Solitary fibrous tumor of the urinary bladder: An unusual case report with literature review.

Solitary fibrous tumor is neoplasm of mesenchymal origin commonly involving visceral pleura however we are presenting an unusual case with involvement of urinary bladder. It is generally indolent in nature therefore proper diagnosis is required for complete characterization to avoid unnecessary extensive surgical resection. Our patient was a 64-year-old female who presented with lower abdominal fullness with change in her bowel movement pattern. On imaging partially necrotic mass with heterogenous enhancement was found which was later biopsied and resected with clean surgical margin. Solitary fibrous tumor is overall a benign tumor with satisfactory outcome. Physicians should keep it in a differential of pelvic masses and with the risk recurrence, 6 monthly follow up imaging are usually required after resection.

Juxtarenal Abdominal Aortic Aneurysm: Results of Open Surgery in an Academic Center.

BACKGROUND: The objective of the study is to report our experience with conventional surgery for juxtarenal abdominal aortic aneurysms (JRAs) by evaluating incidence of acute renal failure and perioperative mortality. Secondary objectives are to evaluate general morbidity and the need for permanent postoperative dialysis and to assess the influence on long-term survival of preoperative risk factors and deterioration of perioperative renal function. METHODS: A retrospective cohort study of 110 patients with JRA electively treated by open surgery between March 1992 and March 2018 was made. Data were obtained from clinical records, describing demographics, perioperative variables, and results. Acute kidney injury (AKI) was defined as 50% decrease in glomerular filtration rate or two-fold increase in serum creatinine. Multivariate analysis was performed by logistic regression to establish risk factors for renal failure. The influence of preoperative risk factors and deterioration of perioperative renal function on long-term survival was studied using Cox regression model. Descriptive and inferential statistics were used in the analysis. RESULTS: 110 consecutive patients were treated with an average age of 71 years, 82.7% male; 81% hypertensive and 41% active smokers. 46.3% had stage III or higher preoperative chronic kidney disease. Median diameter of the aneurysm was 5.7 cm. Interruption of bilateral renal flow was required in 73 patients (66.4%) and unilateral in 37 (33.6%). The average renal clamping time was 34.5 min. AKI occurred in 9 patients (8.2%). Two patients (1.8%) required postoperative dialysis, one of them permanent. Median hospital stay was 7 days. Thirty-three patients (30%) had at least one complication. Postoperative mortality was 2.7% (3 patients), two of them developed AKI. Multivariate analysis established a longer operative time and need for renal revascularization as independent risk factors for AKI. In the survival analysis, age, cerebrovascular disease, chronic obstructive pulmonary disease, and perioperative AKI were identified as risk factors for long-term mortality. CONCLUSIONS: JRA open surgical repair can be performed with low morbidity and mortality. Although transient acute renal dysfunction may be relatively frequent, the need for hemodialysis is low. Our study is a reference point to compare with endovascular repair.

En el modelo preclínico de insuficiencia cardíaca por disfunción sistólica en ratón (coartación de aorta torácica) la velocidad de flujo carotídeo determinada precozmente se asocia a función ventricular izquierda tardía / Carotid flow velocity is associated to late ventricular function in mice with preclinic systolic dysfunction induced by thoracic aortic coarctation

Resumen: Los modelos experimentales de falla cardíaca con fracción de eyección disminuida en murinos son pocos. Uno de estos modelos es el de coartación de la aorta torácica en el arco aórtico (COA) en ratones. Un aspecto importante en su desarrollo es la evaluación precoz del procedimiento y su relación con la función sistólica posterior. En este sentido, las velocidades de flujo carotídeo y la relación entre ambos flujos (derecho, pre-coartación; izquierdo post coartación) pueden permitir evaluar tempranamente la precisión del procedimiento y relacionarse más tardíamente con la función sistólica VI. Nuestro objetivo fue comparar precozmente (semana 2 post operatoria) las velocidades de flujo en ambas carótidas (Doppler continuo) y tardíamente (semana 5 postoperatoria) la función sistólica VI (Ecocardiograma de superficie) en ratones seudocoartados o sham (n= 6) vs ratones COA (n = 12). Se confirmó una diferencia estadísticamente significativa en la relación de velocidades de flujo entre ambas carótidas medida precozmente entre los ratones sham y COA (1,1 ± 0,1 vs 2,5 ± 0,5, p< 0,001), lo que se correlacionó con un deterioro significativo de la función sistólica del ventrículo izquierdo evaluada a las 5 semanas en los ratones COA. Conclusión: En este modelo preclínico de falla cardíaca por sobrecarga de presión con fracción de eyección VI disminuida en ratón, el aumento precoz de la velocidad de flujo en la arteria carótida derecha (pre-coartación en el modelo COA) y sobre todo de la relación entre las velocidades de flujo carotídeo entre ambas carótidas se asocia a deterioro importante de la función sistólica VI cinco semanas después de efectuada la COA, lo que permite predecir la efectividad del procedimiento en este modelo experimental.

Abstract: There are few experimental models of heart failure with reduced ejection fraction in murines. One of these models is transverse aortic coarctation (TAC) in mice. However, an important challenge in its development is the early evaluation of the procedure and its relationship with late systolic LV function. In this sense, carotid flow velocities and the relationship between both (right, precoarctation, left post-coarctation) may allow early evaluation of the accuracy of the procedure and be related to late LV systolic function. The aim was to compare early (week 2 post-operative) flow velocities determined in both carotid arteries (by continuous Doppler) with late (week 5 postoperative) LV systolic function (by echocardiogram) in sham (n= 6) vs. TAC (n: 12) mice. We confirmed a statistically significant difference in the early ratio of carotid flow velocities (left/right common carotid velocity ratio) between sham and TAC mice (1.1 ± 0.1 vs 2.5 ± 0.5, p< 0.001) and this correlated well with a deteriorated left ventricular function in the TAC mice after 5 weeks. In this preclinical model of cardiac failure due to pressure overload with reduced LV ejection fraction in the mouse, the early increase in right carotid flow velocity (precoarctation) and especially the relationship between precoarctation/postcoarctation carotid flow velocities is associated with significant impairment of LV systolic function five weeks after the TAC, which allows to predict the effectiveness of the procedure in this experimental model.

3-Dimensional printed haptic simulation model to teach incomplete cleft palate surgery in an international setting.

INTRODUCTION: Cleft palate is one of the most common congenital anomalies, yet surgical repair remains challenging and can lead to significant complications in the hands of inexperienced surgeons. There is a great need for the development of a simulation model that will allow surgeons worldwide to learn and practice the intricate skills needed for cleft palate surgery. OBJECTIVES: 1. To develop a low-cost incomplete cleft palate simulation model using additive manufacturing technology (3D printing). 2. To evaluate its validity and utility to teach palatoplasty in a global health care setting. METHODS: Three-dimensional models of a soft palate cleft and an incomplete hard and soft palate cleft were developed using 3D printing and silicone casting. The cost and time of assembly of the 3D printed models were calculated. The models were then assessed for validity by cleft surgeons and trainees during a cleft mission in Ecuador. 3D models were assessed for resemblance to anatomy and tissue characteristics, the ability to incise the soft tissue, dissect and reposition the palatal flaps, and the ease of suture placement. Models were rated using the Likeness to Human Tissue Scale. RESULTS: Cleft palate simulators were successfully developed using 3D printing and silicone casting. Participants reported that models provided a realistic representation of human anatomy and were adequate for novice surgeons to practice the procedure. The models were portable, low cost, and easily assembled. CONCLUSION: The use of 3D printed haptic simulation models for teaching and learning cleft palate repair techniques could enhance skill acquisition and possibly improve surgical outcomes. In outreach settings, it could help achieve local, sustainable comprehensive care for cleft palate patients.