Evaluation of long-term results following surgical correction of frontoethmoidal encephalomeningocele.

INTRODUCTION: Frontoethmoidal encephalomeningocele (FEEM) is a neural tube defect with herniation of intracranial contents through the anterior skull base at the foramen cecum. Management is surgical and aims to remove the excess meningoencephalocele tissue and perform facial reconstruction. CASE PRESENTATION: We report on two cases of FEEM that presented to our department. A diagnosis based on computed tomography scans revealed a defect in the nasoethmoidal region (case 1), and a defect was found in the nasofrontal bone (case 2). Surgery was performed using a direct incision over the lesion (case 1) and a bicoronal incision (case 2). Treatment in both cases gave a good outcome, and there was no increase in intracranial pressure and neurological deficits. DISCUSSION: The management of FEEM is surgical. Appropriate timing and careful preoperative planning minimize the risks of intraoperative and postoperative complications. Both patients underwent surgery. Different techniques were required in each case, considering a significant difference between the lesion size and the resultant craniofacial deformity. CONCLUSION: Early diagnosis and treatment planning is vital to achieving the best long-term outcome for these patients. In the next stage of patient development, follow-up examination plays a vital role so that further corrective actions can provide a good prognosis.

Factors related to serum levels of intercellular adhesion molecule-1 in probable COVID-19 patients in surgical treatment: an observational study.

Introduction: COVID-19 causes a systemic inflammatory response, involving dysregulation and misexpression of many inflammatory cytokines. The recruitment and activation of inflammatory cells depend on the expression of many classes of inflammatory mediators, with increased expression of endothelial cell adhesion molecules being related to COVID-19 disease severity. With the World Health Organization having recently updated case definitions to suspect, probable, and confirmed, this study aimed to measure the mean value of intercellular adhesion molecule 1 (ICAM-1) and its relation to suspected COVID-19. Methods: all suspected patients (n=20) were hospitalized and treated following the Indonesian National Guidelines for COVID-19 management. ICAM-1 levels were measured on days 1 and 7, demographic data were recorded, and routine blood count values were measured and additionally considered. Results: the results showed that the levels of ICAM-1 in the 1st-day group (mean 271.3 ng/ml) were higher than those in the 7th-day group (mean 253.9 ng/ml). This difference was statistically significant (p = 0.00, p ≤ 0.05). All of the patients with suspected COVID-19 were included in this study and tested for COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) testing. A total of 10 patients were confirmed positive with a COVID-19 infection, with elevated ICAM-1 levels compared to the confirmed negative patients (with a mean 1st day 296.8 versus a mean 7th day 279.0 ng/ml). ICAM-1 levels of all patients decreased by the seventh day. Conclusion: the mean value of ICAM-1 levels for patients with confirmed positive COVID-19 cases was higher than those with suspected COVID-19 cases.

Cutaneous angiosarcoma: A case report.

INTRODUCTION: Angiosarcoma is a very rare malignancy, which varies based on the location and organ affected. A clinicopathological form of cutaneous angiosarcoma (CAS) involves the head: scalp, face, and neck. We report a 59-year-old female patient with CAS on the temporoparietal region of the scalp. CASE PRESENTATION: The patient presented with lesions in the head area, which appeared suddenly in the last 6 months, (before her surgery). Excision was performed under general anesthesia for bleeding as indicated on the right temporal region. The excision procedure was carried out three times at various stages, and then closed with skin grafts. Pathological examination of the three excised tissues showed progression, leading to CAS. Based on the clinical picture and anatomical assessment, a consultation with the surgical oncology department was necessary for further treatment. DISCUSSION: Angiosarcoma has a high rate of progression. The onset of lesions, which are difficult to detect, does not often lead to progression. Other macroscopic features appear as bluish macules, which can be perceived as bruising. Wide surgical resection is the optimal treatment and is usually combined with radiotherapy and/or chemotherapy. This patient underwent gradual excision, based on bleeding in the right temporal lesion, along with progressive pain. CONCLUSION: Surgical is the preferred management for our patients. Determination of multimodality therapy as treatment for CAS requires assessment of all factors related to age and patient condition. Follow-up evaluation is carried out after palliative therapy - to observe the general condition of the patient, tumor progression, tendency for metastases, and excision of any remaining lesions.