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Al Dihan FA, Alghamdi MA, Aldihan FA, Alamer NM, Alshahrani FA, Alqarni A. Knowledge, Attitude, Awareness, and Future Expectations of Robotic Surgery in Patients Attending Surgical Specialties Clinics. Cureus 2024; 16:e56523. [PMID: 38646294 PMCID: PMC11027023 DOI: 10.7759/cureus.56523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
Introduction The use of robotic-assisted surgeries (RAS) has been growing in surgical specialties. It allows surgeons to perform higher-quality operations with fewer complications, mortality, and morbidity. However, there are a lot of misconceptions about RAS among patients. Therefore, our study aimed to assess the knowledge, attitude, awareness, and future expectations of RAS in patients attending surgical clinics. Methods A cross-sectional study was conducted in King Abdulaziz Medical City (KAMC) surgical clinics in Riyadh, Saudi Arabia. All participants <18 years of age were excluded. The questionnaire was distributed to 304 patients attending surgical clinics with a confidence level of 95% and a margin of error of 5%. Cluster sampling was used since the respondents were from multiple surgical specialties. Finally, multivariate analysis was performed to assess participants' preference for robotic surgery. Results Most participants (58.6%, n=178) were between 21 and 40 years old, and males were 52% of the participants. Many respondents thought a robot did not do the surgery. 70.7% of respondents had not heard of robotic surgery, with the media being the most common source of information. Internal damage was the prevalent concern (51.0%, n= 155) in malfunctions of robotic surgery. A significant relationship was found between participants from 21 to 40 years of age and a stronger preference for robotic surgery (p=.027). Respondents who preferred robotic surgery were discovered to have a significant relationship with participants who thought robotic surgery was safer and had better results (p<.001). 13.9% of participants who did not prefer robotic surgery also took cost into account significantly (χ2=28.93, p<.001, Cramer's V=.22). 67.2% (n=43) of respondents who preferred robotic surgery believed it might eventually replace present practices. Conclusion Our study concluded that the majority did not favor or were unsure whether to undergo robotic surgeries or not. However, most participants had some misconceptions and a lack of awareness about robotic surgeries. Raising awareness among patients can improve the mutual decision-making between them and their treating physician.
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Affiliation(s)
- Fahad A Al Dihan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Mohannad A Alghamdi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Faisal A Aldihan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Nawaf M Alamer
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Faisal A Alshahrani
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Ayyob Alqarni
- General and Colorectal Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU
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Baron E, Wu CC, Gupta K, Wernberg JA, Sheehan MT, Sharma R. Robotic Resection in Succinate Dehydrogenase Subunit B (SDHB)-Mutated Hereditary Paraganglioma: A Case Report of Two Patients and A Literature Review. Cureus 2024; 16:e56336. [PMID: 38633941 PMCID: PMC11021846 DOI: 10.7759/cureus.56336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2024] [Indexed: 04/19/2024] Open
Abstract
Autosomal dominant hereditary paraganglioma-pheochromocytoma syndrome (HPPS) is a rare genetic disorder characterized by neuroendocrine tumor development associated with pathogenic variants in succinate dehydrogenase (SDH) enzyme complex genes. Particularly, HPPS linked to SDHB mutation poses a significant clinical challenge due to its association with aggressive tumor features and a high risk of malignancy. Our report underscores the diversity in the presentation of patients with SDHB-mutated paraganglioma and the feasibility of managing it with a minimally invasive surgical approach. In the first case, a 17-year-old female was diagnosed with a metabolically active, poorly differentiated extra-adrenal retroperitoneal paraganglioma that required challenging robotic resection. Cascade genetic testing revealed an SDHB mutation not only in her but also in three family members, pointing to the inherited nature of the syndrome. Conversely, the second case involves a 37-year-old male with an asymptomatic well-differentiated left paraaortic paraganglioma incidentally found during an unrelated medical examination. Robotic converted-to-open resection allowed the successful removal of the mass. Subsequent germline testing confirmed a deleterious SDHB mutation, initiating a process of familial cascade testing. Both patients remained symptom- and recurrence-free at 12 and six months, respectively. Through these cases, and supported by a literature review, we highlight the variable clinical presentations of HPPS, arising from the same genetic alteration. The successful application of minimally invasive surgical techniques, combined with genetic evaluation, emphasizes the necessity for a comprehensive, tailored approach to treatment and surveillance. This strategy not only addresses the immediate clinical needs but also fosters proactive management of at-risk family members, ensuring a multidisciplinary approach to this complex hereditary condition.
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Affiliation(s)
- Ekaterina Baron
- Surgical Oncology, Marshfield Medical Center, Wisconsin, USA
| | - Chih Ching Wu
- Surgical Oncology, Marshfield Medical Center, Wisconsin, USA
| | - Kanchan Gupta
- Surgical Oncology, Marshfield Medical Center, Wisconsin, USA
| | | | | | - Rohit Sharma
- Surgical Oncology, Marshfield Medical Center, Wisconsin, USA
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3
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Biller J, Silvis J, Duke D. Recurrent Obturator Hernia: A Rare Entity. Cureus 2024; 16:e53732. [PMID: 38455806 PMCID: PMC10919941 DOI: 10.7759/cureus.53732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2024] [Indexed: 03/09/2024] Open
Abstract
Obturator hernias are rare with an incidence of less than 1% of all hernias and are most common in frail, elderly females. They are difficult to diagnose and even more difficult to repair. They often present with a small bowel obstruction from the incarcerated bowel. We report a case of a recurrent obturator hernia after a laparoscopic repair using a patch of omentum. The recurrence was repaired laparoscopically with a trans-abdominal preperitoneal repair (TAPP) with mesh. Given the rarity of the disease, there is scarce literature on the ideal method of repair, especially in patients with recurrence. However, with recent trends toward minimally invasive preperitoneal mesh hernia repairs for inguinal and ventral hernias, this type of repair should be strongly considered for patients with obturator hernias as well.
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Affiliation(s)
- Jessica Biller
- General Surgery, Conemaugh Memorial Medical Center, Johnstown, USA
| | - Jennifer Silvis
- Trauma and Acute Care Surgery, Conemaugh Memorial Medical Center, Johnstown, USA
| | - D'Arcy Duke
- Bariatric and Minimally Invasive Surgery, Conemaugh Memorial Medical Center, Johnstown, USA
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4
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Ahmed Z, Alblowi T. Laparoscopic Resection of a Large Symptomatic Splenic Cyst: A Case Report. Cureus 2024; 16:e54580. [PMID: 38523991 PMCID: PMC10957793 DOI: 10.7759/cureus.54580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/26/2024] Open
Abstract
Splenic cysts are a rare clinical finding, often discovered incidentally during imaging for unrelated conditions. These cysts can be congenital or acquired and may present with symptoms such as vague abdominal pain. This case report describes a 25-year-old female with no significant personal medical history but a family history indicative of a predisposition to lymphoma. She presented with epigastric pain, nausea, and anorexia. Upon examination, a palpable mass was detected in the left upper quadrant. Advanced diagnostic imaging, including computed tomography and magnetic resonance imaging, identified a large benign cystic lesion at the splenic hilum. The patient underwent laparoscopic removal of the cyst, and histopathology confirmed it to be a benign epithelial splenic cyst. The patient experienced an unremarkable postoperative recovery and significant relief from symptoms. This case highlights the importance of advanced imaging in accurately identifying and managing splenic cysts and demonstrates the effectiveness of minimally invasive surgery for such conditions.
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Affiliation(s)
- Zuhair Ahmed
- Surgery, Prince Mohammed Bin Abdulaziz Hospital, Madinah, SAU
| | - Thikra Alblowi
- Surgery, Prince Mohammed Bin Abdulaziz Hospital, Madinah, SAU
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5
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Yusufi MA, Uneeb M, Nazir I, Rashid F. Laparoscopic Repair of Blunt Traumatic Diaphragmatic Hernia. Cureus 2023; 15:e46017. [PMID: 37900497 PMCID: PMC10602394 DOI: 10.7759/cureus.46017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Traumatic diaphragmatic hernias (TDHs) can occur after both blunt and penetrating injury. Laparotomy and thoracotomy are commonly done for the management of TDHs. Minimally invasive surgery, especially laparoscopic surgery, is being accepted as an effective and safe alternative to open surgical repair even in trauma cases. Laparoscopy also allows for the detection and management of clinically occult TDHs, thereby preventing the complications of missed or delayed diagnosis. Our case highlights the importance of timely intervention with a minimally invasive approach. A 39-year-old male presented to the emergency room after a road traffic accident. Computed tomography scan confirmed left-sided diaphragmatic rupture with gastric herniation. Laparoscopic repair of the hernia was done. He had an uneventful post-operative period. At the one-year follow-up, he was asymptomatic and was doing well. TDHs have a variable clinical presentation and radiological findings are not always diagnostic. Such cases can progress to potentially life-threatening complications such as strangulation and perforation of the herniated viscera. Timely diagnosis and management are therefore essential. A minimally invasive approach such as laparoscopy should be used for the management of TDHs in the acute setting where the patient is stable, and resources are available. In this case, once the gastric contents were aspirated via a nasogastric tube in the middle of the night, the immediate need for surgery was converted to an urgent nature, and the patient underwent surgery the next morning in a more controlled setting. In addition, timely intervention can prevent future complications that may occur if the condition is left untreated during the initial admission.
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Affiliation(s)
- Maaz A Yusufi
- General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Muhammad Uneeb
- General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
| | - Izza Nazir
- General Surgery, Bahria International Hospital, Rawalpindi, PAK
| | - Farhan Rashid
- General Surgery, Shifa International Hospital Islamabad, Islamabad, PAK
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Yanamaladoddi VR, Sarvepalli SS, Vemula SL, Aramadaka S, Mannam R, Sankara Narayanan R, Bansal A. The Challenge of Endoleaks in Endovascular Aneurysm Repair (EVAR): A Review of Their Types and Management. Cureus 2023; 15:e39775. [PMID: 37398777 PMCID: PMC10312356 DOI: 10.7759/cureus.39775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/04/2023] Open
Abstract
An abdominal aortic aneurysm (AAA) is a dilatation of the abdominal aorta above 3 cm or 50% greater than the segment above. It is a dangerous condition accounting for a substantial number of deaths per year and increasing at an alarming rate. Various factors come into play in the development of AAAs, which this study has elaborated on, including smoking and old age, demographics, and comorbid conditions. Endovascular aneurysm repair (EVAR) is a newer treatment modality used for AAAs in which an endograft device is placed into the aorta, thereby creating a bypass tract from the aneurysm and generating flow mimicking that of the natural aorta. It is minimally invasive and associated with less postoperative mortality and reduced hospital stay. However, EVAR is also associated with significant postoperative complications, including endoleaks, which were reviewed in depth. Endoleaks are postprocedural leaks into the aneurysm sac that are usually identified immediately after graft placement and indicate treatment failure. They are of five subtypes, categorized according to their mechanism of development. The most common type is type II endoleaks, and the most dangerous is type I endoleaks. Each subtype has multiple management options with varying rates of success. Prompt identification along with appropriate treatment of endoleaks can lead to better postoperative outcomes and improved quality of life for patients.
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Affiliation(s)
| | | | | | | | - Raam Mannam
- Research, Narayana Medical College, Nellore, IND
| | | | - Arpit Bansal
- Research, Narayana Medical College, Nellore, IND
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Kulkarni DR, Goradia PP, Kulkarni ND, Garge S. Multiple Cholecystoenteric Fistulae With Bouveret Syndrome and Acute Pancreatitis: A Rare Combination. Cureus 2023; 15:e38152. [PMID: 37252554 PMCID: PMC10216002 DOI: 10.7759/cureus.38152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Multiple cholecystoenteric fistulae, Bouveret syndrome (a form of gallstone ileus), and acute pancreatitis occurring together is very rare. Diagnosis is seldom clinical and is mostly based on computerised tomography (CT) or magnetic resonance imaging (MRI). Endoscopy and minimally invasive surgery have revolutionised the treatment of Bouveret syndrome and cholecystoenteric fistula, respectively, over the last two decades. Laparoscopic repair of cholecystoenteric fistula followed by cholecystectomy is successful on a consistent basis with skilled laparoscopic suturing and advanced laparoscopy. In patients with Bouveret syndrome, when the stone is <4cm and is in the proximal duodenum, it is usually amenable for endoscopic extraction with snares, nets, forceps and lithotripsy. When endoscopy is unavailable or fails, laparoscopic surgery is suitable for these patients. However, stones >4 cm, located in the distal duodenum, multiple fistulae, and associated acute pancreatitis may necessitate open surgery. We present here a case of a 65-year-old Indian female with multiple cholecystoenteric fistulae and Bouveret syndrome with acute pancreatitis with a 6.5 cm gallstone diagnosed on CT scan and MRI and treated successfully by open surgery. We also review the current literature on the management of this complex problem.
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Affiliation(s)
| | - Pooja P Goradia
- Gastrointestinal Surgery, Liver & Pancreas Clinic, Mumbai, IND
| | - Neha D Kulkarni
- Medicine, K. J. (Karamshi Jethabhai) Somaiya Medical College, Mumbai, IND
| | - Shrikant Garge
- Gastrointestinal Surgery, Liver & Pancreas Clinic, Mumbai, IND
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8
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Muacevic A, Adler JR, Sinha U, Agarwal M. Complete Laparoscopic Ovarian Cystectomy of Giant Ovarian Serous Cystadenoma. Cureus 2023; 15:e33901. [PMID: 36819358 PMCID: PMC9936103 DOI: 10.7759/cureus.33901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 01/19/2023] Open
Abstract
We report here a case of an unmarried teenage girl with a 19-kg giant ovarian cystic tumors of size 37cm×31cm×22cm, which was presumably benign on imaging and with negative tumor markers; treated by complete laparoscopic ovarian cystectomy following decompression and the patient was discharged the next day.
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9
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Krishnan N, Anand S, Sandlas G. Evaluating the Impact of COVID-19 Pandemic on Public Interest in Minimally Invasive Surgery: An Infodemiology Study Using Google Trends. Cureus 2021; 13:e18848. [PMID: 34804702 PMCID: PMC8597661 DOI: 10.7759/cureus.18848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/05/2022] Open
Abstract
Background The pandemic caused by the coronavirus disease 2019 (COVID-19) has impacted the healthcare system worldwide, leading to the suspension of elective surgeries and a decline in the utilization of minimally invasive surgeries (MIS). However, an objective parameter depicting the degree of decline of MIS is lacking. We aim to indirectly evaluate the impact of the COVID-19 pandemic on the number of MIS performed by the surgeons by evaluating the public interest in MIS using Google Trends. Methods A Google Trends search using the string [“laparoscopic” + “minimally invasive” + “robotic surgery”] was performed on June 2, 2021. The monthly relative search volume (RSV) indices were compared with the number of reported COVID-19 cases during the same period. Results RSV was highest between August 2018 and February 2020. RSV at the start of the pandemic was 95 but had declined to 51 during the first COVID-19 peak in April 2020 and 80 during the second peak in May 2021. Conclusion The monthly RSV related to MIS on Google Trends is a good tool to indirectly estimate the degree of decline in the number of MIS (both laparoscopic and robotic) performed worldwide during the pandemic.
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Affiliation(s)
- Nellai Krishnan
- Pediatric Surgery, All India Institute of Medical Sciences, New Delhi, IND
| | - Sachit Anand
- Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
| | - Gursev Sandlas
- Pediatric Surgery, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, IND
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10
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Queirós P, Silva G, Almeida J, Martins D, Primo J. Incessant Atrial Tachycardia: Problem Solving With Minimally Invasive Surgery. Cureus 2021; 13:e18643. [PMID: 34786238 PMCID: PMC8580126 DOI: 10.7759/cureus.18643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2021] [Indexed: 11/25/2022] Open
Abstract
A 35-year-old female with sarcoidosis sought medical attention due to palpitations. The ECG showed an atrial tachycardia (AT), apparently originating in the left atrium. A 24-hour Holter monitoring revealed AT to be present during the entire day. Cardiac magnetic resonance exhibited no cardiac involvement by sarcoidosis but registered a mildly depressed left ventricular ejection fraction (LVEF). Atrial electroanatomical mapping showed the earliest activation zone on the distal portion of the left atrial appendage (LAA). Considering the high risk for perforation with catheter ablation in this region, she was sent to thoracoscopic surgical LAA exclusion with a clip device; it was possible to witness the termination of the arrhythmia during the procedure. She was safely discharged two days after surgery and has completed a one-year follow-up without recurrence of AT or symptoms, and with normalization of LVEF.
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Affiliation(s)
- Pedro Queirós
- Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Gualter Silva
- Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - João Almeida
- Electrophysiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - Daniel Martins
- Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
| | - João Primo
- Electrophysiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Vila Nova de Gaia, PRT
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Okan T, Babliak O, Agarwal K, Kuzyk Y, Lanka SP, Iskander B, Sharma S, Tadepalli S, Jaiswal R, Hussain A, Rashid MY, Chakinala RC. Asymptomatic Left Atrial Myxoma Treated With Minimally Invasive Surgical Approach. Cureus 2021; 13:e18432. [PMID: 34737901 PMCID: PMC8559889 DOI: 10.7759/cureus.18432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/01/2021] [Indexed: 11/30/2022] Open
Abstract
Myxomas, being the most common primary benign tumor among all cardiac tumors, occur rarely with a very low incidence rate. Myxomas can cause various clinical manifestations or can be diagnosed incidentally. Some patients with cardiac myxomas are completely asymptomatic. Cardiac myxomas cause life-threatening complications, thus early diagnosis is imperative. We are reporting a case of atrial myxoma in a 38-year-old female without any significant past medical history, who came to our clinic for cardiology evaluation prior to plastic surgery. The elliptical mobile mass, located in the left atrium with its attachment to the interatrial septum, was diagnosed by transthoracic echocardiography. The patient was referred for surgery and a minimally invasive surgical approach was chosen. A histological report confirmed the diagnosis of myxoma. The patient recovered well. Three years of follow-up did not reveal any signs of recurrence of the tumor. We are also analyzing 20 previously published cases of asymptomatic myxomas and myxomas treated with a minimally invasive surgical approach, reported in the PubMed database for the last 20 years (2001-2021) in the adult patient population (age 19 and over). The aim of this study is to highlight the asymptomatic presentation of cardiac myxomas and to underline the advantages of a minimally invasive surgical approach. In summary, asymptomatic cardiac myxomas are rare incidental findings. Attention to subtle symptoms during a physical exam and scrupulous history-taking can provide a clue to this diagnosis. Early diagnosis of cardiac myxomas is crucial to prevent life-threatening complications. Minimally invasive surgery is a promising alternative approach to standard open-heart surgery for treating cardiac myxomas, providing faster recovery and higher patient satisfaction with surgical care.
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Affiliation(s)
- Tetyana Okan
- Department of Diagnostic Imaging, The Metropolitan Andrey Sheptytsky Hospital, Lviv, UKR
| | - Oleksandr Babliak
- Department of Cardiac Surgery, Cardiac Surgery Center "Dobrobut", Kyiv, UKR
| | - Kriti Agarwal
- Department of Internal Medicine, Hackensack Meridian Health Palisades Medical Center, North Bergen, USA
| | - Yulia Kuzyk
- Department of Pathological Anatomy and Forensic Medicine, Danylo Halytsky Lviv National Medical University, Lviv, UKR
| | | | - Beshoy Iskander
- Department of Internal Medicine, Bon Secours Mercy Health- St. Elizabeth Youngstown Hospital (NEOMED), Youngstown, USA
| | - Sanjeev Sharma
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, USA
| | - Satish Tadepalli
- Department of Internal Medicine, Hackensack Meridian Health Ocean Medical Center, Brick, USA
| | - Richa Jaiswal
- Department of Pathology, Medical University of South Carolina, Charleston, USA
| | - Akbar Hussain
- Department of Internal Medicine, Keystone Health System, Chambersburg, USA
| | - Mohammed Y Rashid
- Department of General Surgery, University of Illinois -MGH, Chicago, USA
| | - Raja Chandra Chakinala
- Department of Internal Medicine, Geisinger Commonwealth School of Medicine, Scranton, USA.,Department of Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
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12
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Pan Z, Bao J, Wei S. Massage of a Hematoma to Assist in Decreasing the Volume of an Intraparenchymal Hemorrhage. Cureus 2020; 12:e12227. [PMID: 33376663 PMCID: PMC7755677 DOI: 10.7759/cureus.12227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spontaneous intracerebral hemorrhage (ICH) is one of the least treatable types of stroke, and its incidence and all-age mortality have increased over the last several decades in China. Surgical evacuation using standard craniectomy for supratentorial hematoma is always controversial. How to ensure effective decreasing of intracranial pressure (ICP) is crucial to the management of ICH. A 48-year-old right-handed woman was brought to our hospital by her family, who stated that the woman could not speak well and had developed sudden left-sided weakness three hours previously. The patients were diagnosed with supratentorial bilateral intraparenchymal hemorrhages, mainly in the putaminal area. After inserting a catheter into the hematoma, we began to perform the maneuver of massage through the catheter by frequently using multiple 2 mL quantities of normal saline and performing the injecting-aspiration maneuver. After performing this massage repeatedly for 15 min, we terminated the operation. After the patient was admitted to the ICU, urokinase (40,000 U) was administered through the catheter every 12 hours for three days. After the patient stayed for an additional 11 days, she was discharged home. Minimally invasive surgery with massage techniques followed by thrombolytic evacuation of clots will be a new method for treating ICH patients.
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Affiliation(s)
- Zhenjiang Pan
- Neurosurgery, Shidong Hospital of Yangpu District in Shanghai, Shanghai, CHN
| | - Jing Bao
- Neurosurgery, Shidong Hospital of Yangpu District in Shanghai, Shanghai, CHN
| | - Shepeng Wei
- Neurosurgery, Shidong Hospital of Yangpu District in Shanghai, Shanghai, CHN
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