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Hand Extensor Tendon Lacerations
No full textExtensor tendon lacerations of the hand are common injuries that can lead to significant functional impairment if not properly managed. These injuries often occur in working-age individuals, contributing to a notable economic burden. The severity of the injury depends on the location and extent of the tendon damage, and diagnosis is typically made through physical examination, provocative tests, and sometimes advanced imaging. Treatment may be nonoperative or surgical, depending on the extent of the functional deficit. Prompt and appropriate management is crucial to preserving hand function and preventing long-term disability
Female Urethroplasty Using Urethral Diverticulum Tissue as a Graft
No full textFemale urethral strictures and urethral diverticula are rare as individual entities and exceedingly rare in combination. To our knowledge, there has not been a report of the use of diverticulum sac tissue for simultaneous female urethral stricture repair. We present a novel procedure with an inverted U-shaped approach with urethral diverticulectomy, then we were able to use the urethral diverticula sac tissue for repair of the stricture. Ultimately, the procedure was successful and the patient is doing well at 10 months postoperatively
SIRT1 Ameliorates Lamin A/C Deficiency-Induced Cardiac Dysfunction by Promoting Mitochondrial Bioenergetics
Get PDFDilated cardiomyopathy (DCM) is associated with high mortality despite advanced therapies. The LMNA gene encodes lamin A/C and is the second most frequently mutated gene associated with DCM, for which therapeutic options are limited. Here we generated Lmna–/– mice and found they exhibited cardiac dysfunction at the age of 1 month but not at 2 weeks. Proteomics showed down-regulation of mitochondrial function–related pathways in Lmna–/– hearts. Moreover, early injured mitochondria with decreased cristae density and sirtuin 1 (SIRT1) down-regulation were observed in 2-week-old Lmna–/– hearts. Adenoviral overexpression of SIRT1 in lamin A/C knockdown neonatal rat ventricular myocytes improved mitochondrial oxidative respiration capacity. Adeno-associated virus–mediated SIRT1 overexpression alleviated mitochondrial injury, cardiac systolic dysfunction, ventricular dilation, and fibrosis, and prolonged lifespan in Lmna–/– mice. Mechanistically, LMNA maintains mitochondrial bioenergetics through the SIRT1-PARKIN axis. Our results suggest that targeting the SIRT1 signaling pathway is expected to be a novel therapeutic strategy for LMNA mutation–associated DCM
Persistent Left-Sided Superior Vena Cava: A Case Report
Get PDFA persistent left-sided superior vena cava (PLSVC) is the most common thoracic venous anomaly. However, it is still quite rare in the general population. PLSVC occurs during the embryological stages and is seen mostly in patients with congenital heart disease. Normally during development, the left anterior cardinal vein will regress and obliterate to form the ligament of Marshall. In cases of PLSVC, the left anterior cardinal vein persists and can become a persistent left superior vena cava (SVC). There are different anatomical variants of a left-sided SVC, most commonly presenting with both a right and a left SVC. In some PLSVC cases, there is an isolated left SVC. Though rare, this anomaly is not without clinical significance. This case report describes a 48-year-old male with incidental findings of isolated PLSVC seen on chest X-ray after the placement of a temporary dialysis catheter. This report will also describe the incidence/prevalence, embryological origin including anatomical variants, and clinical implications of PLSVC
Calyceal Rupture Secondary to Nephrolithiasis: A Case Report Emphasizing Early Diagnosis and Management
Get PDFCalyceal rupture, defined as the extravasation of urine from the renal calyces into the perinephric or paranephric spaces, typically results from increased intrapelvic pressure due to urinary tract obstruction. This condition can lead to the formation of a perinephric urinoma and severe complications, such as infection, abscess formation, and impaired renal function. Timely diagnosis and management are crucial to prevent these adverse outcomes. Calyceal rupture often results from urolithiasis, with other causes including strictures, tumors, and congenital abnormalities. The rupture occurs when intrapelvic pressure exceeds the tensile strength of the calyceal walls, leading to urine leakage and potential inflammation or sepsis. Calyceal ruptures are quite rare, with their exact incidence not well-documented due to the infrequency of the condition and potential underreporting. Although relatively uncommon, the condition is more prevalent in individuals with recurrent nephrolithiasis and other predisposing factors. Timely recognition and intervention, guided by imaging studies such as non-contrast CT scans, are essential. Conservative management with medical therapy is effective in many cases, but surgical intervention may be necessary for larger stones or complications. This report presents the case of a 36-year-old female with calyceal rupture secondary to nephrolithiasis, presenting with severe flank pain. Upon initial presentation, the patient underwent a thorough workup, including imaging studies, appropriate medical management, and continuous monitoring. She was stabilized, her pain was effectively managed, and she was discharged with a scheduled outpatient follow-up. This case highlights the importance of early diagnosis, comprehensive management, and vigilant monitoring in preventing complications and promoting favorable outcomes
Future Prospects of Metabolic and Bariatric Surgery: A Comprehensive Review
Get PDFBackground: The field of metabolic and bariatric surgery (MBS) is currently an expanding surgical field with constant refinements in techniques, outcomes, indications, and objectives. MBS has been effectively applied across diverse patient demographics, including varying ages, genders, body mass indexes, and comorbidity statuses.
Methods: We performed a comprehensive literature review of published retrospective cohort studies, meta-analyses, systematic reviews, and literature reviews from inception to 2024, reporting outcomes of MBS using databases such as PubMed, ScienceDirect, and Springer Link.
Results: MBS is a safe and efficient therapeutic option for patients with obesity and associated medical conditions (mortality rate 0.03-0.2%; complication rates 0.4-1%). The favorable safety profile of MBS in the short-, mid-, and long-term offers the potential to treat patients with obesity and type 2 diabetes mellitus, immunosuppression, chronic anticoagulation, neoplastic disease, and end-organ failure without increased morbidity and mortality.
Conclusions: In conclusion, the future of MBS lies in the ongoing innovation and adapted therapeutic strategies along with the integration of a variety of other techniques for managing obesity. Careful preoperative assessments, coupled with a multidisciplinary approach, remain essential to ensure optimal surgical outcomes and patient satisfaction after MBS
Dose-dependent Cranial Irradiation Associations with Brain Structures and Neuropsychological Outcomes in Children with Posterior Fossa Brain Tumors
Get PDFBackground: Posterior fossa irradiation with or without whole brain irradiation results in high doses of radiation to the thalamus, hippocampus, and putamen, structures critical to cognitive functioning. As a result, children with brain tumors treated with cranial irradiation (CRT) may experience significant cognitive late effects. We sought to determine the effect of radiation to those structures on neuropsychological outcome.
Methods: Forty-seven children with a history of posterior fossa tumor (17 treated with surgery; 11 with surgery and chemotherapy; and 19 with surgery, chemotherapy, and CRT) underwent neuroimaging and neuropsychological assessment at a mean of 4.8 years after treatment, along with 17 healthy sibling controls. The putamen, thalamus, and hippocampus were segmented on each participant\u27s magnetic resonance imaging for diffusion indices and volumes, and in the radiation treatment group, radiation dose to each structure was calculated.
Results: Performance on visuoconstruction and spatial learning and memory was lower in patient groups than controls. Volume of the thalamus, when controlling for age, was smaller in the patient group treated with CRT than other groups. Higher radiation doses to the putamen correlated with higher fractional anisotropy in that structure. Higher radiation dose to the hippocampus correlated with lower spatial learning, and higher dose to thalami and putamina to lower verbal and nonverbal reasoning.
Conclusions: All children with posterior fossa tumors, regardless of treatment modality, had cognitive deficits compared to their sibling controls. Posterior fossa irradiation may affect thalamic volume and aspects of verbal and nonverbal cognitive functioning