Lithiasis is a known side effect of ceftriaxone administration in children. Sex, age, weight, dosage, and duration of intake have been reported as risk factors for the formation of calcification or stones in the bile and urine excretory systems of children who received ceftriaxone. The purpose of this systematic review is to investigate the reported effects of ceftriaxone administration in pediatric patients who were admitted to a hospital due to infection, the likelihood of gallstones, nephroliths, or precipitations in both the biliary and urinary systems, as well as investigate the relationship with their mother’s history during pregnancy. Original studies and literature reviews from the PubMed database were included in the study. No time limit related to research or publication was set for the articles. The results were evaluated, aiming to understand the outcomes and identify any predisposing factors relevant to this side effect. Of the 181 found articles, 33 were appropriate for inclusion in the systematic review. The administered dose of ceftriaxone presented variability. Symptoms, such as abdominal pain and vomiting, were associated with ceftriaxone-related lithiasis in many cases. It was noted that most of the results were the outcomes of retrospective observation and not of prospective randomized research. Definitively, more randomized control studies with long-term outcomes are needed to identify the exact association between ceftriaxone and lithiasis in children.

Summary: Vascular handlebar syndrome with blunt injury of the common femoral artery is a rare vascular trauma mechanism, with high possibility of being missed or delayed. We present two cases of vascular handlebar syndrome treated in our hospital and a systematic review of the literature using MEDLINE and SCOPUS databases. Literature review identified 20 similar cases. The median age of patients was 18 years, and in vast majority males in gender. In most cases, the common femoral artery injury was an intimal flap and lumen occlusion with intramural thrombosis followed by transection and intimal injury without occlusion or thrombosis. The median time between injury and diagnosis/treatment was half an hour. Clinical presentation ranged from asymptomatic to acute limb ischemia. The grade of acute ischemia was mostly Rutherford class I (n=14), while acute IIa (n=4), chronic ischemia (n=3), and no ischemia (n=1) were also noticed. The correct diagnosis was revealed by clinical examination only (n=1), or by the combination of clinical and imaging techniques including computed tomography angiography (n=7) and duplex ultrasonography (n=4) or both (n=10). Management of the handlebar trauma syndrome injuries was surgical in most cases. Outcome was favorable in all patients. Vascular handlebar syndrome is extremely rare and high suspicion is required for early diagnosis and definitive treatment, as the early management is effective and crucial for averting the devastating consequences. An individualized approach to the vascular trauma patient is to be applied with considerations taken to the age of the patient, the mechanism of the injury, the anatomy of the lesion, and symptomatology of the case.

We report a unique case of expanded polytetrafluoroethylene (ePTFE) tube graft rupture that occurred 14 years after abdominal aortic aneurysm (AAA) repair. Endovascular repair with a thoracic endograft was performed. Postoperatively, an increase in the size of the existing hematoma with active extravasation occurred and was managed with iliolumbar artery embolization. Τo the best of our knowledge, rupture of ePTFE graft used for AAA repair has not been reported in the literature.

Article: European and US guidelines on acute DVT management - The Journal of Cardiovascular Surgery 2024 Feb 01 - Minerva Medica - Journals

Coronary artery bypass grafting (CABG) is one of the most common surgical procedures, contributing to improved long-term survival and quality of life for patients with coronary artery disease. However, surgical site infections (SSIs) remain a serious complication, increasing mortality, morbidity, and hospital length of stay. Background/Objectives: The aim of the study was to investigate the incidence of infections in patients at intermediate to high-risk of infection undergoing CABG and to identify the factors contributing to their development. Methods: The study included 51 patients (39 men, 12 women, mean age 67.2 ± 8 years) who underwent CABG via median sternotomy. Patients were preoperatively stratified for SSI risk using the Brompton Harefield Infection Score (BHIS), and only those classified as intermediate or high risk were included. The occurrence and severity of SSIs were evaluated postoperatively using the ASEPSIS scoring system. Data were analyzed using SPSS 26.0. Results: Infections were observed in 17 patients (33.3%). The occurrence of SSIs was positively associated with hospital length of stay (ρ = 0.512, p < 0.001) and obesity (f = 0.348, p = 0.013). Age, gender, smoking, diabetes mellitus, and ejection fraction were not statistically significantly associated with the occurrence of infection. Conclusions: Obesity and prolonged hospital stay emerged as significant risk factors for SSIs in patients after CABG. The high incidence of SSIs highlights the urgent need for targeted interventions in patients at increased risk. Early identification and management of those patients may help reduce infection rates, improving postoperative outcomes and patient quality of life. The small sample size of this study, the data collection from a single cardiothoracic surgery center, and the limited number of examined variables are limitations that indicate the need for further research.

Nikolaos G Baikoussis, MD, MSc, PhD, Loukia Alexopoulou-Prounia, MD, Dimitrios Limperiadis, MD, PhD; Severe aortic valve stenosis in low-risk elderly patients;