Search Results (6)

Background and Objectives: Management of second-trimester placenta accreta spectrum (PAS) is currently center-dependent with minimal evidence-based practices. This study aims to analyze outcomes of hysterectomy as second-trimester active management (AM) versus cesarean hysterectomy as expectant management (EM) in cases of PAS with intraoperative and postoperative outcomes. Materials and Methods: This study is a retrospective case-control study of patients with a pathology-confirmed diagnosis of PAS managed at a single center over 16 years (2005–2020). All cases were diagnosed during the first or second trimester by ultrasonography and managed by the same multidisciplinary team with delivery within the second trimester. Results: Thirty-four patients with PAS were diagnosed and delivered by the second trimester. Of these, (41.1%) elected for active management and 20 (58.9%) for expectant management but ultimately required delivery prior to 28 weeks’ gestation. Baseline demographics were similar between groups. Intraoperatively, no differences were noted in operative time (191.5 vs. 203 min, p = 0.85), blood loss (2300 vs. 2600 cc, p = 0.85), or incidental cystotomy (1 vs. 7, p = 0.10). Postoperative length of stay was similar (3 vs. 3.5 days, p = 0.28), and ICU admission was not statistically different (6 vs. 12, p = 0.48). Conclusions: This retrospective study suggests that when hysterectomy is planned, there is no difference in maternal outcomes and morbidity with an expectant management with cesarean hysterectomy in the second trimester compared to proactive cesarean hysterectomy. Full article

Background: Inflammation in the periapical area of primary teeth can affect the development and eruption of permanent teeth. In an asymptomatic course, they are detected accidentally during routine examinations. In such cases, they often reach significant dimensions and cause irreversible changes. Methods: This report presents the case of a 9-year-old boy with a radicular cyst in the mandible, resulting in the displacement of both premolar tooth buds. To address the inflammation, facilitate the proper eruption of the impacted teeth, and prevent adjacent teeth from shifting, the primary molars were extracted. Marsupialization was performed under general anesthesia, followed by the fabrication and placement of an obturator. Results: Two months after treatment, the displaced tooth buds began aligning along the natural eruption pathway. By the 8-month follow-up, the premolars had successfully erupted into their proper positions in the oral cavity. Conclusions: Marsupialization combined with the use of an obturator is an effective first-line treatment for radicular cysts in pediatric patients, offering a conservative approach that promotes natural tooth eruption while preserving the surrounding dentition. Full article

Background/Objectives: An electric wire inserted into the bladder or urethra presents a specific challenge that is frequently encountered in such cases: the potential formation of a tight knot, making extraction nearly impossible. The primary objective of this study was to share our personal experience with patients who had intravesical electric cable insertions and to provide an extensive literature review, offering detailed insights into the various strategies reported for managing such foreign body cases. Methods: Of the four cases with a foreign body in the lower urinary tract, two involved patients aged 19 and 53, respectively, who had inserted an electric cable. During their attempt at self-removal, they developed an intravesical knot, as confirmed by radiographic imaging. Results: In the first case, a bipolar approach was used: a cystoscope was inserted transurethrally into the bladder alongside the cable, while a laparoscopic trocar was introduced suprapubically. Using laparoscopic scissors, the cable was successfully cut and removed. In the second case, due to the cable’s size, a direct cystotomy was performed. At the 3-month follow-up, the uroflowmetry results were normal for both patients. A psychiatric evaluation revealed no abnormalities in the first patient, while the second patient was diagnosed with polyembolokoilamania. Conclusions: The removal of self-inserted electric cables from the urethra and bladder is a challenging procedure, often requiring the urologist’s creativity to prevent potential complications. Many cases can be resolved endoscopically; however, even this minimally invasive approach must be tailored to each case to provide the most suitable solution for the patient. Full article

Introduction: In light of increased cesarean section rates, the incidence of placenta accreta spectrum (PAS) disorder is increasing. Despite the establishment of clinical practice guidelines offering recommendations for early and effective PAS diagnosis and treatment, antepartum diagnosis of PAS remains a challenge. This ultimately risks poor mental health and poor physical maternal and neonatal health outcomes. Case Descriptions: This case series details the experience of two high-risk patients who remained undiagnosed for PAS until they presented with antenatal hemorrhage, leading ultimately to necessary, complex surgical interventions, which can only be optimally provide in a tertiary care center. Patient 1 is a 37-year-old woman with a history of three cesarean sections, which elevates her risk for PAS. She had placenta previa detected at 19 weeks, and placenta percreta diagnosed upon hemorrhage. During a hysterectomy, invasive placenta was found in the patient’s bladder, leading to a cystotomy and right ureteric reimplantation. After discharge, she was diagnosed with a vesicovaginal fistula, and is currently awaiting surgical repair. Patient 2 is a 34-year-old woman with two previous cesarean sections. The patient had complete placenta previa detected at 19- and 32-week gestation scans. She presented with antepartum hemorrhage at 35 weeks and 2 days. An ultrasound showed thin myometrium at the scar site with significant vascularity. A hysterectomy was performed due to placental attachment issues, with significant blood loss. Both patients were at high risk for PAS based on past medical history, risk factors, and pathognomonic imaging findings. Discussion: We highlight the importance of the implementation of clinical guidelines at non-tertiary healthcare centers. We offer clinical-guideline-informed recommendations for radiologists and antenatal care providers to promote early PAS diagnosis and, ultimately, better patient and neonatal outcomes through increased access to adequate care. Full article

Human echinococcosis is a zoonotic infection caused by the larvae of the tapeworm species Echinococcus. The liver is the most common location for a primary echinococcosis. However, the parasite may bypass or spread from the liver to the lungs, causing primary or secondary pulmonary echinococcosis, respectively. Pulmonary echinococcosis is a clinically challenging condition in which anthelminthic regiments are important, but surgery has the central role in removing the cysts and preventing recurrences. Surgical treatment may involve cystotomy, enucleation, capitonnage, or atypical resections, which occasionally are in combination with hepatic procedures. The utilization of modern devices is greatly underdescribed in surgery for thoracic infections, even though these facilitate much of the work. Therefore, this article aims to describe pulmonary echinococcosis and the role of modern surgical devices in the treatment process. Furthermore, we report surgical treatment of three different cases of pulmonary echinococcosis. Surgeries of uncomplicated and ruptured hepatic or pulmonary cysts are described. Simple small pulmonary echinococcal lesions can be excised by endostaplers both for diagnostic and curative reasons. Larger cysts can be removed by energy devices unless large bronchial air leaks occur. Complicated cysts require treatment by more extensive techniques. Inexperienced surgeons should not abstain but should carefully decide preoperatively how to proceed. Full article

The aim of this case report was to evaluate the use of Partsch I cystotomy in order to preserve a dental implant located in an odontogenic cyst extended from 3.2 to 4.4. A 50 year-old woman showed a circular, well-defined unilocular radiolucent area, Ø2.5 cm, in the right mandibular region with an oral implant intruding inside it. The overdenture in the mandibular right site showed no clinical mobility. The authors decided to perform a surgical treatment aimed to preserve the implant. The patient underwent Partsch I surgery followed by iodoform gauze insertion replaced weekly for one month, revision of the previous orthograde endodontic treatments, and an acrylic resin obturator prosthesis application for the following two months. The twelve month follow-up showed no clinical mobility of the right lateral mandibular implant prostheses. Radiographical analysis revealed cystic lesion healing and perimplant bone regeneration. This report highlights the opportunity to apply cystotomy when the cyst involves a dental implant and undermines its stability. This possibility is offered by the peculiar clinical scenario where the implant was stabilized by the presence of a previous prosthetic fixation. Our study led to the application of an operative protocol that allowed for the preservation of the implant. Full article