The perplexing postsurgical complication of carotid-jugular fistula: A bitter experience

Background: Vascular injuries occur in approximately 25% of all penetrating neck traumas, with carotid artery injuries being particularly lethal. Penetrating neck injuries are potentially fatal. Vascular injuries occur in approximately 25% of cases, which can lead to the formation of arteriovenous fistulas. Case Description: The authors present a case of delayed open surgery to repair a carotid-jugular fistula that resulted in an unprecedented complication, as well as a brief review of the condition’s diagnosis and treatment options. Conclusion: This case report suggests us that, penetrating neck injuries should be thoroughly evaluated for arteriovenous fistulae. To avoid complications, common carotid-jugular fistulas must be treated as soon as possible. Postoperative complications can be effectively managed with prompt action.

Neural network-based modeling of the number of microbubbles generated with four circulation factors in cardiopulmonary bypass

The need for the estimation of the number of microbubbles (MBs) in cardiopulmonary bypass surgery has been recognized among surgeons to avoid postoperative neurological complications. MBs that exceed the diameter of human capillaries may cause endothelial disruption as well as microvascular obstructions that block posterior capillary blood flow. In this paper, we analyzed the relationship between the number of microbubbles generated and four circulation factors, i.e., intraoperative suction flow rate, venous reservoir level, continuous blood viscosity and perfusion flow rate in cardiopulmonary bypass, and proposed a neural-networked model to estimate the number of microbubbles with the factors. Model parameters were determined in a machine-learning manner using experimental data with bovine blood as the perfusate. The estimation accuracy of the model, assessed by tenfold cross-validation, demonstrated that the number of MBs can be estimated with a determinant coefficient R2 = 0.9328 (p < 0.001). A significant increase in the residual error was found when each of four factors was excluded from the contributory variables. The study demonstrated the importance of four circulation factors in the prediction of the number of MBs and its capacity to eliminate potential postsurgical complication risks.

Management of Postsurgical Complication in Multiple Implant-Infected Postextraction Sites in the Lower Arch

Currently, dental implants are a very frequent therapeutic alternative for replacing missing teeth. However, they are not exempt from developing complications of infectious origin. Therefore, this case report describes a 67-year-old female patient presenting infectious complications caused by suture rupture. Surgery combined with therapeutic management with antibiotics was performed, allowing preservation of the osseointegration of the implants in the lower arch. Within the limitations of this study, it was shown that more research is needed to determine the success and survival of implants presenting complications due to infections during the osseointegration process.

A study on assessment of postoperative complications among major abdominal surgeries using Clavien-Dindo classification

Background: Surgical team always tries to provide consistently low incidence of major complications for patient undergoing any operation. Clavien-Dindo (CD) classification is the simplest way of reporting all complications. The main aim of this study was to test the usefulness of Clavien-Dindo classification in patients undergoing the abdominal surgery. In this study Clavien-Dindo classification has been used for assessment of postsurgical complications after major abdominal surgery.Methods: A total of 50 patients admitted to surgical wards for major abdominal surgery were evaluated through history, co-morbid condition and thorough clinical examination based on inclusion and exclusion criteria along with necessary investigations. Post-operative complications and management were recorded, and then postsurgical complication was classified based on Clavien-Dindo classification and assessed.Results: Most of the patients who developed complications were in the age group of 40-50 years. Most of the patients (32%) belonged to grade 2 complications. Serum creatinine, blood urea and post-operative stay were found to have direct relation with Clavien-Dindo grade of complications.Conclusions: The Clavien-Dindo classification represents an objective and simple way of reporting all complications in patients undergoing major abdominal surgeries and comparing the various complications between different surgeries. However, a definite statement on the clinical value of this classification system is not yet possible due to the small case number in this study, but the promising results should encourage further evaluation in larger cohort with the goal to possibly establish its validity as a standard clinical practice.

Techniques and timings for cleft palate surgery: a randomised controlled trial

Background: There is a lack of reliable information on outcomes following cleft surgery. Options for timing and choice of primary cleft surgery had not been compared in randomised trials. Methods: Non-syndromic infants, aged six months, with isolated cleft of the secondary palate without associated lip deformity, were included in this prospective randomised controlled trial to one of four options: Veau-Wardill-Kilner palatoplasty at six (VWK06) or 12 months of age (VWK12), or two-flap palatoplasty with intra-velar veloplasty at six (2F-IVV06) or 12 months of age (2F-IVV12). Results: Of the 76 infants included in the trial, 90.8 per cent received surgery: VWK06 (n=18), VWK12 (n=16), 2F-IVV06 (n=18) and 2F-IVV12 (n=17). Early postoperative complications occurred in two VWK infants (6.1%) and three 2F-IVV infants (8.8%). With surgery planned at six (T06) and 12 months of age (T12) respectively, there were three VWK infants (8.6%) and two 2F-IVV infants (6.3%). At age three, speech assessments were conducted for 62 (84%) children. Velopharyngeal inadequacy symptoms were detected in 4/30 VWK children (13.3%) and 3/30 2F-IVV children (10.0%). With T06 and T12, there were three VWK infants (9.4%) and four 2F-IVV infants (14.3%). Otitis media was documented in 40/61 of children (65.6%) hyper- and/or hyponasality in 27/61 of children (44%) and articulation errors in 53/60 of children (88%). Conclusion: Postsurgical complication rates differ little between VWK and 2F-IVV. At three years, there were no demonstrable differences in velopharyngeal inadequacy symptoms, nasality, articulation and otitis media between the two surgical techniques at two different times.

Gingival Lipoma: A Rare Case Report

Lipomas are benign tumours of mesenchymal origin (mature adipocytes) that are comparatively uncommon in the oral cavity corresponding to less than 4.4% of all benign oral soft tissue tumors. Clinically, they present as slow growing, soft, asymptomatic masses. Histopathologically, they appear as thinly encapsulated lesion composed of mature adipocytes with inconspicuous vascularity. The pathogenetic mechanisms of oral lipomas are still unclear. They are usually treated by surgical excision and bear excellent prognosis. Here we report a case of intraoral lipoma in 54 year old male patient in the left lower lingual alveolar mucosal region that was treated by surgical excision using electrocautery without any postsurgical complication. One-year follow-up showed no evidence of recurrence.