Meldgaardfoster5088

KEY WORDS Clinically node-negative differentiated thyroid cancer, Differentiated thyroid carcinoma, Prophylactic central neck dissection.

As the short-term outcomes may overestimate the true success rates of sphincter-sparing techniques, and follow- up protocols that were reported based on clinical criteria do not ideally reflect real world outcomes associated with complex perianal fistulas (CPF), this study aimed to reveal clinically and three dimensional endosonograpy confirmed long-term outcomes and analyze the factors associated with recurrences of ligation of intersphincteric fistula tract (LIFT) procedure.

A retrospective cross-sectional review was conducted for patients who underwent the LIFT procedure for complex perianal fistulas between October 2015 and February 2017. Cox proportional regression model was used to estimate the mean failure free survival rates and log-rank test was used to compare the outcome distributions for patients who healed vs presented with failure.

A total of 42 patients with the majority of males (n=34, %81), who underwent LIFT procedure for CPF were analyzed. None of patients were lost at follow-up. Endosonograpy-confirmed fistula types were high transsphincteric( n=35), horseshoe fistula (n=5) and suprasphicteric (n=2). After a median follow-up of 25.1 (15-36) months, the overall healing rate was 57.1%, which subsequently increased to 85.7% with a simple secondary intervention. Based on Cox regression analysis, previous perianal intervention was found to be independent risk factor for failure (p=0.025). Having prior perianal surgery significantly increased the risk of recurrence 6.7 times (OR6,7 95% CI1,9-24,1 p=0,003). Outcomes were confirmed by endoanal ultrasound for all patients.

Endoanal ultrasound confirmed long-term assessment of the LIFT procedure provides an acceptable success rate, especially when combined with secondary simple interventions, without impairment on continence for the complex perianal fistulas.

Complex perianal fistulas, Endoanal ultrasound, Ligation of intersphincteric fistula tract.

Complex perianal fistulas, Endoanal ultrasound, Ligation of intersphincteric fistula tract.

Gallbladder perforation (GBP) is an uncommon life-threatening and almost exclusive complication of cholecystitis. It is often associated with relatively high morbidity and mortality rates due to delay in diagnosis. GBP still continues to be a challenging issue for the surgeons. Most cases can only be diagnosed during surgery. The aim of this retrospective, case series was to present our clinical experience with gallbladder perforation and to provide an overview of promoting factors, clinical manifestations, diagnostic workup and management of GBP on the basis of recent literature review.

This study involved four patients with gallbladder perforation (three males and one female), who were treated in our department from May 2019 to November 2019. We made a retrospective analysis of these patients and a review of the related literature.

According to Niemeier's classification, all patients had type II gallbladder perforation. Mean age was 70 years (range 50-85 years). They had also significant comorbidities, of which diabetes mellitus was the most common (three patients). Ultrasonography was the initial mode of investigation in these four patients. Out of the four cases, three patients underwent immediate intervention and only one patient was initially managed conservatively with intravenous antibiotics.

Early diagnosis of gallbladder perforation and immediate intervention are of crucial importance. Clinical examination, diagnostic imaging and high index of suspicion of this severe condition would be significant in establishing an early diagnosis of the perforation.

Cholecystitis, Gallbladder perforation, Niemeier.

Cholecystitis, Gallbladder perforation, Niemeier.The dorsal metacarpal artery (DMCA) flap is considered as one of the working horses to cover exposed extensor tendon or bone of dorsal digits. The periosteal composite DMCA reverse flap (pcDMCAr flap) is described as a fast and safe solution to manage this kind of trauma. Thapsigargin mw A 35-year-old male had a trauma to his left hand from a circular saw. The resultant injury was localized to the proximal middle finger with a dorsal bone loss. A vascularized composite flap, including 3th metacarpal periosteum, was elected as the most appropriate option. Postoperative follow-up at 6 months confirmed bony regeneration. There are no documented cases to the best of our knowledge demonstrating the use of pcDMCAr flap to treat fractures with bone loss in the proximal digits. This report suggests that technique may be employed as regenerative bone flap in reconstructive surgery for proximal fingers trauma with bone loss and open fracture. KEY WORDS Bone regeneration, Dorsal metacarpal flap, Periosteum.

Anastomotic leakage (AL) after anterior rectal resection unresponsive to diverting ileostomy is difficult to manage. Endoscopic vacuum-assisted (E-VAC) wound closure system is a new approach based on co-axial sponge positioning under endoscopic control. If the abscess is not co-axial, however, endoscopic positioning is not feasible. Aim is to report an original method of sponge positioning.

A 62-year-old woman with chronic AL after anterior rectal resection for cancer was referred. AL had been treated with diverting ileostomy without healing. Due to the peri-rectal abscess anatomy, standard E-VAC positioning was not possible. A combined endoscopic-interventional radiology procedure for Endo-SPONGE® (B. Braun Aesculap AG, Germany) positioning was thus employed. Under general anesthesia, a guidewire was passed after small counter-incision on the left gluteus and through the left levator muscle, reaching the anastomotic dehiscence and rectal lumen through the chronic abscess. The guidewire was retrieved through the anus and connected to a long silk thread. By retracting the trans-gluteal guidewire, the silk thread was pulled through the abscess to exit from the gluteal skin incision. A tailored Endo-SPONGE® was then connected to the trans-anal silk thread. By pulling on the gluteal silk thread, the sponge was positioned inside the abscess. The silk thread remained in place under a medication for sponge replacements.

Twelve Endo-SPONGE replacements under sedation were required until AL completely resolved after 35 days.

When traditional endoscopic sponge insertion into AL is not possible, this original "pulley system" proved effective for sponge introduction and replacement.

Anastomotic leakage (AL), Anterior rectal resection, Endo-SPONGE, Endoscopic-Interventional radiology, Pulley system.

Anastomotic leakage (AL), Anterior rectal resection, Endo-SPONGE, Endoscopic-Interventional radiology, Pulley system.