Open Access Indonesian Journal of Medical Reviews

Efficacy of Green Mussel Shell-Derived Hydroxyapatite as a Bone Graft Substitute in Rabbit Femoral Defects: An In Vivo Study

2025-03-26T04:24:34+00:00

Bone grafting is a standard procedure in fracture management to enhance bone healing using osteogenic, osteoinductive, and osteoconductive materials. Bovine hydroxyapatite (HA) is a commonly used bone substitute, but its production can be expensive. Green mussel shells have emerged as a potential alternative source of HA due to their abundance and lower cost, particularly in Indonesia. This study aimed to evaluate the efficacy of HA derived from green mussel shells on bone healing in rabbit femoral defects through radiological examination. A post-test only experimental study was conducted on male New Zealand white rabbits (n=36) with surgically created femoral defects. The rabbits were randomly divided into three groups: a control group (K) with no treatment, a group (P1) treated with bovine HA, and a group (P2) treated with HA derived from green mussel shells. Bone healing was assessed radiologically at weeks 2, 4, and 6 post-surgery using the Radiographic Union Score for Tibial Fractures (RUST) score on femoral X-rays. Statistical analysis was performed to compare the RUST scores between the groups and across the different time periods, with a p-value of <0.05 considered significant. Significant differences in RUST scores were observed between the groups at week 2 (K: 1.33 ± 0.50, P1: 2.67 ± 0.50, P2: 2.78 ± 0.44; p<0.001) and week 4 (K: 2.22 ± 0.44, P1: 3.11 ± 0.33, P2: 3.33 ± 0.50; p=0.003). However, no significant difference was found between the P1 (bovine HA) and P2 (green mussel shell HA) groups at these time points (p>0.05). At week 6, no significant differences in RUST scores were detected among all three groups (p=0.087). In conclusion, the findings of this study suggest that the efficacy of HA derived from green mussel shells in promoting bone healing in rabbit femoral defects is comparable to that of bovine HA, as assessed by the RUST score. This highlights the potential of green mussel shells as a cost-effective and readily available alternative source for HA in bone graft applications.

Topical Fermented Lactobacillus acidophilus Lysate Accelerates Second-Degree Burn Healing: An In Vivo Study in Wistar Rats

2025-04-07T04:22:15+00:00

Second-degree burns, affecting the epidermis and dermis, constitute a major category of thermal injuries globally, presenting significant clinical challenges including pain, infection risk, and potential scarring. While standard treatments like silver sulfadiazine (SSD) exist, limitations including potential cytotoxicity and emerging resistance necessitate exploration of novel therapeutic strategies. Recent interest has focused on topical applications derived from probiotics, such as Lactobacillus spp., due to their suggested roles in modulating inflammation, combating oxidative stress, and providing antimicrobial activity to accelerate wound repair. This study investigated a fermented lysate derived from Lactobacillus acidophilus (L. fermented) as a potential topical agent for burn healing. This study aimed to evaluate the therapeutic efficacy of a 5% topical L. fermented ointment on the healing process of experimentally induced second-degree burns in a Wistar rat model, primarily by assessing the rate of wound closure compared to standard SSD treatment and an untreated control. A true experimental in vivo study utilizing a post-test only control group design was performed following ethical approval. Fifteen male Wistar rats were subjected to a standardized second-degree thermal burn injury on their dorsal aspect. The animals were then randomized (n=5 per group) to receive twice-daily topical applications of either 5% L. fermented ointment (Group A), SSD ointment (Group B), or no treatment (Control, Group C). Wound healing was quantitatively assessed by measuring the wound surface area (mm²) on days 1, 3, 7, and 14 post-injury using digital imaging and ImageJ software analysis. Statistical comparisons between groups were conducted using one-way ANOVA followed by LSD post-hoc tests, with statistical significance set at p<0.05. All treatment groups demonstrated a significant reduction in wound size over the 14-day observation period (p=0.001 within each group). Inter-group comparisons revealed significantly accelerated wound closure in Group A starting from day 3 onwards (p<0.005). At day 14, the mean wound area in Group A (17.5 ± 8.06 mm²) was significantly smaller than in Group B (119.22 ± 45.41 mm²) and Group C (305.18 ± 25.21 mm²) (p=0.001). Post-hoc analysis confirmed the superiority of L. fermented treatment over both SSD (mean difference 101.72 mm², p=0.001) and control (mean difference 287.68 mm², p=0.001). SSD treatment also resulted in significantly better healing than the control group (mean difference 185.96 mm², p=0.001). In conclusion, topical application of 5% fermented Lactobacillus acidophilus lysate significantly accelerated the closure of second-degree burn wounds in Wistar rats, demonstrating superior efficacy compared to both silver sulfadiazine treatment and no treatment. These findings highlight the potential of L. fermented lysate as a promising novel therapeutic agent for burn wound management.

Comparison of Postoperative Outcomes in Colorectal Cancer Patients Undergoing Enhanced Recovery After Surgery (ERAS) vs Non-ERAS: A Retrospective Study

2025-04-07T02:59:26+00:00

Colorectal cancer (CRC) represented a significant global health burden, contributing to approximately 10% of all cancer-related mortality worldwide. While surgery remained the primary treatment for resectable CRC, the postoperative period was often characterized by prolonged recovery and complications. Enhanced Recovery After Surgery (ERAS) protocols emerged as a multimodal approach to mitigate these challenges by attenuating surgical stress, optimizing nutritional status, minimizing opioid consumption, promoting early mobilization, and improving psychological well-being. This study aimed to compare the postoperative outcomes between colorectal cancer patients who underwent surgery with ERAS protocols and those who followed traditional non-ERAS recovery pathways. A retrospective cohort study was conducted at a single academic institution. The study population comprised 201 adult patients who underwent surgical resection for colorectal cancer between January 2020 and December 2024. Patients were categorized into two groups: the ERAS group (n=135), who were managed according to a standardized ERAS protocol, and the non-ERAS group (n=66), who received traditional postoperative care. Statistical analysis involved independent samples t-tests for continuous variables and chi-square tests for categorical variables, with a significance level set at p < 0.05. The ERAS group demonstrated a statistically significant reduction in the mean length of hospital stay compared to the non-ERAS group (7.67 days vs. 8.83 days, p < 0.001). While the ERAS group exhibited slightly higher mean hemoglobin levels postoperatively (11.29 g/dL vs. 11.14 g/dL, p = 0.56), this difference was not statistically significant. Notably, the incidence of postoperative complications was lower in the ERAS group (1 case) compared to the non-ERAS group (4 cases), with a p-value of 0.051, indicating a trend towards significance. In conclusion, the implementation of an ERAS protocol was associated with improved postoperative outcomes in colorectal cancer patients, specifically a significant decrease in the length of hospital stay and a trend towards a lower rate of complications. These findings supported the integration of ERAS pathways into the standard of care for colorectal cancer surgery to enhance patient recovery, potentially reduce healthcare costs, and improve overall patient outcomes.

Successful Management of Pediatric Todani Type IVa Choledochal Cyst with Roux-en-Y Reconstruction: Diagnostic and Surgical Insights

2025-04-07T06:18:23+00:00

Choledochal cysts (CC), or biliary cysts, are congenital dilatations of the biliary tree. Type IVa cysts, involving both intra- and extrahepatic ducts, present diagnostic and management challenges, particularly due to the risk of complications like cholangitis, pancreatitis, and long-term malignancy. Early diagnosis and complete surgical excision with biliary reconstruction are paramount. We report the case of a 4-year-old boy presenting with a six-month history of worsening intermittent upper abdominal pain, nausea, and vomiting. The initial ultrasound suggested a hepatic cyst. Magnetic Resonance Cholangiopancreatography (MRCP) confirmed multiple cystic dilatations involving the intra- and extrahepatic biliary ducts, consistent with a Todani Type IVa choledochal cyst. Laboratory findings showed elevated Gamma GT (179 U/L) but normal bilirubin levels. The patient underwent successful open surgery involving complete excision of the extrahepatic cyst and biliary reconstruction via Roux-en-Y hepaticojejunostomy. His postoperative course was uneventful, with discharge on day six. Follow-up revealed good clinical recovery without immediate complications. In conclusion, Todani Type IVa choledochal cysts are complex anomalies requiring meticulous diagnostic workup and tailored surgical management. This case highlights the utility of MRCP in delineating complex biliary anatomy and reaffirms Roux-en-Y hepaticojejunostomy following complete cyst excision as an effective treatment, offering favourable short-term outcomes in pediatric patients.

Beyond Awareness: Investigating the Disconnect Between Oral Health Knowledge and Caries Experience (DMF-T) in Indonesian Primary Schoolchildren

2025-04-08T03:08:17+00:00

Dental caries remains a significant public health problem among Indonesian children, impacting their quality of life and development. While oral health knowledge is considered crucial for prevention, its direct impact on caries experience, particularly in specific Indonesian contexts, requires further investigation. This study aimed to assess the relationship between oral health knowledge and caries experience (DMF-T index) among grade 2 students at an Islamic Integrated Primary School in Indonesia. A cross-sectional study was conducted involving 85 second-grade students selected via purposive sampling. Oral health knowledge was assessed using a validated, structured questionnaire covering topics like tooth brushing importance, frequency, caries causes, and prevention. Caries experience was measured using the DMF-T (decayed, missing, filled teeth) index through clinical examinations performed by trained dental personnel. Data were analyzed using descriptive statistics and the Chi-square test to determine the association between knowledge level (categorized as low or sufficient) and DMF-T status (categorized as low, moderate, or high), with significance set at p<0.05. The study included 45 (52.9%) female and 40 (47.1%) male students. The majority of students (80%, n=68) demonstrated sufficient oral health knowledge, with a mean knowledge score of 5.52 (SD=1.52) on a scale of 1-7. Despite this, the prevalence of dental caries was high, with a mean DMF-T score of 7.92 (SD=5.11). Overall, 61.2% (n=52) of students were categorized as having high DMF-T status, 18.8% (n=16) had moderate DMF-T, and 20% (n=17) had low DMF-T. The Chi-square analysis revealed no statistically significant association between the level of oral health knowledge and DMF-T status (p=0.920). High DMF-T prevalence was observed in both the low knowledge group (58.8%) and the sufficient knowledge group (61.8%). In conclusion, this study highlighted a significant disconnect between oral health knowledge and actual caries experience among primary schoolchildren in this Indonesian setting. While most students possessed sufficient knowledge, the prevalence and severity of dental caries remained alarmingly high, and knowledge level was not significantly associated with DMF-T status. These findings underscore the inadequacy of knowledge-based interventions alone and emphasize the need for comprehensive, multifaceted oral health promotion programs that address behavioral, practical, and environmental factors to effectively combat dental caries in children.

Intra-abdominal Mixed Germ Cell Tumor (Seminoma and Choriocarcinoma) in an Adult with Cryptorchidism: A Rare Case Report and Surgical Approach

2025-04-17T04:49:38+00:00

Intra-abdominal testicular germ cell tumors (TGCTs) arising from cryptorchid testes represent a rare but clinically significant entity in adult urology. Cryptorchidism, or undescended testis (UDT), persists as the most prominent risk factor for testicular malignancy, and its delayed diagnosis, particularly when testes reside intra-abdominally, frequently leads to complex presentations often discovered at an advanced stage. This report details the case of a young adult male diagnosed with a voluminous intra-abdominal mixed germ cell tumor, incorporating both seminoma and highly aggressive choriocarcinoma components, originating from a previously unrecognized undescended testis, highlighting the multifaceted challenges in diagnosis and management. A 29-year-old Indonesian male presented with a constellation of symptoms including persistent abdominal pain, progressive bloating, and patient-acknowledged abdominal mass. Pertinent clinical findings included bilaterally non-palpable testes within the scrotum and a large, firm, tender intra-abdominal mass upon examination. Contrast-enhanced computed tomography (CT) delineated a massive abdominopelvic tumor consistent with a primary testicular neoplasm, critically associated with significant para-aortic lymphadenopathy and confirming bilateral intra-abdominal undescended testes. Serological investigation revealed a markedly elevated alpha-fetoprotein (AFP) level (>400.00 ng/mL), strongly suggesting a non-seminomatous component. Consequently, the patient underwent an exploratory laparotomy, which confirmed the CT findings and revealed the tumor originating from the left intra-abdominal testis. A comprehensive surgical resection involving bilateral radical orchiectomy was performed, yielding a specimen measuring 20x15x15 cm and weighing 2.865 kg. Subsequent histopathological examination definitively classified the tumor as a mixed germ cell tumor with distinct seminoma and choriocarcinoma elements arising from the left testis; the contralateral right testis exhibited only atrophic changes consistent with UDT. In conclusion, the confluence of adult presentation, bilateral cryptorchidism, intra-abdominal location, massive tumor burden, and aggressive mixed histology (seminoma/choriocarcinoma) exemplifies the complexities encountered in managing such rare TGCT cases. Surgical extirpation via laparotomy remains indispensable for bulky intra-abdominal disease, providing both diagnostic confirmation and cytoreduction. Optimal patient outcomes mandate a meticulously planned, multidisciplinary approach integrating surgery with risk-stratified systemic chemotherapy, guided by precise histopathological analysis and serial tumor marker assessment.

Early Intervention in Neonatal Gastric Volvulus: A Case Report on Prompt Diagnosis and Surgical Success

2025-05-13T01:40:05+00:00

Neonatal gastric volvulus (NGV) is an uncommon but potentially life-threatening surgical emergency characterized by the abnormal rotation of the stomach around one of its axes. This condition can lead to gastric outlet obstruction, ischemia, necrosis, and perforation if not promptly diagnosed and managed. The clinical presentation is often nonspecific, posing significant diagnostic challenges. Early recognition and immediate surgical intervention are paramount for favorable outcomes. We report the case of a 7-day-old female neonate who presented with recurrent postprandial, non-bilious vomiting and significant orogastric tube residuals since the first few days of life. Antenatal and perinatal histories were largely unremarkable. Initial physical examination revealed a generally stable neonate with mild distress during vomiting episodes, but the abdomen was soft, non-distended, and without palpable masses or signs of peritonitis. Laboratory investigations were within normal neonatal limits. A plain abdominal radiograph was initially inconclusive but suggested some degree of gastric distension. Subsequent upper gastrointestinal (UGI) contrast study revealed features consistent with organoaxial gastric volvulus, demonstrating abnormal positioning of the greater curvature of the stomach and obstruction to contrast passage. Exploratory laparotomy confirmed organoaxial gastric volvulus secondary to marked laxity of the gastrocolic and gastrosplenic ligaments. Detorsion of the stomach and an anterior gastropexy were performed. Postoperatively, the patient had an uneventful recovery, with gradual introduction and tolerance of oral feeds. Follow-up at 6 months showed normal growth and no recurrence of symptoms. Neonatal gastric volvulus remains a diagnostic challenge due to its rarity and nonspecific symptoms. A high index of suspicion, particularly in neonates with persistent, non-bilious vomiting, is crucial. Prompt radiological evaluation, typically with an UGI series, can confirm the diagnosis. Early surgical intervention involving detorsion and gastropexy is the mainstay of treatment and is associated with excellent outcomes, preventing potentially lethal complications. This case underscores the importance of early diagnosis and timely surgical management in achieving successful outcomes in neonatal gastric volvulus.

Aggressive Multifocal Recurrent Fibrosarcoma in an Elderly Patient: A Case Report

2025-05-13T04:16:29+00:00

Fibrosarcoma is an uncommon malignant mesenchymal neoplasm originating from fibroblasts, notorious for its aggressive clinical behavior, high local recurrence rates, and potential for distant metastatic spread. Managing fibrosarcoma in elderly patients presents unique challenges, particularly when characterized by multifocal and recurrent disease. This case report aims to describe an unusual and particularly challenging presentation of aggressive, multifocal recurrent fibrosarcoma in a 65-year-old female patient. A 65-year-old Indonesian female presented with a complex history of multiple recurrent fibrosarcomas. Her oncological journey began with an inguinal mass excised in 2022, diagnosed as Grade I fibrosarcoma, followed by chemotherapy. Despite these interventions, she experienced recurrence at the primary site and developed new masses in the abdomen, flank, gluteal regions, left breast, right supraclavicular area, right antebrachial region, and left femur over the ensuing year. Comprehensive imaging, including whole abdomen MSCT, revealed multiple widespread soft tissue masses with suspicious lymphadenopathy and equivocal liver lesions. Histopathological examination of subsequent biopsies and excised specimens, supported by immunohistochemistry (CD34 positive; S-100, CD-117, Desmin negative), consistently confirmed recurrent fibrosarcoma. The patient underwent multiple extensive wide excision surgeries for various tumor locations, including the left inguinal region, left breast, left flank, bilateral gluteal regions, left antebrachial, and left supraclavicular areas. In conclusion, this case underscores the exceptionally aggressive and relentless nature of multifocal recurrent fibrosarcoma in an elderly individual. Despite an initial low-grade diagnosis and adjuvant chemotherapy, the disease progressed rapidly with widespread recurrences. Aggressive surgical management with wide excision remains the cornerstone of treatment in an attempt to achieve local control. However, the propensity for new lesions highlights the limitations of current therapies for such extensive disease. Vigilant, long-term surveillance and a multidisciplinary approach are paramount. This case also emphasizes the need for further research into the molecular drivers of such aggressive behavior and the development of more effective systemic therapies.

Atypical Presentation of Cerebellopontine Angle Dermoid Cyst: A Case of Secondary Trigeminal Neuralgia

2025-05-14T01:38:58+00:00

Dermoid cysts are rare congenital ectodermal inclusion cysts, accounting for a small percentage of all intracranial tumors. Their occurrence in the cerebellopontine angle (CPA) is infrequent, and presentation as isolated trigeminal neuralgia (TN) is considered atypical. This study underscores that rare congenital lesions like dermoid cysts can manifest with relatively common neurological symptoms, prompting clinicians to consider a broader differential diagnosis A 60-year-old female presented with a two-year history of paroxysmal, shock-like pain in the left cheek and intraoral area, triggered by light touch, consistent with trigeminal neuralgia. Neurological examination was otherwise largely unremarkable initially, though the pain significantly impacted her quality of life and nutritional intake, leading to weight loss. Magnetic Resonance Imaging (MRI) revealed an extra-axial lesion in the CPA, compressing the trigeminal nerve. The lesion exhibited characteristics suggestive of an epidermoid or arachnoid cyst initially, but with features also compatible with a dermoid cyst. The patient underwent a retrosigmoid craniotomy for microsurgical excision of the lesion. Intraoperatively, a cystic lesion with contents suggestive of a dermoid cyst was found adherent to the trigeminal nerve and surrounding structures. Histopathological examination confirmed the diagnosis of a dermoid cyst. Postoperatively, the patient experienced significant relief from her trigeminal neuralgia. In conclusion, CPA dermoid cysts, though rare, should be considered in the differential diagnosis of secondary trigeminal neuralgia, even in atypical presentations. MRI is crucial for diagnosis, and surgical excision aiming for maximal safe resection is the mainstay of treatment, offering potential for symptom resolution. Long-term follow-up is necessary due to the potential for recurrence if the residual cyst wall remains. This case underscores the importance of considering rare pathologies in common clinical presentations.

Vitamin D3 Supplementation as a Potential Therapeutic Strategy to Mitigate Inflammation in Chronic Kidney Disease: An NF-κB-Centric Preclinical Study

2025-05-14T07:34:30+00:00

Chronic kidney disease (CKD) represents a global health burden, characterized by progressive loss of kidney function and a heightened state of chronic inflammation. Nuclear Factor-kappa B (NF-κB), a pivotal transcription factor, plays a central role in orchestrating this inflammatory cascade, contributing significantly to CKD progression and associated cardiovascular complications. Vitamin D deficiency is highly prevalent in CKD patients and is increasingly recognized for its potential role in exacerbating inflammation. This preclinical study aimed to investigate the therapeutic potential of Vitamin D3 supplementation in mitigating inflammation by modulating NF-κB levels in an experimental model of CKD. This study employed a post-test only control group design using 24 male albino Rattus norvegicus. CKD was induced, and animals were divided into three groups (n=8 each): a Control group (normal rats), a CKD group (rats with induced CKD receiving no treatment), and a CKD + Vitamin D3 group (CKD rats receiving Vitamin D3 supplementation for four weeks). Blood NF-κB levels were measured weekly for four weeks. Statistical analysis was performed using SPSS, including ANOVA and post-hoc Bonferroni tests, to determine significant differences between groups. NF-κB levels remained stable in the Control group. The CKD group exhibited a significant and progressive increase in blood NF-κB levels over the four-week period (mean at week 4: 657.50 ± 18.68 units/mL). Conversely, the CKD + Vitamin D3 group demonstrated a highly significant and time-dependent reduction in NF-κB levels, decreasing from a mean of 650.72 ± 24.92 units/mL at week 1 to 127.20 ± 4.46 units/mL by week 4 (p < 0.001 compared to the CKD group). Two-way repeated measures ANOVA revealed a significant interaction between treatment and time (p < 0.001). In conclusion, Vitamin D3 supplementation significantly attenuated the rise in blood NF-κB levels in this preclinical model of CKD in Rattus norvegicus. These findings suggest that Vitamin D3 holds promise as a therapeutic strategy to mitigate inflammation in CKD by targeting the NF-κB pathway. Further research is warranted to elucidate the precise molecular mechanisms and to translate these findings into clinical applications for human CKD patients.

Maternal Hypertension as a Dominant Predictor of Neonatal Respiratory Distress Syndrome: A Cross-Sectional Study in a Regional Indonesian Hospital

2025-05-15T07:58:20+00:00

Neonatal respiratory distress syndrome (RDS) remains a significant cause of morbidity and mortality in newborns, particularly in developing countries. While prematurity is a primary risk factor, other maternal and neonatal factors, including maternal hypertension, contribute to its incidence. This study aimed to identify the risk factors for RDS in neonates treated at a regional hospital in Tabanan, Indonesia, with a particular focus on the role of maternal hypertension. A cross-sectional study was conducted using secondary data from medical records of neonates treated at Tabanan Regional General Hospital (RSUD) from January 2023 to December 2024. The study included neonates diagnosed with RDS and a control group without RDS. Data on maternal factors (hypertension, diabetes mellitus) and neonatal factors (gestational age, birth weight, gender, mode of delivery) were collected. Bivariate analysis using Chi-square and Fisher's exact tests was performed to determine associations, with a p-value <0.05 considered statistically significant. A total of 220 neonates were included in this investigation, with 114 (51.8%) diagnosed with RDS and 106 (48.2%) without RDS. Maternal hypertension was found to be significantly associated with an increased risk of neonatal RDS (p=0.021; OR=1.5, 95% CI 1.1-2.0). No significant associations were found between RDS and gestational age (p=0.056), birth weight (p=0.839), gender (p=0.689), mode of delivery (p=0.072), or maternal diabetes mellitus (p=0.248) in this study. In conclusion, maternal hypertension emerged as a dominant predictor of neonatal RDS in this regional Indonesian hospital setting. This finding underscores the importance of vigilant antenatal care and management of hypertensive disorders during pregnancy to potentially mitigate the risk of RDS in newborns.

Head and Neck Cancer in Bali: A Retrospective Study on Patient Characteristics, Predominant Sites, and Histopathology at a Tertiary Referral Hospital

2025-05-16T07:24:06+00:00

Head and neck cancers (HNCs) represent a significant global health burden, with distinct epidemiological patterns observed across different geographical regions. In Indonesia, HNCs are among the leading malignancies, yet detailed regional data, particularly from areas like Bali, remain limited. This study aimed to delineate the characteristics of HNC patients at a tertiary referral hospital in Denpasar, Bali. A retrospective descriptive study was conducted using medical records of patients diagnosed with head and neck malignancies at Prof. Dr. I.G.N.G. Ngoerah General Hospital Denpasar, between January 1^st, 2021, and December 31^st, 2023. Data collected included age, gender, occupation, primary tumor site, and histopathological findings. A total sampling method was employed. Descriptive statistics were used for analysis. A total of 290 patient records were analyzed. Males comprised 69% (n=201) of cases, and females 31% (n=89). The predominant age group was 45–65 years (63%, n=183). Farmers were the most common occupational group (27%, n=77). Nasopharyngeal cancer was the most prevalent malignancy, accounting for 80% (n=232) of cases. Nonkeratinizing squamous cell carcinoma was the most frequent histopathological diagnosis (80%, n=231). In conclusion, head and neck malignancies in this Balinese cohort predominantly affected middle-aged to elderly males, with farming being a common occupation. The strikingly high prevalence of nasopharyngeal cancer, primarily nonkeratinizing squamous cell carcinoma, underscores a significant regional health concern that warrants further etiological investigation and targeted public health strategies.

Surgical Approaches for Orbital Floor Fractures: A Meta-Analysis of Clinical Outcomes and Complication Rates Comparing Transconjunctival, Subciliary, and Endoscopic Techniques

2025-05-20T08:03:29+00:00

The optimal surgical pathway for the remediation of orbital floor fractures persists as a topic of considerable deliberation among ophthalmic and maxillofacial surgeons. The primary surgical modalities—transconjunctival, subciliary, and endoscopic techniques—each present a unique profile of advantages and inherent limitations with respect to surgical exposure, aesthetic outcomes, and the incidence of postoperative complications. This meta-analysis was undertaken to conduct a comparative evaluation of the clinical outcomes and complication rates associated with these three principal surgical approaches employed in the repair of orbital floor fractures. A meticulous and systematic search of prominent medical databases, including PubMed, Embase, and the Cochrane Library, was performed to identify relevant comparative studies published between January 2014 and December 2024. These studies were required to evaluate transconjunctival, subciliary, and/or endoscopic techniques for the repair of orbital floor fractures. Data from seven heterogeneous comparative studies were ultimately synthesized for this analysis. The primary outcome measures assessed were the incidence of postoperative persistent diplopia and the occurrence of significant enophthalmos, defined as globe retrodisplacement of 2 mm or greater. Secondary outcomes encompassed a range of complication rates, specifically including infraorbital nerve (ION) hypoesthesia, lower eyelid malpositions such as ectropion and entropion, and postoperative surgical site infections. Pooled odds ratios (ORs) or risk ratios (RRs) with their corresponding 95% confidence intervals (CIs) were calculated, employing a random-effects model to account for inter-study variability. The analysis incorporated seven studies, comprising a total of 850 patients who underwent surgical correction for orbital floor fractures. The distribution of patients across the surgical modalities was as follows: 300 patients were managed via a transconjunctival approach, 350 patients via a subciliary approach, and 200 patients via an endoscopic approach. The findings indicated that the transconjunctival approach was associated with a statistically significant lower rate of postoperative ectropion (OR 0.25, 95% CI 0.10-0.65) when compared to the subciliary approach. No statistically significant differences were observed in the rates of persistent diplopia (Transconjunctival vs. Subciliary: OR 0.90, 95% CI 0.55-1.48; Transconjunctival vs. Endoscopic: OR 1.10, 95% CI 0.60-2.01) or significant enophthalmos among the three surgical groups. Endoscopic approaches demonstrated a trend towards lower rates of new or worsened ION hypoesthesia (OR 0.60, 95% CI 0.30-1.19 vs. combined transcutaneous approaches), although this did not achieve statistical significance. In conclusion, this meta-analysis suggests that the transconjunctival approach may offer a superior lower eyelid cosmetic outcome by substantially reducing the risk of ectropion relative to the subciliary approach. All three evaluated techniques demonstrated comparable efficacy in addressing the primary functional objectives of resolving diplopia and correcting enophthalmos. The selection of an appropriate surgical approach should, therefore, be an individualized decision, meticulously considering surgeon experience and expertise, the specific characteristics and complexity of the fracture, and pertinent patient-related factors and preferences. There remains a compelling need for further high-quality, large-scale randomized controlled trials to definitively establish the potential superiority of one approach over the others across a broader range of outcomes.

Giant Pulmonary Bullae Complicated by Hospital-Acquired Pneumonia in Chronic Obstructive Pulmonary Disease: A Multidisciplinary Approach to Successful Bullectomy

2025-05-22T01:44:07+00:00

Giant pulmonary bullae (GPB), particularly in patients with chronic obstructive pulmonary disease (COPD), present significant management challenges due to compromised lung function. The development of hospital-acquired pneumonia (HAP) further complicates the clinical picture, increasing morbidity and mortality. This report details a case of GPB with HAP in a COPD patient. A 65-year-old male, a heavy former smoker with moderate COPD and a history of dust and wood smoke exposure, presented with progressive dyspnea and productive cough. Investigations revealed right-sided giant bullae occupying over 30% of the hemithorax, consolidation, and leukocytosis. Sputum culture grew Candida albicans, and intraoperative cultures later confirmed Streptococcus viridans HAP. Following initial medical stabilization with antibiotics, bronchodilators, and corticosteroids, he underwent an exploratory thoracotomy with bullectomy on day 14. In conclusion, the surgical intervention was successful, with no major complications. Post-operatively, the patient showed significant improvement in respiratory symptoms and lung expansion. This case highlights the efficacy of a multidisciplinary approach, combining intensive medical therapy with timely surgical bullectomy, for managing complex presentations of GPB, HAP, and COPD, leading to favorable outcomes.

When the Lung Deceives: Spindle Cell Carcinoma Manifesting as an Aggressive Posterior Mediastinal Mass – A Multimodal Imaging Case Report

2025-05-23T05:46:56+00:00

Spindle cell carcinoma (SpCC) of the lung is a rare and aggressive subtype of non-small cell lung carcinoma (NSCLC), characterized by a significant component of spindle-shaped tumor cells. Its radiological presentation is highly variable, typically appearing as peripheral or central lung masses. Presentation as a primary mediastinal mass is exceedingly uncommon, posing a considerable diagnostic challenge. A 47-year-old woman presented with a 4-month history of progressive lower limb weakness. Initial chest radiography revealed a left-sided mediastinal-appearing mass. Subsequent contrast-enhanced computed tomography (CT) of the thorax characterized a large, lobulated soft tissue mass in the left posterior mediastinum, measuring 5.25 × 4.74 cm. The mass exhibited homogeneous isodensity with peripheral calcification, caused 0.5 cm compression of the descending aorta, and showed erosion of the 4th thoracic vertebra with contrast enhancement. Fine needle aspiration (FNA) cytology, guided by CT, demonstrated atypical, polymorphic spindle-shaped cells within a fibroangiomatous stroma, consistent with spindle cell carcinoma. In conclusion, this case highlights an unusual presentation of pulmonary SpCC mimicking a posterior mediastinal tumor with aggressive features, including vascular compression and vertebral erosion. Despite its mediastinal appearance, subtle radiological signs such as the acute angle with the lung parenchyma, the epicenter of the mass, and the irregular tumor-lung interface suggested a pulmonary origin. This report underscores the importance of meticulous radiological evaluation and cytopathological correlation in diagnosing rare lung cancer variants that can masquerade as primary mediastinal neoplasms.