LEFT-SIDED INFERIOR VENA CAVA ASSOCIATED WITH PROXIMAL DEEP VENOUS THROMBOSIS OF THE LEFT LOWER EXTREMITY.

Left-sided inferior vena cava (IVC) is a rare congenital venous anomaly that is most frequently detected incidentally during abdominal computer tomography scanning. However, as in the case presented, the first clinical manifestation of this anomaly may be deep venous thrombosis (DVT) of lower extremities. Therefore, left-sided IVC should be kept in mind in case of inferior DVT, especially in young patients with no predisposing thrombotic risk factors.

Three-dimensional echocardiography in rapid differentiation of the left ventricular mass - a case of left ventricular myxoma.

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Hyponatremia as a predictor of perforated acute appendicitis in pediatric population: A prospective study.

BACKGROUND: The aim of this study was to investigate hyponatremia as a new biochemical marker associated with complicated appendicitis in the pediatric population. METHODS: Pediatric patients (n = 184) with acute appendicitis confirmed by histopathology were enrolled in a prospective cohort study from January 2019 to May 2020. Medical history, demographic and clinical data were recorded in the study protocol. Blood samples for biochemical analysis, electrolytes and acute inflammatory markers were taken before surgery. Patients were further divided in two groups, those with non-perforated (n = 148; 79%) and perforated appendicitis (n = 38; 21%). RESULTS: The mean serum sodium level in patients with complicated appendicitis was significantly lower compared to patients with non-complicated appendicitis (132.2 mmol/L vs. 139.2 mmol/L, p < 0.001). The receiver operating characteristic curve of plasma sodium concentration in patients who were diagnosed with perforated acute appendicitis showed an area under the curve of 0.983 (95% CI, 0.963-1.00). A cut-off-value of plasma sodium concentration of ≤135 mmol/L was shown to give the best possible sensitivity and specificity, 94.7% (95% CI: 82.2-99.3) and 88.5% (95% CI: 88.2-93.2) respectively (p < 0.001). Patients with complicated appendicitis were more likely to be younger than five years of age (10.5% vs. 1.4%, p = 0.005), have a duration of symptoms for >24 h (97.4% vs. 59.6%, p < 0.001), sodium serum concentration ≤135 mmol/L (89.5% vs. 5.5%, p < 0.001), body temperature >38.5 °C (47.4% vs. 11.0%, p < 0.001) and CRP serum concentration >62 mg/L (26% vs. 2%, p < 0.001). CONCLUSION: Hyponatremia is a novel and very discriminative marker of complicated appendicitis in the pediatric population, and is therefore recommended in appendicitis diagnostic and treatment planning. TYPE OF STUDY: Prospective comparative study LEVEL OF EVIDENCE: II.

Helicobacter pylori infection and severity of coronary atherosclerosis in patients with chronic coronary artery disease.

AIM: Controversy exists concerning the relation between Helicobacter pylori (HP) infection and coronary artery disease (CAD). We aimed to examine the relationship between HP infection and severity of coronary atherosclerosis in patients with chronic CAD. PATIENTS AND METHODS: A total of 150 patients (109 [73%] men; mean age 62.61±10.23 years) scheduled for coronary artery bypass grafting surgery were consecutively enrolled in the cross-sectional study. According to rapid urease test and/or gastric biopsy samples stained with hematoxylin and eosin and according to Giemsa, patients were classified as HP positive (n=87; 58%) or HP negative (n=63; 42%). Coronary angiograms were scored by quantitative assessment, using multiple angiographic scoring system: 1) vessel score (number of coronary arteries stenosed ≥50%), 2) Gensini score (assigning a severity score to each coronary stenosis according to the degree of luminal narrowing and its topographic importance) and 3) angiographic severity score (number of coronary artery segments stenosed ≥50%). RESULTS: In comparison to HP-negative patients, HP-positive patients were more frequently hypertensive (P=0.014), had higher values of systolic (P=0.043) and diastolic (P=0.005) blood pressure and total cholesterol (P=0.013) and had lower values of high-density lipoprotein-cholesterol (HDL-C; P=0.010). There were no significant differences between the groups in the severity of coronary atherosclerosis: vessel score (P=0.152), Gensini score (P=0.870) and angiographic severity score (P=0.734). CONCLUSION: It is likely that HP infection is not a risk factor for the severity of coronary atherosclerosis in chronic CAD patients.

Tension plate for treatment of olecranon fractures: new surgical technique and case series study.

BACKGROUND: Our aim was to determine the effectiveness of a new surgical technique for olecranon fractures using a tension plate (TP) designed by the operating surgeon. METHODS: We included patients with olecranon fractures treated between September 2010 and August 2013 in our study. Treatment involved a new implant and operative technique, which combined the most favourable characteristics of 2 frequently used methods, tension band wiring and plate osteosynthesis, while eliminating their shortcomings. The new method was based on the newly constructed implant. RESULTS: Twenty patients participated in our study. We obtained the following functional results with our TP: median flexion 147.5° (interquartile range [IQR] 130°- 155°), median extension 135°/deficit 10° (IQR 135°-145°), median pronation 90° (IQR 81.3°-90°), median supination 90° (IQR 80°-90°). Implant-related complications were noted in 1 patient, and implants were removed in 3 patients. The mean functional Mayo elbow performance score was 94.8 (range 65-100). The removal of the implant was considerably less frequent in patients operated using the new method and implant than in patients operated using conventional methods at our institution (p < 0.001). Mean duration of follow-up was 8 months. CONCLUSION: Our TP for the treatment of olecranon fractures is safe and effective. Functional results are very good, with significantly decreased postoperative inconveniences and need to remove the implant. Less osteosynthetic material was used for TP construction, but stability was preserved.

CONTEXTE: Notre but était de déterminer l'efficacité d'une nouvelle technique chirurgicale de réduction des fractures de l'olécrâne à l'aide d'un système à plaque et broches (SPE), conçue par le chirurgien pratiquant l'intervention. MÉTHODES: Nous avons inclus dans notre étude des patients victimes d'une fracture de l'olécrâne traités entre septembre 2010 et août 2013. Le traitement reposait sur un implant et une technique chirurgicale d'un genre nouveau, réunissant les caractéristiques les plus utiles de 2 méthodes d'ostéosynthèse couramment employées, soit le brochage-haubanage et la pose de plaque, tout en permettant d'en éviter les inconvénients. La nouvelle méthode a recours à un implant de conception nouvelle. RÉSULTANTS: Vingt patients ont participé à notre étude. Nous avons obtenu les résultats fonctionnels suivants avec notre SPE : flexion médiane 147,5° (écart interquartile [ÉIQ] 130°­155°), extension médiane 135°/déficit 10° (ÉIQ 135°­145°), pronation médiane 90° (ÉIQ 81,3°­90°), supination médiane 90° (ÉIQ 80°­90°). Des complications liées à l'implant ont été notées chez 1 patient et les implants ont été retirés chez 3 patients. Le score fonctionnel moyen à l'échelle MEPS (Mayo elbow performance score) a été de 94,8 (entre 65 et 100). Les retraits d'implant ont été nettement moins fréquents chez les patients soumis au nouveau type d'intervention et implant que chez les patients soumis aux méthodes d'intervention classiques dans notre établissement (p < 0,001). Le suivi moyen a été de 8 mois. CONCLUSION: Notre SPE pour le traitement des fractures de l'olécrâne est sécuritaire et efficace. Les résultats fonctionnels sont très bons et s'accompagnent d'un nombre significativement moindre de complications postopératoires et de retraits d'implants. La construction de cette SPE a nécessité moins de matériel d'ostéosynthèse, mais la stabilité a été préservée.