Spontaneous thrombosis of a large unruptured intracranial aneurysm causing ischemic stroke due to occlusion of the parent artery: A case report and literature review.

Spontaneous thrombosis of an unruptured large or giant saccular intracranial aneurysm is a well-known phenomenon and can cause ischemic stroke (IS), which is a rare event. The possible pathogenic mechanisms of IS include distal embolic occlusion secondary to migration of the intra-aneurysmal thrombus, occlusion of the parent artery lumen caused by the retrograde extension of the aneurysmal thrombosis, external compression of the parent artery due to the increased aneurysmal mass effect. Among these, IS due to simultaneous thromboses of the aneurysm and its parent artery is extremely rare, with only a few cases reported in the literature. Herein, we present a case of a 18-year-old woman who suffered an acute IS, attribute to spontaneous complete thrombosis of an unruptured large saccular aneurysm of the right middle cerebral artery with occlusion of the parent artery, and we review the literature simultaneously.

Post-traumatic recurrent ulnar nerve dislocation at the elbow: a rare case report.

Introduction and importance: Several authors have also made reference to a less prevalent condition known in elbow as ulnar nerve subluxation. However, this particular condition tends to manifest primarily in young individuals who engage in professional sports or activities involving extensive use of the forearm. A more severe form of ulnar nerve subluxation, which is ulnar nerve dislocation, gives rise to a characteristic dislocation and relocation of the nerve at the elbow during flexion and extension of the forearm. Due to the rarity of this condition in clinical settings and its predominant occurrence as subluxation in younger patients, there are instances where traumatic ulnar nerve dislocation can be overlooked and misdiagnosed with two commonly encountered pathological conditions as ulnar nerve entrapment or medial epicondylitis. Case presentation: The authors present a 51-year-old male with chronic pain when moving his right forearm following a fall that caused a direct force injury to his elbow. The patient was misdiagnosed and treated as medial epicondylitis and early-stage ulnar nerve entrapment. However, the symptoms did not improve for a long time. The authors performed the ulnar nerve anterior transposition surgery using the subcutaneous transposition technique and the result is very good without any pain. Clinical discussion: The ulnar nerve can naturally be subluxed or dislocated if Osborne's ligament is loose or when there are anatomical variations in the medial epicondyle. In some case, this ligament can be ruptured by trauma. The symptoms of ulnar instability are caused by friction neuritis. Dynamic ultrasound of the ulnar nerve in two positions show clearly this condition. Conclusion: Post-traumatic ulnar nerve dislocation is a rare condition, and the recurrent characteristic of it leads to neuritis or neuropathy. The condition can be overlooked or misdiagnosed as medial epicondylitis or early-stage ulnar nerve entrapment. The nerve transposition surgery will give good result.

Giant Tracheal Fibroepithelial Polyp Treated Successfully by High-Frequency Electrocautery Ablation.

Endotracheal fibroepithelial polyp is a rare disease in the airways. This report describes a rare case of a tracheal giant fibroepithelial polyp. A 17-year-old woman was admitted to the hospital with severe acute respiratory failure. Chest computed tomography revealed a tumor located below the epiglottis. Endotracheal bronchoscopic examination showed a giant polyp. This endotracheal polyp was removed with ablation, by using high-frequency electricity through flexible bronchoscopy under intravenous anesthesia. The patient has had a good recovery after the intervention and at long-term follow-up. We herein describe and discuss the appropriate therapeutic approach and also review the pertinent literature.

Total humerus replacement with reverse shoulder design for non-oncologic indication: A case report.

INTRODUCTION AND IMPORTANCE: Reconstruction of large skeletal defects pose significant challenges for orthopedic surgeons, particularly in cases of chronic skeletal defects where the surrounding structures differ substantially from the original anatomical structures, further complicating management. CASE PRESENTATION: A 54 year old male patient presented with a large skeletal defect after osteomyelitis surgery. The treatment of choice for this case was reconstruction using a total humerus megaprosthesis. The prosthesis was custom-designed with a reversed shoulder joint and a total elbow joint, which were 3D printed using CT-Scan imaging. CLINICAL DISCUSSION: A short-term follow-up revealed improvements for the patient in arm functionality and expectation-based satisfaction at 6 months post-surgery. CONCLUSION: Total humerus megaprosthesis joint replacement may be a promising option for treating chronic humeral defects.

Reverse shoulder megaprosthesis replacement for aggressive aneurysm bone cyst of proximal humerus: Case report and literature review.

INTRODUCTION: and importance: Wide resection in the surgical treatment of aneurysms bone cysts is often performed in cases where the tumor is large, recurrent, growing, and intensely invasive. Reshaping the defect after tumor removal is a necessary issue to restore shape and maintain function for the patient. CASE PRESENTATION: A 26-year-old male patient, diagnosed with an aneurysm bone cyst in the proximal humerus, underwent surgery for curettage and bone grafting twice. After surgery, there was still pain in the shoulder area, the tumor progressed aggressively with limited shoulder movement. Based on the imaging re-evaluation, it was shown that the tumor increased rapidly in size, invaded the soft tissue, and completely changed the normal structure of the shoulder joint, and the proximal humerus. We used a reverse shoulder joint with an additional module to restore the bone defect of the tumor and the function of the shoulder joint. Follows-up showed that patient no longer pain in shoulder area, shoulder joint function recovery is progressing well, Musculoskeletal Tumor Society (MSTS) score is 25 & 28, shoulder joint function score according to ASES scale: 80 & 93.33 respectively at 3 months and 6 months after surgery. CLINICAL DISCUSSION: Aggresive aneurysm bone cyst of proximal humerus is not common and still a challenge to the treatment. Due to the bone and joint destruction, the indication of tumor resection and reconstruct the joint and bone loss is required. Among several solution, reverse shoulder megaprosthesis is a newest one can favor the purpose of our treatment. Up to now, this solution is mainly used to preserving for malignant bone tumor. CONCLUSIONS: Tumor wide resection with modular reverse shoulder replacement with the modular segment is a reasonable intervention option in cases of large aneurysm bone cysts, with rapid recurrence, aggressive progression, and soft tissue invasion.

Anatomic based microfracture technique of insertion for rotator cuff repair in Vietnamese people: Case series study.

ABSTRACT: Postoperative tendon healing is still a matter of concern after rotator cuff repair. Several techniques have been introduced to help improve this healing process. Among them, the bone marrow is commonly used source and a research subject for methods using stem cells to promote wound healing process. A number of studies have shown that bone marrow stem cells can travel up through the holes on the rotator cuff insertion sites, contributing into the rotator cuff repair process, increasing the efficiency of tendon healing and improving clinical results. PATIENTS AND METHODS: Cross-sectional descriptive study was performed on 41 rotator cuff tear patients. The microfractures for these patients were calculated beforehand, which have great depth but small diameter, based on the anatomical characteristic of the rotator cuff tear insertions of Vietnamese people. Patients' rotator cuff tendon healing processes were evaluated using ultrasound after surgery. Final tendon healing and clinical results ultimately rely on MRI assessments, classified according to Sugaya's classification, UCLA and ASES scale. RESULTS: No cases of rupture and fracture of the greater tubercle was recorded. There was a clear progression of tendon healing on ultrasound according to postoperative follow-up time-stamps (1 month, 3 months). MRI images evaluation also reveals at the latest follow-up time, according to Sugaya classification, the ratio of tendon healing was 87.8%, while the percentage of re-rupture was 12.2%. ASES and average UCLA scale were collected at the end of the study, respectively as 95.41 ± 5.45 and 32.36 ± 2.53. CONCLUSION: The technique's microfractures characteristics based on the rotator cuff tear insertion anatomy ensures a secure, straightforward approach along with promising results in terms of tendon healing rate and postoperative functional outcomes.

Non-oncologic indication for elbow megaprothesis replacement: 2 cases report.

INTRODUCTION: Treatment of elbow bone defects is still a huge challenge in orthopaedic in order to restore the shape and function of the elbow joint. Bone defect reconstruction is very difficult due to biomechanical complexity of the elbow joint and the poor coverage tissue of this area, so mega-prothesis can be considered the most optimal solution in these cases. CASE REPORT: We present two clinical cases of megaprosthesis elbow replacement for treatment of bone defects caused by sequelae of trauma. There is one case of 3 cm bone defect at proximal ulna and one case of 3 cm bone defect at distal humerus. In the 1st case, the elbow joint is fusioned and the second case, the elbow joint is degenerated totally after 3 previous surgery. We performed total elbow replacement with a customized megaprosthesis for them. The Mayo elbow function assessment scale [1] pre-surgery was poor at 50 points. The average age is 35 years old. The mean post-operative follow-up time was 14 months. Range of elbow flexed motion was 135 degrees, both patients were maximally extension, the forearm pronation and supination were 90 and 75 degrees, respectively. The Mayo score is very good with 97,5 points. Both patients were completely satisfied with the postoperative results. CONCLUSION: Our results show that megaprosthesis elbow replacement is a very effective option for cases large elbow bone defects due to trauma sequelae. However, careful preoperative preparation is required for the best outcome.

Long-term outcomes of video-assisted lobectomy in non-small cell lung cancer.

BACKGROUND: Video-assisted thoracoscopic surgery lobectomy combined with lymphadenectomy is widely utilized worldwide for treating non-small cell lung cancer. We evaluated the long-term survival outcomes of this approach and determined the prognostic factors of overall survival. METHODS: This prospective observational study was performed in patients with non-small cell lung cancer who were subjected to video-assisted lobectomy and lymphadenectomy from 2012 to 2016. Independent prognostic factors were determined via uni- and multivariable Cox models. RESULTS: There were 109 patients with the mean age of 59.2 years and males accounted for 54.1%. Postoperative staging determined 22.9% of stage IA, 31.2% of stage IB, 16.5% of stage IIA and 29.4% of stage IIIA. Median follow-up time was 27 months. The overall survival rate after 1, 2, 3, 4 and 5 years was 100%, 85.9%, 65.3%, 55.9% and 55.9%, respectively. In univariable analysis, smoking (hazard ratio (HR) [95% confidence interval (CI)]: 2.50 [1.18-5.31]), Tumor--nodes--metastases (TNM) stage (IIA: 7.60 [1.57-36.9]; IIIA: 14.3 [3.28-62.7] compared to IA), histological differentiation (moderately differentiated: 4.91 [1.04-23.2]; poorly differentiated: 8.25 [1.91-35.6] compared to well differentiated), lymph node size ≥1 cm (8.22 [3.11-21.7]), tumour size ≥3 cm (4.24 [1.01-17.9]), radical lymphadenectomy (6.67 [3.14-14.2]) were identified as prognostic factors of the long-term survival. In multivariable analysis, only radical lymphadenectomy was an independent prognostic factor (HR [95% CI]: 3.94 [1.41-11.0]). CONCLUSION: Video-assisted thoracoscopic lobectomy combined with lymphadenectomy is feasible, safe and effective for the treatment of non-small cell lung cancer. The long-term outcomes of this method are favourable, especially at the early stage of cancer.

Double giant ectasia of right coronary artery in a young woman: A rare case report.

BACKGROUND: Coronary artery ectasia (CAE) is a rare condition that is characterized by the excessive diffuse dilatation of the coronary arteries by 1.5 times in diameter compared to adjacent coronary arteries. The giant CAE is even rarer and life-threatening. CASE PRESENTATION: A 34-year-old female patient was admitted to our centre with three months history of vague chest pain that worsened gradually. The CT scanner confirmed that there were two giant aneurysmal sacs in the right coronary artery (RCA). The first sac was 32 × 36 mm in size and located in the proximal RCA, the second one containing thrombus in the middle RCA with a size of 43 × 30 mm. The patient was successfully treated by aneurysmal resection and concomitant coronary artery bypass. CONCLUSION: Giant coronary artery ectasia is a rare clinical condition and very dangerous for patients unless properly treated. We successfully treated a case of giant right coronary artery ectasia with favorable outcome.

Simultaneous endovascular repair for abdominal aortic aneurysm and coronary artery bypass grafting in an octogenarian: A case report.

INTRODUCTION: Coronary artery disease (CAD) is commonly associated with abdominal aortic aneurysms (AAAs) in elderly patients. When severe CAD requiring coronary artery bypass grafting (CABG) is associated with an impending AAA in a high-risk patient, the options for the suitable timing of CABG and AAA repair strategy (one-stage or two-stage) are still being debated. PRESENTATION OF CASE: An 87-year-old man with non-ST-segment elevation myocardial infarction and a giant abdominal aortic aneurysm was transferred to our centre. Coronary angiography revealed triple-vessel coronary disease, and computed tomography confirmed a giant infrarenal fusiform abdominal aortic aneurysm 9 cm in maximal diameter. We simultaneously performed endovascular aneurysm repair prior to on-pump beating-heart coronary artery bypass grafting. The postoperative course was uneventful, and the patient was discharged on the 15th postoperative day. CONCLUSION: Combined endovascular aneurysm repair and on-pump beating heart coronary artery bypass grafting in a one-stage operation is a promising strategy to improve therapeutic efficiency in octogenarians. More studies are needed to compare the efficacy and safety of one-stage and two-stage operations to treat concomitant coronary artery disease and aortovascular pathology in the high-risk octogenarian patients.

Surgical treatment of acute aortic dissection Stanford type A in the third trimester of pregnancy: A case report.

BACKGROUND: Aortic dissection is rare in pregnancy, but it is often life-threatening. Thus, early diagnosis and optimal treatment are crucial. In addition, regular multidisciplinary care plays an important role in improving the therapeutic outcome. CASE: A 31-year-old pregnant woman (gravida 2, para 1, abortus 0) was transferred to our centre at 34 weeks of gestation with onset of dyspnoea and serious chest pain radiating to her back. Ultrasonography unexpectedly revealed a dilation of the aortic root with a sign of dissection. Computed tomography confirmed a type A aortic dissection based on the Stanford classification. She was successfully treated by caesarean section prior to open repair of acute type A dissection and received multidisciplinary care. The patient was discharged on the 16th postoperative day, and the baby is still alive without adverse events. CONCLUSION: Aortic dissection in pregnancy is relatively rare, but physicians should be on high alert for the condition when a pregnant woman has chest pain. Early diagnosis and adequate treatment in addition to regular multidisciplinary care are crucial to achieve favourable results.

Emergency treatment of bronchial rupture due to trauma

From January 2002 to November 2003 in the Cardiovascular and Thoracic surgical department of Cho Ray hospital, 12 cases of bronchial rupture were operated. The causes of trauma were trafic accidents or working accidents. Male: 10 cases, female: 2 cases. Indications of thoracotomy were: persistence of massive pneumothorax, ineffective drainage, atelectasis, confirmation of bronchial lesions from flexible bronchoscopy before operation 10 cases, 2 other cases performed during operation (with different thoracotomy indications: massive hemopneumothorax: 1 case, large open thoracic wound because of falling: 1 case). Procedure: direct suture of bronchial rupture: 9 cases, main bronchus repair: 1 case, lobectomy: 2 cases. Complications were respiratory failure: 3 cases, pneumonia: 1 case. Death: 2 cases due to respiratory failure, pneumonia, empyema, septicemia