Feasibility of cervical intramedullary diffuse glioma resection using intraoperative magnetic resonance imaging

Intraoperative magnetic resonance imaging (iopMRI) actually has an important role in the surgery of brain tumors, especially gliomas and pituitary adenomas. The aim of our work was to describe the advantages and drawbacks of this tool for the surgical treatment of cervical intramedullary gliomas. We describe two explicative cases including the setup, positioning, and the complete workflow of the surgical approach with intraoperative imaging. Even if the configuration of iopMRI equipment was originally designed for cranial surgery, we have demonstrated the feasibility of cervical intramedullary glioma resection with the aid of high-field iopMRI. This tool was extremely useful to evaluate the extent of tumor removal and to obtain a higher resection rate, but still need some enhancement in the configuration of the headrest coil and surgical table to allow better patient positioning.     

Laparoscopic Roux-En-Y Gastric Bypass is Effective and Safe in Over 55-year-old Patients: A Comparative Analysis

Background

Controversy exists regarding the effectiveness and safety of laparoscopic Roux-en-Y gastric bypass (LRYGB) in elderly patients. We evaluated our outcomes of LRYGB in patients aged ≥55 years.

Methods

A total of 549 consecutive patients underwent LRYGB as primary operation and 132 were ≥55 years old. Patients were divided in two groups: group <55 years comprised 417 patients, with mean age (±SD) of 41.15 ± 8.47 years; group ≥55 years comprised 132 patients, with mean age of 59.43 ± 3.81 years. Mean preoperative body mass index was 47.01 ± 7.47 and 46.21 ± 7.47 respectively, whereas mean excess weightloss percent (EW%) was 88.06 ± 30.28 and 84.86 ± 29.87 %. Early morbidity (30 days) and outcomes at 6, 12, and 24 months follow-up were evaluated.

Results

Significant difference was found in operative time (84.19 ± 29.05 vs. 90.89 ± 30.95 min, p = 0.03). One conversion to open procedure occurred in group <55 years, whereas three occurred in group ≥55 years (p = 0.04). Intraoperative complications occurred in 22 patients (5.27 %) in group <55 years versus 19 in group ≥55 years (14.39 %), which was statistically significant (p = 0.001). One case of death occurred in the younger group. Overall postoperative morbidity rate was 18.7 % in group <55 years and 25.76 % in group ≥55 years, with no significant difference (p = 0.08). Mean EWL% at 12 months in group <55 years was 65.95.05 ± 26.96 versus 62.61 ± 41.78 in group ≥55 years, whereas at 24 months it was 65.08 ± 29.68 versus 64.48 ± 18.44 with no significant difference between the groups (p = 0.51; p = 0.92).

Conclusions

LRYGB for patients ≥55 years achieves outcomes and complications rates comparable to the younger population. Patients should not be denied bariatric surgery for the age alone.     

Minimally invasive percutaneous plate osteosynthesis for ankle fractures: a prospective observational cohort study

Background

The gold standard for the surgical management of ankle fractures is through open reduction and internal fixation. The rate of wound problems has been reported to be as high as 18 %, especially in patients with poor vascular supply or in diabetics. Minimally invasive percutaneous plate osteosynthesis (MIPPO) has been described as a potential solution for these patients.

Patients and methods

This is a prospective observational cohort study. From October 2009 to February 2010, and following ethical approval of our research, adult patients admitted at our level I trauma center with a closed lateral malleolar displaced unstable fracture (Lauge-Hansen supination-external rotation) with or without a medial-sided injury and patients with an undisplaced fracture associated with medial clear space opening on external rotation stress radiographs were recruited and managed using MIPPO technique. All patients were followed up for a minimum of 12 months post-surgery (12–20 with a mean of 16.5 months). Trauma mechanism, comorbidities, classifications, trauma-surgery interval, image intensifier duration, surgery duration, complications, and function American Orthopaedic Foot and Ankle Society (AOFAS) were analyzed.

Results

Thirty-two patients were recruited of which 20 fulfilled the inclusion criteria (16 females, 4 males) and were available for follow-up. Ten fractures (50 %) were classified as 44-B1, 7 fractures (35 %) as 44-B2, and 3 fractures (15 %) as 44-B3 according to the Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association classification (100 % were supination-external rotation injuries). At 8 weeks post-surgery, all fractures had healed. The duration of surgery ranged between 15 and 73 min (average 32.8) from skin incision to closure. There were 2 complications (1 malunion and 1 skin necrosis requiring implant removal). At 12-month follow-up, AOFAS average was 88.3 (72–100 standard deviation of 6.8 points).

Conclusion

MIPPO technique proved to be a viable option for lateral malleolar fracture treatment with a low complication rate and high functional outcome at 1 year. It is particularly useful in patients with a high risk of wound complication.     

One step access to oxindole-based β-lactams through Ugi four-center three-component reaction

A multicomponent Ugi reaction involving isatin, isocyanide and β-amino acid components has been developed. The reactions proceeded smoothly to give β-lactam-containing 3,3-disubstituted oxindoles in only one step and generally high yields. When chiral, non racemic, β-amino acids were used, products were obtained as enantiomerically pure β-lactams diastereoisomers, whose relative stereochemistry was determined by X-ray analysis. For one compound, a weak antibacterial activity has been preliminarily highlighted.

A multicomponent Ugi reaction involving isatin, isocyanide and β-amino acid components has been developed.     

Red blood cell transfusions and potentially related morbidities in neonates under 32 weeks’ gestation

BackgroundPreterm neonates are likely to require red blood cell (RBC) transfusion, and extremely low birth weight infants almost invariably receive multiple transfusions. Transfusion-reduction strategies can reduce transfusion rates, and might diminish certain adverse outcomes associated with transfusions.Materials and methodsIn a single centre, we retrospectively evaluated RBC transfusion rates among preterm infants ≤32 weeks’ gestational age (GA), over a 6-year period before and after adopting national transfusion-reduction strategies. We compared demographic data, adverse events, and outcomes between transfused vs not-transfused neonates. Univariate logistic regression was used to evaluate associations between dichotomous outcomes and number of transfusions, and day of first transfusion. Multivariate logistic regression evaluated the correlation between dichotomous outcomes and transfusion as an independent risk factor.ResultsDuring the 6 years studied, 181 infants born at ≤32 weeks’ GA were admitted to our Neonatal Intensive Care Unit of whom 80 (44%) received at least one RBC transfusion. The transfusion rate tended downwards after adopting transfusion-reduction strategies, reaching 31% in 2018. The reduction was largely due to a marked fall in transfusions of neonates born at 29–32 weeks’ GA (p<0.001). The number of transfusions received correlated with odds of having intraventricular haemorrhage (IVH) (OR=1.9; 95% CI: 1.3–2.7; p=0.0001) and the duration of oxygen supplementation (rho=0.51; 95% CI: 0.33–0.66; p≤0.0001). In multivariate logistic regression analysis, transfusion was an independent risk factor for IVH (adjusted OR=7.38; 95% CI: 2.24–24.30; p=0.0001).DiscussionThe application of national, standardised transfusion-reduction strategies was associated with a lower transfusion rate in neonates born at 29–32 weeks’ GA, but was less effective among neonates ≤28 weeks, in whom transfusions appeared to be an independent risk factor for severe IVH.