical ligation in low-body-weight infants. Post-ligation cardiac syndrome (PLCS) is defined as severe hemodynamic and respiratory collapse within 24 h of PDA closure, requiring initiation or an increase of an inotropic agent by > 20% of preligation dosing and an absolute increase of at least 20% in ventilation parameters compared with the preoperative value. Whilst PLCS is routinely observed after surgery, its incidence remains poorly described following transcatheter closure. This study aimed to compare the incidence of PLCS after surgical versus transcatheter closure of PDA in low-body-weight premature infants. Propensity scores were used to compare surgical (N = 78) and transcatheter (N = 76) groups of preterm infants who underwent PDA closure at a procedural weight less than 2000 g in two tertiary institutions between 2009 and 2021. The primary outcome was the incidence of PLCS. Secondary outcomes included overall mortality before discharge, risk factors for PLCS, and post-procedural complications. Procedural success was 100% in both groups. After matching, transcatheter group experienced no PLCS vs 15% in the surgical group (p = 0.012). Furthermore, overall mortality (2% vs 17%; p = 0.03) and major complications (2% vs 23%; p = 0.002) were higher in the surgical group. Surgery (100% vs 47%; p < 0.01), gestation age (25 ± 1 vs 26 ± 2 weeks, p < 0.05) and inotropic support before closure (90% vs 29%; p < 0.001) were associated with PLCS occurrence. Conclusion: Transcatheter PDA closure may be equally effective but safer than surgical PDA closure in low-body-weight premature infants. What is Known: • Post-ligation cardiac syndrome is a serious and common complication of surgical closure of the ductus arteriosus in preterm infants. • Transcatheter closure of preterm ductus arteriosus is a safe and effective technique that is becoming more and more common worldwide. What is New: • Device closure is safer than surgical ligation for patent ductus arteriosus closure in preterm infants and may be the first-line non-pharmacological therapeutic option in this indication in experienced teams. • Our findings should encourage neonatologists and pediatric cardiologists to start and/or strengthen a durable interventional program for transcatheter PDA closure in premature infants.
Topics: Humans; Ductus Arteriosus, Patent; Retrospective Studies; Infant, Newborn; Female; Ligation; Male; Cardiac Catheterization; Infant, Premature; Postoperative Complications; Infant, Low Birth Weight; Incidence; Cardiac Surgical Procedures; Syndrome; Propensity Score; Septal Occluder Device; Risk Factors; Infant, Premature, Diseases
PubMed: 38381375
DOI: 10.1007/s00431-024-05481-y -
Journal of Cranio-maxillo-facial... Mar 2024This study investigated how the fusion states of the cranial base is related to the degree of increased intracranial pressure (ICP) in patients with Crouzon syndrome....
This study investigated how the fusion states of the cranial base is related to the degree of increased intracranial pressure (ICP) in patients with Crouzon syndrome. This retrospective cohort study enrolled patients who were diagnosed with Crouzon syndrome between May 2007 and April 2022. We categorized the patients into three groups: A, B, and C, according to the severity of increased ICP and the number of cranial vault remodeling procedures for corrective operation. The preoperative fusion states of the cranial base sutures/synchondroses were examined using facial bone computed tomography and compared between groups. Overall, 22 patients were included in Groups A, B, and C, including 8, 7, and 7 patients, respectively. The preoperative average grades of the total cranial base suture/synchondrosis fusion appeared to significantly increase with severity, except for the frontoethmoidal suture, which showed the opposite tendency. In the subgroup analysis, frontosphenoidal, sphenoparietal, sphenosquamosal, parietomastoid, and occipitomastoid suture and petro-occipital synchondrosis were associated with earlier fusion in the more severe group. Premature closure of the cranial base sutures/synchodroses seems to be associated with increased ICP severity in patients with Crouzon syndrome. Precise evaluation of minor sutures/synchondroses at the first visit might help build subsequent operative plans and predict disease prognosis.
Topics: Humans; Retrospective Studies; Intracranial Pressure; Cranial Sutures; Craniofacial Dysostosis; Skull Base; Sutures; Craniosynostoses
PubMed: 38369396
DOI: 10.1016/j.jcms.2024.02.011 -
European Heart Journal. Case Reports Feb 2024Previously, ablation at the outflow tract was considered to be safe and rarely affected the His-Purkinje system due to their spatial distance. However, we have reported...
BACKGROUND
Previously, ablation at the outflow tract was considered to be safe and rarely affected the His-Purkinje system due to their spatial distance. However, we have reported a case of right bundle branch block (RBBB) and junctional beats that were recorded during radiofrequency catheter ablation in a patient who had a history of peri-membranous ventricular septal defect (pmVSD) closure and the implantation of a metallic occluder.
CASE SUMMARY
A 16-year-old girl with a metallic occluder for peri-membranous ventricular septum defect underwent an ablation procedure for premature ventricular complexes. During the ablation at the right ventricular outflow tract (RVOT), RBBB and junctional beats were recorded. His bundle potentials and the high-frequency potential generated by electrical interference were observed when mapping the margin of the occluder. To ensure safety, we attempted ablation at the right coronary cusp in the left ventricular outflow tract, which eventually proved to be successful, presenting an alternative ablation strategy.
CONCLUSION
This is a rare report of RBBB and junctional beats observed during ablation at RVOT in a patient with pmVSD and a metallic occluder. The observed damage to the His-Purkinje system may be attributed to uncontrolled radiofrequency energy heating up caused by the metallic device. This case emphasizes the importance of thorough electroanatomic and activation mapping prior to starting the ablation procedure, especially in complicated cases. Furthermore, it suggests that ablation at a relatively remote position is both feasible and relatively safe for patients with occluder devices.
PubMed: 38362062
DOI: 10.1093/ehjcr/ytae054 -
Annals of Pediatric Cardiology 2023Changes in left ventricular (LV) systolic function have not been well described in premature neonates after transcatheter patent ductus arteriosus (PDA) closure.
BACKGROUND
Changes in left ventricular (LV) systolic function have not been well described in premature neonates after transcatheter patent ductus arteriosus (PDA) closure.
METHODS AND RESULTS
We retrospectively identified all premature neonates < 3 kg who underwent a transcatheter PDA closure at our center between January 1 2015 and January 31, 2021. LV indices before and after closure were extracted and an analysis was performed. Overall, 23 neonates were included with a mean procedural weight of 1894 ± 622 g. At 24 h after closure, the median left ventricular ejection fraction (LVEF) (66% interquartile range [IQR] 12% vs. 61% IQR 12, < 0.001) and median LV end-diastolic dimension z-score (3.3 IQR 1.8 vs. 1.4 IQR 2.6, < 0.001) both decreased and 5 (22%) neonates had an LVEF <55%. Patients who had an LVEF <55% at 24 h had a higher preprocedure LV end-diastolic dimension z-score (4.2 IQR 1.2 vs. 2.8 IQR 1.6, = 0.01), a higher preprocedure LV end-diastolic volume (19 mL IQR 4 mL vs. 11 mL IQR 11, = 0.03), a higher birth weight (940 g IQR 100 g vs. 760 g IQR 140, = 0.04), and were more likely to receive intravenous calcium during the procedure (60% vs. 11%, = 0.04) compared to those with an LVEF ≥55% at 24 h after closure. Of those with LVEF <55% at 24 h, all normalized before discharge.
CONCLUSION
In preterm neonates who underwent successful transcatheter PDA closure, 23% developed abnormal LVEF after closure and those with significant LV dilation before the procedure were at increased risk for the development of LVEF <55% after closure.
PubMed: 38343508
DOI: 10.4103/apc.apc_52_23 -
The Journal of Vascular Access Feb 2024Umbilical arterial catheterization is a common procedure performed on critically ill neonates, especially those with extreme prematurity. Various complications have been...
BACKGROUND
Umbilical arterial catheterization is a common procedure performed on critically ill neonates, especially those with extreme prematurity. Various complications have been described following umbilical artery catheter (UAC) placement including thrombosis, embolism, vasospasm, vascular perforation, hemorrhage, and infection. However, treatment of these complications is challenging due to the small size of this very fragile subset of patients.
METHODS
A 3-day old extremely preterm infant was referred to our institution for percutaneous removal of a fragmented and embolized umbilical arterial catheter.
RESULTS
Catheter retrieval was successful via a carotid approach utilizing techniques from percutaneous closure of PDA in preterm infants and trans-carotid access for PDA stent and aortic interventions.
CONCLUSION
This case report describes the successful percutaneous retrieval of an embolized UAC fragment in an extremely preterm infant, the smallest documented in literature to date.
PubMed: 38342977
DOI: 10.1177/11297298241228613