Intraoperative angiography of the neurovascular bundle using indocyanine green and near-infrared fluorescence improves anatomical dissection during robot-assisted radical prostatectomy: initial clinical experience.

Landmark artery identification in the neurovascular bundle (NVB) is important for nerve-sparing in radical prostatectomy. We aimed to investigate intraoperative angiography using indocyanine green and near-infrared fluorescence (ICG-NIRF) during robot-assisted radical prostatectomy (RARP) to identify the NVB, visualise vascularisation and haemostasis, and preserve erectile function. Our retrospective, unicentric study was performed in consecutive localised prostate cancer RARP patients (stage T1/T2, prostate-specific antigen < 10 ng/ml) who underwent ICG-NIRF angiography in France (2016-2021). When ready to dissect the NVB, the anaesthesiologist intravenously injected ICG (3 ml); the surgeon used alternating standard light or fluorescence to optimise NVB visualisation and facilitate microdissection. Primary outcomes: safety and feasibility of ICG-NIRF. Secondary outcomes: functional erectile dysfunction (Sexual Health Inventory for Men (SHIM) questionnaire) over 9 months, proportion of bilateral NVBs identified, ICG-related complications. Standard descriptive statistics were used; t test determined the significance of changes in SHIM scores versus baseline. Ninety-one patients received intraoperative angiography. The NVB was identified in all cases, without difficulties. No ICG-related complications or allergies were observed. There was no significant difference in the SHIM score at 9 months compared with baseline (p = 0.331), and erectile dysfunction returned to baseline levels in almost all patients. Intraoperative, real-time ICG-NIRF angiography is simple, non-invasive, and improves identification of key anatomical landmarks to optimise micropreservation of the NVB during RARP and preserve erectile function. Larger clinical studies should confirm preliminary results.

Traumatic superior semicircular canal dehiscence syndrome: case report and literature review.

Superior semicircular canal dehiscence (SSCD) syndrome was first reported in 1998 by Minor et al. and comprises a spectrum of auditory and vestibular symptoms as a result of 'mobile third window' mechanism. The aetiology of SSCD is debated, but persistent infantile microstructure of the temporal bone was suggested. However, some authors related a 'second event', such as closed head trauma, temporal bone fracture and sudden increase in the intracranial pressure to the precipitation of its symptoms. In this article, we report a patient with a closed head trauma who developed unilateral auditory symptoms. High-resolution computed tomography images were obtained and confirmed bilateral SSCD with the normal middle ear structure. The patient was provided with a monaural hearing aid. Literature was searched for similar case reports or series where head trauma precipitated the symptoms of SSCD in anatomically susceptible individuals.

Retrograde intussusception causing small bowel obstruction in a 35 year old Female patient following a Roux en Y Bypass. Case report.

INTRODUCTION: Intestinal intussusception is an uncommon entity when preceded by Roux en Y gastric bypass. Retrograde intussusception is an enigmatic phenomenon characterized by reversely intussuscepted intestinal loop that may involve any piece of the Roux en Y limbs. Computed Tomography is gold standard for diagnosis. Surgical management is highly debatable. CASE PRESENTATION: A 35 years old female known for morbid obesity, post roux en Y gastric bypass since 5 years with 100 % excess weight loss presenting for on-off episodes of small bowel obstruction symptoms. She was diagnosed laparoscopically for retrograde intussusception that was reduced easily with closure of Peterson's pouch due to high suspicion of an internal hernia. She did well postoperatively and followed up adequately with no recurrence of her symptoms. CONCLUSION: Retrograde intussusception remains an interesting uncommon phenomenon in the horizon of the roux en Y gastric bypass surgeries. Several surgical options were discussed in the last 12 years and they are still debatable.

Laparoscopic ileo-cecectomy for ileo-ceco-colic double intussusception due to a cecal adenoma harboring multifocal high grade dysplasia in a 24 years old male: A case report.

INTRODUCTION: Intestinal Intussusception is defined as invagination of the intussusceptum into the intussuscepien, and is responsible of 1% of all bowel obstructions. It is rare in adults and common in children. It is mostly due to organic causes in adults that form lead points. Enteroenteric intussusception is the most common type. Signs and symptoms are more classic in children but nonspecific in adults. Usually diagnosis is made intraoperatively, while abdomino-pelvic CT scan is the best preoperative imaging modality. Intestinal Intussusception in adults, especially when the colon is involved, is best treated by surgical resection. CASE PRESENTATION: A 24 years old previously healthy male with no surgical or documented familial history presenting for severe crampy abdominal pain and distention, obstipation and palpable right lower quadrant abdominal mass. Abdominal Multi-slice CT diagnosed an ileo-colic intussusception without signs of bowel suffering. Laparoscopic ileo-cecetomy. Final Pathology showed a 4 cm cecal tubular adenomatous polyp with multifocal high grade dysplasia. CONCLUSION: Intestinal intussusception in adults is an interesting rare entity that have the interest of general surgeons. Malignant lesions can be lead-points and they form a great counterpart among other colonic lesions. Minimally invasive laparoscopic surgery is gaining interest in management, and surgical resection remains the gold standard while reduction before surgery is debatable and can be considered in selected cases.

Giant parathyroid adenoma presenting with a pathological left clavicular fracture: An extremely rare case report.

INTRODUCTION: Parathyroid gland has a distinct physiologic and endocrinologic role in the body system. Primary hyperparathyroidism is the most common cause of hypercalcemia with a marked female dominance. It is characterized by hypercalcemia, hypophosphatemia and elevated parathyroid hormone. Parathyroid adenoma, parathyroid hyperplasia and parathyroid carcinoma form the differential diagnosis. Giant parathyroid adenomas are rarely symptomatic than non-giant parathyroid adenomas and parathyroid carcinoma. CASE PRESENTATION: A 41 years old previously healthy male patient with undetectable surgical and familial history presenting with left clavicle fracture by mild trauma. He was diagnosed for primary hyperparathyroidism after the finding of multiple bony lesions and elevated serum calcium and Parathyroid hormone. Preoperative imaging aided in diagnosis of a parathyroid lesion and secondary bone resorption lesions (brown tumors). After adequate medical treatment and preparation, selective right lower parathyroidectomy was held, and the final pathology came with a giant parathyroid adenoma. CONCLUSION: Primary hyperparathyroidism should be suspected when dealing with a hypercalcemic patient having osteolytic bony lesions. Distinguishing Parathyroid adenoma from carcinoma is a challenging and essential preoperative step in planning and surgical procedure.

Suicide in autism spectrum disorders.

This review focuses on suicide in patients with Autism Spectrum Disorders (ASD) as well as risk factors and comorbidities of persons with ASD who have attempted suicide. Research was conducted by searching PubMed and Psychinfo for articles. Suicide in ASD is largely understudied. Although suicide is common in clinical samples, we have little knowledge of suicide in persons with ASD in the general population. Comorbidity, particularly with depression and other affective disorders or schizoid disorders and psychotic symptoms, is often reported, so it is difficult to determine if suicidality is associated with ASD or the comorbid disorder. Clinical samples suggest that suicide occurs more frequently in high functioning autism. Physical and sexual abuse, bullying, and changes in routine are precipitating events associated with suicide risk. Persons with ASD present risk factors inherent to their diagnosis (deficit in expression of feelings and thoughts), along with risk factors pertaining to the general population (abuse, depression, anxiety, etc.). The inability of persons with Pervasive Developmental Disorder (PDD) to express emotions and thoughts makes the diagnosis of suicidal ideation difficult and demands important adjustments to traditional psychotherapeutic interventions. More research is needed to determine the incidence of suicidal behaviors in persons with ASD, to identify risk and protective factors, as well as to assess the effectiveness of prevention strategies and interventions.

Polytetrafluoroethylene-covered nitinol stent graft for treatment of carotid artery blowout syndrome in head and neck cancer patients.

OBJECTIVES/HYPOTHESIS: To evaluate the efficacy, tolerance, and outcomes of covered stents in the treatment of carotid blowout syndrome (CBS) in head and neck cancer patients. STUDY DESIGN: Individual retrospective cohort study. METHODS: We retrospectively reviewed the medical and image files of all 20 consecutive head and neck cancer patients treated with covered stent grafts for CBS. Six acute, 12 impending, and two threatened cases of CBS were treated in patients who all had previously received radiation therapy. We evaluated the feasibility, hemostatic efficacy, survival without bleeding, and complications. RESULTS: The etiologies of CBS were as follows: group 1, 13 carotid axis (common or internal carotid artery) pseudoaneurysms and one rupture; group 2, six patients with no identifiable source of bleeding on angiography but with a threatened carotid axis on computed tomography (CT). In all patients, a polytetrafluoroethylene-covered nitinol stent graft (Fluency; Bard/Angiomed GmbH & Co, Karlsruhe, Germany) was successfully placed. All of the stents were patent at the end of the procedure. Immediate hemostasis was achieved in the six hemorrhagic cases. Immediate transient ischemic attacks were observed in two patients, and carotid sinus syndrome was observed in one patient. Post-treatment bleeding was observed in five patients in group 2 and no patients in group 1. Survival without bleeding was 251 days in group 1 and 35 days in group 2. During follow-up, three asymptomatic stent thromboses occurred at a mean of 58 days. CONCLUSIONS: Covered stent placement is highly feasible and proved effective without major complications in CBS due to carotid axis bleeding.

Infarcted accessory spleen due to segmental portal hypertension.

Accessory spleens are frequent entities, but their infarction due to arterial stasis caused by segmental portal hypertension is extremely rare. We present this case of a 38-year-old female patient with a three-week history of abdominal pain and an abdominal CT scan revealing a 7 cm mass near the spleen and tail of pancreas with segmental portal hypertension. The patient had no hematologic disease. This mass was surgically resected, with a pathological diagnosis of an infarcted accessory spleen.

Epidermoid cyst of the spleen: case report.

Splenic cysts, very rare pathologies, are classified into parasitic and the highly uncommon, non parasitic cysts. Based on the presence or absence of an epithelial lining wall, the latters are classified into true cysts and false cysts. We present a case of a 23-year-old male who presented to our clinic with a several-month history of abdominal discomfort that was due to the compressive effect of a huge nonparasitic true splenic cyst.

Pain relief by continuous intraperitoneal nebulization of ropivacaine during gynecologic laparoscopic surgery--a randomized study and review of the literature.

STUDY OBJECTIVE: To evaluate the efficacy of intraperitoneal nebulization of ropivacaine on pain relief during and after gynecologic laparoscopic procedures including a review of the literature. DESIGN: Double-blinded, randomized, controlled, clinical trial (Canadian Task Force classification I). SETTING: University hospital ambulatory gynecoendoscopic department. PATIENTS: Forty patients (20 patients in each arm) undergoing elective gynecologic same-day outpatient laparoscopic surgery including unilateral/bilateral salpingo-oophorectomy or unilateral/bilateral ovarian cystectomy. INTERVENTIONS: The study group received 10 mL of 1% ropivacaine and the control group received 10 mL of sterile water by intraperitoneal nebulization. During surgery, vital signs were recorded and summarized. Postoperatively patients were followed up for 24 hours including visual analog scale scores and analgesic use. MEASUREMENTS AND MAIN RESULTS: No significant differences existed between the groups during surgery and at the recovery department in terms of arterial blood pressure (p=.42) or heart rate (p=.60). Regarding postoperative analgesia, no difference existed between the groups in terms of morphine consumption (p=.52) or other analgesics (p=.53). No significant difference existed between the groups in postoperative visual analog scale scores including visceral, abdominal wall, and shoulder pain during rest and during cough at the different time frames (30, 60, and 120 minutes and 6 and 24 hours after surgery). CONCLUSION: Our study is the first to examine the effects of intraperitoneal nebulization of ropivacaine throughout laparoscopic gynecologic procedures on patients undergoing general anesthesia. Nebulization of 100 mg of ropivacaine under our specific regimen of anesthesia does not improve patients' outcome in terms of intraoperative and postoperative pain along with consumption of analgesics. Further research with other regimens is required.

Synchronous epidermoid cyst and mature teratoma of the testis: an unusual association.

We describe here the first case of a synchronous epidermoid cyst and mature teratoma of the testis occurring in a young man presenting a with bilateral testicular tumor. After a clinical, biological and ultrasound evaluation, testis-sparing surgery was performed on the left testis and a total orchiectomy on the right side in accordance with oncological principles. Histopathological examination revealed a simple epidermoid cyst on the left side and a mature teratoma on the right side, following Price's criteria. No metastasis was detected, and the patient was closely followed. The patient remains disease-free and has normal postoperative testosterone levels 3 years after the surgery.

Open partial nephrectomy with selective renal parenchymal control: a new reliable clamp.

We describe our experience of open partial nephrectomy with a parenchymal clamp, the Reni-Clamp, in 30 patients from January 2002 to May 2005. The mean operative and clamping time was 150 and 27 minutes, respectively, and the blood loss was 150 mL. The Reni-Clamp enabled us to perform partial nephrectomy safely in all cases of polar or external edge renal tumor.