Three-dimensional printing-assisted anterior and posterior combined surgery for treating a giant aggressive vertebral hemangioma

Aggressive vertebral hemangioma (AVH) is a type of non-neoplastic and congenital developmental abnormality of spinal cord blood vessels. We report the innovative application of three-dimensional (3D) printing-assisted anterior and posterior combined surgery for treating a giant AVH. This could be a novel treatment in the future. A 44-year-old man suffered from persistent neck pain and limited limb mobility for approximately 2 weeks. An imaging examination showed the destruction of C2–4 vertebral bodies, and a giant lesion invaded the spinal cord. He underwent 3D printing-assisted anterior and posterior combined surgery. Postoperatively, his symptoms of persistent neck pain and limited limb mobility were alleviated. An imaging examination showed that internal fixation and the prosthesis were fixed in place, and the spinal canal was unobstructed. Treating a giant AVH by 3D printing-assisted anterior and posterior combined surgery is feasible and effective.

Tumor response as defined by iRECIST in gastrointestinal malignancies treated with PD-1 and PD-L1 inhibitors and correlation with survival

Background Atypical tumor response patterns during immune checkpoint inhibitor therapy pose a challenge to clinicians and investigators in immuno-oncology practice. This study evaluated tumor burden dynamics to identify imaging biomarkers for treatment response and overall survival (OS) in advanced gastrointestinal malignancies treated with PD-1/PD-L1 inhibitors. Methods This retrospective study enrolled a total of 198 target lesions in 75 patients with advanced gastrointestinal malignancies treated with PD-1/PD-L1 inhibitors between January 2017 and March 2021. Tumor diameter changes as defined by immunotherapy Response Evaluation Criteria in Solid Tumors (iRECIST) were studied to determine treatment response and association with OS. Results Based on the best overall response, the tumor diameter ranged from − 100 to + 135.3% (median: − 9.6%). The overall response rate was 32.0% (24/75), and the rate of durable disease control for at least 6 months was 30.7% (23/75, one (iCR, immune complete response) or 20 iPR (immune partial response), or 2iSD (immune stable disease). Using univariate analysis, patients with a tumor diameter maintaining a < 20% increase (48/75, 64.0%) from baseline had longer OS than those with ≥20% increase (27/75, 36.0%) and, a reduced risk of death (median OS: 80 months vs. 48 months, HR = 0.22, P = 0.034). The differences in age (HR = 1.09, P = 0.01), combined surgery (HR = 0.15, P = 0.01) and cancer type (HR = 0.23, P = 0.001) were significant. In multivariable analysis, patients with a tumor diameter with a < 20% increase had notably reduced hazards of death (HR = 0.15, P = 0.01) after adjusting for age, combined surgery, KRAS status, cancer type, mismatch repair (MMR) status, treatment course and cancer differentiation. Two patients (2.7%) showed pseudoprogression. Conclusions Tumor diameter with a < 20% increase from baseline during therapy in gastrointestinal malignancies was associated with therapeutic benefit and longer OS and may serve as a practical imaging marker for treatment response, clinical outcome and treatment decision making.

Combined surgery for stomach cancer

In the Kharkov regional oncological dispensary for 7 years and 5 months (1953-1960) 1034 patients with stomach cancer were hospitalized. 632 patients were operated on. Radical operations were performed in 445 patients, of which combined (with resection of adjacent organs, germinated by the tumor) 72 (17% of all resections).

The effect of phacoemulsification performed with vitrectomy on choroidal vascularity index in eyes with vitreomacular diseases

This study evaluated the effects of cataract surgery combined with pars plana vitrectomy (ppV) on choroidal vascularity index (CVI) in eyes with epiretinal membrane (ERM) and full thickness macular hole (FTMH). Medical records of 132 eyes with ERM or FTMH were retrospectively reviewed and classified into a ppV group and a ppV combined with cataract surgery group (phaco + ppV group). The CVI were measured at baseline, 1, 3 and 6 months after the surgery, using the selected swept-source (SS) optical coherence tomography (OCT) scan passing through the central fovea, which was then segmented into luminal and stromal area by image binarization. The mean CVI of phaco + ppV group were 61.25 ± 1.97%, 61.66 ± 1.81%, and 62.30 ± 1.92% at baseline, 1 and 3 months, respectively (p < 0.001). The mean CVI of ppV group were 62.69 ± 1.92%, 62.03 ± 1.51%, and 61.45 ± 1.71% at baseline, 1 and 3 months, respectively (p < 0.001). The final CVI were measured at 6 months and compared with the baseline CVI. The mean CVI of phaco + ppV group were 61.21 ± 1.99% at baseline and 60.68 ± 2.02% at 6 months (p < 0.001). The mean CVI of ppV group were 62.93 ± 1.70% at baseline and 61.77 ± 1.74% at 6 months (p < 0.001). Vitrectomy significantly decreases CVI in vitreomacular diseases possibly due to the removal of vitreomacular traction or postoperative oxygenation change in the eye. On the contrary, combined surgery of vitrectomy and cataract surgery significantly increases CVI in the early stage of postoperative period, which suggests choroidal vascular dilatation or congestion due to postoperative inflammation. Although the CVI were measured lower than the baseline in the end, more thorough inflammation control may be essential after combined surgery.

Features of combined endoscopic tympanoplasty in children with chronic otitis media with cholesteatoma

Topicality: Chronic purulent otitis media is a disease that is often encountered in everyday practice by otolaryngologists. To date, the full rehabilitation of the middle ear in pediatric practice has caused much debate about the method of surgery and remains a difficult surgical task. Aim: to develop a more effective combined method of endoscopic microsurgery in children with chronic otitis media with cholesteatoma. Materials and methods: examined 52 children aged from 2 to 12 years, operated on a closed variant of tympanoplasty for cholesteatoma otitis. Patients were divided into 2 groups: 1st group (comparison), which used the standard technique of closed variant of surgery with retroauricular incision using an operating microscope (33 patients); and the 2nd group (main), where the combined surgery with retroauricular incision with the using of a microscope and endoscope and endoaural drainage of the antrum was performed in 19 patients. Results: We conducted an analysis of different types of tympanoplasty in a closed variant of tympanoplasty in children with cholesteatoma otitis and endoaural drainage of the antrum or without it. In the main group, the number of secondary engraftment of the neotympanic membrane decreased 3.4 times, residual perforations – 2.9 times, residual cholesteatoma – 2.9 times, the number of repeated operations – 3.5 times relative to the comparison group. Conclusion: At the combined surgery of cholesteatoma otitis with endoscopic support at patients of the main group the percent of residual cholesteatoma is lower. The endoaural drainage of the antrum provides additional ventilation and drainage of the reconstructed cavities of a middle ear in the early postoperative period, increases the number of primary engraftment of the neotympanic membrane and reduces the percentage of residual perforations.

Application of the “telescopic rod” in a combined surgical technique for the treatment of congenital pseudarthrosis of the tibia in children

Background The current surgical treatment of choice is the combination surgical technique, involving tibial intramedullary fixation to maintain the mechanical axis and mechanical stability of tibial pseudarthrosis. In traditional combined surgery, the Williams rod is often used. Long-term intramedullary fixation of the foot and ankle will affect the ankle joint function of children. The intramedullary rod is relatively shorter due to the growth of the distal tibia. In addition, there are some complications such as epiphyseal bone bridge and high-arched foot. The use of a telescopic intramedullary rod may avoid these complications. Purposes To investigate the initial effect of the “telescopic rod” in a combined surgical technique for the treatment of congenital pseudarthrosis of the tibia in children. Methods A retrospective study including 15 patients with Crawford type IV CPT who were treated using a combined surgical technique and the telescopic rod from January 2017 to May 2018. The average age at the time of surgery was 43.3 months (16–126 months). Of the 15 patients, 7 had proximal tibia dysplasia and 12 exhibited neurofibromatosis type 1. The combined surgical technique using the telescopic rod included the excision of pseudarthrosis, intramedullary rod insertion, installation of Ilizarov’s fixator, tibia-fibular cross union, and wrapping autogenic iliac bone graft. The incidence of refracture, ankle valgus, tibial valgus, and limb length discrepancy (LLD) in patients were investigated. Results All patients achieved primary union with an average follow-up time of 37.3 months (26–42 months). The mean primary union time was 4.5 months (4.0–5.6 months). Nine cases showed LLD (60%), with an average limb length of 1.1 cm (0.5–2.0 cm). Ankle valgus, proximal tibial valgus, telescopic rod displacement, and epiphyseal plate tethering occurred in 1 case (6.6%) (18°), 3 cases (20%) (10°, 5°, and 6°, respectively), 6 cases (40%), and 2 cases (13%), respectively. There were no refractures during the follow-up periods. Conclusion Although there are complications such as intramedullary rod displacement while using the telescopic rod in a combined surgery, the primary healing rate of congenital pseudarthrosis of the tibia in children is high.